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COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730 Agw "4,4
715-962-3121
800 - 962 - 5227 4:1:w
. WROIX IOUN,'f DATE: 1/30!93
r
"OMTHOLISE
UDSON. WI 5401
I Z 'r
SWNEFi: Lon "i lberi io
E: 327 S. At Hudse,:
i~R: M. Jenlr i ns
eE \NDEPEHOf.NT
O= `9p
C heans "LESS HAW Detei-tabie t.evei Approved by".
J
+ -e ; ~It„ AL LABORATORY SERVICES SINCE. 1952
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
1 911 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.
------FEE: $ 25.00
WATER TESTING----------------------
(For nitrates and coliform bacteria)
WATER TESTING FEE: $175.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 L
(Determines if system is properly functioning at time of
inspection) -
Property owner's name L-~<v -,JAx)A-"A
Property owner's address 32- 4-~'(
~C( Legal DesL=o-l ion 1/4 of the 1 4 of Section , T~N-R_v-l
u Town of Lot Number Subdivision N me
3
FIRE NUMBER LOCK BOX NUMBER
Color of houserZ:(~_ /~i Realty sign by house? If so, list firm:
t~
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 requesting services: D~tJ f , 1otlwCk
Telephone Number `7/5--Z &
REPORT TO BE SENT TO / AL ~fJl A(6, S r" Lolkti TT--, 2,i--_0 L
3 2- Lc~): P A--I n,' ~c S Svc r-r-f-f c.U 54 6 l
Closing date kf'
Signature CJViZL ~p
i
1
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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Jan. 28, 1991
First Federal Savings & Loan Assoc. of Eau Claire
372 W. Main
Ellsworth, WI 54011
To Whom It May Concern:
An inspection of the septic system on the property
of Lon & Janna Gilbertson, located at 327 Co. Rd. A, Hudson, WI
was conducted on Jan. 28, 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. 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
operations 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, feel free to contact me at this
office.
Sincerely,
Mary J.~Jenkins
Assistant Zoning Administrator
cj
Parcel 020-1045-10-000 09/28/2006 05:07 PM
PAGE 1 OF 1
Alt. Parcel 19.29.19.177K 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
O - BROWN, LAWRENCE G & LAURA L
LAWRENCE G & LAURA L BROWN
327 BAER DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 327 BAER DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 19 T29N R19W PT SE NW LOT 1 OF CERT Block/Condo Bldg:
SURVEY MAP AS SHOWN IN VOL I PAGE 36
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
19-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/31/2002 680447 1901/385 WD
11/04/1998 590834 1373/627 WD
07/23/1997 1160/347 WD
07/23/1997 896/404
more...
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 53,000 152,300 205,300 NO
Totals for 2006:
General Property 1.000 53,000 152,300 205,300
Woodland 0.000 0 0
Totals for 2005:
General Property 1.000 53,000 152,300 205,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch 113
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
• Wisconsin De rtcont of Health s4'11 Social Services
40 - 11 Plb. #67 3/70 Division of Health
SEPTIC TARS; PERMIT APPLICATION 5-~, --7
TYPE or USE BLtCK INK 3!o Z3
Id
/ f s~
A. CWNER OPROFI:RTY
Namo Address (Street, City, Zip Colo) C /
B. LOCATION OF PROPERTY Wir-RF. SYSTY24 WILL BE CONSTRUCTED ALTERED CR_CTFNDEDCOUIITY-
Chock One:
CITY VILLAGE LEGAL DESCRIPTION (LU1 J r- J \Ji'IV c
TOWNSHIP ` j !
..,e > JC, {Ly /llIL~ y SC I /j i~ ~1T~ -
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER
D. SEPTIC TANK CAPACITY U C Gallons NEW INSTALLATION REPLACFTIENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMBER OF TAMCS TO B£ I1 STALLED:
E. TYPE OF OCCUPANCY
-Cheek One: One or Two Family Residence Commercial Industrial other
(specify)
Number of persons to be Accommodated L Number of Bedrooms 2
F. APPLIANCES, ETC: Food Waste Grinder _ YES NO Automatic Clothes Washer YES G ' NO
Dishwasher YES - NO Automatic Potato Peeler YES i:,< NO
Other (Specify)
G. MASTER PLUMBER HAKING INSTALLATION
Address Name: License Number:
Signature of Applicant": tom'<r~"~ f~(~ MP RSW
Addresss
H. (To be Completed by Issuing Agent) /
Date of Application Fee Paid
Permit Issued (date) Permit Number
Agent (Name) For:
_T V Town, Village, City, Counfy, etc.
(Specify)
Note: The application cannot be considered for filing until all of the above questions are answered and the
fee paid. Agents will for-r:ard application, the fee of $1.00 for each septic ta?ut and the third copy
of the permit (canary) to the Division a. Health. Checks and money orders should be made payable to
the Division of Health.
Do not writo in space beio-e - FOR DEPAR5ZIENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETMI-ED
(Initials) (Date) (See Corres.)
FEE RECEIVED VALID. No. _ PERMIT 140.
Yes or No
REVIEWED BY APPROVED DATE
(Initials) Yes or Noj
COMPLETE 0?V R SIDE
.,rrt
SEPTIC ':AIM PZRMIT 1410. (r
R E P O R T O N S O I L P E R C O L A T I O N T E S T
A N D S O I L B O R I N G S
TO N
DIVISION 07 HEALTH - FLMBII:G S .CTIt`Y
P.O.Box 309, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
` ` "1510" T1"':i
P E R C 0 L A T 1 0 11 T E S T r G
[A. .
Test Depth Charaotor of Soil Hours Water Test TL~o Drop in k'atar Level L,oines iinutos
Ntt:.bcr Inches Thio'moss in Inches Sinco Hole in Holo Interval Second to Next to Last To Fall
1st Nottod Ovorni'7ht in Minutes Last Pariod Lrst Poriod Period Cni- Inch
Err
i
P - 0 3611 Top Soil 10". Clay 261, 25 Yos or No 30 112 ____I Z2 112 60
L~
RECORD DATA FRVM MIN DUM 0.1 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Adainietrativo Codo.
S O I L B O R I N G S- Minin" 3611 Belca Proposed Abso tien SYSt-c
Borinr, Total Depth De th to Ground Uat€r D3 0th to Bodroc%
Number Inchon Gbsorved ;;stim'%ted Observed Estic ted Character of Soil with Thio'.cness in Inches
Exaaple
B - 0 721# 72" Black Top Soil 12''; Cl2y 1811; Sand 1811; Gravel 2411
k a..
RECORD DATA FROM MINPRN 0? 3 BORE: HOLES
YPE OF OCCUPANCY:
RESIDENCE: Number of Bedrooms OTP,ER: (Specify) Number of Persons
FOOD WASTE GRINDER: Yes No Distcasher= Yes No A,.itomatio Clothes Washer: Yes n No
FFLZTENT DISPOSAL SYSTEM: NEW V\ EXTENSION ADDITION sir REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Bed: Length Width Depth Tile Size No. Lines
! Seepage Pit: Inside Diameter Liquid Depth L;,
I, the undersized, hereby certify that the psroolation tests reported on this form were made by ce or under my ~upe;-
vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Ad-ministrative Code, and
tFat tho Bata recorded and location c: test holes are correct to the best of my knowledge and belief.
NAME ANT v ti TITLE
Typ or Print)
REGISTRATION NO. or MASTER PLUMER LI.CENS£ NO. l~7
} n r ...._.r,
ADDRESS C) IV
1~- l / ; (~(I -
t /
DA E f "f l J
SIGNATUR3~!
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