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HomeMy WebLinkAbout020-1142-80-000 0 0.0 ~vn d 3 CD n N 'a C1 iy~ fD (D 1 n v 01 V=i O N C V ON • S O N FBI O. d O N A m_ NO CD O "i"I" n 0 3 o w C 0 o CCD C a 4 o c co 7 3 to o p A c m a c m v- D m ca cD a v CD W s CD CD CL o C 0 3 O 7 'lot (D 00 0o a (0 (D 0 r- cn CD CC) CC) D o n N O c Q N O ~ 7 z O O O O lV Cl) -V J N fn N o vvv a' m m 0 m rn m y CD y m N 3 CD a) (n 0) CD z N N z m z - n D o 0 O a Nr • o' CD N -0 N 0 CD N 1~ c CD m co Q a 3 z (D I Cl) O O a p Z CD c n A z O v a O W m T z r ::t 0 3 Z Z o 3 m z w w y CL a a CL CD ;:W ao. v v c ° o a 0 a m 3 I ~ a w m `D b m m 3 Z2. 0 a I o 0 a o_ hAp b O N i ~ O ti a o m o C Parcel 020-1142-80-000 12/05/2005 05:10 PM PAGE 1 OF 1 Alt. Parcel M 17.29.19.737 020 - TOWN OF HUDSON 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 MARIE L SKERBITZ O - SKERBITZ, MARIE L 484 MCCUTCHEON RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 484 MCCUTCHEON RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.530 Plat: 2276-PARK VIEW ESTATES 2ND ADD SEC 17 T29N RI 9W PARK VIEW ESTATES 2ND Block/Condo Bldg: LOT 44 ADD LOT 44 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/12/2004 768545 2614/475 WD 08/15/2002 686998 1948/340 WD 07/23/1997 1119/480 07/23/1997 855/371 more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.530 59,100 180,600 239,700 NO 05 Totals for 2005: General Property 1.530 59,100 180,600 239,700 Woodland 0.000 0 0 Totals for 2004: General Property 1.530 30,500 159,800 190,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 311 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 j► AS BUILT SANITARY SYSTEM REPORT 0`G NER ADDRESS z-i , t TOWNSHIP n SEC. 1 T 2- N, R ~ 4W ST. CROIX COUNTY WISCONSIN. SUBDIVISION t , LOT LOT SIZE i Distances & dimensions to meet requirementsWof H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A7 I di, ate ort-hl A-+rr_ow SCAL i I SEPTIC TANK(S) MFG R. CONCRETE STEEL Nff7-oT rings on cover 39 f -Depth PUMPING CHAMBER SIZE PUMP MFGR. GALLONS Per CycleL NO. TRENCHES NO. of wi t length area BED NO. of lines 7 width t len th deptg~-to top o~ pipe g - area- - NUMBER OF SEEPAGE PITS AGGREGATE Outside iameter total pit area PERK RATE ARE REQUIRED ' f 4-- AREA AS BUILT Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH T IS SYTEM. INSPECTOR DATED ' ` ' PLUMBER ON JOB LICENSE NUMBER / V :Z`, AS BUILT SANITARY SYSTEM REPORT y µ R , T014NSHIP SEC. T N, R W 1 0. ADDRESS $ T. CROIX COUNTY, WISCONSIN. .3DIVISZON LOT LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ R I i jI I ~ y Indipate North Arroy SCALE : i tPTIC TANK(S) MFGR. CONCRETE STEEL N0. of rings on cover Depth DRY WELL ANCHES NO. of width length area no. of lines width length area depth to top of pipe aGREGATE ~tRk: RATE AREA REQUIRED AREA AS BUILT I,SCiaimer: The inspection of this system by St. Croix County does not imply complete .o.?liance with State Administrative Codes. There are other areas that it isWnot possible 10 inspect at this point of construction. St. Croix County assumes no liability for j5tem operation. However, if failure is noted the County will make every effort to ,jtermine cause of failure. SASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ''INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER %COMMERCIAL TESTING LABORATORY, INC. 514 Muin Strreet, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ws.uUNT REPORT HATE. 10106/8. RTHOUSE T IA': WI _ !.1`w: F I1 .r P..,F3{N.f Ith 011Z ~i".~ jZ'0 2- 1.37 AA ~'aION: 484 McCutcheon F,. :_FCTORi St, 'OURCE OF SAWLE, FORMS } R RETATION" Bade iFtr I L;~:V l ; OF.\NDEDFNpf'Y J?G ~m O p u y 5 0" o PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN p {Y k i, Y ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ` 911 FOURTH STREET • HUDSON, WI 54016 -.W (715) 386-4680 October 4, 1989 Carroll Farrell 706 19th St. Hudson, WI 54016 Dear Ms. Farrell: An on site investigation of the septic system on the property of Patrick Baumgartner at 484 McCutcheon Rd. Town of Hudson was conducted on October 4, 1989. At the same time I also obtained a water sample and submited it to the laboratory for testing. The results of that testing will be sent to you as soon as we recieve them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. 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 is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary Jenkins Asst. Zoning Administrator ';~y Sid. CROIX COUNTY ZONING OFFICE St. ,Croix County Courthouse ' 911 4th Street ' Hudson, WI 54016lU_ f ` ~ ~ ~ r ra GOFFlGc 1. Q, Telephone - (715)386-4680 i The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. i ' Completion of this form is essential so that the property can be located. r~ 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: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if syst is properly functioning at time of inspection) Property owner's name Property owner's address / 'C Legal Description Nt 1/4 of the 1/4 of Section J Town of hlu °f~ o "i Lot Number Subdivision Name T 1Z N-R FIRE NUMBER LOCK BOX NUMBER Color of house - P,; t.; -Realty sign by house? 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 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 requestin services: C Telephone Number ~ C i. j REPORT TO BE PENT TO: r~;-ct 1 7 `r r'r e SL{may ~~sC Closing dat Signature L K l_ IJ L H J I_I I':. H I U 1'•'. 1 L,'-> I L L IN L l M 0 i' 1 IJ I' T. 1 1 Z 1 w SERCO Ur born tors es 1931 West County Roar! _ $t. P20. Minnnrntn RAI13 PhnnP' (612) RIA-7173 . . VAX # 612/aSd-777A DATE: ,44LL- TO# _ ~iGraao deli5r~r jjjjgj6djq~Vjy r' 1 x M lie) t r~ FROM; 1 MEN 4()&0 rai arias t Numbor of PdRZ3 f l iii:~,r~j r~y~ r•~„rrai' vl700C - - Comments: pl-efcy~ C A as you do nqt receive. a1 1 of fi,hR ragas, possible. P10000 iall f ♦ir IQ 1 ig ,_71T3 as soon When Qualo and ,Service Coent ER "0 L B0 F'.r~T0F,IEv T E L I J u 17' 0 . cti 12 F . tL9EH 0 ij;1buraZorles - r Ct, tt ruvl rvhnrc:,cra ,b i t'.i (W di UJb 71 7$ I ORDi i1Tt7RY AhIALVCIIG' idcponT 1J0: ~ 10.'10/83 YAQK St• Croix County Zoning .11th Etreat Hudson, W1 54016 va''E RECEIVED: 10/06/89 COLLECTED By r CLIENT VI:L I YLRL:i;) !!Y I "r. I i. IV I SAMPLE TYPE r WATER Atl.ri. Mary J. Jenkfns 9F;F?r0 SAMPLlii )10l 00CIS CAM PLL uLaare j rT t 8ld Baum- ANALYSIS: gartner Bromodichloromethane, ua/L-------------- - Bramoform, ug/L IV.f - t--'"-- BY'i~i+aui>;rethanw, C.1 Carbon t ftrAGh l gr i da. ug /l, <1' 1 41.0 Chlnrnpthant~, ug/L 2 Chloroethylvinyl ether, ugiL 0.2 Ch l ornf nrm, ugfL <0. 3 Chlcromethans, ug/L <1.0 Dibromochloromethane, ug/L <1.0 <0.2 1.2 D i r.h 1 nrobanzane, ugfL 1,8 Dich1orobenzent, ug/L <1.0 I,•l 131 ehIarobonzoiju, ug/L 0,0 ulchlarodifluoramethane, ug/L <1.0 1,1 Dichloroothaneo ug/L <1.0 p,$ D10ilurnmthanc, ugfla 1.1 L>3Ai►larri8tl,ylar►ar ug/L <0. 1 1„2 Diohloreethyla n*. <0. 1 1.2 L~loF►~!~!8 !ati,alla. iigii, fQ.1 1'X114, ur,r'L. 1. Divhloro-i• U ;d raFY1olla, uito ug/L ~.U. 1.3 nie~dlIQro- l -PraPYl*not L+-aailat ug/L ~0.z methylene Chlnridm, ug/L 1. 1,3,' TetpRmhlarq *tl„k„t, <U+0 , ug,•'L <U.2 C mpana "not detoctead it#. this 1 yvr i l M z M 3.1-jou ug. 8111 .C0 L UVI'iiitf>t'1t~ nii it, m_ 1........,. LABORATORY ANALYSIS REPORT NO: - 10/13/B9 2415 PAGE 2 SERCO SAMPLE NO: 55519 - - 8AMPLE DRS'CR I PT I ON s lya.um- ANAL,YO I S ; isear tner - 1l'a lulilurueLnane, t L CO. ---g/L <0.5 1,1.P. Tr7r,hIoroathano, ug/L Trichlornetbyleno, uq/L. I rl CrIl arof 1 '8/L Lli-vi skla.:•..vi .5'.1' X1.8 Benzene, Llg/L X<5.0 1 .0 Ethylbanzene, ug/L 'Puluwnw, 11Cfl, C1.Q t1.0 A 1 1 *rla 3 vaoc mares Samples that mar beaofoano euatng EPA vthar acOwPted methodolo i rampie to nvirollmantallY hazardous nature W411 beB~. date ,n L to O`lter samples w111 bm stOrOd for 3f? days report, triers disposed of by SERCO LABORATORIESfrinm thQ P14a6e oontRr.t me If Othop Qrrmts98ffi41N .m cLm i1wwrJ®d. Itii a p * ~ ~ ■ u k AF5 i ~ f. s■ s,l L v . lt:UCY Di:~yta J. Anderson Project Managor ! moane "not ~r4wc:Le+d mot, hig lirivel . 1 mQ : 1000 ue- . M~mbar SERCO Laboratories 1931 West County Road C2 St Paul MinnE-sota 55113 i612) 636 7173 LABORATORY ANALYSIS REPORT N : --415 PACE 1 l c. ? S...= / r5 St. Croix County Zoning 911 4th Street DATE RECEIVED: 10/06/8:' Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE WATER Attn: Mary J. Jenkins SERCO SAMPLE NO: 68519 SAMPLE DESCRIPTION: Baum- gartner ANALYSIS: Bromodichloromethane, ug/L <0.1 Bromoform, ug/L <0.2 Bromomethane, ug/L <1.0 Carbon tetrachloride, ug/L <0.1 Chlorobenzene, ug/L <1.0 2 Chloroethylvinyl ether, ug/L <0.2 ~r:, Ch 1 oroform, ug/L <0. 5 O 4 Chloromethane, ug/L <1.0 Chloroethane, ug/L <1,0 CJXWM1N4GG0&F1ti Dibromochloromethane, ug/L <0.2 "N39 1,2 Dichlorobenzene, ug/L <1.0 1,3 Dichlorobenzene, ug/L <1.0 1,4 Dichlorobenzene, ug/L <1,0 Dichlorodifluoromethane, ug/L <1.0 1,1 Dichloroethane, ug/L <0.1 1,2 Dichloroethane, ug/L <0.1 191 Dichloroethylene, ug/L <0.1 1,2 Dichloroethylene, trans, ug/L <0.1 1,2 Dichloropropane, ug/L <0.2 1,3 Dichloro-l-propylene, cis, ug/L <0.2 1,3 Dichloro-l-propylene, trans, ug/L <0.2 Methylene Chloride, ug/L <9.0 1,1,2,2 Tetrachloroethane, ug/L <0.2 t' < means "not detected at this level". 1 mg = 1000 ug. D Member SERCO Laboratories 1931 West County Road C2. St Paul. P4 n-so!a 551 13 61 Pi 636 7173 LABORATORY ANALYSIS REPORT NO: 2415 PAGE 2 1:_#: 89 SAMPLE DESCRIPTION: artner ANALYSIS: Tetrachloroethylene, ug/L <0.2 1,1,1 Trichloroethane, ug/L <0.5 1,1,2 Trichloroethane, ug/L <0.1 Trichloroethylene, ug/L <0.5 Trichlorofluoromethane, ug/L <1.0 Vinyl chloride, ug/L <1,0 Benzene, ug/L <1.0 Ethylbenzene, ug/L <1.0 Toluene, ug/L <1,0 All analyses were performed using EPA or other ac.cepted met.hodolo~zieY. Samples that may be of an environmentally hazardous nature will be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO LABORATORIES. Please contact me if other arrangements are needed. Report submitted by, Diane J. Anderson Project Manager t~ means "not. detected at this level". 1 mg = 1000 ug. ~ Member 0 2o-J jL(2 - SERCO Laboratories 7 2-9. t 7 3 :7 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 1 of 3 03/01/95 St. Croix County Zoning DATE COLLECTED: 02/13/95 1101 Carmichael DATE RECEIVED: 02/15/95 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Priebe SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: ' Benzene, ug/L <1.0---- Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 ` :71 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropane, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) < means "not detected at this level". 1 mg = 1000 ug. gr~,, 7 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 2 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <2.0 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, uq/L <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <1.0 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L 1.4 A 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. o. N't I' Ar~, 7 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 3 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,1,2-Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon 11) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <1.0 1,3,5-Trimethylbenzene, ug/L <1.0 (Mesitylene) Vinyl chloride, ug/L <1.0 Total Xylene, ug/L <1.0 This sample's analytical results are below the U.S. EPA's SDWA Maximum Contaminant level of 01/30/91 for those requested compounds which are also on the SDWA MCL list. A: This compound observed in the laboratory blank at a concentration of 1.4 ug/L. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Carol A. Davy Project Manager < means "not detected at this level". 1 mg = 1000 ug. a SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 1 of 3 03/01/95 St. Croix County Zoning DATE COLLECTED: 02/13/95 1101 Carmichael DATE RECEIVED: 02/15/95 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Priebe SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: Benzene, ug/L <1.0 Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0,2 Bromoform, ug/L Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 r sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0,4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropane, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) < means "not detected at this level". 1 mg = 1000 ug. SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 2 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <2.0 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1,1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.7_ trans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, ug/L <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <1.0 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L 1.4 A 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. hI J~ J y g SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 3 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,1,2-Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon 11) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <1.0 1,3,5-Trimethylbenzene, ug/L <1.0 (Mesitylene) Vinyl chloride, ug/L <1.0 Total Xylene, ug/L <1.0 This sample's analytical results are/are not below the U.S. EPA's SDWA Maximum Contaminant level of 01/30/91 for those requested com- pounds which are also on the SDWA MCL list. A: This compound observed in the laboratory blank at a concentration of 1.4 ug/L. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Carol A. Davy Project Manager < means "not detected at this level". 1 mg = 1000 ug. } 03/01/95 15:59 FAX 612 636 7178 SERCO LAB. -*ii COUNTY CLERK 0 001 SERCO Laboratories St. Paul, Minnesota 1931 West County Roar! C2 St. Paul, Minnesota 55113 rr ` Phone: (612) 636-7173 FAX (612) 636-7178 COMFIDEMTU►LITT NOTICE This facsimile transmission is intended only for the use of the individual or entity to which it is addressed, and m<iy contain confidential information belonging to the sender. if you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or the taking of any action In reliance on the contents of this information is strictly prohibited- If you have received this transmission in error, please immediately notify us by telephone to arrange the return of these~docLsoents. DATE:f Please Deliver this Fax ImediatEly '1D: r f u Fps: " ~Iz ETCH: ~ N=ber of Pages (including this page) If you do mC receive all of the gages, please call (612) 636-7173 as soon as possible. Wnen Quality and Servrre Count FFFFFFFF A X X F A A X X F A A X X F A A XX FFFF A AAA A XX F A A X X 1 F A A X X FAX F A A X X GOVERNMENT CENTER 1101 CARMICHAEL ROAD HUDSON WI 54016 -z I (j Q DATE: TO: FAX NUMBER: c) NAME: FROM: FAX NUMBER: (715) 381-4400 NAME: RU98ER OF PAGES INCLUDING COVER SHEET: IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NA M F : TELEPHONE NUMBER: -tO CONFIDENTIALITY NOTICE: The documents accompanying this fax contain confidential information which is legally privileged. The information is intended only for the use of the intended.'(~"` ~-~-c recipient named above. if you are not the intended recipient,.' l you are hereby notified that any disclosure, copying, distribu tion or the taking of any action in reliance on the contents of this telecopied information except its direct delivery to the intended recipient named above is strictly prohibited. If you have received this fax in error, please notify us by tele- VL2 phone immediately to arrange for return of the original documents C to us_ 03/01/95 15:59 FAX 612 636 7178 SERCO LAB. i-~ COUNTY CLERK 2002 SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 1 of 3 03/01/95 St. Croix County Zoning DATE COLLECTED: 02/13/95 1101 Carmichael DATE RECEIVED: 02/15/95 Hudson, WI 54016 COLLECTED BY ; CLIENT DELIVERED BY : CLIENT SAMPLE TYPE ; DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Priebe SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: Benzene, ug/L <1.0 Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0.5 i Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropans, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 ~ 1,2 Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) < means "not detected at this level". 1 mg = 1000 ug. r 03/01/95 15:59 FAX 612 636 7175 SERCO LAB. 444 COUNTY CLERK f~003 SERCO Laboratories 1931 West County Floo C2. St. Paul, Minnesota 55113 Pnone (612) 636-7173 FN( (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 2 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,4-Dichlorobenzene, ug/L <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <2.0 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 Ethylene dichloride) 1{1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropane, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, ucj/L <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <1.0 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethane, ug/L <0.2 Toluene, ug/L 1.4 A 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. 03/01/95 16:00 FAX 612 636 7178 SERCO LAB. 444 COUNTY CLERK 1J004 SERCO Laboratories 1931 West County Road C2. St. Paul. Mhnnesota 55113 Phone (612) 6$6-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 3 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,1,2-Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichlorofluoromethane, ug/L (Freon 11) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <1.0 1,3,5-Trimethylbenzene, ug/L <1.0 (Mesitylene) Vinyl chloride, ug/L <1.0 Total Xylene, ug/L <1.0 This sample's analytical results are below the U_S. EPA's sDWA Maximum Contaminant level of 01/30/91 for those requested compounds which are also on the SDWA MCL list. A: This compound observed in the laboratory blank at a concentration of 1.4 ug/L. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, ~&Z 6/,c DA~- Carol A. Davy Project Manager < means "not detected at this level". 1 mg = 1000 ug. ST. CROIX COUNTY WISCONSIN ZONING OFFICE p a x u n u n n - „~,,,p ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 March 1, 1995 Ms. Corrine Yuengst St. Croix Realty 536 Lemon Street North Hudson, Wisconsin 54016 RE: Water (VOC) Inspection for Residence Located at 484 McCutcheon Road, Hudson, Wisconsin Dear Ms. Yuengst: Enclosed is the original test results from SERCO Laboratories for water (VOC) inspection of the above property. If you have any questions with regard to said report, please do not hesitate in contacting me. ncer ly, Ja•Ce s K. Thompson -`Assistant Zoning Administrator St. Croix County, Wisconsin mz Enclosure cc: Pat Collins 03/il1/95 09:07 FAX 612 636 7178 SERCO LAB. 4-*4 COUNTY CLERK Z002 SLRCO Laboratories 1931 West County Road C2. St. Paul, Minnesota 55113 Rhone (612) 636-7173 FAX (6121 &J6-7178 LABORATORY ANALYSIS REPORT No: 50553 PAGE 1 of 3 03/01/95 St. Croix county zoning DATE COLLECTED: 02/13/95 1101 Carmichael DATE RECEIVED: 02/15/95 Hudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT SAMPLE TYPE DRINKING WATER Attn: Mary J. Jenkins CLIENT'S ID: Priebe SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: Benzene, ug/L <1.0 Bromobenzene, ug/L <0.2 Bromochloromethane, ug/L <0.4 Bromodichloromethane, ug/L <0.2 Bromoform, ug/L <0.5 Bromomethane, ug/L (Methyl bromide) <1.0 n-Butylbenzene, ug/L <0.3 sec-Butylbenzene, ug/L <0.4 tert-Butylbenzene, ug/L <0.5 Carbon tetrachloride, ug/L <0.2 Chlorobenzene, ug/L <1.0 Chloroethane, ug/L (Ethyl chloride) <0.4 Chloroform, ug/L <0.5 Chloromethane, ug/L (Methyl chloride) <0.6 2-Chlorotoluene, ug/L (o-Chlorotoluene) <0.2 4-Chlorotoluene, ug/L (p-Chlorotoluene) <0.2 Dibromochloromethane, ug/L <0.4 1,2-Dibromo-3-chloropropane, ug/L <1.2 1,2-Dibromoethane, ug/L <0.2 (Ethylene dibromide) Dibromomethane, ug/L <0.2 1,2-Dichlorobenzene, ug/L <1.0 (o-Dichlorobenzene) 1,3-Dichlorobenzene, ug/L <1.0 (m-Dichlorobenzene) < means "not detected at this level". 1 mg = 1000 ug. 9~-422: _ 03i01/95 09:08 FAX 612 636 7178 SERCO LAD. COUNTY CLERK 2003 SERCO Laboratories 1931 west County Road C2. St. Paul. Minnesota 55113 Pnpne (612) 636=71 T3 FAX (612) 636.7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 2 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,4-Dichlorobenzene, ug/L T 4s <1.0 (p-Dichlorobenzene) Dichlorodifluoromethane, ug/L (Freon 12) <2.0 1,1-Dichloroethane, ug/L <0.1 1,2-Dichloroethane, ug/L <0.2 (Ethylene dichloride) 1 1 1-Dichloroethene, ug/L <0.2 cis-1,2-Dichloroethene, ug/L <0.1 trans-1,2-Dichloroethene, ug/L <0.1 1,2-Dichloropropane, ug/L <0.1 1,3-Dichloropropane, ug/L <0.2 2,2-Dichloropropane, ug/L <0.2 1,1-Dichloropropene, ug/L <0.2 cis-1,3-Dichloropropene, ug/L <1.5 trans-1,3-Dichloropropene, ug/L <0.9 Ethylbenzene, ug/L <1.0 Hexachlorobutadiene, ug/L <0.3 Isopropylbenzene, ug/L, (Cumene) <1.0 4-Isopropyltoluene, ug/L <0.5 (p-Isopropyltoluene) Methylene chloride, ug/L <5.0 (Dichloromethane) Naphthalene, ug/L <1.0 n-Propylbenzene, ug/L <0.4 Styrene, ug/L <1.0 1,1,2,2-Tetrachloroethane, ug/L <0.2 1,1,1,2-Tetrachloroethane, ug/L <0.1 Tetrachloroethene, ug/L <0.2 Toluene, ug/L 1.4 A 1,2,3-Trichlorobenzene, ug/L <0.2 1,2,4-Trichlorobenzene, ug/L <0.2 1,1,1-Trichloroethane, ug/L <5.0 < means "not detected at this level". 1 mg = 1000 ug. 103;401/95 09:08 FAX 612 636 7178 SERCO LAB. 444 COUNTY CLERK 0004 SERCO Laboratories 1931 West County Road C2. St. P3ut. Mimes ma 55113 Phone (612) 636-7173 FAX (612) 636-7178 LABORATORY ANALYSIS REPORT NO: 50553 PAGE 3 of 3 03/01/95 SERCO SAMPLE NO: 16895 SAMPLE DESCRIPTION: Priebe ANALYSIS: 1,1,2--Trichloroethane, ug/L <0.1 Trichloroethene, ug/L <0.4 Trichiorofluoromethane, ug/L (Freon 11) <0.7 1,2,3-Trichloropropane, ug/L <0.2 1,2,4-Trimethylbenzene, ug/L <1.0 1,3,5-Trimethylbenzene, ug/L <1.0 (Mesitylene) Vinyl chloride, ug/L <1.0 Total Xylene, ug/L <1.0 This sample's analytical results are/are not below the U.S. EPA's SDWA Maximum Contaminant level of 01/30/91 for those requested com- pounds which are also on the SDWA MCL list. A: This compound observed in the laboratory blank at a concentration of 1.4 ug/L. The analytical results in this report pertain only to the items tested. All analyses were performed using EPA or state approved methodologies. Samples that may be of an environmentally hazardous nature may be returned to you. other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not be reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, 0AW6t1Z b~7,_ Carol A. Davy Project Manager < means "not detected at this level". 1 mg = 1000 ug. ST. CROIX COUNTY WISCONSIN ZONING OFFICE \ 4 4 u n N u r n wI,,,~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 February 22, 1995 Ms. Corrine Yuengst St. Croix Realty 536 Lemon Street North Hudson, Wisconsin 54016 RE: Water Inspection for Debbra R. Priebe Address: 484 McCutcheon Road, Hudson, Wisconsin Dear Ms. Yuengst: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for a water inspection of the above property. If you have any questions with regard to said report, please do not hesitate in contacting me. S' ce ly, 2ames . ThomPso Assistant Zoning Administrator St. Croix County, Wisconsin mz Enclosure COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 C2:A:wl 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 e<<t`:. if. ~•'.'J~V sI«E:. S'it i'"ui1. l~hit+ .alil L01 CARMICWL ROAD IGOW W1 'f ION: 484 McCuichei JILLECTOF: Jiru Thomson 5 y } .1 tNALYZED S 2-14--95 ~~J' t_ > ?LYZED'.2.00pm fMtFCC: !100 m' f f/~c JOF.\NOEGENOFN L, C1) 2~ r9 O y~l Z e'w-~~ p \ ( J 1P 4 ~J PROFESSIONAL LABORATORY SERVICES SINCE 1952 c ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER ~r - 1101 Carmichael Road - - Hudson, WI 540 1 6-771 0 (715) 386-4680 February 13, 1995 Ms. Corrine Yuengst St. Croix Realty 536 Lemon Street North Hudson, Wisconsin 54016 RE: Septic Inspection for Debbra K. Priebe Address: 484 McCutcheon Road, Hudson, Wisconsin Dear Ms. Yuengst: An inspection of the septic system on the property of Debbra K. Priebe located at 484 McCutcheon Road, Hudson, Wisconsin, was conducted today, February 13, 1995. 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. i Also, water samples were taken. Once we receive the results we will forward the same on to you. Should you have any questions in the meantime, please do not hesitate in contacting this office. rinc~relYr J es K. Thompson 'Assistant Zoning Administrator mz i ST. CROIX COUNTY ,•,1~ ' WISCONSIN ZONING OFFICE Y lrrt r ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680, SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. E~~Watter er (VOC's) $185.00 ('Septic $2(Nitrate & Bacteria) .$-3-~.~o (Visual inspection) y--~ o o owner: Debra Priebe Requested by: Debbie Priebe , Mail results to: Address: 484 McCutcheon Rd Add ress:St.Croix Realty_,536 Lemon St. N. Hudson, Wi City & State: Hudson Wi City & St. Zip Code: 54016 Zip Code: '54016 Telephone N4: ( 715) 386-6061 Telephone N4: (715 )38,n,6-(n9855 FAX 386-9009 Property address (Fire N2 & Street) : a Location: NE , , NW Sec. 17 , T 29 N, R19_W, Town of Hudson St. Croix Co., WI. Tax ID N2 Parcel ID N2 House color: Brown Realty firm: St. Croix Re Lock Box Combo: Wa er Ig ion: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? 2 --Yes ❑ No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: AJ. e1 Me&_1 Date: ,Z Tql Previous Owner's Name (s) : Patrick Baumgartner Have any of the following been observed? ❑Y XN Slow drainage from house. ❑Y ON Sewage Back-up into dwelling. ❑Y ~,N Sewage discharge to ground surface, road ditch or body of water. ❑Y VN Slow drainage from the dwelling. ❑Y \ _)~K Foul odors. Other comments relative to system operation: I certify that the above information is complete;a d true to the best of my knowledge. OWNERS SIGNATURE : ~'lZt DATE : 4/93 aT'4Ts .TO4oadsui "i J NOIZKooq WRISAS do Hblams S-dowa ISNI : s4uaunuOO Tle.zaua0 :abTeu~sTap :buTpuod❑ J@ggo❑ A a T • do.zd❑ TIOM❑ asnollo : sxopggos tua-4s S UOT-4TosgV TTOS bUT.TTM • OaTSp u'.zaTV[I sgpoTd/duindp Tagi2T buzu.TPMp .Tanoa bUTNOO7p -Tay-40E] OUTT •do.zdp TTaMp asnoHp :sxoieq-4a xuL4 a ~o .TaygOp T-auTT •do.Tdp ---TTaMp ~osnoj;p :sxopq-4aS XuP4 oTq aS UMOUNunp .1014-40p SsION3I0IdsQ QsAldaSUO odTd TTp3gno❑ NUes, bUTPTOH❑ TTOM AJGEI uOua.zs❑ pag❑ Z'~3 pazT.Tnssa.Tdp asoQp A-4TAaIOp X, azTs •xo.TddV punowE] pig-qvp pab MoTogp :utags s uoTq .zosge TTos 3o a s # -4aags :AaA.TnS TToS S0S -Tad saT,Tas TTOS ON[] sOAD LaTT3 uo gTu[.zad .To/)g ubTsap uiagsAs xoN3ov NoiioddsNl xa aaiagawoo sg os L LD ~I l N0I,ZK00rI WaISAS OIZdSS '4 dSnOll 30 ONIMV'dQ SHRNMO RLPORT OF INSPECTION - 7NDIVIOUAL SWAGE' SYSTEM Sa_ni. tait y Peif of < t Slate Sen ic/~f NAML /m__- - - --T a w vt h c n- S .t . C n o i. x C u u yr f' c L.oc(t on~E yy~~ sect.%on Lai( y Subdi,vi,4on St PTIC TANK Size 9afe0ytA Nu.mbeh. o[) campan.rtmentA DiA%taVlce. Oom: --12% Agape H~ ghwateA PUMPING CHAMBER Size-- gaL4r'nh P((mp HOLDING TANK Si ze_- all ov(A Numbest. o o Carnpccrc me.n to Pe~mpe~(- Ala,,cm System D A t a,rl T h o m: W c, e i' B u.i d~. n g 12 0 A Z. o p e Hi,ghwate.A ABSORPTWN B e. d~ o~ SITE t.5 - -7- e f :e n h. D ~,tance_ nom: tU? ~ _ f3ai ling 12o Afope-- H.Eghwa;te~c ABSORPTION SITE DIMENSIONS W.Ed 6( a( V eneh_ ---f" )~t Re-quti teal aILea ,_vce Length a( each eDepth oA ~(oc.fz be('ow -tiee Nu_mbe~( of ('i-nc-6 De-pith 06 h-oc,k oven ,tifie f~ ~r To tak eength . a~ f i n.eA 6t Depth o6 tits, be.eow ghade DiA tan.ce be to"en- {t Scope a I`jce.neh Z~ , peer 100 To:tat' ahAoI(Y ._-)t.t,on anea - 1 ype o{ Cuve.I(.: I'apetr a A t~(aw PIT DIMENSIONS N u- m b e h o ( p7( :t,5 Giua v e i' a n o u n d v(( OutA,idP di:ffMe teIr` 11 t Dep-th 1)ceow .tind'e-l f Total ab6oit.p;tcon "Ilea A ~e e a n e g a ~t e- (t: INSPECTE_"D BY - TITLE_ -C APPROVED DATE 1 g k REJECTED VATL 19 REASON FOR REJECTION REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection ame, ress, icense o. o ns a ing Plumber Time of Inspection t (3)IN 'S ALLATIO CONSISTS OF: Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit Seepage Bed ❑ Holding Tank ❑ Fill System BENCHMARK: (Permanent reference oin escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: lCQ?Y_) Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: 9P # ft to well : (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons ; construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ N0; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES a NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liqui' ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slop greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: /Z_ ft width; t ft length; ;~,n the depth; - ~--1 i.neal feet ti 1 e; F 0 ft to residence; JZ>_'~_ft to wel 1 ; 1290 ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed /1 ft 11 SEEPAGE TRENCH. Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? YES ❑ NO 'knq (13) Has system been installed in floodway? ❑ YES NO Floodplain? ❑ YESi NO DILHR-SBD-6095 N.05/80 Signature of Inspector: EH-- 1 15Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 U / LOCATION: '/4, '/4, Section ,T_N,R_E (or) W, Township or Municipality Lot No. , Block No. ` u J County Subdivision Name Owner's/Buyers Name: Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT 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 MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- P- P- P- P- 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- B- B- 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. : E . , y s r IY, m f e s I F E , E ~ I E rt ~N 3 , j,t ®m ,m , w s r a t ' s . a s I, the undersigend, 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 Name of installer if known Copy C -Property Owner CST Signature_v______ - PLB 6 7 / State and County State Permit # Permit Application County Permi # 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: 5' Al i P" C 4" I'll 5 B. LOCATION: '/Q '/a, Section 2_, T g_j N, R E (or) W Lot# City Subdivision jNaame, nearest road, lake or landmark Blk# Village ~Lk V 1 /E-- S & /Township s c n C. TYPE OF OCCUPAf~sY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY G` c Total gallons No. of tanks I HOLDING TANK CAPAg~TY 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~BISPOSAL SYSTEM: Percolation Rate Total Absorb Area C T~ sq. ft. New -Replacement Replacement Alternate (Specify) Seepage Trench: No* of eal Ft. Width Dh Tile depth top) i No. of Trenches r Seepage Bed: Sue Length A A- Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land-4n 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 ified Soil Tester, _ NAME ,4 / C J p ~j.~n 5!''1 C.S.T. # $~Ivd other information obtained from A (pwner/buildpH :4 4A Plumber's Signature MP/M RSW# 414-1 )0- ;?Phone #,19-7- 2 Plumber's Address s✓ G y 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. 2fI ra '7o 10, J, F S 3 J • Cie ' e e_ ~ g...` a 1 oo rie- 14 ..~m..,_ .,,e lot; J 2 C u l f-t, A T 6f Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application a-ff o Fees Paid: Stat' County Date Permit Issued/Re~eeEefi (date) `7 Issuing Agent Name G/}tea e~E~ Z 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 9/78 1 REPORT ON SOIL BORINGS AND PERCOLATION TESTS RM7115Rev. (r7~ 6VC0 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES JUL L P.O. BOX 309, MADISON, WISCONSIN 53701 il~9 ~ ~ OFFICE LOCATIONYTA~ '/4J ~'/a, Section ,T~N,R 17P (or )Township or Municipality L Lot No., Block No. /ten ~°s County S'i, r ubdiwslon ame ......r- Owner's/Buyers Name: L,'/ e/^ Mailing Address: dv ~C c~: L -66K clu -3 TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT -ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS S--d-146 PERCOLATIO TESTS - „jam / SOIL MAP SHEET___ NAME OF SOIL MAP UNIT ~ 1~~1r0 14 _ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- SINCE HOLE HOLE AFTER INTERVAL BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- QG Byre 7 z- O 3 S 00", See— Pope P- -3 " -5-Pc 6.0" 44 / O 3 • P- P- 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- r,ez rr S d .,X B- *4VIAte- / B- L n A4w , 1, • rr 9-4. 5. rr B- 6 401 7 4 s. Ir rr t/ S 9 r•~C B S' rr Q/1!Q, 7 rr raj /Sr~ 1C! it .3 26 Is- Co :?,6 1 A614 0, 7 2746 1/0 1, 6,114 s;, 6 9 -S 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 6f~~'i• 1. 000 j'" Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. le- /}ref/ tail - f/.- 1O 9vres N [j2_-f1= /e,L/ 91 Ev. = /Lo's' -3 2v Slo~c Sv~~-~ O Pe,~Cs N l33 -F/. /vB' I G - E/ i /0/ Are/f 5, r Res.' J"C a- tN IN "6 17 0 13 P& C yq /30` ©✓AU(ie shoke' /Ij e I, the undersigend, 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. I'V Name (print) Certitication No. - ~5 Address Name of installer if known Copy A -Local Authority CST Sig iacu w