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AS BUILT SANITARY SYSTEM REPORT
OWNER t, 9 e TOWNSHIP SEC.gLT~!*N, R
ADDRESS ST. CROIX C UNTY WISCONSIN.
SUBDIVISION- - ~
LOT LOT S I ZE
Distances & dimensions to meet requirementsWof H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
'.1
FT_
s _
i
I di a e 114o the Arrow
SCAL
SEPTIC TANK(S) ,I MFGR. CONCRETE /Q STEEL
NO. o: rings on cover Depth
PUMPING CHAMBER SIZE PUMP MFGR. *~►L NO.
;~wl,uiv~ Per Uycle
TRENCHES NO. of width length area
BED NO. of lines width length area
dept to top o pipe
NUMBER OF SEE GE PITS Outside diameter total pit area
AGGREGATE ---~-1~
PERK RATE O-/D AREA REQUIRED ~Q 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 thn
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 ,4 failure.
CREASES AND OILS SHOULD NOT BE DISPOSED THROU H T IS S EM.
INSPECTOR
DATED_ g)"7V.' PLUMBER ON JOB
LICENSE NUMBER
3 -la v ~ 2
ST. CROIX COUNTY ZONING OFFICE 1 ws69
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 is essential 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 V/
(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)
Property owner's nam e'21!%'~
Property owner's address '750
Legal Description 1/4 of the 1/4 of Section , T Zll~ N-R /
Town of r Lot Number-* Subdivision Name 1i" pIill'
-ZZ: Is- T- 79 S jy
FIRE NUMBER -7'E:p r~ LOCK BOX NUMBER
Color of house /Realty sign by h use? If so, list firm:
~ \ t7" Lam/ f c. L~•/.'~ ~i'"! A
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PL T 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 requesting services: & c'_ 1 '~-P~/l~✓/ - Gl/`~G9"
Telephone Number,
REPORT TO BE SENT TO: G,c ;/~1 •jy+/~j,/~ -7~~~ (Z
/ .
Closing date✓ 7
Signature
ST. CROIX COUNTY
rya WISCONSIN
- to P~ k"M," k L~1'
ZONING OFFICE
s r ST. CROIX COUNTY COURTHOUSE
tit { 911 FOURTH STREET • HUDSON, W154016
-Mmto 715 386-4680
October 31, 1989
Jim Henry
706 19th St. S.
Hudson, WI 54016
Dear Mr. Henry:
An on site investigation of the septic system on the property of
Mike & Kelly Dorweiler of 750 Kinney Rd., Section 26, T29N-R19W,
Town of Hudson, was conducted on October 30, 1989.
At the same time I also obtained a water sample and submitted 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 In2i In s -
Asst. Zoning Administrator
TCN:cj
i
4
MIMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
to rz „ ~ b6) K
C3:w iiocc
ST. CROIX ZONING REPORT N0,74 35641/01 PAGE 1
ST. CROIX COUNTY REPORT DATE; 11/02/89
COURTHOUSE Cr-CT!1'h7 + Ar. fiit
HUDSON, WT 540,1 c'=
r
OWNER: M # i<e cc ke l iy i.iorwe i Le
LOCATION: 750 Kinney Rd., Hudson
COLLECTOR: St. Croix Zoning
SOURCE OF SAMPLE; Outside faucet
COLAFORMI if i1Ov ,AL
INTERPRETiyTION PaLtev'iologicaLLy SAFE
NITRATE-NS t 1 ppm
Under 10 ppm is safe for human consumption.
COLIFORM + NITRATE
LAP TECHNICIAN; Rai, Gane
WI Approved Lab No. 14
4,NOEGErrpf ~
(Means "LESS' THAN" Detectable Level. Approved by;
o PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY
WISCONSIN
- - ZONING OFFICE
CBIIp0Na11 - nNNW6
_ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
April 25, 1994
Ms. Karen Ostby _
Landmark Bank 70
P.O. Box 808 r
Hudson, Wisconsin 54016 LOT C~
RE: Water Inspection for Charlie and Joni VanDusartz
Address: 750 Kinney Road, Hudson, Wisconsin
Dear Ms. Ostby:
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 let me
know.
SincerE y
es K. Thompson 4
Assistant Zoning Administrator
mz
Enclosure
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
G
FAX-715-962-4030
ST.CROIX CITY COti.CiR t,EPORT DATE: 4/21/,•
1101 CARMICHAEL ROAD
-,TION. 751 K's nney Pd.. Hud.. o=~ 2
1 3
ECTOR. j i m Th om+s ,,Ti
COLLECTED. 4•-13-94 t°9 U
COLLECTED. 320Pr,
2 r3 Ln
. t rt a,~., rr s • -
:,Ct OF SAMPLE'
p
ANALYZEI44 iai.....:F:~
ANALYZED. 2t00v
i?FRETATIOil. Sacter i o log ica i ty SAFE.
1 APm
;:ire 10 Ppm exceeds the recommended Public
OF.NDEGEI.~fNl
;a:i Lab No. 19
O p
~ y
v SA wtr.,W "yati.si' t {..P7F£+1. fS3(n';7;:,~5 i
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY
` ` WISCONSIN
ZONING OFFICE
A 0 x Ir p x e x■ ro■nb ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
- Hudson, WI 540 1 6-771 0
(715) 386-4680
April 14, 1994
Ms. Karen Ostby
Landmark Bank
P.O. Box 808
Hudson, Wisconsin 54016
RE: Septic Inspection for Charlie and Joni VanDusartz
Address: 750 Kinney Road, Hudson, Wisconsin
Dear Ms. Ostby:
An inspection of the septic system of Charlie and Joni VanDusartz
property located at 750 Kinney Road, Hudson, Wisconsin, was
conducted on April 13, 1994.
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 this office.
3nce~ely,
mimes K. T-"Assistant Zoning Administrator
mz
; 32--'q4
Sqw,-,ROIX COUNTY
WISCONSIN
ZONING OFFICE
~ d p N II p 11 11~
" ""'■b.
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
Please 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 that entry can be gained.
u Water (VOC's) $185.00 Septic5?).0'$50.00
t045.00 0 Nitrate & Bacteria
Water (Nitrate & Bacteria) Y X
retest $15.00
Owner: C.[WI;e-4S61I ~q►&A,5irt<-~ Requestedby: hcz~r4mc._~k r~:,k
Address: 75p Address: f',~,, I X &eS
-I dud , Z I P S c tL ci srn" , i Z I P ~5c
Telephone N4: (~/5) 3S,~,- 1~ 7 I Telephone N4: (,?t6) 3 ~4• ~FyEc
Property address (Fire N2 & Street) : 7S~' K r,•~t , (~~I. y-{« s~^
Location: Sec. , TN, RW, Town of
Realty firm: Lock Box Combo: Closing Date:
V
4
TO BE COMPLETED BY PROPERTY OWNER A' , t 7 .
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS ~
Water sample tap location:
Is the dwelling currently occupied. Yes
If vacant, date last occupied:
Age of septic system:
Septic tank last pumped by: 5i- ate:
Previous Owner's Name(s):
Have ar)k of the following been observed?
❑Y N Slow drainage from house.
❑Y a VNJN Sewage Back-up into dwelling.
❑Y1 Sewage discharge to ground surface or road ditch.
❑Y N Foul odors.
Other comments relative to system operation: Lf,
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE: DATE:
1/94
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
IN j/
A.
I
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? []Yes ❑No
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: []Below grd ❑At-Grd []Mound
Approx. sizeX []Gravity []Dose []Pressurized
Ft.' []Bed []Trench []Dry Well
[]Holding Tank ❑Outfall pipe
OBSERVED DEFICIENCIES []Other []Unknown
Septic tank
Setbacks: ❑HouseC/,-/ []Well ('I~ - []Prop. line 6<[]Other Y
Do tank ""tt
acks: []House []Well []Prop. line []Other
1~ Locking cover []Warning label []Pump/Floats
Alarm []Elec. wiring
Soil Absorption System
Setbacks: ❑Ho=aL []Well` []Prop. liney-❑Other_
❑Ponding: []Discharge: General comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
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Inspector
Title
I
Z _ ~•'3D
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitaay Peam.i-t d 76
S.ta.te S P p-tic_Q2lqS~6_
NAME o w n 4 h i p X/ l(C7w~D S Cno~.x County
Location a f Section
SEPTIC TANK
Size gattone. Number o6 Compa4tmen-t.6
,
T
Distance Fnom: Weil' it. 12% on greater z tope f o6.t
Buitd.i.ng it. Wettanda
~.ghwa.tea
- 6.t.
DISPOSAL SYSTEM H
s
DiA Lance Fnom: Wett ,'E% 6 12$ an gaeatea mope U it.
Bu-i tding . ; it. W e.t.band.6 Ft.
N.Eghwa.ten 6 t.
FIELD DIMENSIONS:
Width o 6' .tren ch it. Depth o6 no ck b et ow. -ti.l' e Z ~ - in .
Length o6 each tine it. Depth o6 Aoch oven .ti.f'e ~ in.
Numb en o tin ea L/
6 Depth o6 .t.L.E'e betow 9rade,± in.
r
° To.tat .l'eng.th o6 Zine44 it. S.l'ope o6 .trench kn pen 100 it.
I i4 tance between tinea it. Depth .to ' b edao ch it.
To.taL abs oab tLon anew6 t2 Depth to gnoundwa-teA it.
Requi,%ed area it2 Type o6 CoveA: Paper oA S.taaw
PIT DIMENSIONS:
Numbers o6 pita GraveZ around pity yea no
Out.6ide di.ame.teA it. Uepth below inZet it.
To.ta.E' abaoAb.tion aaea it2.
Area %eq u4 aed 6t2 rn
INSPECTED BYr~_,~ TITLE
APPROVED DATE_ ~ Y 197 .
REJECTED DATE 197
'~yJ
C~
f
PLB 67 State and County State Permit #
Permit Application County Permit # C5 Zo
for Private Domestic Sewage Systems County <5-~'t~
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address: /
V" H ESS L („fie 1 t7 j T , ?u~5 2ai"j Z L~rS .
B. LOCATION: 5~E Section 2 , T22 N, R_L9 E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
/ D) / Township f4 S007
C. TYPE OF CUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family A Duplex No. of Bedrooms 3 No. of Persons
D. SEPTIC TANK CAPACITY 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- e Total Absorb Area sq. ft. -L L New ?111 Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth ' Tile depth (top) 34 No. of Trenches
Seepage Bed: X Length Width / Y Depth Tile depth (top) No. of Lines N
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: Gir' ) e n -A Win,- X ;i
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 %5 <t C.S.T. # and other information
obtained from 'ac i (owner/builder).
Plumber's Signature 1L~t~-• MP/MPRSW# Phone # V9--31
Plumber's Address f`
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 o*P roperty or neighbors
property. If well has not been drilled please indicate. PLANA/CD
Q9 WELL LoCA T1 on/
:
N
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MARV ~m .
e_ ek
:
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:
,
12 07,, No- eL 1,4 :_ZR14tc!)
PRoPC-QT r> l; N C IC: 4 t
Do Not Write in" Space elow FOR COUNTY AND STATE DEPARTMENT USE ONLY t
Date of Application Z Fees Paid: State County c9Yt 0-7') Date ~.7 d
Permit Issued/Rejected (date) S laklf Q _Issuing Agent Name
Inspection Yes No State Valid# Date Recd
1. county (whit 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
Il
E• 15 0!4. 4778
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
}
LOCATION: Section r T N,R_E (or) W, Township orMuniewity
Lot No. Block No. County
ubdivision 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 BOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- I j ! r
P- / ! f
P-
P_
P_
P_
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
TEXTURE, MOTTLING AND DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B-
B-
B- f
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.
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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 A -Local Authority CST Signature_._ . _