HomeMy WebLinkAbout040-1073-30-000
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-COMMERCIAL TESTING LABORATORY, IN [e.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
C Aw
715-962-3121
800 - 962 - 5227
C MIX COUNTY REPORT i ,l 14-d 3. Us;;
,;JRTH(XJSE 0DATEROCE
:,ON, WI 5
4016
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OF SAMPLE'# Rasemer
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PROFESSIONAL LA ORATORY SERVICES SINCE 1952
ST. CROIX COUNTY ZONING OFFICE
911 4th Street
> Hudson, WI 54016
1
Telephone - (715)386-4680
l
The St. Croix Co. Zoning Office offers the service of septic.and
water inspection to Lending Institution, 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 CO. ZONING, 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:$175.00
(VOC'S)
SEPTIC SYSTEM INSPECTION FEE:$ 25.00 v
_77>
PROPERTY OWNERS NAME : A i_cr /-c u v SC l r~^ e s' s Sr
S d L r
PROPERTY OWNERS ADDRESS:--7-30 G 1 •r~ 1: CITY: H ltcA
Legal Descri tion 1/4, 1/4, Sec. , T N-R W,
Town of c,l _,Lot No. Subdivision
FIRE NO. _ LOCK BOX NO.
Color of house Realty sign? yes-_Firm: ► L4 ~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: if
Telephone No. _
REPORT TO BE SENT TO : _ ~1 u T / (T i o ! b r
CLOSING DATE:
Signature:
ST. CROIX COUNTY
WISCONSIN
4.~~
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Mar. 7, 1991
Richard Saltness Sr.
330 Co. Rd. F
Hudson, WI 54016
Dear Mr. Saltness:
An inspection of the septic system on the property
of Richard Saltness, located at 330 Co. Rd. F, Hudson, WI was
conducted on Mar. 6, 1991. At the same time a water sample was
obtained for testing. The results of the 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.
J,
Sincerely,
yyy _
James K. Thompson
Assistant Zoning Administrator
cj
Parcel 040-1073-30-000 05/25/2007 09:41 AM
PAGE 1 OF 1
Alt. Parcel 18.28.19.280D 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
THERESA M LAMB 0 - LAMB, THERESA M
330 CTY RD F
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description * 330 CTY RD F
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 18 T28N R19W PT NE SW COM S 1/4 COR Block/Condo Bldg:
SEC 18, TH N 1505 FT TO POB: TH N 100
FT, W 445 FT, S 100 FT TH E TO POB EXC E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
45 FT FOR HWY 18-28N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 901/398
07/23/1997 466/364
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 1.000 38,000 97,400 135,400 NO
Totals for 2007:
General Property 1.000 38,000 97,400 135,400
Woodland 0.000 0 0
Totals for 2006:
General Property 1.000 38,000 97,400 135,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 120
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Departmont of Health and Social Services
;11b. #67 3/70 Division of Heal;:h -
SEPTIC TANK PERMIT APPLICATION
?Y.n or LSE BLACK INK D 7~J(D / 3'
A. OWNER OF PROPERTY Vb
Name Address (Street, City, Zip Coda)
7
B. LOCATION OF PRO?ERTY WF-RE SYSTLM 'AiLL BE CONSTRUCTED ALTERED OR E:tTENT'ED COUNTY
Check One; /~U.J
CITY VI:.LAGE LEGAL D,SSIRIPTION
TOVNSHIP
ice- Sub
C. IS LOCAL PERMIT RFQUIRED FOR THIS WORK? YES NO PER,'iIT NUYbZR
D. SEPTIC TAN7, CAPACITY Gallons NiX INSTALLATION RaPLACR'SNI' ADDITION
MATERIALS: Prefab Concrete Poured in Place Steil Other
NU'.m3ER OF Tdi::S 7O BE I`iSTALLED: /
E. TYPE OF OCCUPANCY
Check One: One or Two Family Residence Commarcial Industrial Other
(Specify)
Number of Persons to be Acca,=od_.tnd Number of Bedrooms ---1
F. APPLIANCES, ETC- ?ood Waste Grinder YES h~ NO Automatic Clothes Washer Th-' No
Dishwasher YES NO Automatic Potato Peeler YIS~X NO
Other (Specify)
G. ."L~STER PLUPBrR CAKING !NSTALLATION
f; Addrass: /,7- 1L License Nwnber:
Signature of Applicant: MP RZ-4
Address:
3. (To a Comp ted by Issuing Agent)
Date of Application Fee Pal ; J
Permit Issued (date!/' /0 7 7 Permit Number
i ' LC
Agent (Name) Fort
Cz-a L' C~ -~C! r
Tcxn, Village, City, 'County, etc.
(Specify)
Note: The application cannot be considered fir filing until all of the above questions are answered and the
fee paid. Agents will forward application, the fee of 41.00 for each :::;p~ie tanic and the third copy
of the permit (oanary) to the Division of Health. Checks ani- money or3ers should be made payable to
the Division of Health.
Do not write in space below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED ACCEPTED BY RETUR!=
(Initials) (Date) (Se~Corres.)
I~ FEE RECEIVED VALID. No. 'y PERMIT NO.
es or No
REVIEWED BY APPROVED DATY
(Initials) Yes or No
COMPLETB OTHER SIDE
+ SEPTIC TANK PERMIT NO.
R= P O R T O N S O I L P I R C 0 L A T I 0 N ? I S T
A H D 5 0 1 L B O R I N G S
TO
DIVISION OF HEALTH - PLG'??-1Y'w S=Ti6N
P.O.Box SC9, r"dison, Wig. 53701
Pur-suant to H 62.20, Wis. Aft nistrativs Cods
P I R C 0 L A T I 0 N T E S T
r
Test st Depth ~ &ota of _ .4-• rs Water Test Time Bra in 'Pater Leal irons , ,nut Q;7
E117sbar Inches Thic;mess in Inches Since Hole in Hole Int3rval Second to Next t0 L-3st ,To Fall
1st Wstted Ovomi^ht in Minutes Last Paricd Last Period 0s '.nu,
Example
P 0 36" To Soil 10f. Clay 261, 25 Yes or No 30 1 1~2 1 2 I 60
/i / ( -l j t/ jig /i '-l~~ L~l ~l j J cLL✓J! ' 'r' ~S ~ ~ / ~ ~ / ,l,
Al'
RECORD DATA FROM i°IL'dII".U.''f OF 3 T-ST HOLES
Compute vize of absorption area in accord with H 62.20 Wis. Administrative Code-
S 0 I L B O R I N G S- Muir-33 3611 Be'_ca Proaosad fib3orvtien S-3t?=:i
Boring Total Depth Depth to Ground Wate- 2!pth to Badro
c':t
Number Inches Cbservad 1 Ietimated Cbee:tied Esti tcd C'naracter of Soil with Thi,)'rz3s in L,ches
Er~p1e
B - 0 721# 7211 / Black`ior) Scii 12"; Clay 1811; Sand 18"; Gravel 2411
ji~LJir; J t ref`s:'
L' T 1 1/ J
14 tf L 7 ti.,.
RECORD DATA FROM, MINu Ui 03 3 3OP.% F'OLr3
TYPE OF OCCUPANCYt
RESIDENCES Number of Badrocias OTHF.Rs (Speoify) Number of Parsons ` FOOD WASTE GRINDERt Yes No - DishYashert Tas No Autonatie Clothes
Washirs Yes ;f
No
FFUJENT DISPOSAL SYSTEM: NEW ~ EXTENSION ADDITION REPLA.CEILNP
Tile Size No.Lin.Feet Trench Width Depth Number of Lines
Seepage Beds Length Width Depth Tile Size No. Lines
Seepage Pitt Inside Diameter i~ Liquid Dept:
I, the undersigned, hereby cart! y that the percolation tests raported on this form were made by me or under m- super-
vision in aocord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Adxinistrativs Code, and
that the da rsoorded and.location of test hh9les are correct to the best of my knowledge and belief.
d ® ! d
NAME
TITLE.,~:~~
Type or7rint
REGISTRATION NO. or MASTER PLUMEER LICENSE NO.
ADDRESS
DATE X71._
SIGNATURE
V
~1~~ .S~ l ~
yes' -
~ r
~ ,