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G++~~'lIMERCIAL TESTING LABORATORY, INC.
5 t l ir, Street, P.O. Box 526
Colfax, Wisconsin 54730 C: Aw '4',
715-962-3121
800 - 962 - 5227
CROIX C.OU QTY REPORT BATE: 5/10/91
UJRTHOUSE DATE RECEIVED,. 5/09/91
-'GnN. b4T 7 4G 1,4
r
7-1
1jCATION*# 463 West Omaha, Hudson
siLLECTORt M. Jenkin7
URCE OF SAMPLU Outside faucet
~LIFORM: 0 /100 ml.
4TERPRETATIOW Bacteriologically SAFE
5 ppm
>tove 10 ppm exceeds thf
A DEPENOEryr.
2` 9m
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PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX G LINTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson WI 59016
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.
t.
WATER TESTING----------------------------FEE: $ 25.00, 00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S) a U v
SEPTIC•SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at time of
inspection)
Property owner's name
Property owner's address
~p
Legal Des iption~4L(_7 1/4 of the 1/4 of SE cti I , T N-R
Town of Lot Number Subdivision Name
FIRE NUMBER ~Cs LOCK BOX NUMBER F
Color of house :~to,1.ect Realty sign b house?_ZA& If so, list firm:
z r+ G 1 `0-f
PLEASE INCLUDE, IF AT AL 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 se vices:,
Telephone Number_
v
REPORT TO BE SENT TO:
Closing d 4e
Signature
ST. CROIX COUNTY
fx~
' Yf
u. x l ~;-f t z r~.. WISCONSIN
= { `n ~rr ZONING OFFICE
a @5w
,Yydk ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
- (715) 386-4680
May 8, 1991
Judy Steiner
Edina Realty
700 2nd St.
Hudson, WI 54016
Dear Ms. Steiner:
An inspection of the septic system on the property
of William Johannsen, located at 463 W Omaha St., Hudson, WI was
conducted on May 8, 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.
Sin erely,
P
Ma kins
Assistant Zoning Administrator
cj
Parcel 040-1067-70-000 06/01/2007 04:53 PM
PAGE 1 OF 1
Alt. Parcel 17.28.19.257D 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - DEETZ, SCOTT A
SCOTT A DEETZ C - DEAN, JULIE E
JULIE E DEAN
463 W OMAHA RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ` 463 W OMAHA RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.600 Plat: N/A-NOT AVAILABLE
SEC 17 T28N R19W 2.6AC IN NW NE COM N1/4 Block/Condo Bldg:
COR, TH S 52 DEG E 696.4 FT,S 81 DEG W
33 FT, S 7 DEG E 303.7 FT TO POB: N 78 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG E 283 FT, S 12 DEG E 458.3 FT S 78 17-28N-19W
DEG W 231.7 FT, N 18 DEG W TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
10/20/2004 777575 2679/501 WD
07/23/1997 904/233
07/23/1997 834/448
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.600 56,000 264,500 320,500 NO
Totals for 2007:
General Property 2.600 56,000 264,500 320,500
Woodland 0.000 0 0
Totals for 2006:
General Property 2.600 56,000 264,500 320,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 315
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
e' Wiseons- DRpEtrtment of Health and Social SerJicas
lb. 67 Divinion of Health
FEW,!" APPLICATION
F
PRIVATE DCiuSTIC SEWAGE SYS'PE."1S ~
7-
A. MiER OF PROPEF'PY TYI'r. OR USE BLACK INK
?dame Address (Street, Cityp Zip Code)
4 3,5
County
B. LOCATIO14 OF PROPERTY WF?'r'RE SYSTFM WILL, BE CO;dSTP•JCTED, ALTERE.D_IR EXTENDL'Di
Check One:
_ CITY _ VILLAGE LEGAL DESCRIPTION:
{ TOWNSHIP
• ~ fir' E"(= ~ ~
C. IS LOCAL PEFMIT PEaUIRED FOR THIS 'rOFX? 4 YES _ NO
r„
D. SEPTIC TAN{ CAPACITY Gallons NEW INSTALLATION / REPLA.CGT2-';T ADDITION as
MATERIALS: Prefab Concrete L.-` . Pourod it Place Steel Other
NiT23ER OF TANKS TO BE II'STALLED:
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commercial Industrial Other
Specify
Number of Persons to be Accorr.,nodated /
J4 ti` C','/ S
F. APtLIANCES, ETCt Food Waste Grinder YES NO Automatic Clothes Washer / YES NO
Dishwasher Y YES NO Automatic Potato Peeler YES _ NO
Other (Specify)
G. EFFLUENT DISPOSAL SYSTEI NEW EXTENSION ADDITION REPLACEMENT
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width Depth Tile Size No. Lines
r Seepage Pitt Inside diameter Liquid Depth 3 "1
J'y
L 7, l
P E R C O L A T I O N T E S T
Test Depth Character of Soil Hou•s Water Test Time Drop in Water Level Inches Minutes
Number Inches Thickness '.n Inches Since Hole in Hole Inter'ral Second t'oTNaxt to Last To Fall
1st Wetted Ov®rnio~ht in Mi~~tps Last Peiiodl Last Peric Period One Inch
P- 0 36" To Soil 1011. Clay 26" 25 e3 or no , 30 112 1 2 1/2 60
7 / it 7 Lu ,4 F "
~i_.~~ ✓ ' ~ • T.S. ~ I
RECO[1)!DATA FROM MINIrZ,11 OF 3'TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Adninistra`ive Code.
S O I L B O R I N G S - Minimums 36" Below Proposed Absorption System _
oring Total Depth Depth to Ground Water Depth to Bedrock
umber Inches Cbserved Estimated Observed Estimated Character of Soil with Thickness in Inches
x&npl e
- 0 72" 72" Blaok To Soil 12"• Clay 18"• Sand 18"• Gravel 24"
7 2' r <
RECORD DATA FROM MINA M OF 3 BORE HOLES
COMPLETE OTHER SIDE
' r r
. i
I, the undarsi&ned, hereby certify that the peroolatiorr, tests reported on this form were made by me
or undar by suparvision in accord with the procedures and mathud specified in Chapter H 62.20 (3),
Wisconsin Administrative Code, and that tho data recorded and location of test holes are oorrect-to
the best of my kno- ledge and belief.
NZE TITLE
or Print)
REGISTRATIG.d NO. or MASTER PLUMBER LICENSE No.
ADDRESS
DATE SIGNATUFT //rt'r~ J_~ y'-•
/STER L Ui BER MAKING APPLICA`~ION MP
Signatures License Number.
'w, 74LIL/
(To be Co-ipleted by Issuing Agent)
Date of Application Fee Paid
Permit Issued (date)/~~i Permit Number
Agent (name) For: / L'e{-,-%
Town, Villity, County, etc.
(Specify) ~
Notes The application cannot be oonsiderad 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 Divisia: of Health. Checks and money orders should be made
payable to the Division of Health.
Do not writs in space balosv - FUR DE.°ART 1NT USE ONLY
DATE RECEIVED r~l •S' ~7(~ ACCEPTED BY RETUPNiKD
(Initials) (Date) See Corres, r
FEE RErEIV:;D
VALL). NO. PSi,I'ITiT NO. Z/
Yes or No)
REVIEWED BY / APPROVED ` DATE
(Initials) (Yes or No)
COMMENTS:
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