HomeMy WebLinkAbout020-1051-40-000
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Parcel 042-1011-40-250 03/13/2007 11:28 AM
PAGE 1 OF 1
Alt. Parcel 05.29.18.73B-50 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/20/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - OLSON, RICHARD A
RICHARD A OLSON
1134 105TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1134 105TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 2.960 Plat: 5294-CSM 21-5294 042-06
SEC 5 T29N R18W PT NE SW FORMERLY LOT 2 Block/Condo Bldg: LOT 07
OF CSM 8/2283 FKA LOT 2 CSM 9/2471 5AC
FKA CSM 21-5224 LOT 3 (9.88 AC) BEING Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
CSM 21-5294 LOT 7 (2.96 AC) 05-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/20/2006 837104 21/5294 CSM
06/19/2006 827757 21/5224 CSM
05/15/2006 825212 QC
10/13/2005 809306 2908/326 QC
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 01/09/2007
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
CO%MERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227 cz:w
FAX - 715 - 962 - 4030 C
n
Iwo
"'IWIR Ulji e3 i' i;t=t OkI DATE' 4/09/93
THOUSE DATE RECEIVED: 4/47/93
COLLECTED! 2:30pm
-`E OF SAMPLE: Kitchen faucet
RPRETATION'* Bact.-.;- 1
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PROFESSIONAL LABORATORY SERVICES SINCE 1952
r . 3-
ST. CROIX COUNTY ZONING OFFICE
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: $ 35.00
(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 time of
inspection)
PROPERTY OWNER'S NAME : n_Ul r rT VI/IT (Jrcw q t
PROP. ADDRESS:-91.6 !V 0✓ t,,Vll e &„1 Dr. CITY__ S sLk3
Legal Des=150V1 tion 5C-' 1/4 of the L✓ 1/4 of Section Z.O , T 29 N-R~w
Town of Lot Number Subdivision:
/
FIRE NUMBER ~I LOCK BOX NUMB 7~/,~ 2
Color of house ✓'owv~ Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOR,
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: Mary 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 re uestinq services: re Qonl Y✓l. Spy
Telephone Number 3 g~
REPORT TO BE SENT TO: Gres M ri l or "e,,
~i Sa h I.~J ( s ~Le17 C~
CLOSING DATE: - 14 4P - t Signature
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Type Dist # Description ' 442 JACOBS LN
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 5.010 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R19W SE SW COM SE COR SE SW Block/Condo Bldg:
TH W 1019.6 FT, TH N 52 DEG E ALG CEN LN
HWY 12 FOR 703 FT TO POB; TH N 567.9 FT, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
E 441.4 FT, S 424.8 FT TO CEN LN HWY, 20-29N-19W
WLY ON CEN LN TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
08/21/2003 736760 2383/411 QC
05/22/2002 679747 1896/302 QC
12/28/1998 594473 1390/162 QC
07/23/1997 1229/394 QC
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 5.010 87,100 134,400 221,500 NO
Totals for 2006:
General Property 5.010 87,100 134,400 221,500
Woodland 0.000 0 0
Totals for 2005:
General Property 5.010 87,100 134,400 221,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
` Parcel 020-1051-40-000 08/30/2006 05:12 PM
PAGE 1 OF 1
Alt. Parcel 20.29.19.193F 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 - JENKINSON, ROBERT W & LORI L
ROBERT W & LORI L JENKINSON
442 JACOBS LA
HUDSON WI 54016
RTHUDSON T29N-R - 2s
A .20 19 W
SEE PAGE 99
Jh~• .F 9nit2 rw,•,•~~
Ec.Er?r/- L ad M ~y so yycn[N" ~o . cState of -
IS/ .UZ F vo ~ ROo K:F1/li- Ypy i' Gt~sCOr/~s'//]
E Sta n~ N WILL 0W8 R
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a o~ R, oUE a
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Pev /979
GILBERT ob\ e QUALITY ALFALFA
MOTORS INC. ty it • & SOYBEAN SEEDS
MELVIN VOLKERT
Allis-Chalmers New Richmond
ALawn & Garden 246-4118
Equipment SO Years of Dining Tradition
Open Daily at 11:30 a .m. For
Luncheons, Cocktails and Dinner c r min
Pontiac & Olds
Sales & Service PHONE:247-3305
Toll Free From St. Paul-Minneapolis 439-7220 ~
Phone: 386-5155 Headquarters For the Apple River v6
• Inner Tube Trip SIM
Hudson, Wisconsin 1`/, Miles East of Somerset
Highway 64_;~
• AS BUILT SANITARY SYSTEM REPORT
TOWNSHIP SEC. ~N, R~W
.0. ADDRESS , ST. CROI COUNTY, WISCONSIN.
1r8DIYTSION LOT LOT SIZE
PLAN VIEW
-Distances b dimensions to meet requirements of H62.20
;1 r
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G~
,f
is ; .
\MU
? , a ^ ,)x, moo-
c
L
"TIC w1 "TANK (S) MF!GR. CONCRETE TEEL
130. of rings on cover Depth DRY WELL
1ENCHES Tina of width length area
D no. of lines width length= area7~
depth to op of pa 14 4
-G:iEGATE
RK RAT A REQUIRED AREA AS BUILT,--
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.
BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. '
--INSPECTOR
DATED PLUMBER ON JOB
LICENSE NUMBER
x
REPORT OF IIISprCTIO?1--171DIJIDUAL SE ~JAGE DISPOSiV, SYSTFIi
Sanitary Permit
• • r State Septic /8_
IE CJ im . X a~~cd c_ TO[•TNSHIP
• t. Cro "County
S'FPTIC TA' ?K
ze
gallons, 'umber of Compartments
Distance From: We 11 ~ ft.
120 or greater slope ft.
Building* d<00 ft. Wetlands
811water ft.
DISPOSAL SYSLE:1 Tile Field or Seepage Pit(s)
Distance From., t7e11 -4 ft. 12% or greater slope ^ft
Building; ft. Wetlands f:.
FIELD ighwater .~,...A.£t ,
Total length of lines I-An-f
t, Number of lines Z., . Length of
each line _414 ft, Distance between lines ft. Width of the
trench A. ft. Total absorption area sq, ft, Dept;;
of rock below tile / Z in, Depth of rock over the in. Cover
aver . rocL"in .`Depth of tile below grade Z in. S10po of
trench ner 100 ft. Depth to Bedrock ~ ft. Depth to
around water ft.
PITS
Dumber of pits t e diameter ft. Depth below inlet
ft. Gravel aroun pit: __yes no, Total absorption area
sq. ft.
.Square feet of seep tre h bottom area required
%:quarQ feet of s pap.e t ar a required 10
Inspected by: Title': .
Approved Date 197,2.
Rejected Date 197.
EH 115
i 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,•`~ ~'/4, Section G` , N, R 15 Township V1SJ `
Lot No. Block No. c~ I I
County
Subdivision Name
Owner's Name: ` ~I vt ' OZ
Mailing Address: ~C; `3 r N f y~ ~~=5~~= ~t~f• ~YGf a°
TYPE OF OCCUPANCY: Residence _ No. of Bedrooms _3 Other
EFFLUENT DISPOSAL SYSTEM: NEW KC ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 1) /11 -is PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE _F)10 -S "t-~
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_ ;PbGilc TEIS -I
P- l_ 4~ i~ U e-t AjtJ )C,+ Lam- Ll M 1
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
7 Z IJc` in? = a. 1 13 ' ' ; lG
n > Gr 2 y
Z `J Z N~ 6 7 -7 Z i an S~ 30 Tg% 17-
-72 B-_' 7 IVi !JL 1~a._ _13g S~1 t? IN 'S Z
'7 2. l~ n. 7 Z _3 p s 1 2.1 n C,.- Z
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. '1) 'SL' t' i1 V1< 6E %4 b 73 r~~ Indicate scale
or distances. Give horizontal and vertical reference points. Indicate slope.
i I i ! y j i T >t tip i^~Z.f A i r Or
t IN
I C
LrW _ - sue' x
t- 'S - - 'Y
3 ( 11 I{ty ~ ~ i I L 41 ~ 4 ~ ~ i~
,
I _
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) Certification, No. J
Address _LLSLiZ j'1-t) ICJ/
Name of installer if known
CST Signature
OPY A - LOCAL AUTHOFI~:
i
PLB67 State and County State Permit # 7~, `
Permit Application County Permit
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PR ERTY Mailing )VICIress:
ld,4,e) r~4~e_e~ 7 P
. ~~t 7 404
B. LOCATION: Section , T 20N, RtC/E (or) W Lot# City
-T 7
Subdivision Name, nearest road, lake or landmark Blk# Village
Township Q~ys~
C TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES L----NO Food Waste Grinder YES j--N0 # of Bathrooms
Automatic Washer t~ YES NO Other (specify)
E. SEPTIC TANK CAPACITY IV VC Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation J~ Addition _ Replacement Prefab Concrete
*Poured in Place Steel 0! ,?r (speci )
_
F. EFFLUENT. DISPOSAL SYSTEM: Percolation Rate 1) a bsorb Area sq. ft.
Newer/ Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length,j~Width Depth Tile Depth No. of Lines __2 1
1
Seepage Pit: Inside diameter -Liquid Depth Tile Size 7
Percent slope of land a~ Distance from critical slope 4-~
I, the undersigned, do hereby certify that the information 1 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 S it Te r,
NAME C.S.T. #and other information
obtained from (owner/builder), I'
y~~- C77
Plumber's Signature JM11'MPRSW# Phone # 4i
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
F E
E
o w_ .
1
L~
r
E
i ;
E
Do Not Write in Space Beloyv FOR DEPARTMENT USE ONLY
Date of Application Fee Paid: State ~ye County Z. Date
i Permit Issued/RejeSted (da4) Issuing Agent Name 'c f
Inspection Yes No Valid# Date Recd
1. county (w ite 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 6/1 /76
i
4
Parcel 020-1051-30-000 03/16/2007 05:07 PM
PAGE 1 OF 1
Alt. Parcel 20.29.19.193E2 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 - SASS, MICHAEL L & PATRICIA M
MICHAEL L & PATRICIA M SASS
815 NORTHVIEW DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description 815 NORTHVIEW DR
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.500 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R19W SE SW LOT 2 CERT SURVEY Block/Condo Bldg:
MAP IN VOL III PAGE 776 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/18/2003 736108 2377/320 WD
1142/593 QC
8
95/18
more...
2007 SUMMARY Bill Fair Market Value: Assess i In.
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.500 72,000 189,100 261,100 NO
Totals for 2007:
General Property 2.500 72,000 189,100 261,100
Woodland 0.000 0 0
Totals for 2006:
General Property 2.500 72,000 189,100 261,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 135
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
r
Parcel 020-1051-20-000 03/16/2007 05:12 PM
PAGE 1 OF 1
Alt. Parcel 20.29.19.193E1 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 - WAXON, VERNON E & IRENE S TRUST
VERNON E & IRENE S TRUST WAXON
907 BENJAMIN LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): ,Primary
Type Dist # Description " 428 JACOBS LN 7
SC 2611 HUDSON 'f 2 I
SP 1700 WITC i -
`SC k m t_..
cT ( C( Y3
Legal Description: Acres: 2.520 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R19W SE SW LOT 1 CERT SURVEY Block/Condo Bldg:
OL III PAGE 776 ORD (HISTORIES
826/202 37/466 841/407 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
20-29N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/08/2001 644903 1634/512 WD
07/23/1997 1052/402 WD
07/23/1997 1032/155
07/23/1997 1032/154 TD
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.520 72,100 172,800 244,900 NO
Totals for 2007:
General Property 2.520 72,100 172,800 244,900
Woodland 0.000 0 0
Totals for 2006:
General Property 2.520 72,100 172,800 244,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Parcel 042-1011-40-230 03/13/2007 11:27 AM
PAGE 1OF1
Alt. Parcel 05.29.18.73B-30 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/20/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - OLSON, RICHARD A
RICHARD A OLSON
1134 105TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1142 105TH ST
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 2.340 Plat: 5294-CSM 21-5294 042-06
SEC 5 T29N R18W PT NE SW FORMERLY LOT 2 Block/Condo Bldg: LOT 05
OF CSM 8/2283 FKA LOT 2 CSM 9/2471 5AC
FKA CSM 21-5224 LOT 3 (9.88 AC) BEING Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
CSM 21-5294 LOT 5 (2.34 AC) 05-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/20/2006 837104 21/5294 CSM
06/19/2006 827757 21/5224 CSM
05/15/2006 825212 QC
10/13/2005 809306 2908/326 QC
more...
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 01/09/2007
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 020-1051-40-000 03/16/2007 04:35 PM
PAGE 1 OF 1
Alt. Parcel 20.29.19.193F 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 - JENKINSON, ROBERT W & LORI L
ROBERT W & LORI L JENKINSON
442 JACOBS LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 442 JACOBS LN
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 5.010 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R19W SE SW COM SE COR SE SW Block/Condo Bldg:
TH W 1019.6 FT, TH N 52 DEG E ALG CEN LN
HWY 12 FOR 703 FT TO POB; TH N 567.9 FT, Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
E 441.4 FT, S 424.8 FT TO CEN LN HWY, 20-29N-19W
WILY ON CEN LN TO FOB
Notes: Parcel History:
Date Doc # Vol/Page Type
08/21/2003 736760 2383/411 QC
05/22/2002 679747 1896/302 QC
12/28/1998 594473 1390/162 QC
07/23/1997 1229/394 QC
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/25/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.010 87,100 134,400 221,500 NO
Totals for 2007:
General Property 5.010 87,100 134,400 221,500
Woodland 0.000 0 0
Totals for 2006:
General Property 5.010 87,100 134,400 221,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 121
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ar
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i
4C M1ERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730 CIJWAZW
715-962-3121
800 - 962 - 5227
. CROIX COUNTY RFF`ORT DATE: 9/14192
COURTHOUSE DATE RECEIVED'. 9110/92
JDSON. WT 541 ~ 1
r i;c~~t'r tet!!s ~ i1~Gn ~ CIA
Y
udsoT,
w0LLLUI LD i 9-06-v2
COLLECTED: 1:30pm
''E OF SAMPLE: Outside faucet
RPRETATION: Bacteriologically SAFE
1 ppm
,ve 10 ppm exceeds the recommended Public
-~^~ira !~at~i standard,
g 1p
0
2 C4
y !L~
t:• v
S ip
G
-:cans "LESS THAN" Detectible Level Approved
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
j~
Telephone
- (715)386-4680
rThe 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 ia essential a4 that Aiig property can D-e
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: $ 35.00
(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 time of
inspection)
PROPERTY OWNER'S NAME: t CL-b~. f n1, ,In
PROP. ADDRESS: CITY
Legal Description 1/4 of the _1/4 of Section T _N-R
~~,(}C.~+ Town of Lot Number Subdivision:
FIRE NUMBER ll , LOCK BOX NUMBER
Color of house C u Realty sign by house?L If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP j.e,COPY OF PLAT BOOR,
WITfi 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:
Y1}`lt'("'Ct (C~'~C
Telephone Number ~k( r, Cl 3(-CLk
REPORT TO BE SENT TO:
CLOSING DATE: G
Signature-~A1r: i i
F_t31''iTPR(: I] FROPF R9IONAl, fN(:INfi'It
LICENSED LAND SURVEYOR
a
CARROLL A. GRUBB
River Falls, Wisconsin
•
July 22, 1970
A parcel of 5.01 acrt'!!s located in the southeast quart-r of the
southwest quarter of Section 20, T 29 N, R 19 1.1, further ~e-
~'rri.b~--d as follows; from the southeast corner of said southeast
quarter of the southwest quarter of S-ction 20, go west along
the south line of said Section 20 a distance of 1019.6 feet,
th-.Ince North 52° 27' last along the centerline of the original
I
STH 12 a distance of 703.0 feet to the point of beginning for
the rarcel to bn conveyed herein; thence dur- north a distance
of 567.9 feet, thence due east a distance of feet, thence
South 1° 13' West along fence line a distance of 424.8 feet to
centerline of said highway, thence South 89° 38' west along said
centerll.nP a distance of 50.0 feet, thence vresterly on a curve,
.concave to th- south, having a long chord bearing South 69° 30'
4(-st a cli tnnce of 1108.2 feet to the point of beginning.
I~~OaE~GZ ✓cAJ~C/.u 5 ON
E 441.4•
S 0/4 SW "~4 56G . 20 -Z9-19
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'ARG1►t'~EC.TS ~NGa1N~'~RS (~~S 1 of 1
14VG50N4 W►SCohIS11J
ST. CROIX COUNTY
WISCONSIN
l y j
ZONING OFFICE
r ST. CROIX COUNTY COURTHOUSE
r;
~W 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Sept. 9, 1992
Robert Jenkinson
442 Jacobs Lane
Hudson, WI 54016
Dear Mr. Jenkinson:
An inspection of the septic system on the property of Robert
Jenkinson, located at 442 Jacobs Lane, Hudson, WI was conducted on
Sept. 8, 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 you receive them 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,
Mary J. `Jenkins
Assistant Zoning Administrator
cj
Wisconsin Department of Health and Social Services
Plb. X67 10/69 Division of Health
PEFd11IT APPLICATION ,
W 6 d 7 for
/ PRIVATE DG,:ESTIC SEWAGE SYSTEMS
J.Qi1+-~L11it5 m , '71 s jy -(7. I 'I1-~ ~(y 4 q z`- g's -a► o ff'
A. OWNER OF PROPEFC Y TYPE OR 11SF. BLACK INK
N$lpJe Address (Street, City, Zip Code)
C ou my
B. LOCATION OF PROPERTY WHERE SYST&MI WILL BE CONSTRUCTED, ALTERED OR EXTEP:DED
Check One:
CITY VILLAGE LEGAL DESCRIPTION: L '
TOWNSHIP
C. IS LOCAL PEFUIT REQUIRED FOR THIS WORK? YES NO J '~J PERMIT NLTnER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION REPLACEMENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel Other
NUMNER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
/ (Specify)
Number of Persons to be Accommodated Number of Bedrooms
F. A?rLIANCES, ETCs Food Waste Grinder YES X NO Automatic Clothes Washer y^ YES NO
Dishwasher YES - NO Automatic Potato Peeler YES NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width Depth Tile Size No. Lines
Seepage Pitt Inside diameter_ Liquid Depth
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Ninutes
Number Inches Thickness in Inches Since Hole in Hole Interval Second to 1 Next to Last To Fall
1st Wetted Overni ht in Mi:utes Last Period! Last Perio Period One Inch
Example
P- 0 36" To Soil 10" Cla 26" 25 es or no 30 l Z2 1/2 1/2 60
-c ~=c1rt
. M
~L• .SiI:L ~ i 1. ` t`f " F
RECORD DATA FROM MINIMUM OF 3 TEST HOLES
r
ompute aize of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L B 0 R I N G S- Minimum 36" Below Prooosad Abso. tion System
Boring Total Depth Depth to Ground Water Dooth to Bedrock
umber Inches Cbserved Estimated Observed Estimated Character of Soil with Thickness in Inches I
xample
- 0 (72" 72" Black Too Soil 12"• Clav 18"• Sand lE"• Gravel 24"
41
bit, Atj
cf<
RECORD DATA FROM MINIMUM OF 3 BORE HOLES
COMPLETE OTHER SIDE
I, the undersigned, hereby certify that the percolation tests reported on this form were made by me
or under by suparvislon in accord with the procedures and method specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to
the best of my knowledge and belief.
NAME TITLE _~[_~rff L L I=
(Type Print)
REGISTRATION NO. or MASTER PLUI-3ER LICENSE No.
ADDRESS f<'L"
DATE
L%~- SIGNATURE 9.t_
c~ - K-
MASTER PLiTLDE:R MAKING 4PPLIC'TION
MP
Signature: L`~ W ~ License Number: /
MP RSW f^, f
(To be Completed by Issuing Agent)
Date of Application 7 Fee Paid $ o
/ I /
cif
Permit Issued (dat ) / .Z 70 Permit Number _
Agent (name) For. Town, Village, City,'County, etc.
(Specify)
Notes The application cannot be considered for filing until all of the above questions are answered
-and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the
Permit (yellow copy) to the Division of Health. Checks and money orders should be made
payable to the Division of Health.
Do not write in space below - FOR DEPA r:SNT USE ONLY
DATE RECEIVED ACCEPTED BY RETURNED
(Initials) (Date) (See Corres.)
FEE RECEIVED VALID. NO. PERMIT NO.
(Yes or No)
REVIEWED BY APPROVED DATE
(Initials) (Yes or No)
COMMENTS :