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COMMERCIAL TESTING LABORATORY, INC.
X514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730 [:A; w
715-962-3121
800 - 962 - 8378 (WI)
800 - 962 - 5227 iio 9
'?•t+ CROIX ZONING REPORT NO.; 32516/01 PAGE
ST. CROIX COUNTY BEEGI+T -DATET_.. ,.1311~i1"#3tCOURTHOUSE DATE RECEIVED; 8/11:89
HUDSON, WI 54016
~-v
S '
-R: David Doreen F'rotz
LOCATION: 1093 Hwy 12, Roberts. WI
COLLECTOR: Mary Jenkins - St. Croix County Courthouse
SOURCE OF SAMPLE! Kitchen Faucet
COLIFORM: 0 /100 mL
INTERPRETATIONS BacterivtOgiCaLly SAFE
Linder 10 ppm is safe for human ccnsumpllun'
COWFORM NITRATF,
LAB TECHNICIAN Pam Gane
W1 Appyoved Lab No. 1?
co'D N'T'f by W
?C00N a 0FFFCE
O Hr 4
u >
means "LESS THAN" DetectabLe LeveL Approved by:
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY ZONING OFFICE
Rf St. Croix County Courthouse Z ✓J
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: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at ti e of
inspection)
Property owner's name jri
Property owner's address L,ti
Legal Description 1/4 of the X1/4 of S ction , T N-R
Town of Lot Number Subdivision Name
FIRE NUMBER' LOCK BOX NUMBER I1~
Color of house Realty sign by house? If so, list firm:
1 3 rl,t M 5 s c
PLEASE INCLUDE, IF AT ALL POSSIBLE, MAP,i.e,COPY OF PLAT BOO"
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. L,
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 'o
test can be conducted. ~i
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. V 1
rz2 Z
Firm or individual re uestin~ services: >E:-~---E--~~"~ ~
Telephone Number ~1~
Y
REPORT TO BE SENT TO: , Pr-J 7
Closing date
Signature l~t_- I
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I
ST. CROIX COUNTY
WISCONSIN
A
ZONING OFFICE
a ~ l ST. CROIX COUNTY COURTHOUSE
f = 911 FOURTH STREET • HUDSON, WI 54016
715 386-4680
August 10, 1989
David and Doreen Protz
1083 Highway 12
Roberts, WI 54023
Dear Mr. and Mrs. Protz:
An inspection of the septic system on the Protz property located
in the Town of Warren was conducted.
At the time of the 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 is totally dependent upon proper
maintenance of the system.
Should you have any questions regarding this subject, please feel
free to contact this office.
Sincerely,
Thomas C. Nelson
Zoning Administrator
TCN:sa
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
1 Hudson, WI 54016G~ /Y, 3,,
.f Telephone - (715)386-4680 L
I q 7J'
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: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $175.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at ime of
inspection)
Property owner's name (';k ~/U r V-b
Property owner's address
V'L' 1 <A,
Legal Description 1/4 of the 4/4 of Section T N-R
Town of Lot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER
Color of house j,\, L,~# j Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOO
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: z-
Telephone Number
REPORT TO BE SENT TO: Closing date
Signature ,
I
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE '
ST. CROIX COUNTY COURTHOUSE
V 911 FOURTH STREET • HUDSON, WI 54016
386-4
(715) 680
Feb. 6, 1991
Doreen Protz
1083 Hwy. 12
Roberts, WI 54023
Dear Ms. Protz:
An inspection of the septic system on the property
of David W. Protz, 1083 Hwy. 12, Roberts, WI conducted on Feb. 5,
1991.
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.
sincerely,,
J
Mary J. Jenkins
Assistant Zoning Administrator
cj
Parcel 042-1055-20-000 01/02/2007 10:44 AM
PAGE 1 OF 1
Alt. Parcel 20.29.18.306A 042 - TOWN OF WARREN
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 - HARRINGTON, DAVID L
DAVID L HARRINGTON
1083 HWY 12
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 1083 HWY 12
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 6.100 Plat: N/A-NOT AVAILABLE
SEC 20 T29N R18W 6.1A IN NW NE W 300 FT Block/Condo Bldg:
OF E 1704.3 FT OF N 1/2 NE LYING N OFRR
R/W Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 897/284
07/23/1997 697/229
2006 SUMMARY Bill Fair Market Value: Assessed with:
149431 254,400
Valuations: Last Changed: 07/11/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.100 51,800 133,800 185,600 NO
Totals for 2006:
General Property 6.100 51,800 133,800 185,600
Woodland 0.000 0 0
Totals for 2005:
General Property 6.100 51,800 133,800 185,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 206
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSMENT 15.00
Special Assessments Special Charges Delinquent Charges
Total 15.00 0.00 0.00
• AS BU1 - xi4ITARY SYSTEM REPORT
OWNER TOWNSHIP,'!~~ SEC . J; T., ` N, R f,~
P.O. ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100FEET OF SYSTEM
G u
s
SEPTIC- TANK (S) MFGR.~ f r' CONCRETE STEEL
N0. o rings on cover Depth DRY WELL
TRENCHES No. of width length area
BED no. oT lines widt length area u'
dept to top of pipe /S
AGGREGATE
~l-
PERK RATE 5 AREA REQUIRED AREA AS BUILT
DISCLAIMER: The inspection of this system by St, Croix County does not imply
complete compliance with State Administrative Codes_ There are other areas
that it is not possible to inspect at this point of construction. St. Croix
County assumes no liability for system operation. However, if failure is
noted the County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH TE .
INSPECT
DATED PLUMBER ON JOB '
LICENS2'14t~
z
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
SanitaAy PeAmtit='. V
State Septic'
NAME Township St. CAOix County
Locatio~c~~% Section,,- N,R GI
SEPTIC TANK
Size gatton,s. NumbeA o6 Compattments
Di.s Lance FAom: W e.Lt___IQQi it. 12% oA gneateA 6t o pe it
Building it. We.ttand/s ~ .
H~.ghwateA it.
DISPOSAL SYSTEM
Di.stance FAom: wetf /6®le it. 12% aA gAeateA stope _ 6t.
Building it. wettands Ft.
HighwateA it.
FIELD DIMENSIONS:
Width ab tAench113'L-gt. Depth a6 Aock below tite /Z in.
Length o4 each tine it. Depth o6 Aoch oven tote ~ in.
NumbeA P6 Una Depth o6 t,ite betow gtc.adelc-in.
Totat .Length o6 tines t' it. S.Eo pe o6 trench in peA 100 it.
Distance between .2ines~ it. Depth to b edto ck
L;X14 To tat ab~s atcb ian atcea-~' -6t2 Depth to gAOUndwa eA it.
D
3 RequiAed atcea w it
P T-lDIMENSIONS:
NumbeA of pitz GAavet atound pitz yeas no
Outside d.i..amete it. Depth below inter it.
Totat absoAbti. n ea it 2
z
A
AAea Ae Aed i2 rn
INSPECTED B TITLE
APPROVED ~;rr , SATE 19 7 ~y.
REJECTED DATE 197
i~
P
L.
EM•115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
` DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
ryry REPORT ON SOIL BORINGS AND PERCOLATION TESTS`
LOCATION: Section TOO' V, R ! _,e (or) W, Township or Municipality
f0
Lot No. , Block No. County!
Subdivision Name
Owner's Name: 13 %0s .
Mailing Address:
TYPE OF OCCUPANCY: Residence f/ No. of Bedrooms 73 Other
y
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 4 ~SrfERCOLATION TESTS e:~
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES jRATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL
I BER / 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/I'd
~P-
Gf,
4
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES 1
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
t B- _
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
dicate on the plan the location and square fee suitable areas. JII ~di cJK
number of square feet of absorption area
needed for building type and occupancy. of U . r,..-,ce •»Gt~ Indicate scale
„r distances. Give horizontal and vertical reference points. I d' Ste slope.
3 9
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1
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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.
10
Name (print)! UL !j4z J 14~~~ Certification No. I t/ I 3
Pee"
Address
Name of installer if known
CST Signature
L
PL867 State and County State Permit #
c
Permit Application County Perm
for Private Domestic Sewage Systems County 7 c`l
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
B. LOCATION: A1'/, Section IV, T .X7 N, R /tl E (or) W Lot# City _
Subdivision Name, nearest road, lake or landmark Blk#~y/ Village
Township
C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance
Single family w Duplex No. of Bedrooms No. of Persons _
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder/ YES L 0 # of Bathrooms-
Automatic Washer L,-VLS NO Other (specify)
E SEPTIC TANK CAPACITY / Total gallons No. of tanks L
'Holding tank capacity Total gallons No. of tanks
New Installation
Addition- Replacement ln.~~Prefau Concrete L-'°-_
`Poured in Place -Steel Other (specify)
FFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area
ft.
New Addition _ Replacement *Fill System
Seepage Trench: No. Lin. Feet _ Width Depth Tile Depth No. of TrenC
Seepage Bed: Length ;5;2~ WidthDepth '3 =Tile Depth ;Z y No. of Lines :1-
Seepage Pit: Inside diameter Liquid Depth Tile Size tj
Percent slope of land 00 Distance from critical slope
I, the undersigned, do hereby certify that the information I 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 Certifie Soil Tester,
NAME _ jt1 -_-L-LI C.S.T. # f y/ _ and other information
obtained from- (owner/builder).
Plumber 's Signature MP/MPRSW# _ A0~5 Phone #-2-Y6-~
Plumber's Address
PLAN VIEW: Provide sketch below of s stem ! m 1L
y (include direction of slope and all distances in accord with
H62.20, including well).
l ~
?YA~ 5,-,;L X /IPL A:-e%
Do Not Write in Space elo FOR DEPARTMENT USE ONLY
Date of Application 7 ees Paid: State b o' County w Date 7//a/7e
Permit Issued/ eiected (date) 7 to v Issuing Agent Name t,
49
Inspection Yesx_No Valid# Date Recd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
r ether (canary copy)
Revised Date 6/1 /76