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020-1164-40-000
. nCO) o n■ o ■ - 0 c 2 E § @ § § ; e e % ; k e ■ - z o (4 a) ¥ = z o « CD _ n f; o t c § ° » E/§ - e< /( G) A k z/ 2 k ' / / CL ; i \ S g § / 8 8 2 Q @ e 2 §§ t ■ °~ 3 E£\ I 2 J W 8 ƒ � o k�£ � ( / / .. § a m e .. ; a) .. C CC 0 k k 7 0 § C CL 9 e @ ® $ 7 § I 4 n r ■ § k A m k k �� @° "wA, $ C § - = ■ o 0 00 000 E� o m � \ 0 2 § § \ A I § CA CA ® 2 §& f( v g% e( v v �I % C) D CD } = 03 CD i ; % \ E E = 2 � I 0) § .. C z 3 � 5 / / 0 § CD o k 0 R 7 Q 'o J § / k A � =r k \ / \ \ \ \ } CD 5 1 � I w CA 0 a z 0 0 k k § { § k ° E ® c § z § F k e { CO q m / z \_ t ^ � ^ o > § _ > D -\ § \\ " �- nG- 8 =' c D ; CD } % } $ z % z 2/A 7 iA _ \D § 2 � RL / ƒ i E b / + E % CL S \ a ƒ w % » 9 7 M e o o » � < < t % f ° D ® � Parcel #: 020- 1164 -40 -000 12/13/2004 05:04 PM PAGE 1 OF 1 Alt. Parcel #: 7.29.19.971 -973 020 - TOWN OF HUDSON 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 * JEFFREY G & SHELLY R BUSBY BUSBY, JEFFREY G & SHELLY R 313 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 313 EDGEWOOD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.003 Plat: 1929 - EDGEWOOD ESTATES SEC 7 T29N R19W EDGEWOOD ESTATES LOTS Block/Condo Bldg: LOT 41 41, 42, & 43 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07123/1997 764/199 07/23/1997 712/312 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 49034 245,000 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.003 32,000 157,500 189,500 NO Totals for 2004: General Property 1.003 32,000 157,500 189,500 Woodland 0.000 0 0 Totals for 2003: General Property 1.003 32,000 157,500 189,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 109 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMEI� rt AS BUILT SANITARY REPORT Owner 3' Property Ad ess City /State ffA-4cen Legal Description: Lot q 3 Block Subdivision/CSM # $ W %4 6V C t /4, Sec. _, T- ,N -R�� Town of PIN # z rr — 10 0 00 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: - 7 O ' f 7 gj g "'Roo Tank manufacturer 8 9 0 W i4 Size ST/PC / Setback from: House e Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM 2 -- g , s" Type of system: Width_ Length Number of Trenches Setback from: House .3�2 Well 5_ P Vent to fresh air intake ELEVATIONS lei Description of benchmark 1 d ©, Elevation 1 Description of alternate benchm Elevation �Q Building Sewer ST/HT Inlet ST Outlet 9 7 36 PC Inlet ilt o .R� gco _%r 79 PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines (t) Bottom of System () �/ �� `� ( ) 1 ,SSA 3 S (} 9 LS Final Grade O O ( ) Date of installation /T ! Permit number 3 qq &(,&& State plan number Plumber's signature a-� License number - !9, 2 7 8 l Date Inspector Complete plot plan � NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW to o 1 °u5 3 1 3 `( us 3 s + 9 ,. so y INDICATE NORTH ARROW <-- Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION Sanitary Permit No.: X (ATTACH TO PERMIT) 344666 Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)). Pergj sglde;s Nrpg F ❑ Citv_a Sll Town of: State Plan ID No.: CST B Elev.; E 'itt' Insp. BM Elev.: BM Description: FjjJD 1jV Parcel Tax No.: 02 -29 t I 0'Z. 2 T 9 — P , +�, CSrIN** Z 020 - 1164 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (S Q .� Benchmar II& a.5"0 l0`{, } 81. 2_ j Aeration Bldg. Sewer„ Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet �� q�, 29' Ventto TANKTO P/L WELL BLDG. Ai Intake ROAD Q* Inlet Septic �sO` .��' � NA Dt Rottvm ST e "� �.�� 9(e•�I ' Q asiW 5-r > Sp I s NA Header /Man. s ; 4� • . Aeration NA Dist. Pipe 7 3 t Holding Bot. System 3 r s• z6 PUMP/ SIPHON INFORMATION Final Grade Ma turer Demand 'f , l , 3S ' Model Number GPM TDH Lift L oss ction System TD t m ead F main Length Dia. Dist. To Well SOIL AB PTION SYSTE s s' 3 3 `>L�s r 12 N Width L n th No. f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 a 4k 41 � 5 3 DIMEN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf ctj'f er: SETBACK � - INFORMATION TypeO � � r CHAMBER M del Number: t. System: , I ? g'$ OR UNIT DISTRIBUTION SYSTEM b 9 Header / Manifold �� Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake �y i Length's Dia - 1 Length Dia. Spacing 7 8 S SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only fj Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) �.QCATION: HUDSO T 7 29 19.971 -973 X13 DG OOD / DR -- 5DGEWOOD EST OT 43 gk 2 - v�- M 3 ( ;U., U- - v d h2aaw % FC 1L Plan revision required? ❑ YesNo Use other side for additional information_ t SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. I � ' ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: f 3 °... .�°.. m..,. ms ... _...... _ ,... ° e e � — 7 mm i p z c a B i ,° ,- »....._e ea .: ........ .. .e .. '.. .� ., mom.,__ ....°. ._. . ,.. ... Q .. '...... _ ,.. ........ ......, e. . 6.... _. .. t .... _._._ .f ,.. a # s i t � ww e 2 s i e e j, e. ®�....e E.e. �. I , ^ee A ° ... ,,. §., w.a.....°,.,...,.,y...M�.. t t i 3 S k a 4 e { 5[ Q {.em .° z € e t 4 e. € # d �., ... ,__. ......�. w. ,.m.. .,m° ..,c.. .�....z...P. -_.,, .. ._P .. ,,.....«,. .,,.,*> ..m....,..r ._...... ..° ._ .....� ,..,..,,...d. ._A ..,.a.... .- ..e.w....._ __.�. _. t ,.......�,._,..,s...,— ...,,, .,,�,. .. �..w.M.,m,d7 Safety and Buildings Division SANITARY PERMIT AP N Bureau of Building Water Systems j 201 E. Washington Ave. In accord with ILHR 83 A, Wis;,Adm�:rtode,._J ;; P.O. Box 7969 f i Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, o les`sr '- , ounty If ;K than 8 112 x 11 inches in size. ('O • See reverse side for instructions for completing this ap 'IlSatiorP r f ;t r� �r St to Sani Permit Num / ,....} .. J �.J The information you provide may be used by other government agency ogrlpms 3T CROIX Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. �' �. COUNTY e tate Plan I.D. Number f , I. APPLICATION INF ORMATI O N -PLEAS PRINT AL ZONING OFFr RMATIO . ti Property Owner Name �' Lbc Ion 1 /4 S : fB , N, R E (or) Property OwQ Mailing Address Lot Numbe�QY— #J k Number CC f W o City ate Zip Code Phone Number Subdivision Name or CS u be So* W -T �D / 1 71 S )Mt6 II. TYPE OF BUILDING: (check one) E] State Owned El Cit Q Nearest Road ❑ V age Public 1 or 2 Family Dwelling - No. of bedrooms own OF s 4* 44qe UJ Ood P Ill BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ,- LA -' °l . T1 1_:-97 3 1 E] Apartment/ Condo ®°- —06 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (CheZia ment ly one box on line A. Check box on line B, if applicable) A ) 1, ❑New 2. ce 3. ❑ Replacement of 4, ❑ Reconnection of 5_ ❑ Repair of an _____System________ System _ ____________Tank Only Existing System ----- --------- -- ---- ------- B) B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ S epage Bed 21 E] Mound 30 ❑ Specify Ty e 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure / x =�` (ZClk 42 E] Pit Privy 13 E] Seepage Pit ( 43 El Vault Privy 14 ❑ System -In -Fill , , r, �a VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 73 G�$ Required (sq. ft.) Jlroposed (sq. ft.) (Gals/clay/sq. ft.) (Min. /inch) lx, )7, Elevation 60o /f ;?No - ;? 0 $ , ►S r Feet Feet ac lt VII. TANK in Ca g allom Total # of Prefab. Site Fiber- Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin p strutted Tanks Tanks / tic Tank Tank El t (�(, —u u�•t. ❑ ❑ ❑ ❑ ❑ L amber ❑ ❑ 1 n I ❑ VIII. RESPONSIBILITY STATEMENT �.� OW-*" « e) Z �r I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb is Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: 7 /S- 7`{9 - :3 lumber's A ress (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuincl Agent Signature (No Stamps) � roved Surcharge Fee) App roved ❑Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �,1�i./ r j ✓� t,�'. /I✓!' `1 1 V` '? J" 4[3 SBD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Dive. ion, Owner, Plumber F INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information_ Fill in the capacity of every new /or existing tank list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber into fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX_ County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 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; pump or siphon tanks; 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; and F) all sizing information- ---------------------------------------------- ------------------------------------------------------ GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. w 00 , 04 MA a� r /3 _ - T - 7 �, F /vp � , / _3 CIN X67 r - r d Apt g � A� (0 N � � -as ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the JE ff -&"'5,V residence located at: Section R /9 W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: �a . 7 Did flow back occur fro absorption system? Yes _No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete !/ Steel Other Manufacturer: (If known): Gv�� Age of Tank (If known): / 9 8S C L Signa ure) (Name) Pl a e pri dam (Title) (License Num er) �)' z� - Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). 7 8'l �u �N ; Name ';(� r k y, l lr=s ignature " SAFETY & BUILDINGS DIVISION ' 'Lt5 �•�t':. State of Wisconsin Department of Industry, Labor and Human Relations a1� t 34 '�.�s* Gre-er IK-ly Ttr• GT: t7 x r, { 11w`YSIDE P_JM I N. 04"C W1 540 + :S3w -30653 r. PECEIVED: !00.00 r F i'Et`ITI!' -N PCP VAPIANrE T() CODE SECTION'S ` ';: '_. P 8�'.1pt 1 4 �tes�ar *_men+ has rt-*.+iawaci the �akxr ✓�? -ref �r�7^ " ��.�Fami' ' _ . _ 6f the .^ tatemer-ts :ind .suoport:inq doccument at: ..r inc ,,tided 'N;rh t! pet.it;c�� C i ncp + requer't i -. -. I t l a." t7. t �'° r�+r: i t is bnc dpprpS'?G b t tmr~rt S — 30A?^. 59:3 - 503 _T: f .?t3' X33 203�lt and S31 '17 1 ? . t ne. pet i t i rxI "is o por oved . �0* -,ca recNested was to allow bui ldinq ocl ~r7n *-c be lr�c�, *_ed one ! � ✓ ) frt* the exisiring smItic tank and 10 tee" sir t!l soil romign sys ..,i et^itiic+n approval is granted ccndi r. irx-al 1 +, , the urderst��rd ?,,c} that ., df the pet statemen included on t 'ae varl ance. appl i cation f0f 1 *dl any other docuffents submitted to the X -cart: ,,or +* w 1 1 to carried out. 'his ji'i'artGe i soecific to the sub.1ect cet gin,.+ �:annot be uw� for any m icl ti rm-dificatiC I . r3 '' All ra�rmis r eau 'lyd by+ he cir,l 9 cr cra nt "/ si,al 1 be gained pr ier to installation. r•es shrcrld be rw+irect+�d to ,* rl °:e nr mb* V *: + "yelew. Please rater vkt� Ithe Oar: �ry nnber shown a bove - r a 3' r 'ith �`� 4r:'l f 1Ct of Private Se jag ; ��115 ' }' 1 324 -3630 7 :!9D a.m. to '�•� -• t - Li 1 w � }rBD•r4ii/N.U1/8l1 . Wisconsin bepartment of Commerce SOIL AND SITE,EVALUATiON Page-1 Division of $afety and Buildings in accord with Com .QS -VY+s. Ad i!ro Environmen Y Attach complete site plan on paper not less than 8' /z x 11 inches in size. IarTraLst unty include, but not limned to: vertical and horizontal reference point (BM), and i "IV � $t. CiOlx pe slope, scale or dimensions, north arrow, and location and d' near El. � roel I.D.# APPLICANT INFORMATION - Please print all into " n. R $ €� pate Personal information You Ix� may be used for secondary Purposes (Pnva.Y 15.04 (1 } 9' plx viewed F _ Z vt , Property Owner ro pi p , FIC[ , 1�/ NW 1/4 S 7 T 29 N,R 19 W Busby, Jeff <. Name or CSM# Property Owners Mailing Address Fci o `. 313 ewood Drive - Ed ewood Estates C, State Zip Code Phoneer E] Numb City E] Village ®Town Nearest Road Hudson WI 54016 Hudson Edgewood Drive ❑ New Construction use: ❑ Residential / Number of bedrooms 3 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 4 • bed, gpolfls 5 . bench, gpolf� Absor lion area required 1125 bed, ft' 0 trench, fl? Maximum design loading rate 4 bed, gpollF 5 tr ench, gpd/fF Recommended infiltration surface elevation(s) 96.17 to 95.18 It (as referred to site plan benchmar Additional design / site considerations Replacement system to be used alternating with failed system by valve system Parent material Loess Over Glacial Outwash Flood nlain elevation, if applicable na ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade F trn in FBI Holding Tank U= Unsuitable f o r s y s t e m ®S ❑ u ® S El U M S O U ® S El S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure GPD/ftz Horizon Consistent Boundary Roots Boring# in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. - Bed: Trenc 1 1 0-4 10yr3/2 - sil 2msbk mfr cw 2f 5 6 2 4 -17 IOyr4 /3 - sil 2msbk mfr cw if 5 6 Ground 3 17 -22 10yr4 /4 - is 2msbk mvfr cw - .7 .8 elev 99.68 ft 4 q33-48 10yr4 /6 - is 2msbk mvfr cww - .7 8 Depth to 5 7.5yr5/6 - cs Osg ml cw - .7 .8 limiting 6 48 -68 7.5yr5/6 - s Osg ml cw - .7 8 factor >90 7 68 -90 7.5yr5/6 - s* Osg ml - - 4 5 Remy: * with bands of vfs7.5 5/4 2 1 0-4 10yr3 /2 - sil 2msbk mfr 0-4 2f 5 6 2 4 -17 10yr4 /3 - sil 2msbk mfr cw if 5 ! 6 Ground 3 17 -23 10yr4/3 - is 2msnk mvfr cvv - .7 .8 elev 98.93 ft 4 23 -90 7.5yr5/6 - s* Ogg mvfr - 4 ; 5 Depth to limitin factor >90 Remarks: * bands of vfs 7.5 4/4 CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date �, CST Number Ref # 1432 120th Street, New Richmond, Wl 54017 227387 221 PROPERTY OWNER: Busby, Jeff SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL LD.# Environmental By Design Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -4 10yr3l2 - sil 2msbk mfr cw 2f .5 .6 2 4 -20 10yr4/3 - sil 2msbk mfr cw if .5 .6 Ground elev 3 20 -96 7.5yr5/6 - s Osg ml - - .7 .8 97.83 ft Depth to limiting factor >96 Remarks: Ground elev Depth to limiting factor Remarks: Ground. elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: i [MV 14x212C)"SIRE [-"I, NEW RICHMOND, WISCONSIN '715-246-2454 Tom Nelson 1 7 t.t ilc,l Tester 22738 Swilarim SR(10 13 L c SCALY F, 'I om �NNOVSSO�� L) BNI 2 -T L Wfamnsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental BY Design ' Attach complete site plan on pa r not I an 8% x f 1 inches in size. Plan must County include, but not limited to: vertical an orizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D.# APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law s. 15.04 (1) (m)). Reviewed By Date Property Owner Property Location Busby Jeff Govt Lot SW 1/4 NW 1/4 S 7 T 29 N,R 19 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 313 E ewood Drive 43 Ed ewood Estates City State Zip Code PhoneNumber 1:1 City ❑ Village ®Town Nearest Road Hudson WI 54016 Hudson Edgewood Drive ® New Construction Use: ® Residential / Number of bedrooms 3 ❑Addition to existing building ❑ Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .4 bed, gpdff .5 trench, gpd/ff Absorption area required 1125 bed, ff 0 trench, ff Maximum design loading rate •4 bed, gpd/ff .5 t rench, gpd/fF Recommended infiltration surface elevafson(s) 96.17 to 95.18 ft (as referred to site plan benchmar Additional design / site consideration Replacement system to be used alternating with failed system by valve system t material Loess Over Glacial Outwash Flood lain elevation, if a licable na ft ble for system Conventional Mound In- Ground Pressure AT-Grade System in FBI Holding Tank itable for system N S❑ U N S❑ U N S❑ U N S❑ U ❑ S N U ❑ S N U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistent Bound Roots GPD/fF Boring# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 1 0 -4 10yr3 /2 - sil 2msbk mfr ew 2f .5 i .6 2 4 - 17 10yr4 /3 - sil 2msbk mfr ow if .5 i .6 Ground 3 17 -22 1 4/4 - is 2msbk mvG Cvir - 7 I 8 elev 99.68 It 4 ,2 -33 10yr4 /6 J� = /4� is 2msbk mvfr CW - 7 8 Depth to 5 33 7.5yr5/6 (3 - cs Osg ml cvir limiting factor 6 48 -68 7.5yr5/6 s Osg ml ca► - .7 .8 '90 7 68 -90 7.5 5/6 - yr ; s* Osg ml .4 .5 Remarks: * with bands of vfs7.5yr5 /4 i 2 1 0-4 10yr3/2 - sil 2msbk mfr cw 2f .5 .6 2 4 -17 10yr4/3 - sil 2msbk mfr cw if .5 .6 Ground 3 17 -23 10yr4 /3 - is 2msnk mvfr cw - 7 8 elev 98.93 fl 4 23 -90 7.5yr5 /6 s* Osg mvfr - 4 5 Depth to limiting factor Remarks: * with bands of vfs 7.5yr4/4 CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, Wl 54017 227387 211 4 PR09RTY OWNER: B- by, Jel SOIL DESCRIPTION REPORT 221 Page 2 of 3 PARCEL I.D.# Environmental Bv Desian Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ;Trench 04 10yr3/2 - sit 2msbk mfr Cw 2f .5 .6 2 4 -20 10yr4/3 - sil 2msbk mfr cw If .5 .6 Ground elev 3 20 -96 7. SyrS /6 - s Osg ml - - .7 .8 97.83 ft Depth to limiting factor ( 3 >96 Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: [MV1 * P0NA[R7AL Y 0[51 M 1432 120"' STRFET, NEW RICHMONI) WISCONSfN 715- 1 , 011i Neism fed ,oil I cz,,tet 227397- -Rcmi - vTcd say I man SRO() L ,ox A 0 'Lis 4 SCALE. I Tom Nelson B -.I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address z/ „D� L c w Property Address _ /7 Gt aQ S o Ri / -Y0 / (Verification required from Planning Department for new coastiuctioa) City/State � oA/ j l,� Parcel Identification Number ;:Z6 - / l y - ©00 LEGAL DESCRIPTION Properly Location e 2W r /., ..t�J�1 %, Sec. TN RW, Town of 8 Subdivision O Lot # Certified Survey Map # Volume . Page It Warranty Deed # /71 4 Volume Page # Spec house O yes [$ no Lot lines identifiable ®"yes ❑. no SYSTEM.1VLajN"t�.�NANCE o lm p ro= wcand maiaftsnceofyoursicsystmcouldresakisits faff metoDandlewastes.PropaummD=um g out the septic tank; every three years or sooner, if needed by a licensed pumper. What you put into the system can affect_the limction of the septic tunic as. a trcatmcat stage is the waste disposai_sydem, MW Property owner agrees to submit to St Croix Zoning Department a certification form, signed by the owner and by a maAerplumbcr. ] Plumber; nstrictedphmrberor a licensed pumpervcrifying that (1) the on -site wastewatwdisposd system ism Proper operating condition aadlor (2) after mVectioa and pumping na &C wptic.tank is less than 113 full of sludge. Ywr, the andersigued have read fire above requirements and agree to maintain the private sewage disposal system with . ft standards set fork herein, as set by the Dqa&aca of co mmerce and the Department of Natural Rasp stating mat Your septic system has been maintained must be State of Wisconsin.. Certification days of the three nation date. and returned to the St. Croix County Zoning Office within 30 tldkkft 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 owners) of the Property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGMA F APPI;ICAN DATE « « « « «« Any information that is mis4Weseated may result in the sanitary permit being revoked by the Zoning Department.****** «• 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 W 1/e1 TNii MwcS RL>tIWW iOR " AtCOiIO�Nt aKT4 ;" ElICyGLMli:N'T i�iRtr. CM ETATL BAR Of WISCONSIN FORM I 1911111 ST. CRCV M% Wes. . H #r . D API�V` INC. . .............................. bet for aumd *h { r _ 16th Y ..I .................. ....................... ..................... .. .................. i °f .__.:....,, 198 f AL ' tenw am warren:$ to ........ • "I fi t7S8Y AI�f) SE 1�' . ........ _ 2:4 P ............. ................ F A3C ........... ................ . ........................ .............:,--- ......•-- .................._.. } .......... ...................................... ....... ........................................... .......... C . ............... ........................ .... 4 nCTU*" TO ....... ........... ..............._... ._.__..........._.........._... i the following described real estate In ._........_- ........Cl..oi7r - -- — ----• °-. ..... .County, State of Wisconsin: Ta: Parcel No: ................. ............ wm 41, 42, 43, Edgewood Estates Subdivision in the Town of Hudson, St. Croix County, Wisconsin. ' i MO ! FEE s ai This _...5_ not I •_--__•--..... homestead property. ; (is) (is not) Exception to warranties: easements, restrictions and rights -of -way of record, if any. Dated this . ....---- Mh-- ---- ................. day of - -- - -- November ld'6 -.... �� '. - B & / H � Development, Inc., by ....... ........................ ------ ----(SEAL} - .........(SEAL) ... .. _.... • .... Donald - B,jornstad • -- ........ ....... ....... --•- i ---•- ----- ----- ---- -...(SEAL) --/ Z. f; frL� •�6aa<i.{;-- e..t��....,,--.... .. --- -- .(SEAL) ' ........... ....................... ....... ............. William Harwell ADTB=NTICATION ACKNOWLBDGMBNT Si�natare(s) -- -----•- ----- -- -- - - - - - -- ----- - -- STATE OF WISCONSIN - ----- - -- •-- - -. --- ---- -- -- -. _....... ..County. authentic" this ........ day of ..... ...... It ..... Personally came before me this 7.3_!! ....day of Qtli`- ................. the above named -- ----- ---- ---- -- ---------------- �nR4!9__. .......................... •-- ---------- . -- - -• - -• - -• -_. ---- - - -- --- -------------- •- ...... isi I- ll_.A� - - - - -- . ....................................... _ TITLa: MEMBER STATE BAR OF WISCONSIN ........................ ................................ ...................... ( satbo�ris - ed b� f ?06.06-, - Wls. Stats.j' •- - - - - -- -- k to be the person ............ who e*e Ijikt.the fore and acknowledge the sIkh*�''." THIS INSTRUMENT WAS DRAFT[D BY A Kristin Gland Lundeen - -- - - -••' . " --'- . T• -- - - - - -- --- t - -- a� Iaw - - - - -- Atorney $ Nota Public - - -.. .,�. NP . -__ ti::�o. s . (SignstarEs may >•-e eothenticateel sckno..ledgee. Both My Commission is r ^tan t. (If not, ate ea� n ax not necessary.) _ . rate: . .... ..... L�` *Sam -* Of NOMMO 0 Is •n7 MII sluLM be 4W or Prial —I below their tisnetures. VASFa13FY'P VXWB STATIC $P i 01 W1 I itii.. �r,.. :.. - L. irO Alsnk Co. Inc FOAL" No ! 1994 rl iV» K :� ,C 14 R'..3" ''�- e..'.s •';'s =m',� __� .'�"t'f:",...`.�" i .�.. "'" �'ls.;.Si )GEWOOD ESTATES ! I M OF SEMON 12, T29N, R201N, AND IN THE SWV4 OF THE NWV4 QF Qi '7► 1.ON 7 , T2 HUDSON, ST. CROIX COUNTY, WISCONSIN NORTH LINE OF THE *W—NW Nei 09'20 "E 1:33.23' 9i 11 �— 10• 198 I 141f X4 .00' J IM r 2 , 1 r « 6� I � 29 ; �» 30 �I l0 34 I I 35 � 1 + 37 A « 1 1 .. .. ' it AI P. WI 0 '20 " w N 11410 11' "w ° 1 ' s- 9.7 M iai 1/' 20 - w �I to « 100.00' :�I 88911'20 "w 12: 38 5.0 « 28 p �„ 31 ac I OI : o� IN 100' I ,A A „I 1• ; .e A V wl I ° 20 " w o s" °11' "w I I; . O • - O °1 (� se0 11 1 1 t , 0 33 w» I ,40.1 i° 01 I « • « I 36 a' 1 27 $�a 32 !I ». t 39 9 241 �5,�' ��•i i3O16 100.09' — IN 1�0 1.�i ��0.4o I y A 1 4!.11' — 'w 320.12' -� --- - — — — ED 0 UMW ° 2 90.12' see 1 1'se " w off 4 192 71C. 1 sTo� 46 64 1 la . 43 42 41 40 Z ia sis 11' « « •- It ; • w 1 i.s 4' �sl: »' 1 ; I �-- - -- — — — 'so_w — — �'1 1 0 --- — °« _ h 49 C44 of i 9. ;, I sas 11' 63 °" I! 44 45 ". 46 A ° 47 1 - ° 105.34' « « •i I g « M L e o w w 50 A ' iN 11': 930. R:N• 90 PUWC ROAD 90 600'o0" iM�11' 20 - w 7 a t. i 9• 111.00' 112.00' S7 11 S Vii' 11 a.�' 11 a.Od� '— 1 00.41 i / 56 0 55 54 = 53 52 w � w 119 w � 11s.14' _ 11a.11f_ _ 17� 11i.00 111.14 112. 11�1d= i f Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �t� t � TOWNSHIP Z _> C SEC. TN -R LZ W .l ADDRESS S' . CROIX COUNTY, WISCONSIN LOT -` LOT SIZE SUBDIVISI01 PLAN VIEW Distances and dimensions to meet requirements of IZIiR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r e /IYO k ( IL INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used r i �,� �,r� / /$"_ Elevation of vertical reference point: ��� �" Proposed slope at site: SEPTIC TANK: Manufacturer. ',. Liquid Capacity: ��f' 6 Number of rings used:_ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side, Rear, O �� feet From nearest property line Front 1 0 Side,0 Rear, O feet Number of feet from: well 6e - - ' building: 2. ' (Include this information of the above plot plan)( 2 reference dimensions to septic tank` SEE REVERSE SIDE PUMP CHAMBER a 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, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: d X Width: Length: Number of Lines: -F Area Built:� Fill depth to top of pipe: �^ Number of feet from nearest property line: Front, Q Side, O Rear,0 Ft. Number of feet from well: a S6: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: I Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK 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, 0Ft. i Number of feet from well: Number of feet from building: Number of feet from nearest road: f Alarm Manufacturer: Inspector: Dated: �7 / �� % Plumber on job: ��. License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR S HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. ROX -7969 - - BUREAU OF PLUMBING V A*SON, WI 57 CONVENTIONAL ❑ALTERNATIVE [1 , , 1, PI,nI_D_Nu1b11: assigned) ❑ Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTI DATE 8 S H Deve2o mev�t 836 St. Ctoix S�.ee t, N. Hud6 on, W 1 / BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL V.: CST REF. PT. ELEV.: SW NW, Sec. 7, T29N -R19W, Town ob f1U4on,Lot #43, Edgewood E.Status Name of Plumber: MP Cou /MPRSW No.: nty: Sanitary Permit Number: W 22iam Sch.umaken 6382 St. Cnoix 58944 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: AN OUTLET ELEV.: WARNING LABEL LOCKING COVER C� P OV ED: PROVIDED: � 00, ! YES ONO DYES ❑NO BEDDING: VENT DIA.: VENT MATL: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH i � q ALARM: FEET FROM LINE: A INLET: ❑YES - ]NO ❑YES ❑NO NEAREST ? / !0 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. P /SIPHON N ACTUR WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO DYES ❑NO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATI AL: N' MBER OF PROPERTY WELL: BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN F ET FROM LI "E' AIR I "LET' PUMP ON AND OFF) DYES N AREST SOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plow) g vcrH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until ORGE the soil is dry enough to continue.) MAIN'' CONVENTIONAL SYSTEM: ` 'WIDTH: LENGTH: N J DISTR, PIPE SPACING. COVER =INSIDE DIA.. Ji PITS. LIQUID #XN M AL•� DEPTH: w E?MIth1S GRAVEL DEPTH FILL DEPT H DISTR. PIP DISTR. PIPE DISTR. PIPE MATERIAL: R NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABO E COVER. ELEV. INLET ELEV. END. �j PIPE FEET FROM LINE: I > C AIR INLET: a j •3S 2 7Z- NEAREST 3 / P/ J MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA DYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER I TEXTURE p ERMANENT MARKERS OBSERVATION WELLS DYES ❑NO ❑YES LINO [CENTTE:. EPVER TRENCH/BED H!BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED I SEEDED. MULCHED. EDGES: DYES 1:1 NO DYES ONO EYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. WtRN TRENCHES: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELE V.. ELE V.. OIA.. ELEV.: PIPES: DIA.: E 9R�O�9i ° A HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED . TAN PLANS. DYES ❑NO ❑YES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NR 7., PROPERTY WELL: ] BUILDING: FEE� "R. LINE: YES NO ❑YES 1:1 NO NEAREST t-4 L �2_ C, ' S 7.29 Sketch System on etain in county file for audit. Reverse Side. SIGNATURE: �. TITLE: �— I DILHR SBD 6710 (R. 01/82) r wlecon51n APPLICATION FOR SANITARY PERMIT , ' D.1 L H R COUNTY (PLB 67) oEaRRTmenT OF UNIFORM SANITARY PERMIT # InOUSTRV LRBOR 6 HUMRn RELRTIOns — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8Yzx 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPr=RTY LOCATION .g}*AL- Ii 1 /4 €�'; 1 /4, S , T° N R �' ��u -a`s E E (or VII TOWN OF: •'�—c C LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED r Z 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: 5� New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): "?•� C y �/�- " ( Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: P PRSW No.: Phone Number: i Plumber's Address: Name of Designer: i r i f- COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved �;r V _ 7G��L El Owner Given Initial i !! OcA Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 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 ") , tthen a second fora skould be retained and completed when the property is sold 1-W N11 to this oi.lice With the approp; taru died recording. - - - - - - - - - - - - - - Owner of Property e> D c---dEFL..o ,Jc— i Location of Property _:�� �4, Section 7 T N - R W Township -) Mailing Address ���� ��/?C �-I- /V Subdivision Name p�yy Lot Number Previous Owner of Property h �(�O 5 Total Size of Parcel Date Parcel was Created Sco 4 Are all corners 'and lot lines identifiable? � Yes _ No Is this property being developed for resale (spec house) ?_ Yes No Volume tp and Page Number 4 as recorded with the Register of Deeds INCLUDE WITH THIS APPL.LCATI ONE OF THE FOL LOWING : -1.-' Warranty Deed 3. Other recordings filed with the Register of Deeds Office In addition, a certified 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAti.6y Vcat aP.e etate.mert6 on th,iz �onm ahe tAue to the best os my (owe) hnowtedge; that I (we) aan (ane) the owneAk) o6 the pn.openty deg nibed in •thi.6 in6oamati.on 6on.m, by viAtue o6 a wwvtanty deed %ecoaded in the 066ice o6 the County Regi -6 ten. o6 Deeds ah Document No. ; and that I (we) pnersentty own the p4opo.6ed bite. b on the sewage dizpos 6y�stem (oA I (we) have obtained an ea6 ement, to nun with the above deh cic ibed paopen ty, 6oA the eon,stmiction o6 said .6ystem, and the same has been duty nee_on.ded in the 066ice 06 the Courzfiy Re9i.6tvL. o6 Dee4, a6 Document No. ) . SIGNATURE OF OWNER SICNATURE OF CO- WNER (IF APPLICABLE) `1 — a 0 a 01,0 -6 DATE SIGNED DATE SIGNED OOGiMSMT NO. ><TAT1 R11Z Of Ni 11 aw"� wps �I r t1 va 6 rwcc 445 Cmusc . 1W gad beew«. - Alaits..R.�..l ..«».•....•»...•».».•»«•»..».«.+..«...•».......«• «...••..•..•.•.•...•.••••.•w•r. ,s , F. li. wbstbw osi W Mile) aM....Aw• ..�.. », Yl ►� �-»+ .+wa........ 113sr �'+ i .�r .... .... .. .... .... ..................... ( "Pu:ebsase", wbs" watt ee i111114• ry Vonder was and gross to essysy to Atrehow. upon tbs Pee50 aM INV M" formanae of this eontrad by Purehwr, tM fdkwlet P111WIV. *sow via ft realk �Y _.1 _.tom �.�.,1.� � ,r an ✓ . � . �p� � Yid. •• Croix .......... Ottatab. Stall et asraaau Sh of NW% of Section 7, T29N, R19W, EXCEPT the South 30 rods thereof.` . X44 All that part of the SEC of NEC of Section 12, To road Mil,`.. .,ww »w». --•• T29N, R20W, lying Easterly of State Trunk Highway "35 ", EXCEPT the South 32 rods thereof s and EXCEPT that part thereof lying Southerly and 4 Westerly of the Southwesterly right- cf-wlY lirM of the easement described below.� LoA SUBJECT To a non - exclusive easement for foriingress Tow of the SEh of the NE% of Section j described as follows: Commencing at the East qs4z "WKM WI NW_ of Section 121 thence N90 "00 - N 1,332.81 feet to the Ely t �Ol -erY S.T.H. "35 thence N34e27'20 "E 637.14 feet aloa�i Y , of S.T.H. "35" to the Nly line of the propertY ZS, Ooc. Windol,ff and Mazy Ann Windolff, as recorded in Vol. 519, P&" No. 325163 in the Office of the St. Croix County Reg I o.f Deeds, being This is. not... .. . homestead property DESCRIPTION CONTINUED ON ADDENOS� (is) (is not) Vanftc's sesids000e %witten Purchaser agr ees to purc the Pro perty a nd to pay to Vender at ........ ib� �.. . "Sum of i•. t 39.5.00 ....` .............. in the following manner: (a) S ....... ' at the execution of this Contract; and (b) this W&M of hereof on the balance outstanding from time to time at the rate ef.tM- {. 11M ` Per atmana until paid in .ell, as follows: Annual installments of 510, 000.00 each, plus accrued interest, on or before the first and second anniversaries of this Oontract, and the entire bslance, plus accrued interest, on or before the third anniversary of this Contrwt. See attached ADwrii iw! for provisions for release of lots and application of Pwflmnts at thereto. Estimated R Estate Taxes for 1984, payable in 1965, helve been pl= ated closing; Purchaser shall thus pay the entire 1984 Twoes and subesquenit yaws as due. Provided,, however, the entire outstanding balance shall be paid is fug on or before tbo..... ......•..... day of FlehCUaty ... _ ...... , 1 967 _ ... ( the maturity date) . Fo!IJw itig any default in payment, interest shr!1 accrue at the rate of ... 0.... % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal halanPC ). Purchaser, agirees to pay miapt! p due. mumannual tuxes, special assessments, fire and required insurance pr emium* . Minimal and furnish copies of receipts on Vendor's written request• Payments shall be applied first to interest on the unpaid balance at the rate speelbed and tbee to principal. Any amount w4 be prepaid without premium or.fee upon principal at any time In the event of any prepayment, this contract shall not be treated as in default with respect to payment so last as the ampaid halance of principal, and interest (and in suci: case accruing interest from month to month shall be treatw; %3 ::'paid pru:c, pal) is iess than the amount that said indebtedness would have been had the montbly payments been niade as nrat spec;tied ai,ove; provided that monthly paymonts shall be continued in- the event of credit of any proceeds of tnyuratxv nr tv,tltlemnatiun the coentemned premises being thereafter excluded herefrom. Put,h.kser - rr.t that I',rciu.: r is sutisfied with the title " shown by the title evideme'submMed to Partl1sw for ta:.m nat;c,n e:xrept: Within six (6) months hcroafter, Vlerldor shall record a certified copy f t;ll. j<,,,ttt ( of William F. Marty, and release of inheritance tax liens in tht )f t. ;i l l iam F. %brty, to the satisfaction of purchaser's attorney. if title evi is In the form of an abstract, it shall i r a ;, s „' t, j fIt i�1CCl .'C nay ivive9 no , w abstracts pr M. �PT; J finaw446 POW-Mm praiden a a:r &w M wb tart W a elessa b b" aft !Y lei liM 4 in it and a deliver a Vender on dessarw abewing "A peitasmt, Purchaser chap acne the lmp» sW o as Y ft 00 dor w a fastand w a � ' t cov erage peril sad sung ot ��,� wsr ay nyuie�s. tAaro the Adsna ewit't sdar t#is Coateaat. PtiterArast Mf we=n , coata6r the standard claw In favor of the Vegdori latae+ut " na m Veadair of W polkNs eovorist flee SW be Mp1a1W wkb Vendor. Rtt+iwar � ' iasunuice companies and Vendee. Wsos twomasr aad Vender otherwise eism Is be applled to restoration or repair of the Property dawape4 provided the VenAw irises P s !M «onwnNslly feasible Parehassr eovenaaa we a eewwk waste aw afow wade to be somnd" N fir lhNrll to edam yy Wit A law oAiwad� r iw�affeet�'n r taw ej �;ews superior a tM>wMnaE Vendor &stun that is case the parebass price wM lot~ and other wene3 d" shall be tuft performed at this times and is eM maser show speeibed. Vender wW M A the Purchaser. a Warranty b fie of nice Pro rt free and eioar of of M , Deed. y. 4 slanplai, tl~ _ an liens or encumbran b e K d Pis and except: > easements as setafo�n�t . L i e oue. See ....... ii [>s f prmisic - m nio�it 1 *�+oe�s aN►,�,ag�'� tie .... ............................................................................... ..............................» .......: ��.. r :........ Purchaser agrees that time is of the eadenoe and (a) in the event of a default in the Pon 1- 4 00V dr interest which continua for a period of 1P .... days follow ing the specified das date or (b) In rice Mani et a d) 0" IN performance of any other obligation of Purchaser which continues for a iod of .3Q..... days writNrtlg adieu thereof by Vendor (delivered personally or mailed by certified mail), then the per entire outstanding bdaaeoo ddo eanIN rhall become immediately due and payable in full, at Vendor's option and without notice (rs1 1 Palrsbaeor 1118e4by waives), and Vendor shall also have the following rights and remedies (subject to, any limitations pi-0 bawl a addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Csubwo Mel b Yssr's rights, title and interest in the Property and recover the Property heeler through strict twedo rdr wft atir oeft of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest tbas o from the date of default at the rate in of feet on such date and other smountsdue hereunder ( in which event all anoon paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and n for tJe e nd date if and chase fail to redeem) ; or (ii) Vendor may sue for specific performance of rich cowlenet to - I I imp payment of the entire outstanding balance, with interest thereon at the rate o lets in offset as d of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial oak and 1Itreiieeee shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase �si�e'or W thereof: or (iv) Vondor may declare this Contract at an end and remove this Contractaseele" en tiW in a title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser /�sdtsi�rptn;INesdldioo of the Property and have a receiver appointed to collect any rents, issues or profits during the psnddae)► of silty action under (1). tidal or (iv) above. Notwithstanding any oral or written statements or actions of VMderson dMetNe of any of the forecoing remedies shall only be binding upon Vendor if and when pursued in litigation and sf davits and expenses Including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated w not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in• curred, 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, sad pro is of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be bald and applied as the court shall direct. * Purchaser shall not transfer, sell or convey any legal or e. uitable interest in the Property (b of any of Purchaser's eights under this Contract or by option, long -term or in a "k ; w * consent of Valor tmt th eas either e outstanding balar. -e payable under thin Ce ' jMti �r `tJltb istsrest • e conveyed is a pledge or assignment of Purchaser's inters- t under this Contract solely as security for an Indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding * balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. • Vendor shall make all payments when due under urn 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 Mortgaree if Vendor fails to do so and all wr mcrit� so made he Purchaser shall he considered payawnts 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 Detente of the heirs, Wgd �a�a ativa, sueeessors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vander for a s valuable consideration joins Mrein to release homestead rights in the r.ubject Property and agrees to join in the execution of the deed to he made M fulfillment hereof.) Dated t6„ 23rd ,lay of February it 84 B. & H. DEVE kFMEIJT INC. (PurchaMr) By: (SEAL, Anita P. Marty (Vendor) ! nala B• ell, President And: " - William C. Harwell, Secretary , �? AUTHENTICATION ACHNOWLEDf3MXN Signature(,) Of Anita P. Kirty, a single STATE: OF WISCONSIN foli In t$. /• ST. CMIX Count;;. � t 23 reLiruai Rte ' 23rd authen:icatO this dqy of ' .. Y 19 Persomilly came before me this day of i FfbriL 19. .. the abor amed Donald E. Bjornstad, President, and . Robert F. Wall William C. Hartsell, Secretary, of said Corporation, wtx) ackrx that they executed this instrtmlent as such offi6iim .,l 1., ;n,, ,,, , �� ,< t- , of slid CNr�or lion JW its aothOri , and t� III, o e n 1T.1 a o execu the f„r i�� XAst1unu �;t' :�r :�I ;cc6nAVC)Cfig� tilyr6ante. tti.11i i„ ,�. t tt!g,rt, �,tt• �'. �,., .- ;?T_ "' WiIIi,,un 1 . Gillx,rt }% !! �t. Croix '� „t. ( . Cotirty, Win. „ . • „ y r N t •n„ n�.r tt r..,n vn i i 1, :� �. o..•r, i5 PermaneM >y' ` O . 4 7 ADDENDUl�i COMINOATION OF PROPERTY DESCRIPTIONS the lily line of the South 32 rods of said 8E4 of NEB[ of As�o�lAU " o said Nindolff property thence N90.00 1 00 0 2 along said Nly line f =48.49 feet to the centerline and Point of Beginning of sail! 60 easement, being described along said centerline as folloMSS the N12 0 55 1 00 "w 199.43 feet; thence Nally on a curve concave to the 1 a radius of 99.45 feet, whose chord bears N46.05'00 "N 108. N79.15' 20 "W 111.50 feet, more or less, to the Ely right -of -rosy Of 6•T•9• "35" and the Point of Termination of said easement. (For the purposes q t line oflSeectiong12 x29 -20, to the East 00 00 *W)- q SUBJECT TO recorded easements for e.ectric and telephone lisle;. SUBDIVISION AND RELEASE OF LO'T'S: Vendor agrees that Purchaser may subdivide said Property, with all ao!fts associated therewith to be paid by Purchaser, and that Vendor Will Join in execution of any plat(s), certified survey map(;) and other instsumnts necessary for such subdivision, except that vendor's interest shall not be subordinated to any indebtedness incurred by Purchaser. Purchaser may develop, improve and sell subdivided lots, With or without to buildings being constructed thereon by Purchaser. y ndor a g e e ss ee ution release such lots upon sale thereof by Purchaser, b of Warranty Deeds thereto to Purchaser; Purchaser shall prepare and fur- nish at Purchaser's expense all such Wa rranty Deeds and the a,er Real Estate Transfer Returns, except the Pr y which shall be at Return conveying the remainin g p the value of Vendor's expense. Upon such release and conveyance of lots, each released lot shall, for calculation of the transfer fee, be determined by rounding off the acreage of the lot(s) released to the n s tee v shall number and multiplying same by $1,500.00 pe acre; s e said Property, be paid by Vendor. Upon conveyance of the remaining pa rt the balance of the transfer fee not paid upon lot releases shall then be paid by Vendor regardless of the acreage of such remaining part. Upon Vendor's release of lot( ;) as af ua1 s to 50% of price a paid r shall then pay to Vendor an amount e4 provided, however, that the $10,000.00 to Purchaser for such lot(s) released; annual payments due on the first and second anniversaries of this Contract shall be deemed advance pavment toward such release- payments, thus entitling Purchasers to release of lot(s) for sales up to $20,000.00 for each s uch annual payment, and Purchaser shall be obligated with respect to such credit selling prices that exceeds x20,000.00 aggregate lied first to for each annual payment. All payments received shall be aid at the interest and then to principal. The $10,000.0 down payment p execution of this Contract shall not be applieentotow rd release vendor's release but instead shall be deemed to be advance paym and joinder in the dedication of public roads and of any parkland or similar areas which car may bs theubeliefoofetheapartiesuthattsuch s >ubdivision of a Prop $10,000.' down ?aym up i istcxemptafromnrealdestatentransfersfee the Town o f iiudsor. f p ubli c pursuant to sec. 77.25(2), Wis. Stats., and that clue r�ovidedfaboveill thus be ue only upon $84, 395.00, to be paid b Vendor as p i T . ' Nothwithstanding the aforsaid method of calculating bligstOd tO 41 to vendor for release of lots, rurchaser shall additional amount,, it any, for lot releases to assure tbat the acreage not theretofore released as lots iredodiattod Vii ; !" multiplied by $1,500.00 per acre, doe not due under this Contract. The foregoing provisions shall be deemed to modify any confliotu4l Of this Contract which restricts and a tit to aid Property, rovisions. the foregoing p O 9 i 4 i Q. 1 �2 'N. - I • •^ � P °s ew .s CC ro �Il ��STa�c¢,S r"1taS�rtO To ve.n� p;pts i CI-cgn o�� a- C40 V e r` �4n O� h O4 S GLS S uh, S��STGr� C,��JR..�►on D r a 'a d l,s o g Oro y CO 0 ., H , N r-3 ST C- 105 r ti SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d 9 OWNER /BUYER ROUTE /BOX NUMBER ��.� �'%,� /, Fire Number CITY /STATE �/,i� ",�,j� ���;�,. ZIP 1 I PROPERTY LOCATION ,,Z 1 �, ' Ai 1 4, Sectio T R W, Town of �� /,' e r f , St. Croix County, Subdivision /��//!� - ,Tj`_ » Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), 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. o I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- �o ment 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 i DAT 1 Arl St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715 -796 -2239 or 715 -425 -8363 Sign, date and return to above address. I ST. CROI X COUNTY WI S C O N S IN ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 February 26, 1985 James E. Rusch James E. Rusch Surveying & Mapping 407 Second Street Hudson, WI 54016 RE: Percolation test done for B & H Development on Lot #43, Edge - wood Estates, Town of Hudson Dear Jim: An application for a sanitary permit, including the percolation test, for the above mentioned property was submitted to this office today by Mr. Bill Schumaker, Master Plumber. There is a need for the percolation test to be corrected to conform with ILHR 83.09(5)(D), under test procedures for sandy soils. A ten minute test time interval cannot be used with a 27 minute percolation rate. I am returning the EH 115 to you for these corrections. Should you have any questions regarding this, please refer to ILHR 83, contact this office, or Mr. Leroy Jansky, State On Site Waste Specialist. Sincerely, .j Thomas C. Nelson Assistant Zoning Administrator TCN:mj Enclosure: EH 115: B& H Development cc: Bill Schumaker DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IND cT�, DIVISION F PERCOLATION TESTS (115 MADISON WI 53707 .HUMAN RELATIONS _(H63.09(1) &Chapter 145.045) LOCATION: SECTION: TOWNSHIP Y: ] C _ 0TNO.:BLK.N0.: SUBDIVISION NAME: �/ 7 /Tz9 NA /9 , # COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: S CP'0 / E VFc_oP A et t4 1 ,5-34 Sr Ca✓ooe Sr "o. . v psw i 'v,,,/' 0, US E DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI IONS: 1PERCOLATION TESTS: Residence •3 , A `� I - L New ❑Replace I y / / /g z. 4�Ca��^^' P . 4-9 I T � S c) I L_ S: -I ` few l � -r T RATING: S= Site suitable for system U- Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUN -PR URE: SYSTE IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) t �v �� �v �� �J ❑� ©J ❑V EIS ®� CDN\/mNTIOnI/�1 16 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: M GLASS z I Floodplain, i Floodplain elevation: , ►fllprL PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH-44, ELEVATION OBSERVE EST. HI HE ^T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) I B - / 9,4z - /©z.70 IJ0AJ6- 79, 6;L Z 6,i LS or <. /S' L F3r�ir5 B -2 8•/0' �oa,oz Nonl� y g 74, 3,06' 8c- S ;L; 1,30 SAr 5;L; 0.2,0' 13N L; 4.7_o' B4 ME'C, + S; NARO PIA nJ of L0NIE1r7 el-') RD gA/ V 4' 3. 00 • P, L_ 5; L; 7;00 +. 8Aj S; L; 3.00' Y BA/ i3C.) S w /E,rz.', o' B -3 �,00' 104 9,00' S'00' Al rOaM6 w -C M> 7- 4 O r"or 1, 0o' 5 S ;) 0 .70 8.,r S 'L; /.Z0 8n, L5 W/ o0' Brr ME7n - Nc B- 4- $,3,7' /0 4 4=(o P�IOIJE >• S•30' G,r-• C1.z- o'P_D&4 L S w Tara cvB •- o'RAr ht E�3 w lac 1. o K r JN' I,oU' L 5ij 0,30 C BN 5rj 1.40 `( 8.4 W Ea A''s. -05 B - 8,100' /n4.�1' /��oN� 8. �o' GR .• oao'i2°B,r LSWI &L ¢ <.oz'gS Y s BALLS; /,00' 8,.1= 0,4' $'J mmV ; 2, TO 8 5; A Aft.DP'r OF CL- M!` /rTL-:G Re, gr, v � 5 B-6, 7,9o' /03,0/ A1.0 Ala >7."Jo• /,00• 81_ 5: r.o° S: L; a,2o' 5, L; 5,70'r3n/ $ MaU 5 DECiMkf_ PERCOL TION TESTS °4'_o.'s' '"s C>Ic $A/ --:5 F MIRVT coR.2L�.SPr�nrq� ,Tµ 8DJ4CEIdT 13c> R_'. CHE rvC -� TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL•INS RATE MINUTES L NUMB ; AFTERSWELLING INTERVAL -MIN. PE t PER I D PERIOD 3 PER INCH P_ I 4.1 o' N o 1J 30 1 !e 1 Va r— o3 'S' P. av 4 - , SO' N N l O 13 M. ��8 / 15 is P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what air. 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 an&percew of land slope. NOTE D�IVr✓ vvp?1( MUST gE 1n1 K'__..t- r' •'i TI . 4.3 try I� V o ii SYSTE ELEVA g9 ! i �,�� I l i 11 � i L_ "PC-A o � 0 goe.EE hoL- PGn t�A\ t Q nl TIr,ST ' G i i A5 T-, 1 I�m..Or s ✓Ti.. ��Nc;; �lc�r./ `eJ S e �va� p o ;,: 5 E I- M OF V pk 5' 1170 , o 3+ P ,I; . / - -- 0 rn ? + NO UD .� O N , o �. _�PFNT S(5?EA1 L °P ! 4¢ "Td 7A LL;� O'i L-0T 43 3 VNSU ITP<EI~E 3. ENGN MAt_K_ r 1" Pr Pis LAT P A I" T Eli C-P_' U kE (_E V. I CN.'_ - <' 0 I, the undersigned, hereby certify that the soil tests reported on this fonn 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. NAME (piin0: TESTS WERE COMPLETED ON: I � / 4 u.� �GL� ._ __ �,�_ —� v < � —�— ADDItCSS: CERTIFICATION NUMBER: PHONE NUMBER (optional): `�O ? 2 N - ° �.:rT � �UD 50AY, V�� 's' CJ /!� 56 7is 3��(� �c�8 0 CST SIGNATURE: / Di,;l RIRU - I ION: Original and one copy to Local Authority, Property Owner and.Soil Tester. DILHR- S13C) -6395 (R. 02/82) -OVER -- )EPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'NDUGT^ DIVISION t P.O. BOX 796 ,AT PERCOLATION TESTS (115) MADISON WI 53707 ,IUMAN �iELATIONS (H63.090) & Chapter 145.045) -- —� _ _OCATION: r SECTION: TOWNSHIP Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: 5VV '� 7 /TZ`) N/R I `j ) COUNTY: OWNER'S BUYER'S NAME: MAI LING ADDRESS: 5_r.6P f�( �VE�aP E�N 83G Sr Cr- OIXST "o, 'v RSpr f !SE DATES OBSERVATIONS MADE NO. BEDRT MMER IAL DESCR PTION: PROFIL RIP IONS: LA ION TESTS: 3 A , New ❑Replace I /��� -- `/� 4/S -��; '�/ ,ATI S= Site s uitable for system U= Site unsui table for system ONVENTIONAI.: MOUND: IN- GROUND•PRESSURE: SY TEM -IN -FILL HO �LQING TANK: RECOMMENDED SYSTEM: (optional) S DU S �U �S 11U ©S 1U I [IS ®U C ONVfcNTIONA.1 - IEY Y J ?j Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the ;nder s. t indicate: Z Fioodplain, indicate F l oodp lain elevation: N ra Dr---c IMAL_ PROFILE DESCRIPTIONS f = � - T _ ;QRINGI TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH 1UMBER DEPTHIN. E LEVATION O BSERVE D EST. HIGHEST TO BED IF OBSERVED (SEE ABBRV. ON BACK.) PJ, t z ' $LLB Z, ('0' $rr G f'C e') % ^ V ♦.rjc O.. t_pBrJ fvtED r Ro 5N L-S Z. +0* nr 3. P,r+: G ` 2 X5.70' /04-OZ- Pie (G > 13,70 3,00' Ht_ SiL� / F3r.1 $ ;L, o•"J' �r✓ L; 4,ZP' Br! Mr±(� � S: NAMbPAIIJ of G6NlEtJTd: Q0 6r/ V+S 3.00' g� 5; L� u0o ," l3,J ;�; L� 3,UU' ti' Bn/ r.tg +;> �y'E,r...•. ,.,' 3 0 0 10433 9,00 S,00' 3 w/ r 1,00' BL SS) 0.70 8,,r ",'L; o' 8nr L5 o 13- 4- �3 b ¢- •¢�o l'• /0�1rz 7• L �ti. O.'.�O'P -D Br! I. 7 u.,�Gk `r.oGi • O k ,rMFi .10 ✓ ur`i / - i =' +` wd' L $ Gy 6" 5;; 1.40 y &, ;L VV � >2;/.3o'c;.rl.rsf 3 8,l00� /P�¢.Zl' ��CN= } g, &0' bl%j 0.70'ko&J LS - 1&i,L . Y 5: f3 At_L5' /.00 5r1 $14 tM '* Z. 3' OF B 7,9D' /o3,(o! NOAJF- >- 7•)0' l.00' Sc- 5.'; I,ua D1=crMA -� PERCOL TION TESTS O4 - 4'rs' Nole,z,nrvs (?K rte,/ r C+ F NV co¢�R -¢.SPo VEL -I ,- rµ AGJ M. Er�T' 13�r •roc - ", TEST DEPTH WATER IN HOLE TEST TIME DRO IN WATER LENCHES RATE MINUTES ,_ ,_ E; / dUM ffS AFTER SWELLING INTERVAL -MIN. P - R1 Qg t PERIOD 2 PERIQ 3 PER INCH P - 1 ¢, I O' 0 0 N 0 ) 3 / ( . Z 7— P. _ f} .91 Z IZ G 0 t , i rJ P- (0 4-, 50' N N a P- — - -- -- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- rital 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 f land slope. � O -rLG : Dr>' IVL� WiPti"f R\ tJ S T E )1 r. r aYSTEM ELEVATION 99.40 a -�°' 4- 3 r° '° vc. * _ .- i t i p SoeE Not-E 'T»s5T C O P E7C-GO l_pk"R q ^) 'TEST ):1457"' L -rWC -I ` V. i ta7 14 �7H rc!( � o St"CE c O F )8� 4 . t S Ver AO ...Y 1 01 1- -16, HT -0F V v" O - o ,s tN o a 13 ._ NO UDSON s _ � ¢7S A sa • ,` i i in Tb 7A t t. 0 ,1 >r 43 3 UNSu ITArBI_C ...�r. i Y r 6 r i ...o . '�i..'..,,wr..�-- +•-- •- -.. -_ T f'iE.r,(CN MAe -rL ,S 1" PI PM @ SV\./ L_oT c n�r•IE J PA 1"T F_L7 I:.(r'"LJ� t= f,E V. ! C�•••- '-,..7 `_ ,_ r r.,' = the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods spepified in the Wisconsin Arninistrrtive Code, and that the data recorded and the location of the tests are correct to the best of my knowledge anti belief. TAME (punt): TESTS WERE COMPLETED ON: jA M EL" a. 4 ,DDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 07 2- N- X51 UP 5 V,# 5 /� 5b S ` , 715 3,?2(b ¢v80 CST SIGNATURE: / l I:iTf'{ffilfTlUN: O,iginal and one copy to Local Authority, Property Owner and Soil Tester. )ILHR -ShD -6395 (R.02/ &2) -OVER - 1 A h rt v LA r m x � x r v Vj w w S N dl ►V 3 0 o °�Cy o 2 3 ° cc co ° Er N m o v, ap° wo�w°ccoo co�w� Q - w o ° mo r n O n�� (3D C 0 > > ? w o c °_ O L C Ul 13C ��,► � c�u w w N m _ D 0 :1 < O m y c Dv � moo° c cu O w n O D.Q7 W m ° Pn � ��°- ° =�v N i Z N G. w =ai m°A�m p Z a N � D 3 mw ?a � —1 ° ?fo ?' m M w .9 ' .9 M QN m w =ate 'O a w 0 IV ° tt 6 O m ° ,n. _ . (o as w O O O g g n N w YI ww Q M N ap C Q3 f a ty M, H o �� c � (D 3 m O C � -1 U3 O O y g to O o �. o ... ° a cOw -C m— �C 7 3 C =w ^•v CD a o C 0 � CD a w O 1 � 0 • r f ir ms`s A1. t t00%& t 1 dtoA o '► '`f �roa` • of CID !I �� A o A"Ok X00 "� •f i N. LS '009*96t P �0 et a V ;>! (0 ci '� a �w ~•ea .,,M •- Q is ,��-�° NI, .Oli