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Wis:on;;in L :nt of Health anJ Soci?:.1 Se. i s
P'b..#67 10/69 Division of H4alth
Hil-UT APPLICATION
for
PRIVr.TE DOMESTIC SEWAGE SYST [15
A. Gt•~_:2 O PRO: TYPE OR - iii CK INK
N66Ma - Address (Street, City, Zip erode)
C ounty
B. L0J4;10'? OF PRnPFR Y St"'_i _ 1'T.L F C0::4SI JCT_'Dt AL•7Y 1R rD°'0
CITY _ VILA I' 10 ''AL DF~C~IpTION•
y TOLr?I5HTP ! ✓i u _2 'i f is
I t
C. IS LOCAL PE:V17T FOR THIS r,D dC?YES NO jp pEiZ!LT N T 5P.
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION RERLACE~:NT ADDITION
MAIERIALS: Prefab Co:crete Pou-ed in Plane v Steel Other
Nul~iZ.. OF TAN :S TO B5 I +STAIMD:
E. TYPE OF OCC'J~ N,Y
Check One: One or Two Family R..=;idenoe ~'1"- Comme-vial Indust::°ial 0th-?r
(Specify)
Number of Persons to bs Acco=odated i Number of Bedrooms
F. A?.'LIANCES, ETCs Food Waste Grinder 1. YES NO Auton-O-ic Clothes Washer YES NO
DistiTres rer YES NO Autor.r! sic Potato Peeler YES NO
Other (Specify)
G, EFFLIJIE~ i DISPC'SAL SYSTii'i NEW r _ EXTENSION ADD IT 10.^i _ REPLACEMZENT
Tile Size / No.Lin.Fe,et i Trench Width rte` Depth Number of Linea
Seepage Beds Len:nth Width Depth _a Tile Size No. Lines _
5eapage Pits Inside diameter =r~ Liquid Depth ;
P E R C O L A T I O N TEST ~ W
_ Pi^e Droo in Water Level _inc:^as te.s~
Test Depth rCharacter of Soil _ Hours water Test
Number Inches Thi,-n-ss in Incises Since Vole in Hols Interval Se•and to Next to La3t o Fart
1st Wetted Cvernizht ;in ML rtes Lz Period Last Perio Por.od_' e In - h
Example _
P- 0 36" To Soil LO", Clav 26' 25 as or no 30 1 2 I 1z2 112 6C
RtECO:"D DATA FR:ai P4:.`iI liit OF 3 -ES'
i
omnute size of absorption are in accord with H 62.20 Wis. Ae_ministnetive Ccda.
I
S 0 I L B _0_ R I N G S- Minimum ' 6" Behr Pro„oosed Absoroticn Syssen, _
oring Total Depth-5t, oth to_Ground Waver Depth to Bed. rook
!.amber Li(*h=.s Cbserved FEstimated ~Obsarved Estimated Cha;rmter of Soil with Thickness in Inures
xamole ~ I
- 0 72" 72" Blank Too So 1 12' ; Cla v 13"; Sand 1~"i Gra ial 2411
. ✓ -
CIO
REC0-Lk DATA FROM MIVI'JM OF 3
COMPLETE OTHER SIDE:
d
AMIl9ERCIAL TESTIN . , V.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
f. CROIX ZONINUI ntr~t i ;tu.; i0 i4,
S'T, CROIX COUNTY REPORT DATE: 9/13/'
.'OWTFOIISE ; "
,!DSOs'!, WI 54Cj
7!!' . Tt ;`1A4Af K! 7 ^R~I
~ Z /G~ 2 - & 6
~,3
'OLAlERi 'CATION' 1189 Ri
3LLECTOR: M. Jenks
,]JRCE OF SAWLE14 Xi
3LIFORMI, 0 /100mL
ITERP'RETATION: Bac#e
W -N* 7
ps.
.\"DEVENp
y
oF fHt.
~4 `90
ZJ ~
PROFESSIONAL LABORATORY SERVICES SINCE 1952
T. CROIX COUNTY ZONING OFFICE
~l St. Croix County Courthouse
~I 1 911 4th Street
t Hudson, WI 54016
Telephone - (715)386-4680
Vt
The St. Croix County Zoning office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Com~letn 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
(For nitrates and coliform bacteria)
WATER TESTING FEE: $175.00
(For VOC'S)
f~ SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at time of
inspection)
Property owner's name ~~~!l~~1- ZGr~~~l
Property owner's address - kris -
Legal Description _ 1/4 of the ft 1/4 of Section ~,I/ T~1~N-R j~oz:
Town of Lot Number Subdivision Name _
FIRE NUMBER 1. LOCK BOX NUMBERS
Color of house ►-67'(2o Realty sign by hou 5 If so, list firm:
PLEASE INCLUDE, IF A 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:/per- dt:'el~~C1
Telephone Number'
REPORT TO BE SENT TO: le&j ca:t7 4 , 7eve) x114 '
Closing date 12eL I~~~'
Signature
ST. CROIX COUNTY
0. 71. ~ WISCONSIN
`jr{ZONING OFFICE
,Yh4w~ J ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
' (715) 386-4680
Sept. 17, 1991
Kathy Smith
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Ms. Smith:
An inspection of the septic system on the property of Esther
Weigel located at 1189 River Dr., Hudson, WI was conducted on
Sept. 16, 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
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,
N
Ma 4,J.i s
As ing Administrator
cj
I, tha uld9ryi;ned, hereby cer,,ify -i t tr.e aer:.olation tests reported on this four, were mach by me
` or unuer by supsrvision in accord suith the procedures eid.meti-I specified in Chapter H 62.20 (3),
Wisconsin Administr=Live Code, and that the data recorded and location of test holes are eorreot to
the best of my kn^rrledge and belief.
TITLI~
(Type or Print)
PLEIGISTi~Ik'I'ION N0. or MASTER :J°3ER LICEN7 E No.
ADDRESS
71
DATE A-____
M',S['E.R PLi!~3:E!? x (Nv AQ?LIC^:tION
MP
NLa RSW i i
(To be Completed by Issni.rq; Agent)
Date of Application Fee Paid
l~
Permit Issued (data/) Permit Number
I l I ! I ! / %
Arent (nama) For: . i
Torm, Village, -ty, County, etc.
(Specify)
Notes Thn application caruiot be considered for filing; until e11 of the a,jove question ars 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 belo'',+ - FOR DE:PAM11 NT USE ONLY
DATE RE.CEIJED /I ACCEPTED BY RETJP,14ED
r~ (Initials) (Date) Sea Corres.)
FEE. RECEIVED VALID. NO. _ P£ E IT NO.
(Yes ~r No)
APPROViD DA?E
REVH-,iED BY
(Initials) (Yes or No)~ }
C OrL IEN TS
Parcel 022-1062-60-100 01/04/2007 12:37 PM
PAGE 1 OF 1
Alt. Parcel 21.28.18.336C 022 - TOWN OF KINNICKINN CC
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
JOHN W & LORI S HUMPHREY O - HUMPHREY, JOHN W & LORI S
1189 RIVER DR
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1189 RIVER DR
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 7.850 Plat: N/A-NOT AVAILABLE
SEC 21 T28N R18W SE SE 7.851 AC LOT 2 Block/Condo Bldg:
CSM 6/1740
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
21-28N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/22/1997 565664 1265/210 1 WD
07/23/1997 1-- . ° .#z.~E'tva-tc
07/23/1997 905/202
2006 SUMMARY Bill Fair Market Value: Assessed with:
179190 424,100
Valuations: Last Changed: 08/10/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.850 90,000 301,500 391,500 NO
Totals for 2006:
General Property 7.850 90,000 301,500 391,500
Woodland 0.000 0 0
Totals for 2005:
General Property 7.850 90,000 301,500 391,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 108
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00