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040-1124-60-000
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Q N ro °mQ. 3 -0 , co 10 c ~Qp tv ro p c v v o p O cn 7A O 5C N o (D ° 'v C) (D C) 0- N v Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 87 GENERAL INFORMATION (ATTACH TO PERMIT) 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: Cernohous, David Troy, Town of 040-1124-60-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /60 ) ( 33.28.19.516 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt. BM ) Z Z_ gQ C7 Aeration Bldg. Sewer Holding St/Ht Inlet (P • 7 74' z TANK SETBACK INFORMATION St/Ht Outlet 7,551 3 Z.S TANK TO P/L WELL B(.DG. Vent to Air Intake ROAD Dt Inlet L,J Q w_ 21.,.) Septic -7 51 i ,7 56i I ' f Dt Bottom Dosing Header/Man. .4 g0• ~Z Aeratio Dist. Pipe 'I Cz J o Holding Bot. System (D S PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover \ Z G ?M Model Number TDH Lift Friction Loss System H Ft Forcemain nth Dist. to Well SOIL ABSORPTION SYSTEM BED1TRENCH Width Length~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1141 )44 13 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR s(~ .i-,n~'I Type Of System: 30, /16' , 1- UNIT Model Number: GOJ~ Z.V~1 V . ~J DISTRIBUTION SYSTEM / _f Q Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake / Pipe(s) \ \ Ir^~ I Lis t) Length Dia Length Dia_ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulc Bed/Trench Center Bedrrrench Edges Topsoil ~ ~ h l Yes E] No edYes :[::]N], COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / ~~~lll Inspection #2: / / Location: 531 Cty. MM River Falls, WI 54022 (NNE 1/4 NW 1/4 33 T28N R1 9W) 40 acres Lot I- Parcel No: 33.28.19.516 1.) Alt BM Description 2.) Bldg sewer length ='Ll - amount of cover = /g N Plan revision Required? Yes /y4 83~ L~~s `~°JJ Use other side for additional information. I SBD-6710 (R.3/97) Date Insepctor ignatur Cert. No. r C/c y/ CC'yho ljGt,rC J PA c CL cr, ' o S Cy4..H~ c`~~~1 k Q''~h~o cr ~.,el ~J~i Ito 6 c ~1 ' O r d ~ea~/ _ we. l t b~ '!ti ~ flew ODD she p g e-d f1 a 3©~ Ind Cex~ e~~ 74 c<:/ere .9 )to r ~''/c s t e~~~ N~' ~e~lcc,. Gil=/G~D• Q -/Uotc t 1S /DOrl) S6~e~c~ ~er So, l 7cszs ~caay r rar ~cy So f S N P d i,,c C~c,y / ~~1 0 h G c` l C ~ x w33Z 0 S O r a ~ee~> ~ -41 ~ ( ~Fd~jof t pp tt?? Rew - She p t ~ w c S l off' ~ Ql~ Cexc !G i Safety and Buildings Division Carob' is 201 W. Washington Ave., P.O. Box 7082 ~~^te ea►nsin Madison, Wl 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261-6546 ~ -71i z Sanitary Permit Appli tl state Plan cn. Na~ r In accord with Comm 83.21. Wis. Adm. Code. pasomal ' oar you provide 1U may be used for secondary purpoaa Privacy 14aw. I s.040 5 Project Address (f differew dust 1 mailing address) I. Applleatlon Information - Please Print All Iaf CUNTti Property Owner s None " Parcel N Lest U Bktek fl D f 0A I yoll S (7-1~1 Property owners Mailing Address Property Location ("551,0) City State ` tip Cade Phone Number ` ' y, 4161114, Section N: II. Type of BtdWing (check all that apply)Q T ~i B o Subdivision Name CSM Number til or 2 Family Dwelling Number of Bedrooms ❑ Publie Commucial - Describe Use ❑State Owned - Describe Use ❑City ❑Vilbga ❑i owadtip of 0 11L Type of Permit: (Check only one box on line A. Cotnpleft Hoe B if appliciablo A. ❑ New System Re libco went system ❑ Trmbnent0olding Tank Reps Only ❑ Oiler Malificatinn to Emstittg Syaten B. ❑ Permit Renewal ❑ Permit Revision ❑ Lin Permit Number and Date 6amd Boron Ewhation Charge of ❑ Parotid Tawfer to New Plumber owner 57~P~ IV. of POWTS System- C-b k all that a r e l t e Q1 ~Z n t r a n lp Nat -Perseeme j_hkg otmd ❑ Mound 24 in. of suitable soil ❑ Mound < 24 at. of suitable t7 ❑ At-Gmdc ❑ Single Sand Fiber ❑ Comatracted Wetland ❑ Pressurized ❑ Holding Tank ❑ Peat Filer ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filler ❑ Recirculating Synduide Matta Filter Chamber ❑ Vm Loa ❑ Gmvel-less P ❑ Odw ( lain V. t eatment Area lnf rma h -/7r 6b2&2 C-Af - Design Flow (pd) Design Soil Application Rae(gpdst) Dblieaal Area Required (st) rispersid Aron hWdnd (91) System Elevadw ✓ ~-etweerl .d . VI. Tank info Capacity in TOW Number / Prefab site Steel Fiber Plastic New Gallous Gallons; of units Canerote Consducrod Glass I Tomb Twits sep4e°twlrBsaT'd` X- t LL Asobie'ftUas Dodr4 (3mnbw er RECEIPT DATE 6-- NO, 18 2 9 9 ® RECEIVED FROM T co ADDRES 00 ro S ) S G{/lC FOR <17. ACCOUNT HOW PAID ' AMT If ACCOUNT CASH I AMT. PAID CHECK L~y BALANCE DUE MONEY ORDER Ric ®CGe SBD-63982) 4,0haC, . VS, 3 Brz-~u~ Wisconsin Department of Comma ' ee-\ SOIL EVALUATION REPORT Page / r of Division of Safety and Buildings in rdance ith ~tk~ County Attach complete site plan on paper not leis 1/2 11 inches in size. Plan must fj C ~u+x include, but not limited to: vertical and h " r fer nce po tMb d/i.~ection and Parcel I.p percent slope, scale or dimensions, north arr and I cation~'ddYlisth%e rest r ad. Qy C~ - ( y - - ~GL7 Please print all infor atioS?F CR I n Revi ed b Date Personal Information you provide may be used for seconda urpos tW rbr b' 15.4 (i) ( , / J Property-Owner ~JJY~ff cation p d ve or, Cep n o a u S Govt. Lot N.E 1 /4 NW 1 /4 S 3~ T .Z8 N R 9 C--(ec) Property Owners Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road ❑ New Construction Use,"~Residential / Number of bedrooms 3-1 Code derived design flow rate 4-S0 o+- Coo GPD Replacement ❑ Public or )commercial - Describe: Parent material Ch T r l/ Flood Plain elevation if applicable /n! 4 General comments GGSe c/--¢ iaAl7t,~/or. Cch . ~S sc7` d'7i S fie 6'ti be la5i a~ 5 •r.f~ and recommendations: :a Q/e Fov 3~ct/i sys~.~. uSc r,,h-+•,ti o~'~¢c~ ,14 S- For ~ tS ~v+-~ r`, S'~`c.~f use •w,,ti-'/+7 u.Yh o~ 4 a.ti ~ f s - ' Boring Boring # Pit Ground surface elev. ` ~ • 3 ft. Depth to limiting factor in. Soil A olication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary j Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Q Ar F, 17-17 th d 6 K kh'rk C L'V 3 27- 4 le f x r h' r/ 2 P -Y,1 k Fr c w 2 wi o E U. g (o o a Boring # Boring q 7• l . Pit Ground surface elev. ~ ft. Depth to imitin9 factor> //O 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 0-/ b /rJYIQ /G R 3'- i a d p" c w Z r+-I t; - d- llp SIOA S 62s I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg'L CST Name (Please Print) Signature CST Number Coda/cs we-Z.9 if '--IV 73 Address Date Evaluation Conducted Telephone Number -.2 73 -3 430 rtl.sy/s 770 t4 sr- L //r or-t~ cvz J-4 o,f 6-11'-11" -5- 7/5- . d e Parcel ID # ~O -400 Page of 3 PropertyOwner ~ Boring # Boring t~ ❑ Pit Ground surface elev. ~V - D ft. Depth to limiting factor > / / O 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 ~7-1 f io 3/ 5- - A al k M C- w 1 0- 6' a. -ll .s +4 s o s of 0.7 (0 U Boring # ❑ Boring F-1. ❑ Pit Ground surfaceelev. 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 i Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil A lication 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 GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 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•6330 (R.07/00) s~~~~~ nor sa, js~ Rcp~y Fbr ~6 3 N PdL c C/cv/ ~~ho ~~wre C4-- C A 'Al NJ ~ w33~ 0 Oo S ~.S1~•hf St~f'.C r~J~ ~ ~ C- ~p4,.- Q CF ~~~h Q~ah~O U c..C~ Ito 6 C ~O[ we. ll ~v z s ~ ~c:. ~ lrec✓ i 1 w e- 1 ~ - f1 r F- - ~S J v C- y a 4-41 hex, 7" u-4 eke a~: />7c.,S .`pti e- - M = ~ o t/' ~ e' 1' S t4° e ~ S, ins Cf ji ir.Je/c S ;ems/~; N[-- ra~.rc,. f//=1c0_ v /VG'ftC c y 3 c d v1 z ~ z 000 0 -4 C, ~e o v o CD m 9D J N N O F tD N "S CR 0 I ° O sv Cl. ~ w a ! °o O cf) q. m co D C. O co 0 CL O W ~ ~1 Z IV X O N N w C - 3 OOOy• 4 E Ca 0 CD Im 21 0 N A 3 N H ' M N D m O EP s m A m c m fD m U a c CD - 3 -1 N co c6 C3 A Z cn c , ; A CL Z -1 w _m w CD co a z c 3 A o zz CX N C < CCD r ~f A A O O O O C'oo 0) tu = O a > CD a c S- -0 CL 0 0 CD CD K X n n N y r. » N C' gCD 2.~o ~ 3CD U~En M 3 co 0< y o v a o N c 6 m N CD m.CaD Z fl: c~ ~0 3 --a CCD m c 3-, x x > CD ati rj 3m-»~- `4 =r 0 a < CD C S 0) N I'D Cn'5 ai D~ A 0 o =n'•~ w c ~•o f7D 3 O a) 9 N 3 O fC 7 O O f < A EA O ti a n f~ co- v ~11~1t s, a~/`~d q Sep~~C- on (~rb~ew~ _Itl,~aS '~~nnC~lani~lc~ ~b~e_rl. _J l 7 B en is S2h~~c_'r2(~CIJ Siiue ,~tS~l~C`~id12 r ~ 30~-2'~crcenw~t~ _ _ Xet,O PoolQvU I i I I I li I ~i I~ i I I ORIGINAL County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFRCE Personal information you provide may be used for secondary purposes S . CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1xm)] 1101 Carmichael Road Hudson, WI 54016-7710 (715)386-4680 Fax (715 686 Attach complete plans for the system on paper not less than 8-1/2 x 11, in size. County, Pena # ❑ Check If revision to previous applica _ Dt rr - - Application Information - Please Print all Information Location: Pumpm 7A-V6 Name Ol {Olf-S T 1 N, Z2 R4~ Sec E (WW . Property Owner's Mailing Address Lot Number Block Number 3 ~ 4 o . State Zip Code Phone Numer Subdivision Name CSM Number 1 Type Building: (check one 0:4' ❑ Village own of 1 or 2 Family Dwang - No. of Bedrooms: O PublidCommercial (describe use). O Stale-owned Nea Road L Type of Permit: (Check only one box on tine A-6Check on tine B if applicable) ~J Parcel Tax N ber(s) 1Repair 2.1~J Reconnection 3.❑Non-plu ❑Rejuvenation 0 L10 -/l241 -x-000 B) V Yl "m, - 0) d eV -fQ r-m h Number Date Issued Siate Sanitary Permit was previously issued O of POWT System: (Check all that apply _ ^ Owl N 'FAI Lt/,j6 RV A4. P. Non-pressurized In-ground OY 15~ /`jf~ ❑ C ,h~ ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In-g L` ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ Atlrade ❑ Aerobic Treatment U ❑ Recirculating . tats r+eatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil App ca ' Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (GalsJday .ft.) (Minfinch) l s Elevation . Tank Information Capaicty In Gallons Total # of nutacturer Prefab Site Con- Steel Fiber New Existing Gallons Tanks Concrete structed gla Tanks Tanks k.1 00 2t ~2d a e w~sfi ❑ 'Al ❑ ❑ 1. Responsibility Statement Iva i, the undersigned, assume responsibility for repair/reconnenction/rejuve tionfnstallation of non-plumb i for O S shown on the attached plans. A kense Is not required for terralift repair or the installation of non-plumbi sanitation system. Pkxnbees Name (print) PI be~s~signa ure ( tam MP/MP No. Business Phone Number a?a ? /s- a s Tess (Street, City, State, Cod ) Q' L ' /[(:-;--7Z, ~S u~ 6 Z`Z~ VIN. County Use Only Disapproved San' ry emit Fee Date Issued Iss Age t Signat#tamps) (Approved Owner Given Initial Adverse Determination IX, ditions of A=VR for Disapproval: a 1-4 ~ s ue` Q O r O > K Z M m z Z oo m • v O mm -n X o 0 4 X O m r o M~ x rV z ~O O G m C t ~ m O ~ o n W vo m O 2 N y r z= Cl) D M C7 nm z m m N O CDo ~ ;b N C --1 6 vo N . X 00 ;u U) Z < ` •`hl~j --Iz m o F C) z~ m 0 Z m m m C~ mT W a m~ Q a m m W ~O r m _ _ C a, ; - ' p M Q 0 y W C O H W m n~ C y = y~ - a ? X y 9 ;w W 0 7 q y N 7 W a O= D N W N 'O no) =y g a m f y G 3 a d W (J 03 o cn OZ m p m r- o m y..0 y m z r = W z _ ° D D n m s m W = C. .0 ~ W W y ~t O = y > _I £ S c~ y 9.1 O O z O D m y~ On ° z z G) z W 0 -8 0 7 ❑ ❑ ❑ 9t 9 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSffiP CERTIFICATION FORM Owner/Buyer Lot ce~z~ Lac, Mailing Address C 1 Property Address (Verification required from Planning Department for new ast action) ~~9~0 d~~oao - City/State t (m y, " Parcel Identification Number ©yv , J`ayA LEG DESCRIPTION Properly Location NE '/4, N~) v, sec. T Ld N-R-JZL , Town of Subdivision . Lot # Certified Survey Map # , Volume _ ..Page # / Warranty Deed # Volume Page # C~ Spec house ❑ yes ono Lot lines identifiable P yes ❑ no SYSTEM rAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplunim, joutueymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Ilwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE permit being revoked b the Zoning Department.'"*** Any information that is mis-represented may result in the sanitary pe g by Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed M'~, System Management Plan • Pursuant to Comm 83.54, Wis.Adm. Code Sects- 'crank The septic tank shall lie maintained by an individual certified to service septic tanks under s. 281.48. Slats. The contents of the septic tank shag be disposed of in ac--inlartt a vkh NR 113, Wis. Adm. Code. The operating condition of the septic tank and . outlet fitter s6ad be assessed at least once ever/ 3 years by inspection. The outlet filter ezfl be cleaned as necessarl to ensure proper operation. The filter cartridge should not be removed unless provisions are rude to retain solids in the tank that may sough off the fitter when removed from its en&,ure. If the filter is eychipped nrdh an alar.al, the biter s.W be 'serviced if the alarm is activated continuously. Intenjultent filter alarms may indicate surge lows or an &r hg conf sous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the dquid volume of the tank If the contents of the tank are not removed at the time of a Idennial assessment, mainteniulce personnel shall advise the owner of when the net servim needs to be performed to maintain less than maximum scum area sludge accumulation in the tank The addition of biological or dwmicd additives to enhance Mac tank pefonnance is generally not regtlred. E roproducs are used they shad be approved for septic tams use by the Department of Commocp, Snotty and Fumn Tank The pump (dosing) tank shall be inspected at least once every 3 years. Ad switches. Warms, and pumps shall be tesi8d to V e* Proper operation. If an eftw t triter Is installed within the tank k shad be inspected and serviced as necessary. At-grade Component and Pressure Distribution System o_trees or a ru s should e planted or allowed to grov on the component. Plantings may be made around the perimeter and the component shall be seeded and mulched as necessary prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold v install- ations require the component to be heavily mulched for frost anther protection. • Influent quality into the at-grade system may not exceed 220mg/L BODS, 150 mg/L TSS and 30 mg/L FOG. Influent flow may not exceed the maZimnm design flow s for this installation. specified is the permit Iatse Pre= be *abed s on ~m Is provided with a flushing point at the end of each lateral, and it is recommended alai each MMWW ar cumulated solids at least once every 18 monft When a premn test is performed 8 should be o1 the MW test whN the system was inslaDed to determine if orMc a *991110 has oc =W and I orifiea cleaning is mq*W won within the dispersal cell. Observation pipes within the dispersal cell shall be'chacked for effluent ondin . Pouding levels should be reported to the owner and any levels above 4 inches considered' as an Impending h y lunatic 'failure requiring additional, more frequent monitoring in accordance with-Comm 83.52 (2). General Ms system shall be operated is accordance with Comm '82-84 Wis.Ada.Code and shall be maintained in accordance with it!s component manual SBD 10570-P'(B.6/99)-and -local and state sales pertaining to system maintenance and maintenance reporting., No one should suer enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and p POWTS abartdonment shad be In accordance w8h Conan 83.33, Wis. Adm. Code when the tanks are no longer used as CompormtL . Sqft ocPAP tank mwftw +hws, access tigers and covers should be inspected for water tighblew and mss. Access openkW used for service and 88sass stern Shall be sealed ww<aWrloht upon the completion of srrvica. -Any opening deemed be dt~oM or su b failure must be mptr~. Exposed access opusdngs greater than &Wlas; in diameter shall device to prevent acddemtal or waftdz d soy Into a tank or componott. b became deflective the tank or component: shad be repaired or reps! to keep site ' !f t PUMP. PCB cartbots, aimm or mlW ed Wit becomes diva tut d vts txa4onent sia;d bs ' It eh- wed uft a camponwAofSte mmt ore" pedon nance. Component to accepti siascevatsr'or b'i► iaa o disc arge vaatewater~to the zionnd surface, it may be necessary to install as aerobic pre-treatment unit or -replace the component. Additional site and soil•evaluatious may need to be done. and additional plaits may-need to be prepared and approved by the Department of Co*msrce,• Safety and Buildings Division. . -Questions about the o _ peratioa or aiintenance of•tcliia _s.ysues_s_hould-lie directed to:' • The County/Zoning Office at 2-13- 6-7q7 p1Qstm--,Sf,6rel'A38'6-~~~c The system installer at _ BLS- ~2$- °l~1SR W1?t'1~1~ The tank manufacturer at ~pp.,3ZS-$~lS~, h]L~T'S~iZ The effluent filter' manufacturer at 8`W - ZZI- S`?l4Z. Z.r'MeL TIML Vb%jv. ,r, 6 30-.$2.o~y u g Gouts Safety and Buildings Division County s „ 201 W. Washington Ave., P.O. Box 7162 ,sconstn Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608 266- Z Sanitary Permi 'cat n ,w S to Plan I.D. Number o2(~ ~Q ~D In accord with Comm 83.21, Wis. Adm. Code, i lion y*g"i t S' may be used for secondary purposes Privac 's 1)(m) 005 oject Address (if different than mailing address) 1. Application Information -Please Print All Information ZONING OFFICE S- Prope Owner's Name Parcel # Lot 1/ Block # ~ku ~ er ne lno ,3 moo- a o- Property Owner's Ma iling Address ProoppProperty Location// 531 )~D City rate ~TY Zip Code Phone Number '~,(MSection 23 y,/vJ C Ells t ~ lJ : ' - I (circle o ) • ~O H. Type of Building (check all that apply) T N; RE Subdivision Name CSM Number A~: 1 or 2 Family Dwelling -Number of Bedrooms ❑ Public/Commercial -Describe Use ❑ State Owned - Describe Use &i4 ❑City_❑Village gTownship of III. Type of Permit: (Check only one box on line A. Comple line B if applicable) A. ❑ New System replacement System ❑ Treatment/Holding Tank Replacement Only 19 Other Motif a ' n to xisting Sys m List Previous Permit Number and Date fAsued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner rl P IV. Type of POWTS S stem: (Check all that apply) 5VISz N-Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade Single Pass Sand t ter i S 7-!'y~ ❑ onstracted ~ eland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks ' Septic or Holding Tank /200 Aerobic Treatment Unit Dosing Chamber gU f VII. Responsibility Statement- I, the undersigned, assume responsibility for u>ctallati WTS shown on the attached plans. Plumber's Name (Prin t) Plu tore /MPRS Business Phone Number ~S I ~ r Plumber's Address (Street , City, tate, Zip Code) WOO ~D 1)e kio& /Uh V VIII. Count Department Use Only ❑ Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) El Owner Given Reason for Denial IX. Conditions of Approvat/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) I . -v`i"~ fir' ~'~.FO~f~1C~. GV`~.V ~ ~ c F~ Goulds SubmBysible Efflant Pump y 3871 EP04 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle • Motor: Available for automatic and Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. • auto Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with construction. • Solids handling capability: automatic reset. . ■ EP04 Impeller: Thermo- 3/4" maximum. • Power cord: 10 foot plastic Semi-open design AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for mechanical seal protection. CO. Canadian Standards Association r'1 • Total heads: up to 24 feet. with three prong grounding n EP05 Impeller: Thermo- Discharge size: 1 1/2"NPT. plug. Optional 20 foot plastic enclosed design for (GSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with end in "F" or "AC". rotary/ceramic-stationary, three prong grounding plug improved performance. ) BUNA-N elastomers. (standard on EPOS). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 1040F (400C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 ! l • Capable of running dry without damage to s 30 ' -r-- -4-~fSGPM: components. Pump: EP05 $ I I i '~-2sr f. F • Solids handling capability: a 25- /4" maximum. W ! F i • Capacities: up to 60 GPM. _ I • Total heads: up to 31 feet. 2 6 20 • Discharge size: 11h NPT. a • Mechanical seal: carbon- > 5 i rota /ceramic-stationa ° 15 ryry, a 4 BUNA-N elastomers. o ' ! E • POS' Temperature:. 3 10 9.99 1040F (400C) continuous f 1401F (600C) intermittent. 2 EP04'- f 5 _ ~ 3 1 l . - 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m°/h CAPACITY 0 1995 Goulds Pumns. Inc. • 1,U111U1.11Q L1U11 OCPI, U' id11K 611U. _ PUMP CHAMBER CR055 SECTION AND SPECIFICATIONS PAGE S OF -VCEJT CAP l WEATHER PROOF JU1JCTI0IJ »ox 4'C.I. VEkIT PIPE % APPROVED LOCKING ~:.10' FROM DOOR. MANHOLE COVER >tiCSN .hmDOW OR FRESH I~vA(2tvitJ6 l.i4gEL_. ALP, IMTAKE S rIL3 S ~OcJ i6~raiN. 1raRJ~1 ( Y~MIIJ. y'w5r e?ctton~ PtPt 11~ - - - PROVIDE I NJLE T IAIRTIGHT SEAL ( Y • I APPROVED JOINT A I + APPROVED JOIIJT: W/C.z. P+PEOR Tank construction ( ICI W/C•I• PIPE we ALARM I I ~ shall comply with ILHO ('33.15 and 33.20 a i iI I I ON C I I CLEV. FT PUMP--, --J OFF 0 COAJCRETE 5LOCK ADPR~c'. RISER Ex1T PERMITTED OWLy IF TAWK MAUUFACTUR{CR HAS SUCH APPROVAL T3" BEVOItvC SEPTIC E 5PEC.IFICATIOKIS DOSE 1~►~O wt~IV Pl~t3T T/.WK MA!<JUFACTURCR: IJUMBER OF DOSES: 3'~O PER [?Ay TAWK SIZE: ~Z"00 ~~OU GALLOWS DOSE VOLUME t ALARM MAUUFACTUREIZ: ItJCLUDIIJG BA-CKFLOW: t6g'~! GALLONS MODEL WUMBER: I V L N W CAPACITIES: A= Zq IMC14E5 OR LIDD' O GALLOWS SWITCH TUPC: 1'1L-12C1.AZ~/ B= Z IutHES`OR '4Z'1 G(1LLOUS PUMP MANUFACTURER: ~DUL~S C= q~ IM-HESOR GALLOWS MODEL NUMBER'.. D-_L- INCHES OR GALLOUL 5WITCH TYPE: CUI2I{ MOTE: PUKP AMD ALARM R TO bE •O MIWIMUM DISCKARGE RATE nb GPM INSTALLED ON SEPARATE CiRCUtTS VERTICAL DIFFEICENCE DETWEEU PUMP OFF AWO.DISTRIBUTIOM PIPE.. -P., FEET + MIIJIMUM {.NETWORK SUPPLY PRESSURE , -.So FEET 3 FT. + _ FEET OF FORCE MAIN X ' ✓ o fl.FKICTIOU FACTOR-- j- FEET • TOTAL OyNAMIC. HEAD = ~s `I FEET Pump chamber DIAMETER - , IIJTEKLIAL DIMlLWSIOlJ~ OF TAWK: LEAICvTH ;WIDTH LIQUID DEPTH 's a BOTTOM AREA 231= GAL/INCH AS PER MANUFACTURER = Z k, OS " GAL/INCH STATE BAR OF WISCONSIN FORM II -1962 LAND CONTRACT r~ 532130 ladlviAaaloWCorporate TO USED FOR ALL TRANSACTIONS WHERE OVER ! I 95.000 IS FINANCED AND IN OTHFR NON-CONSUMER L` Co J DOCUMENT NO. vy~ I. l+, ACT TRANSACnONS) I1,_ - -1 1 -'lived fur Fro. ,;;j f ContraCt by and between Mari ' ane Cernohous Family 11 AUG 41995 ! Trust, David Cernohous and Diane M. Dado. Co II &t 9:30 A. ~.j ~f Trustees Denise L. Maier, 1st Alternativ V odor", I r T1~4' he-era IJo e}:1~ u power to se and ncuAger }1 David E. Cernohous and Cheryl A. Cernohous, husba d and w'fe hgldin% s I s ,ptlrchant", whether one or more). j I endor se s an agrees to convey t ur aser, I, the prompt and full p. rfor- I mane of this contract by Purchaser, the following property, together with the rents. I ~O~) l profits, fixtures and other appurtenant interests (all called the "Property"), in TH15 SPACE RESERVEO FOR RECORDING DATA I St. Croix County, State of Wisconsin: _ NAME AND RETUQN ADORESII 1 I' The Northwest Quarter (NW 1/4) of Section Thirty-Three (33), Township Twenty-Eight I~ (28) North, Range Nineteen (19) West. F R L4 (Parcel Identification Number) The Vendor shall be responsible for and pay one-half of the 1995 real estate taxes as they become due in 1996 and shall be entitled to one- half of the farmland preservation tax refund as allocated for the 1995 l~ calendar year. *It is acknowledged b the parties hereto that the purchase price ! ii has been reduced by One Hundred Thousand Six Hundred and 00/100 it Dollars ($100,600.00), said amount to be construed as a gift to the I Purchasers hereunder, with is being agreed by the part-ies hereto that This 13 not homestead property. j (is) (is not) 4 Purchaser agrxs to purchase the Property and to pay to Vendor atsuch place as reasonably directed 'I the sum off 170.000.00 in the followin manner. (a) S - 0 - at the execution of this Contract; and,tb) sl<e balantxof .S 170,000.0$ , together with interest fmm date hereof on the balance outstanding from time to time at the rate of seven (7%) percent per annum until paid in full, as follows: Monthly payments of principal and interest of One Thousand Two Hundred j and 00/100 Dollars ($1,200.00) per month commencing July 20, 1995, and monthly thereafter. *should the Purchasers resell the property that is the subject of this l4 contract prior to July 1, 2005, that any amount received by the Purchaser! II in excess of One Hundred Seventy Thousand and 00/100 Dollars 0170,000.001 b split q all ith thhe Vendor; ho ver it is a e h tt said amount tfa w.Q'tU11 d ~e ~~i~ to he Venao sh~~ n0 exc~ed ?ga ~Qh. $U. i i ovi ed, however, t e entire outstanamg Wan— s al paid in ull on or before t e E day of l July , *90- Q-2 Qthe mates ity date). 1 j I Following any default in payment, interest shall accrue at the rate of 9 % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). i it l 2Dtci>tiltit]GDCttiOilbtai)jrlfeUlb7~ii~?[iYoiIQOjXil4af~IdKiralflaii6lE$i7llXriiiEXdfpY~4KliliiflY~fy~6~t1E~a~t)!i!'G~In+~, bee& xpaadatx~ga~a io~aoaotce~modooetnd>InCd~ome~oom[ace~itedt !tan i~ I) 3O*KilooxJm tKgkd wEo!> omxbmdjtlO OOdX1~0[ tt[KANIO gigXMIN l gf09~tOf0001M12*0 ' i 74K0000~07~itIGOC111AUtt1d11000IdICgl7Q1R717LA010igf1d1Ct790itXC(gCdttt~bX11]t: j~ Payments shall be applied first to interest oa the unpaid balance at the rate specified and then to principal. Any amount may be prepaid (i without premium or fee upon principal at anytime after date of closing. I 3x911~474DG14CGD6~iC0]CT!CYWtdD7La j In the event of any prepayment. this contract shall not be treated as in default with respect to payment so long as the unpaid balance of I principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Ii Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: l'I No exceptions. l II it I Purchaser agrees to pay the cost of futur_ title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purcht se price is paid. Purchaser shall be entitled to take possession of the Property on July 1 •Cnm Ch. One. LAND CONTRACT-InOvWual and Corporate STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. FORM No. 11 - l"Z Milwaukee. Wis. i 113U PM: I Purchaser promises to pay when due all taxes and assessments levied on the Propel ty or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extendzd coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of f f s iI I nSitrable but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay twr. insurance premiums value when due. The policies ;hall contain the standard clause in favor of the Vendor's interest and, -mless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste not allow waste to be committed on the Property, to ktep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interes_ and other moneys shall be fully paid and all conditions shall be fully performed at the.imes and in the manner above specified. Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens aqd encumbrances, a cept )tny liens ore cumblances sted by the act o fault of Purchaser, and except: Easements restrictions and rights-o -war 0 rerecord. It any, Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues fora t period of 60 -days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 60 days following written notice thereof by Vendor (delivered personally or mailed by certified mail): then the entire outstanding halance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by' v or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property ar.J recover the Property back through stric• foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shat( he forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full paym4at of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the,-quitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under(i), (ii) or (iv) above. Notwithstanding any or&[ or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendancy of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the irterest-coi veyedis a pledge or assigment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, W or conveyance without Vendor's written consent, the entire i outstanding balance payable under this Contract shall become immediately dua J payable in full, at Vendors option without notice. ` Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shad be considered poym:nts made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Ve and Purchaser. (if not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in th~ subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this 1St day of July , 1945 MARIJANE CE OHODUS FAMILY RUST 40 q^ f (SEAL) ~~ce ( eAa!h(SEAL) D vid Cernohous _ .David E. Cernohous Co-Trustee 09- (SEAL) By: /r L ~~Q (SEAL) • C eryl A. Cernohous .Diane M. Dado, Co-Trustee I AUTHENTICATION ACKNOWLEDGMENT i .3 Signature(s) of David E. Cernohous, Cheryl STATE OF WISCONSIN Sa. A. C rnohous and Diane M. Dado-- County. ant thi 19tday f Jinx _ '199 Personally came before me this _ day oft 19 the above named .Leo A. Beskar TITLE: MEMBER STATE BAR OF WISCONSIN (if not, _ authorized by §706.06, Wis. Stets.) to me known to Le the person who executed the. foregoing instrument and acknowledge th.o same. THIS INSTRUMENT WAS DRAFTED BY Leo A. Beskar, Attorney • ROUL1, BESKAR, 219 North Main Street P. Q. Box 138 Notary Public County, Wis. R-i naPtt es m`~ Stith Ali cared lodged. Both are not My commission is permanent. (if not, state expiration date. necessary.) I9 ) 'Names of persons signing in any opacity should be typed or printed below their signature. LAND CONTRACT - Individual mad Corporate - Stan Bar of Wtseondn, Form No. 11 - 1991 Parcel 040-1124-60-000 06/01/2005 AM PAGE E I OF 1 Alt. Parcel 33.28.19.516 040 - 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): Current Owner * CERNOHOUS, DAVID E & CHERYL A DAVID E & CHERYL A CERNOHOUS 531 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 531 CTY RD MM SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 33 T28N R19W 40A NE NW (FLP 628/528) Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-28N-19W Notes: Parcel History: C;V Date Doc # Vol/Page Type 07/23/1997 11331638L-3'1 3/1997 706/495 07/23/1997 320/131 2004 SUMMARY Bill Fair Market Value: Assessed with: 27115 Use Value Assessment Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 38.000 7,300 0 7,300 NO U?H LOPED G5 1.000 100 0 100 NO ER G7 1.000 10,000 500 126,500 NO Totals for 2004: General Property 40.000 17,400 116,500 133,900 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 17,300 111,100 128,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 214 Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Parcel 040-1124-70-000 06/01/2005 09:15 AM PAGE 1 OF 1 Alt. Parcel M 33.28.19.517 040 - 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): * = Current Owner CERNOHOUS, DAVID E & CHERYL A DAVID E & CHERYL A CERNOHOUS 531 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 33 T28N R1 9W 40A NW NW (FLP 628/528) Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1133/638 QC 07/23/1997 1133/637 07/23/1997 706/495 07/23/1997 320/131 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27116 Use Value Assessment Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 6,700 0 6,700 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2004: General Property 40.000 6,800 0 6,800 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 7,100 0 7,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1124-90-000 06/01/2005 09:15 AM PAGE 1 OF 1 Alt. Parcel 33.28.19.519 040 - 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): * = Current Owner * CERNOHOUS, DAVID E & CHERYL A DAVID E & CHERYL A CERNOHOUS 531 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 33 T28N R19W 40A SE NW (FLP 628/528) Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1133/638 QC 07/23/1997 1133/637 07/23/1997 706/495 07/23/1997 320/131 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27118 Use Value Assessment Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 40.000 4,000 0 4,000 NO Totals for 2004: General Property 40.000 4,000 0 4,000 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 4,200 0 4,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 ' Parcel 040-1124-80-000 06/01/2005 09:11 AM PAGE 1 OF 1 Alt. Parcel 33.28.19.518 040 - 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): = Current Owner * CERNOHOUS, DAVID E & CHERYL A DAVID E & CHERYL A CERNOHOUS 531 CTY RD MM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 33 T28N R19W 40A SW NW (FLP 628/528) Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1133/638 QC 07/23/1997 1133/637 07/23/1997 706/495 07/23/1997 628/528 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 30.000 2,800 0 2,800 NO PRODUCTIVE FORST LANC G6 10.000 52,500 0 52,500 NO Totals for 2005: General Property 40.000 55,300 0 55,300 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 55,300 0 55,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER, r rill jd l S TOWNSHIP *0 SEC. -53 T a~ N-R g W ~c t ADDRESS f~,3 & to tr (l~~~s ST. CROIX COUNTY, WISCONSIN L)i C9 SUBDIVISION LOT LOT SIZE A61e PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e r C !g6 7y 0' 1a~xb9`6~1 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used rd a 7L ' Ch~~~e Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: -JlkdWl?~t *e4Tf Liquid Capacity: goo Number of rings used: a~ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,©Side,O Rear, O /D 0 feet ..From nearest property line Front,OSide 10Rear, 0 feet Number of feet from: well ~~Q ► , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) nno rnc.rn no ntra PUMP CHAMBER ' • Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width:_ I ' Length: Number of Lines: c2 Area Built: Q a~ Fill depth to top of pipe: A Number of feet from nearest property line: FrontO Side, O Rear,0 Pt. Number of feet from well: S'Q Number of feet from building:. 3 (Include distances on plot plan). AGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop-box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK 4. jl Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: 7 JQ/2Q S ~4 ~1 License Number: 3 3 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOY-7929 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NE%, N(.V 2,S33, T2 8N-R 19W ® CONVENTIONAL ❑ ALTERATIVE (If assigned) Town o6 Tu y ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 1111-11 Jill I A" A 44AUE ERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: MaA "ane CeAnohOUJs Route 3, RiveA Fatt6, W1 54022 1 p1- a 11 ~-W BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Thoma6 A. Wan 3231 St. Cnuix 119385 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: T V.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: /Y i ~ Tu 2_4 ~t..~c~ ENYfES ONO DYES 0 BEDDING: VENT DIA.: VENT KATL.:., HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM ! LINE: AIR INLET: ❑ YES ❑ NO EYES NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIOUID CAPACITY: PPUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ ES NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROP EBUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES [:1 NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETE ERIA AND MA ING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: BED/TRENCH NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: ( MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. D TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE OW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: tt3 PIP~ FEET FROM LINE: AIR INLET y. q~/• 1'1 C)~~ NEAREST---1111" v~+ MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES D NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO D YES D NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES D NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES D NO ❑ YES 0 NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST tf ~r Sketch System on Retain in county file for audit. Reverse Side. TURE: TITLE: Zoning A SBD-6710 (R. 06/88) COLA- DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # 3 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES 9 NO PRO RTY OWNER PROPERTY LOCATION ` K LA rp~rn 4 ~'/a '/a, S 3 5 T N, R E( W P OPERr.Y WNER'S MAILING ADDRESS LOT NUM- ERA BLOCK N MBER SUBDIVISION NAM CITY, ST E/5 . ZIP CO E PHONE NUMBER CHV CITYLLAGE LAKE OR LANDMARK r~ ♦ : ~ INV& II. TYPE OF BUILDING OR USE SERVED: X6' /`017 - 4 Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. R Replacement c. ❑ Replacement of d. ❑ Reconnection of e. El Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. 'Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. See a e Bed b. ❑ seepage Trench c. ❑ See a e Pit 2. PER 0LATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED Square Feet): PROPOS D (Square Feet): A— C !t~~2 gl-~ / Feet Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Q® r'r~e Cis Lift Pump Tank/Si hon Chamber ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): PI s Signature: (No ps) MP/MPRSW No.: Business Phone Number: O'kes -3a 3 ( bras' Plu ber's Ad ess (Street City, St e, Zi?-der- Vill. je): Nam of Designer: 2 a GJ SOIL TEST INFORMATION Certi ie SoiilT^ste (CST Narpe CST CST's ADDRR?E S~ (StreePity GJSta~ gte Zip Code / Phone Number: A20 Zz- 4W~ ocVqer IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate issuing Agent Signature (No Stamps) A roved rcharge Fee pp ❑ Owner Given Initial S f2v, Adverse Determination G UO X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION z TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit maybe needed if there is a change in your building plans, system location, estimated wastewater floW(number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in_ ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed- pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; } X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 816 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn. to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. - - - - - - - - - - - - GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was thek result of over 2 years of steady negotiation and public debate. The groundwater bill Ground~ater - included the creation of surcharges (fees) for a number of regulated practices which Wiscor{y in's a can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buriedreasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) APPLICATIOMOR SANITARY PERMIT STC-100 This application form is to be completed in full and signed by the owner(s) of • the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submit At to* this office with the appropriate deed recording. Owner of property 1&1 ,4 eel- iv La a Location of property 1/9 J/~1/4, Section 3_, T~~ N-RW • Township Mailing address' 5-A 2 Address of site Subdivision name Lot number 1 Previous owner of property ` Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _ 'Yes No Is this property being developed for resale (spec house)? Yes No Volume 3 Af)and Page Number as recorded with the Register of Deeds. • INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AM. PAGE JNUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certifid'd survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warrant dee recorded in the Office of the County Register of Deeds as Document No. of f • and that I (We) presently own the proposed site for the sewage disposal system ~(or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been ~1 uly tr c~ rded in th~@ Office of the County Register of Deeds, as Document No. 010 / / Signat re of Owner Signature of Co-Owner (If Applicable) Die of Signdture Date 04 SOnatuie t r • it 0 3 ,j _ f • • • 1t, ~s Uo 1.3(o ps.131 20711 EXECUTOR'S DEED TO ALL TO 'i'i.'0?Tj THESE PIicSENTS SI ALL COME, '~Ve, Earl Cernohous and Bernard J. Cernohous of the Town of Troy, in the County.of St. Croix, State of 'Nis cousin, and City of St. Paul, Rcunsey County, Nlinn., respectively, co-executors of the Lstate of Peter Cernol-.ous, deceased, late of St. Crnix County, v+i.sconsin, send Greeting: r,HEREAS, by an order made by the County Court, of St. Croix County, on the 25th, day of klarch, 195)1, we., the said Earl Cernohous and Bernard J. Cernohous in our capacity of co-executors of said estate, were authorized and empowered to sell at private sale the real estate of said Peter Cernohous, deceased, hereinafter described; y. WHEREAS, in our capacity aforesaid no further or additional bond is required pursuant to the order of the Court; ( V WHEREAS the Court having concluded that the said contract is for the best interests of the estate the ,heirs, and they having consented to the sale and having on the 25th. day of March, 1954, made an order confirm- ing and directing a deed of said real estate to be executed and delivered to the said Earl Cernohous, upon performance and as provided in such order of March 25, 1954. h AND, V+HEREAS, all the conditions of said order have been fully performed and the purchase money has been fully paid accordinf> to the terms thereof; NOW, THEREFORE, Ki,IOiv YE, That :ie, the said Earl Cernohous and Bernard J. Cernohous in our capacity of co-executors aforesaid, by virtue of the power and authority in us vested as aforesaid, and in consideration of the sum of Sixteen thousand 016,000.00) and no/100 Dollars to me in hand paid by the said Earl Cernohous and Marijane Cernohous, husband and wife, as ,joint tenants, the receipt whereof is hereby acknowledged, do hereby grant, bargain, sell and convey unto the said curl Cernohous and Marijane, husband and wife, as joint. tenants, their heirs and assigns, all of the following described real estate in the County of St. Croix, State ,of 'aisconsin, to-wit: The Northwest quarter (NV41) of Section thirty three (33), Township-: twenty-eight (28) North, Ranre nineteen (19) West, St. Croix County, 'isconsin. TO HAVE AND TO HOLD the above bargained real estate to the said Earl Cernohous and Marijane Cernohous, husband and wife, as joint tenants, their heirs and assigns, FOREVER. IN WTU ESS ViHEREOF, 'lie the said Larl Cernohous and Pernard J. Cernohous, as co-executors aforesaid, have ,hereunto set our hand and seal this 30th day of July 195G. Signed, Sealed and Delivered in Presence of Earl C',ernohous (SEAL) Earl Cernohous Paul A. Magdanz ($17.60) Paul A. Magdanz (R. S. ) Pernard J. Cernohous (SEAL) (Can. ) Bernard J. Cernohous Daphne Thompson co-executors of the Estate of Peter A. Cernohous, Daphne Thompson Deceased. STATE OF WISCONSIN, ) ) ss. Pierce County. ) On this 30th day of July, 1951, before me personally appeared E2 rl Cernohous and Berr and J. Cernohous, known to me to be the co-executors of the estate of Peter A. Cernohous, deceased, late of St. Croix County, Viisconsin, mentioned in the within conveyance, and acknowledged that they executed the same as such co-executors freely and voluntarily, for the uses and purposes therein expressed. (SEAL) Paul A. ivlagdanz R.er.ei-ved for Record Paul A. Mardanz August 5th, 195, at 2:30 P.M. Notary Public, Pierce County, Wisconsin David Hope, Register of Deeds My commission expires July 6, 1958. L State of Wisconsin 1 1} ss County of St. Croix THE ST. CROIX COUNTY ABSTRACT COMPANY here'by certifies that the foregoing abstract consisting of entries No. 124 to 133 , both inclusive, is a correct abstract of title since • August 5, 195 at 3:00 o'clock in the P M. of lands described in the Caption at No. 124 - hereof, to-wit: NW! of Section 33-28-19. That, for the period covered by this certificate, said abstract correctly shows all matters affecting or relating to the said title which are recorded or filed for record in the office of the Register of Deeds of said County, including Federal Tax Liens and Old Age Assistance liens filed therein against the parties listed below. For the period covered by this certificate, except as shown by this abstract, there are no unsatis- fied mechanic or material liens affecting title to such lands docketed in the office of the Clerk of Courts in said county for the past two years. That, except as shown in this abstract, there are no unsatisfied judgments, including delinquent In- come Taxes, docketed in the office of the Clerk of Courts in said County within the past ten years, as and against the following named persons which affects the title to the real estate above described to-wit: Earl Cernohous or MariJane Cernohous. That for the period covered by this certificate, all instruments appearing in this abstract contain the necessary number of witnesses and acknowledgments unless otherwise noted. We further certify that for the period covered by this certificate that we have carefully examined the records in the office of the County Treasurer for St. Croix County, Wisconsin, and find no record of un- paid taxes or assessments standing as a lien on the real estate described in this abstract, except as shown herein. Such examination covers up to and including the taxes for the year 19 80 . That this certificate and annexed abstract and also any prior certificates, if any, made by the un- dersigned, covering the some land, are furnished for the use and benefit of any and all owners of the land described in said caption and their successors in title, including mortgagees and guarantors of title. Dated at Hudson, Wisconsin, this 12th day of June A.D. 19 81 at 8:00 o'clock in the All. ST. CROIX COUNTY ABSTRACT COMPANY BY A S S t t. Secretary SEAL Ssi'. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER f c.L 4 NE &_22-12v-o IAi~B ~c 5 ROUTE/BOX NUMBER FIRE NO. ~,3 O , CITY/STATE /3 fi`?L L S . Lt) / ZIP PROPERTY LOCATION: AIL' 1/4 .,V) 1/41 Section , la_N, R2~ W, Town of /,y q , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED` rLI, , i DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address l~p~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY„ ~ DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN- RELATIONS N W53707 ,ell & Chapter 145.045) LOCATION: SECTION: NICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: / 4 t3 3 /1P?-N/ E (p ► a COUNTY OW R'S BUYER'S NAM MAI ING ADDRESS: ~-t. C~r6; ~c Ica " 1. r e C'~er e ~►o s c°r- USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE RI TIONS: PER L TION JESTS: Residence El New 'Replace .01 RATING: S= Site suitable for system U= Site unsuitable for system / ONVENTIONAL: MOUND: IN-GROUNDPRESSURE:SSTEM-IN-FILLHOLDINGTANK:ERECOMMENDED SYST M:(optional) ©S ❑U ®S ❑U ~S ❑U ❑ S ®U ❑ S RU '~'X6d 'f~-i -n - Z-S a r /.7fd5P beck If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: ILFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- " . GAD 04 'j Y66) /,5D S; , 5"o B r 60e; 4eg3e 'Yl6r, B-3 ~b 60ro•~G~ B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P_ ~l.oc a 1,9 P_ a 3, a to P_ v b -3 6-b P114 P-_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 13DD de I FFT_ I i ~ r , 6D' j I N r j i f , c t I I, 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 the location of the tests are correct to the best of my knowledge and belief. NAMP~r- t : / TESTS WERE COMP TED O O ~ S ~i1/4iz ~ ~ 3 ADDRESS:~~ / r ~ 46 e,57 /clli CERTIF. ~ TIO NUMB R`QI~ IyU~BER(gptional): A 1 4 612 CST SI RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - S BD - 6395 ` i To he a complete and accurate soil test, your rec)ort must include: 1. comp) sc6ption; 2_ Th r t I,,n must clearly indicate whether this is a residence or commercial project; 1 MAXI c"Ier of bedrooms or commercial use planned; 4. Is' is -ment syst, Cone i`,, ratirn', A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHE -RE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEo Deviations sh I here for writing profile descriptions and completing the plot plan; 7. MAKE diagram a~,r ~-ly locating y(~ test locations. Drawing to preferred. A sir a used if'r,, g, mark and =:il elevation i I point are clearly sho pt rmanent; f3_ i,'te boxes dates, na+r flood plain data, per I I test exemp- tio 10. If Bch as floor' I, elevation) t apply, place N.A. in the appropriate box; 11. Sign the CO your cu ~Jdress and fication number; 12. Make and distr t cUi, L SOIL TESTS MUST BE FILED WITH THE LOCAL A Y WITHIN : f ' LTION. ABSRL AI. e~.,AIS FOR CERTIFIED SOIL TESTERS 1. 1 _ >-tures Other Symbols drock coin - t =e gr i cs I - j - c rhrr E I _ mot r V c - 13, VF - VeItI TO THE O VV[-; report is the fi Dep< It May request f this soil v A i of l,l „rivat~.~ I orc'.er to u t r'l mu 1 r. i I 1 . osted prior to ti J 1~ "~veF LJ1 t~p0.r t L e s S7"e~, Elea ~3,n 4 t3 !-C>A ) 0Zo tao©y[ Sep' , i I II