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N CD Q 3 D iy (D IUj .,ti +a ff 0 tv O I(D COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 C:!:: FAX - 715 - 962 - 4030 WPURT DATE' 1/03/ r 101 nn,Cl!ARMICPAEL ROAD MILi-: Da to fa. ?npi LL- -27. _ECTED: 122C. -F SAMPLE: E ANALYZED: 12-24--'u ANALYZE 1;:2F00pm JRM.MFU,'0 /100 . R ; -Z1 w _ Ii ! S: am d° r r. Z~1~'i!NfY 'ae4'F-ilr`- oF.NDFGfNOpHj ~ o = o ~d Mears THAN" jiefectdble Level Approve. PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN ZONING OFFICE l rn„ ,vj ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 1 L (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. ❑ Water (VOC's) $185.00 G Septic $25.00 11 Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner:, Requested by: Address: Address: City & State: City & St. , Zip Code: Zip Code. Telephone N°: ( ) Telephone N°: ( ) Property address (Fire N2 & Street) : Location: 1 1 Sec. , TN, R W, Town of St. Croix Co., WI. Tax ID N2 Parcel ID N2 House color:. Realty firm: Lock Box Combo: Water sample tap location: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? D Yes ❑ No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: -Date: Previous Owner's Name(s): Have any of the following been observed? l:•.~ ❑Y ❑N Slow drainage from house. ❑Y ❑N Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface, road ditch or body of water. F.- ❑Y ❑N Slow drainage from the dwelling. ❑Y ©N Foul odors. Other comments relative to system operation:` / I - I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE:. 4/93 i OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 3 TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? []Yes ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: G elow grd OAt-Grd []Mound Approx. size 'X 901avity []Dose OPressurized Ft. Z 7JOBed []Trench Wry Well []Bolding Tank []Outfall pipe OBSERVED DEFICIENCIES ❑Qther OUnknown Septic tank Setbacks: ❑Iiouse C'LOWell~°`` []Prop. lined 00ther Dose tank Setbacks: OHou []Well []Prop. line []Other OLocking cover ~cK ; []Warning label []Pump/Floats []Alarm OE1 c. wiring Soil Absorption System Setbacks: ❑Iiouse t!- OWell~~ OProp. lineC ' 00ther ❑Ponding: ODischarge: / c/ IP r~ r1cc r r~ i,i ~7Xr ! ` rz,J General comments:,/ INSPECTORS SKETCH OF SYSTEM LOCATION I Inspector Title ST. CROIX COUNTY WISCONSIN ZONING OFFICE 1 x x x N x x x e rrrrd ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road f - Hudson, WI 54016-7710 (715) 386-4680 Allan Cowles December 29, 1993 706 19th St. So. Hudson, WI 54016 Dear Mr. Cowles: An inspection of the septic system serving the Dale Moe home located at 443 116th St., Roberts , was conducted on Dec. 27, 1993. This inspection was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly, there may be hidden defects in the system not discoverable by this inspection. A water sample was also taken to test for bacterial and Nitrate contamination. We will notify you of the results when they are made available to us. Our records do not date back to the time this system was installed, so it is impossible to determine exactly what the system consists of or how many square feet of drainage area there may be. At the time of the inspection, the septic system appeared to be functioning, but not at full capacity. It was noted that sewage effluent was ponded within the drywell indicating that this portion of the system may be approaching failure. I was unable to locate the drainfield that Mr. Moe indicated was beyond the drywell, so I cannot report on the condition of this portion of the system. Given these factors it is very difficult to estimate the useful life remaining in this system. I cannot predict nor guarantee that this system will continue to function properly in the future. In an effort to prolong the system's life, I recommend that steps be taken to minimize the wastewater flow which enters the system. For example, replace existing fixtures with water conserving fixtures, reduce time spent in the shower, wash clothes and dishes only when there are full loads, use a washing machine with a suds saver feature, etc. I would also recommend that you have the septic tank pumped at a minimum of once every three years. Should you have any questions or concerns that I can clarify, please feel free to contact me at this office between the hours of am.- 5:00 pm., Monday - Friday. Since ely, J es K. Thomp4n ssistant Zoning Administrator cc: file ST. CROIX COUNTY f~. r WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER - - 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 April 25, 1994 A43 Mr. David Soward 443 116th Street Roberts, Wisconsin 54023 RE: Water Inspection for Soward Residence Address: 443 116th Street, Roberts, Wisconsin Dear Mr. Soward: Enclosed is the original test results from Commercial Testing Laboratory, Inc. for water inspection of the above property. If you have any questions with regard to said report, please let me know. incerel , mes K. T ompson 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 cz::w FAX-715-962-4030 c .i:R~ilot U14 UGV4GTR REPORT PATE 4/21,'94 .LO1 CARKD4AEL ROACH DATE RECEIVED: 4/15/94 U` 4'r?h I 1 I iTI N14 443 1161h S#.. Roberts 1 ...ECTORIO, Jim Thompson COLLECTEDIf 4-14-94 COLLECTEW 2130Pto RECOVEO CE ~1 VEC' ~'1q'!!`LE'f k.i yu. n faliC.fi+ 2 -5 ZED. 4-15-94 ED *4 11100asn i;OUNTY ZDNING0ffIGE n _ iw 'IX-CC10 0 /100 RFRETATIOiI: ;NDEGENO OF. FNl. Approved Lab No. 19 O > Z A 5 r'PS E~ CG=' THANE• ACP Dtled g _ PROFESSIONAL LABORATORY SERVICES SINCE 1952 Parcel 022-1026-90-100 10/26/2009 09:07 AM PAGE 1 OF 1 Alt. Parcel 09.28.18.142C-10 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 11/18/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner KATHRYN S & TERRANCE M CASEY O - CASEY, KATHRYN S & TERRANCE M 443 VALLEY VIEW RD ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 443 VALLEY VIEW RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.500 Plat: N/A-NOT AVAILABLE SEC 9 T28N R18W S 275' OF N 575' OF W Block/Condo Bldg: 396' OF NW SE ALSO S 742.82' OF N _ 792.82' OF W 396' LYING ELY CL TN RD EXC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 1ST DESC PARCEL & EXC AS DESC IN 09-28N-18W 2698/202 Notes: Parcel History: Date Doc # Vol/Page Type 09/02/2005 805324 2881/043 V., 11/18;2004 780288 2698/202 C 07/23/1997 1062/326 V11 07/23/1997 867/68 more 2009 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/07/200' Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 60,000 176,000 236,000 NO Totals for 2009: General Property 2.500 60,000 176,000 236,000 Woodland 0.000 0 0 Totals for 2008: General Property 2.500 60,000 176,000 236,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 c) r ~U- ST. CROIX COUNTY WISCONSIN ~`t _ ZONING OFFICE r r p r r r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST RE +I2 ! 41, Please specify desired test(s) & remit approbtljal with application. Outside water lanes are often'.turped off - ring winter months, making access to the home necessary: ,°;;'Ptea make arrangements with this office to insure that entry can er ned. ^R ❑ Water (VOC's) _$185.00 ❑ Septic i~o 00 ❑ Water (Nitrate & Bacteria) 45.00 )9~ Nitrate-..&,"Bacteria retest $15.00 Owner: IA&D S,3-,tZ-D Requested by: 30P~J>D 5Cuoi~-+2o Address: 44-3 jjto='^ Address: 443 IIIDt-h Sr (L)NIQ!4~ -LLD) Z I P. Ru6zs2+t ZIP SN o Z Telephone N4: (71S ) Telephone N4: (-7rs-) yZs- - LQ T,3Z Property address (Fire N4 & Str et) 3 (I lob Si- - Location: Sec., T N, R W, Town of /7fj,C - O Z2 Realty firm: Lock Bo Combo: Closing Date: TO BE COMPLETED BY PROPERTrOWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently occupied? ❑ Yes ❑ No If vacant, date last occupied:_ Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ❑N Slow drainage from house. ❑Y ❑N Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface or road ditch. ❑Y ❑N Foul odors. Other comments relative to systein operation: I certify that the above informati n iso le and true to the best of my knowledge. OWNERS SIGNATURE: DATE: ~ I 1194 - ~ l ~ j T J ST. CROIX COUNTY WISCONSIN - ZONING OFFICE r r r r r u ■ a ■ - ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road W - Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION WATER TEST RE t Please specify desired test(s) & remiir 'appropr1~~~ f with application. Outside water lines are often.,,turped off~,•yd ring winter months, making access to the home necessary:!"I'M 'make arrangements with this office to insure that entry can ~eiI ned. ❑ Water (VOC's) _$185.00 ❑ Septic `'$;O. 00 ❑ Water (Nitrate & Bacteria) 45.00 ,K Nitrate Bacteria retest $15.00 Owner: J'A~;D Requested by: ~JL7 SCt,UrvZi.~ Address: 443 Illo" Sr. (t,',ail~„t),u Address: 4y3 Illot-" i-r S-yoZ~ ~;,Vxe yi ZIP uZ RiDCCZ+L ZIP Telephone N4: (71 Z1-- lv~ uZ Telephone N4: (-71 Z/ Zr - soZ Property address (Fire N2 & Street) : 4~I 3 I I ~1 S i - Location:;, Sec. , TN, R W, Town of - h, Realty firm: Lock BTv,`,r Combo: ~1 Closing Date: n l E Gt S u L~ (~i.Cw~ a VO it l Lv 1-, &'L i kr 1 Ajk- TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: 11 f CLC(G Is the dwelling currently occupied? 0 Yes ❑ No If vacant, date last occupied:_ Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ❑N Slow drainage from house. ❑Y ❑N Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface or road ditch. ❑Y ❑N Foul odors. Other comments relative to system operation: I certify that the above information is tom,,le and true to the best of my knowledge. I OWNERS SIGNATURE. _ DATE: 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN 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. size 'X []Gravity []Dose []Pressurized Ft.' []Bed []Trench []Dry Well []Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES []Other []Unknown Septic tank Setbacks: []House []Well []Prop. line []Other Dose tank Setbacks: []House []Well []Prop. line []Other []Locking cover ❑Warninglabel []Pump/Floats []Alarm []Elec. wiring Soil Absorption System Setbacks: []House []Well []Prop. line []Other ❑Ponding: []Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector_ _ Title Parcel 022-1026-90-100 02/02/2007 04:20 PM PAGE 1 OF 1 Alt. Parcel 9.28.18.142C-10 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/18/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CASEY, KATHRYN S & TERRANCE M KATHRYN S & TERRANCE M CASEY 443 VALLEY VIEW RD ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 443 VALLEY VIEW RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.500 Plat: N/A-NOT AVAILABLE SEC 9 T28N R18W S 275' OF N 575' OF W Block/Condo Bldg: 396'OF NW SE ALSO S 742.82'OF N 792.82' OF W 396' LYING ELY CL TN RD EXC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 1 ST DESC PARCEL & EXC AS DESC IN 09-28N-18W 2698/202 Notes: Parcel History: Date Doc # Vol/Page Type 09/02/2005 805324 2881/043 WD 11/1812004 780288 2698/202 QC 07/23/1997 1062/326 WD 07/23/1997 867/68 more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 178793 204,200 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 50,000 138,500 188,500 NO Totals for 2006: General Property 2.500 50,000 138,500 188,500 Woodland 0.000 0 0 Totals for 2005: General Property 2.500 50,000 138,500 188,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 022-1026-90-000 02/02/2007 04:19 PM PAGE 1 OF 1 Alt. Parcel 9.28.18.142C 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/18/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - SOWARD, RETIRED RETIRED SOWARD Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 443 VALLEY VIEW RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.500 Plat: N/A-NOT AVAILABLE SEC 9 T28N R1 8W S 275' OF N 575' OF W Block/Condo Bldg: 396' OF NW SE ALSO S 742.82' OF N 792.82' OF W 396' LYING ELY CL TN RD EXC Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 1ST DESC PARCEL 09-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1062/326 WD 07/23/1997 867/68 07/23/1997 446/202 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2005 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: 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 Wisconsin Department of Health and Social Services Plb. #67 3/70 Division of Health ' SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. LrdNER OF PROPERTY Name Address (Street, City, Zip Coda) n B. LOCATION OF PROPF2TY WF-.RE SYST WILL BE CONSTRUCTED, ALTEREDYOR EXTENDED COUNTY Chock One: CITY VILLAGE LEGAL DESCRIPTION 7 TOWNSHIP i . ~l JIU~ C Cf C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION X REPLACEMENT - ADDITION MATERIALS: Profab Concrete Poured in Place Steel Other NUMBER OF TANKS PO BE INSTALLED: J E. TYPE OF OCCUPANCY Cheek Ore: One or Two Family" Residence Come: eial Industrial _ Other Specify) Number of Persons to be Accommodated Number of Bedrooms } F. APPLIANZES, ETC: Food Waste Grinder YES _ ,(.NO Automatic Clothes Washer YES _ NO Dishyrasher YES _ -?,,NO Automatic Potato Peeler YES -A--NO Other (Specify) G. MASTER PLL/iE.R MAKING IFSTAL"k Name: / i ~ A Address: Lieonce Number: t t! M? 1 Signature of Applicant: MP Rv 5 G+ Addresat } i? r ~1~~t ' r~~,t.-,, s fi. (To be Completed by Issuing Agent) Date of Application /7 Fee Paid Permit Issued (date) Permit Number Agent (Name)` r Fors Town, Village, City, County, etc. (Specify) Note: 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 $1.00 for each septic taruc and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED it) - (3- -7 O ACCEPTED BY RETURNED _ (Initials) (Date) See Correa FEE RECEIVED VALID. No. `7 PERMIT NO. Qtb~~G i~ es or No REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE XRER SIDE SEPTIC TANK PERMIT NO. R$ P 0 R T O N S O I L P I R C 0 L A T I 0 N T I S? A N D S O I L B O R I N G S TO 4 DIVISION OF HEALTH - PLU,1BI1KG S=TI&A P.O.Box 309, Kadison, Wis. 53701 Pursuant to H 62.20, Wis. Atministrative Code P E R C O L A T I O N T I S T Test Depth Charaoter of~ Soil Hcu s Water Teat 'I ima D. o in Water Level I1.olies ites Number Inohas Thickre,;s in Irohos Sir,co Hole in Hole Interval Second to Next to Last To Fsll 1st Watted CIerni ht, in Miznutcs Last Period Last Period Period ~e Inch Example P - 0 36'~ To Soil 10" Cla 2611 25 Yes or No 30 _ 112 1/2 1& 60 Ci 3-, 5 RECORD DATA FROM OF 3 TEST H0LIK3 Compute size of absorption area in accord with H 62.20 Wis. Administrative Cods- S O I L B O R I N G S- Mini.27.= 3611 Bale-:v Pronosnd Absorption S -5ti: ^ - - - _.e Boring Total Depth D3pth to Gr~u..d Depth Number Inchni 03a_vad E.timat<d Observed Esti^;aaAd Charactzr of Soil Soil with Thio';a-iess in Inchss B - 0 72" 7211 Black To Soil i2''.• Clay 18,11 Sand 1811- Gravel 2411 x - RK-':O D DATA FRO-.M MINIMUM 02 3 DO_R.z: H0?,"' YPE OF OCCU°ANCY: R SIDENC s Number of Bodroaa9 j OTH Rs (Specify) Number of Persons OD WASTE GRINDER: Yes No Dishwashers Yes No Atom,tic Clothes Wash.,r: Yes No FFWE'iT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACC&Mq NT Tile Size No.Lin.Feet I O Trench Width 3 Depth -5' Number of Lines Seepage Bed: Length Width Depth ?ile Size No. Lines Seepage Pits Inside Diameter _ S ' Liquid Depth I, tho undersigned, hereby certify that the percolation testis reported on this form were made by me or under nay super- vision in accord with the proced.ires and method specified in Chapter H 62.20 (13), Wisconsin Adninistrative Coda, and that the re orded and lotion of test holes are correct to the best of my knowledge and belief. NAME TITLE Type or Print REGISTRATION NO. or MASTER P14MER LICENSE NO. ADDRESS DATE s 7 r 7f 11 SIGNATURIw / / L l x'L { L'~L 33''3 , . 306 z~ qq~ 30 1 5 S 2 7 I