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Home My WebLink About040-1289-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453221 0 GENERAL INFORMATION (ATTACH TO PEI tMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon Troy Townshi 040 - 1289 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: '.7 Cs�T 18.28.19.1653 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` Benchmark ' .' ` at, Dosing Alt. BM • 1 /.b 95.2 Aeration Bldg. Sewer 13 90. 722 Holding _ St/Ht Inlet 44 ,O 7 13 89. 72.. TANK SETBACK INFORMATION St/Ht Outlet 8'.Ss TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` Septic ZS 1 ' �` _ Dt Bottom \` Dosing 7 � Header /Man. Aeration Dist. Pipe nl ��Z9 = Holding Bot. System 04 4 1.63 PUMP /SIPHON INFORMATION Final Grade 4S 92.3s Manufacturer SgInand St Cover GP rl 'DA to.o. Model Number TDH Lift Friction Loss m Head T Ft Force in Length Dia. Dist. to Well S IL ABSORPTION SYSTEM y.s BEDITRENCH Width T ength D S No. Of Tr" as PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth r IMENSION •�� SETBACK SYSTEM TO I P/L ABLD WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION Ty Of System: + CHAMBER OR UNIT Model Nu on va.�. } i oh i`' N � A . � # DISTRIBUTION SYSTEM tS cA*-rn..♦�+s Header /Manifold Distribution x Hole Size "Hole acing Vent to Air Intake Pipe(s) Length ' ? Dia Length Dia pacing �— (O SOIL COVER x Pressure Sy em Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of ded xx Mulched Bed/Trench Center 5 Bed/Trench Edges Topsoil T77 El Yes [N No [] Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �� / (Z / Inspection #2: IKVJ � Location: 361 English Court Hudson, WI 54016 (NW 1/4 NE 1/4 118 T28N R19W) English Estates Lot 9 Parcel No: 18.28.19.1653 1.) Alt BM Description= 6 2.) Bldg sewer length = 3C. amount of cover = ;Po 5 �� Plan revision Required? Ej Yes Use �� I / Use other side for additional inform SBD -6710 (R.3/97) Date Insepcto's Signature Cart. No. r Safety and Buildings Division County N visconsin 201 W. Washington Ave., P.O. Box 7162 Madison, Wf 53707 —` 7162 Sanitary Permit Number (to e filled in by Co.) Department of Commerce (608)266 -3151 L /53 Z 2 Sanitary Permit Application State Plan I.D. Number r n PJX01 In accord with Comm 83.21, Wis. Adm. Code, pe so nal information y may be used for secondary purposes Privacy Law, s15.04(1)( Project Address (if different than mailing address) I. Application Information - Please Print All Information. ,310 /w/� �S�( C o v4 Property wn 's Name Parcel # Lot # Block # Prope Owner's ailing ' Address e 9 Property Location 9410 41Z ' /<, y Section J 9' City, Sta Zip Code C}At3P'CE II. Type of Building (check all that apply) �1 or 2 Family Dwelling - Number of Bedrooms J Subdivision Name �— ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use �l n C (f ti✓ Z ❑City , age 19Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. � Newer ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Keaching Chambe Drip Line ❑ CAvel -less Pipe ❑ Other (e V. Dispersal/Treatment Area Information: Design Flow (gpd) sign Soil Application Rate(gpdsf) ispersal Area Required (sf) Dispersal Area Pf6pdTed (sf) System Elevation VI. Tank Info Ca acity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit jl Dosing Chamber !J VII. Resp nsibility Statement- I, the undersigned, ssume responsibility for installation of the POWTS shown on the attached plans. Ptum r' ame Print) Plum is 7S're MP/MPRS Number Business Phone Number 17 0 41� Plumber Address (Street, City, State, Zip ode z j," Z VIII. C nty /De a rtmint Use Onl pproved El Disapproved Sanitary Permit Fee includes Groundwater D'atg Is su d suing Age Signature ps) Surcharge Fee) �� ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval /4wgs V J3 SYSTEM OWNER 1 t, a uen er and tlispersal Cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained P j as per app ans (to the County only) for the system on paper not less than 81/2 x 11 inches in size - SBD -6398 (R. 01/03) M _ a Z V �� Q r � a 4 0 �ZL b.-� TI L LA w Wisconsin Department of Commerce SOIL EVALUATION REPORT Page —/ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County j Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. rJ Please print all information eviewe Date ty Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r' O Property O ner _._ s_,._ _) Property Location P — ifp t 1 Govt. Lot Ll 1/4 1/4 S T N R E (or Prope Owner's Mailing Address C L 811 # Su d. Name or C+SAA# s City State Zip ode Phone Number City ❑ Village ® Town Nearest Road New Construction use: �4 Residential / Number of bedrooms Code derived design flow rate Z/2�'S GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material (S `/ Flood Plain elevation if applicable ft. General comments and recommendations: Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor 7 /2(� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 2 Al / 4 4 � ❑ Boring # ❑ Boring 17 J Pit Ground surface elev. �q / _ ft. Depth to limiting factor �f_3cO in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r g 9 q r Ali I * #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 m /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST N m (Plea Pr' t)) 7 t ) CST Number 1�.A L Addre s Date Evaluation Conducted Telephone Number G - 31'� SBD -8330 (R07 /00) Property Owner Parcel ID # Page of 3 Boring # ❑ Boring F-3 Pit Ground surface elev. 2 2 ft. Depth to limiting factor > /,?/� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. S . Cont. Color Gr. Sz. Sh. / *Eff#1 *Eff#2 n /J a ? 4 4 -- ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) G � h r a R \\ y INI � j - w►�oonsn 0e0abx d C01"" SOIL EVALUATION REPOR 3 QlYk mdS9IWWd$ baoenrdenoewo Cam ft Wb. Adm. Cods St Croix paper intiess d►an 61R x 11 Mdtes In afze. Plan must P9 but nd (67ided b WWWW end hnisanbl re/aranco t� PM)- nand pafcal I.D. p yoaba• notsl►areoww andbrapon enddblatrsbt+ W Dale ReMe•wd Plus priest ON Wwwo bw• p., ierentu��rawow�. ,►�waerer..osiewrt+�•raaa r L ow . •.1sa14)J"M• �oparryLocallan r cat Lot NW 114 114 S 18 T 26 N R 19 9M W . . 7hcvas o" Loary td d Bloch 11 Sid t4wo er CS � d1Q88 9 na - avlsih Estates . RD. F" t3ode ❑ CRY ❑; ® TOW memam Road Wi S4016 5 381 - TmY cmut a Nor umla pmt /Nwnbarofbedroonw__4_.__ Coo dnNad dodo ft- ras WD ❑ paAcar=mn del -De MOM Q Re011bente� Flood Plain elovatlon K applra6la - ~ - powi ffa letlit •�• - — C'euetet aot9tom ands t MIChM ! el. 96.50, spaced to vode 4.00 "below grade � N 0 p ctounaaAMd&v -90 R Deahbum" b ciw 100 , h,• Shc idle t�edu Doaato on EL S6uctwe t anslstettw Bo�mdary Roble tio�on V2 0t Gr � Sk ou. Sz cwt Color 10yr3J3 noate 2 75.=y4/4 rOm Zak 1 3 W- 100 7.5 /6 nOft }�[ S Cl 100.50 Uev� b litnlwg odor 1 00 h PAM L�J 1si pit t3rou<td�taclelev- ._._ ---- _ Dva Tertuta Slructuo Ca>sfa� �� Roo�a F{otizan Oapth Redax Oeeatpoon or. SL Sk WL tda Ov. SL Cont. Color 2csbk dSh CS if .5 .8 2 W 6 10yr4/4 >now oil lcsbk 3 6-30 Syr4 /4 Lane Cos ml 4 100 ?5.ry4/6 none ms Al > > eftd TSS ��0 < X50 82 = 6QD S and T8S = rnpti - EAhlane t�11 80D 7l0- 22Q rtgM1• NarrDer F W NN pft� � ar L. Steal Tdoph mionher m 715 - 246-6200 5�! 200th. Ave. , Nett Riclomd, WS. 5401? 8 -30 -2001 �y Owrter � •t. �� Peroel ro • �� Pag° 2 °I 3 • :3] 8odrag f ® is'rourae earfaoo eaw. 97.70 R oapn; b amp fts"r 100 In t�la ltris,o.� DOW � Redma thm1pta► ?uuus 5bnacexs Ooeaatatenoa BoaRaOaay An* GP W aq Ss. Cain cow sr. .fir. sn. 1 0 10yr3/ none L ZC&k dsh 95 dish - 9 2 6-25 102r4/ none ail 3 25-101 75.ry4/ node r4] na na 7 1 2 Q ❑ iMt Graa+Aar�aooafay. A Depl�►bYniM�9�+d�— _=- -�' qab }Ip{app C Qalaabaaaal Radeaa Daaa:ipb>• Tomas S1fuWats COna�klea+oa li01Na�MY '� I is �Auaaee� OL sz coat cm Gr 9s. Sh. 'E(M1 'ice ❑ Pk 6aoaawaRlxrsalar, It oean+p h tiara 11mbu- o,a, iaaanraaaal no :tea M swama caawaw±a. sotwaewr � IFL �SL �� or. SL � , ts1 eoq> ans r�o d aTSS ?ao: �sa�aae+� - a.aaara • eaq: summa aa.atss. RVL 71t Depattintaaatt of Commas is aas oq�a) � � ptovi w 84 Carlow. If you award suiaumm to accaa suviees a i a Wd maraud in as ab fot enmu mak please oostaax the dWKSmm at 60- 266 -3151 or "y 60Q- 261 -t7 i STEEL'S SOIL SERVICE 1554 20M Am Zry L Sreei "mi s o'Leaiy New Richmond, WI 54017' TM?.298 sie- Warn -r19w (715) 246 -620Q MPRSW 3M town of Troy lot #9- Eralish Estates Ibis sail evaulWAM ws crovd■c -'ted to osttsty a "aft Wit, it > or �l oat be enitime for raw me. "a loa -Im o! m tot My a =W oot be as shorn m . Iis■s sam aot ontabUslod at the ties 0 trst re4 oaedo�ted• N ss.= toys ofwoochn oorcner.poet 0 el. 160,00' alt. HM.= tOp of steel poat 0 el. 99.80 . eo- J' '. �% 30 -2001 or APR. 2$. 2004' 1; 09AM, ,,_, r- + JaEDINA REALTY HUDSON -- - -- NO. 054 P. 1 ST CR04x COUNTY Sf:PT1C TANK MAINTI -WANCE AGREEMENT i AND OWNrmsfi P Cfi1i71FICATiON FORM ownerBuyer r i Mailing Address Property Address 3 6 t (vcrit'uahion tlquired from Pt img pep'3tlrnent for "W C01n°'c � Jam, Lji J �— Parcel ldefiiiftcacion Number S� 2 City /State r �/� t/• T'. N -R W, Ton of Property Location /•, • Ste' tK • Lot N�. Subdivision — N�r�i S Volume Page p Cenifled Su Map N dub t: N 4�srr ty (O C 1 volume ___�� Page 1-- - 1 1 Spec house y es O no L6, lines identifiable fxyes D no l SYSTEM EN MAINTANCE crmanite tatture to handle Wastes. proper matntenan. i. itttgroper use snit ttiaitttenan ld re ceof your sept systm cousult M►As pt a licensed tA/�as into the systm Consists of pun4 mg out the septic unit every three pears of sopser. if needed by can affect due fimclion of the septic tang as a trcatmew suite 'u1 the waste disposal syatern. The property owner a9lim to submit to St. Croix ZQ4ing Deparonw s d to al e owner and 5v eons &atiettr font+, sttM a ntastct plumber. $0rseyman plumber. testric+rd plumhcr or a lie jttscd pumper verifyittt that (1) the an•ane wasu wet 13 full of sludile. osit systc ra is in proper operating cmndttion a ^t (2) altor r nspccuon amd pamping (if netessaryl. the septic tank is less &MO to i'il have read the above requirements aid s/,jec t0 mainoin the private sewage dispooal system with the standards Uwe. the wtdessttned t Resources. Sate of Wisconsm Cenificatwn set fon ee[�te se due Dcpan menr of Commerce And the Department of Nature Office within 30 r►6 the your aeptte . stem R1s b>Yt+►tN�ntaLn.at Muse trio rniiglctcA omA returned to the St f rout County Zoning days of the rhtr lion dam. ' r DATB SI GNA A"LICA:NT 0 ON a the owner($) of . ( Bert' that l staternents opt this forth are 114 the best of my (our) knowledge. 1 (we) am (re) the de ovc by vtnuc or., .arranty decd reoprded in Register of Deeds Office. -� u SIG A CANT y the Zoning 1)epa mrscni ••• Any information that is rots- scpresentcd may result r�'the santim permit being revoked b •••••• f Deeds office •� Inctuds with this applicattorr- a copy of the centfi d�rvty it totteerettcetnade in the ttraruamy dead POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ,� of FILE INFORMATION ' s SYSTEM SPECIFICATIONS Owner Septic Tank Capacity, , al ❑ NA Permit # Septic Tank. Manufacturer ;t -#j6 C3 NA 0E81ON PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units j�_NA Pump Tank Capacity a l _2� NA Estimated flow (average) ., g al/day Pump Tank Manufacturer —d NA Design flow (peak), (Estimated x 1.6) g al/day Pump Manufacturer '' _S NA Soil Application Rate al /da /ft2 Pump Model ONA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit J3 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids., ITS$) 5160 mg /L ❑ Disinfection ❑ Other: , Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD.) 530 mg /L A In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) .51 ' u /100m ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia ❑ NA Other: O NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear s Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal call(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) f can effluent filter At least once every: ❑ month(s) ❑ NA ear(s) spect pump, pump controls & alarm At least once every: ❑ month(s) AO NA ❑ year(s) i ,sh laterals and pressure test " At least once every: ❑ ❑ m onth ) ea l ,, . ."A ,her: ❑ month(s) At least once every: O year(s) NA or; ❑ NA f. AINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer;, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface, 'he dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding �f effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code:. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized .components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) START UP AND OPERATION t'y /�� Pape of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the disperse) cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outdoes pump tanks may fill above normal hlohwater levels. When power is restored the exceellt wastewater will be discharged to the dispersal cells) In one large dose overloading the collie) and may result In�the backup or surfaco'discherge of effluent. To avoid this situation have the : oontents of the pump tank removed by a Septage Servicing Operator prlor`to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump' controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or of the following' from the wastewater stream may improve the performance and prolong the life , of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants, fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides;, meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings Sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. :ONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must ,be taken, to provide a code compliant replacement system: Z� A suitable replacement a rea has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances In POWTS technology 'a holding tank.may be, installed as a last resort to replace the failed POWTS.- E3 The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS" a soli and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be Installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <WARNING>> .... SEPTIC, PUMP AND OTHER TREATMENT' TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. 'k DDITIONAL COMMENTS , OWTS INSTALLS POWTS MAINTAINER . _. Name Name Phone — Phone EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY N ame 4 ::;,,. - . ,..,,,; . Name f . Phone i��4f ,:,, Phone , iis document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. �7 6 2 0 ®Wisconsin Bankers Association 2002 Z 3 7 $ P 1 6 KATHLEEN H. MALSH DOCUMENTNO. REGISTER OF DEEDS ST. CROIX CO., MI /— RECEIVED FOR RECORD REAL ESTATE MORTGAGE 08/19/2003 09:30AM (For nsuer or Business Mortgage T sections) KERNON J BAST ANn MORTGAGE MARITAL PROPERTY ( "Mortgagor," EXEWT # whether one or more) mortgages, conveys, assigns, grants a security interest in and warrants REC FEE: 13.00 to THE FIRST NATIONAL BANK, 104 E LOCUST STREET, RIVER TRANS FEE: FALLS, WI 54022 ( "Lender ") COPY FEE: CC FEEL in consideration of the sum Of EIGHT HUNDRED THOUSAND AND NO/ 100 PAGES: 2 Dollars ($ 800.000.00 ) , loaned or to be loaned to KERNON J BAST and Recording Area DONALDA J SPEER -BAST ( "Borrower," whether one or more), Name and Return Address evidenced by Borrower's note (s) or agreement dated � ////�� FIRST NATIONAL BANK 19 the real estate described below, together with all privileges, hereditaments, easements and LOAN PROCESSOR appurtenances, all rents, leases, issues and profits, all claims, awards and payments made as a result of the exercise of the right of eminent domain, and all existing and future PO BOX 166 improvements and fixtures (all called the "Property ") to secure the Obligations described in RIVER FALLS WI 54022 paragraph 5 on the reverse side, incI din but not limited to repayment of the sum stated above plus certain future advances Lender. 1. Descr his Property o t the homestead of Mortgagor.) 0 4 0 - 10 71 - 3 0 - 0 0 0 0 (is) ps n arcs eniitrr o. LOTSC3 4 ,COCINT$,B�7IAN NGLISH ESTAT SUBDIVISION, TROY TOWNSHIP, El If checked here, description continues or appears on attached sheet. ❑ If checked here, this Mortgage is a construction mortgage. If checked here, Condominium Rider is attached. 2. Title. Mortgagor warrants title to the Property, excepting only restrictions and easements of record, municipal and zoning ordinances, current taxes and assessments not yet due and FIRST REAL ESTATE MORTGAGE TO FIRST FEDERAL SAVINGS BANK LACROSSE - MADISON 3. Escrow. Interest will not be paid on escrowed funds if an escrow is required under paragraph 8(a) on the reverse side. TWIQ w not 4. Additional Provisions. Mortgagor agrees to the Additional Provisions on the reverse side, which are incorporated herein. The undersigned acknowledges receipt of an exact copy of this Mortgage. NOTICE TO CUSTOMER IN A TRANSACTION GOVERNED BY THE WISCONSIN CONSUMER ACT Er DO NOT SIGN THIS BEFORE YOU READ THE WRITING ON THE REVERSE SIDE, EVEN IF OTHERWISE ADVISED. DO NOT SIGN THIS IF IT CONTAINS ANY BLANK SPACES. YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN. YOU HAVE THE RIGHT AT ANY TIME TO PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS AGREEMENT AND YOU MAY BE ENTITLED TO A PARTIAL REFUND OF THE FINANCE CHARGE. Signed and Sealed AUGUST 12, 2003 (SEAL) (Type of Organization) By: (SEAL) (SEAL) KER N J BAST By: (SEAL) (SEAL) By: (SEA DONALDA J SPEER-B T (SEAL) By. - -- - (SEAL) — (SEAL) AUTHENTICATION OR ACKNOWLEDGEMENT STATE OF WISCONSIN Signatures of 2 ss. County of PIERCE j � This instrument was acknowledged 6 7 12 2003 by KERNON J BAST and A J _ E -BAST authenticated this day of a s o as as = -n /a * = (Type of aur 4 offlcekrustee, ♦ on Z Title: Member State Bar of Wisconsin or of i� (JEi� authorized under 5706.06, Wis. Stets. : y arc o w . . i an This instrument was drafted by MARY LANGER COMM LOAN ASST J LAR Notary Public, Wisconsin 'Type or print name signed above. My Commission (Expires)(Is) MAY 3 2004 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1289 -90 -000 Parcel Number 18.28.19.1653 OWNER NAME: First KERNON J & DONALDA SPEER Last BAST PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 361 ENGLISH CT SECTION 18 TOWN 28N RANGE 19W 1 /4160 NE 1 /440 NW Line Description Line Description TOTAL ACREAGE 2.040 PLAT ENGLISH ESTATES 02 LOT9 BLK 01 SEC 18 T28N R1 9W PT NW NE 15 02 LOT 9 ENGLISH ESTATES 16 03 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit I do I NN to so so i Isis do p It \v •. �► ✓" r �� ' 4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Cr oix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pending Please print all information. ' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Re 2 S Property Owner Property Location Thomas O "Leary Govt. Lot NW 1/4 NE 1/4 S 18 T 28 N R 19 IS (or) W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 389 ay. RD. "F" 9 na Englsih Estates City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson i W11 1 54016 (715 ) 381 -5590 Troy I English- Court M New Construction Use: [3 Residential / Number of bedrooms 4 Code derived design flow rate ` ` ! �D ❑ Replacement ❑ Public or commercial - Describe: E. Parent material outwash Flood Plain elevation if applicable General comments rtrtrtt ;. and recommendations: _ C -7 2UlJ 1 ,� a -, , eta' �? trenches @ el. 96.50, spaced to code 4.00' below grade S Bori dltL Fi Boring # g 100 in. l; :- ® Pit Ground surface elev. 99.90 ft. Depth to limiting factor I appigw Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 1 -6 10yr3/3 none L 2csbk if .5 .8 ,lP 2 6 -20 75.ry4/4 none sl 2msbk dsh ClW if 5 Ae 3 0 -100 7.5 4/6 none ms •�- ° !G • V �o •k v:i i. t T T Boring # Boring 2 ® pit Ground surface elev. 1 00.50 ft. Depth to limiting factor 1 00 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 1 -6 1 2csbk dsh cs if .5 .8 rip 2 -16 10yr4/4 none sil 1csbk dsh qw if #q 3 6 -30 5yr4/4 none cos Osg ml ClW na 4 0 -100 75.ry4/6 none ms Os •a" Lb Q.AQ i t Effluent #1 = BOD > 30 220 mg/L and TSS >30:S 150 mg /L nt #2 = BOD < 0 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature ST Number Gary L. Steel - Address Da a Eval abon cte Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -30 -2001 715- 246 -6200 Property Owner ThMa n' Tamar= Parcel ID # pending Page 2 of 3 1 3 1 Boring # ❑ Boring Q Pit Ground surface elev. 97.70 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 -6 10yr3/ none L 2csbk dsh cs 1f 5 ( P 2 6 -25 10yr4/4 none sil 2csbk I dsh qw if •(p 3 25 -10 75.ry4/ m none s Osg ml na na .7 1.2 •� � 3• �o ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # 1:1 Pit Ej Boring Ground surface elev. ft. Depth to limiting factor in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.6/00) III s � STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. 518- T 28N -r19w CSTM2298 Thomas 8- ��' New Richmond, WI 54017 town of Troy . MPRSW -3254 (715) 246 -6200 town lot #9- English Estates This soil evaluation was conducted to satisfy a zoning requirmwnt, it may or may not be suitable for your use. The location of the test may or may not be as shun as permanent lot lines were not established at the time the test was conducted. T N 1 " -40' , ofwooden corner. post @ el. 10 top of steel post @ el. 9 9. b � jab, w OA -s pl Gary L. Seel 8 -30 -2001 w 80. FT. �• w ;� Lcyr Of MAO i f r• r � \ ._..__._ .__. .��'' � f r T\ ar OO Ar LCM 4 + r tQ .. - - -. G&Mi4. FT. r ESA F.F.E. — a31.61 t 98.v) ._ .�. _.. — — — — — — Aqmw ' L {NBI'10'QZ'W 132ZY4) SQI,/[Fl I..NE 0F 1W WQRTIi tq6 FE#T CIF 1HE NMf tA CF 111E NM. 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