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CROIX COUNTY ZONING DEPART NTr AS BUILT SANITARY REPORT ` Owner V Property Address c °r G' City /State � O Legal Description: Lot Block Subdivision/CSM # l 1 ��,nljr '/a , ' /a, Sec. - 7 , T -R .&W, Town of zZ u PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/P / _Setback from: House 1,� Well 92" P/L} 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 Type of system: Width -- _ Length zT Number of Trenches _ Setback from: House Well //-3' P/L 7_ Vent to fresh air intake t /66 ELEVATIONS Description of benchmark - _ Elevation s C9 p Descri tion of alternate benchmark _ Elevation Building Sewer Z2,99 ST/HT Inlet 91, l3 ST Outlet 1. � / PC Inlet �i- ?e, 7e PC Bottom Header/Manifold 2e. 7 Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System (r /) 32:Z2 Final Grade Date of installation 1Z k 6 P mit number �' State plan number Plumber's signa ure a License number Date Inspector - ' Complete plot plan � l 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 f�SiL a� /7Z INDICATE NORTH ARROW i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y: • Safety'and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353189 Permit Holder's Name: []City ❑ Village ❑ xTown of: State Plan ID No.: Town of Tro CST BM Elev.:- Insp. BM Elev.: BM Description: _ `^ Parcel Tax No -: 6D , a' on , 0 � 1 " (A wt I 040 - 1211 -10 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 5 Q Q Benchmark SQ IVD • Sv .p f Dosing Alt. BM 3 4y q:�- j/. f Aeration Bldg. Sewer 1 :7 -w q? 81 1 Holding St/ Ht Inlet B 91. G3 TA K SETBACK INFORMATION St/ Ht Outlet z Ql• 24 TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet Air Septic `7 5 (0 NA Dt Bottom Dosing Header/ Man. Aeration N Dist. Pipe Holdin Bot. System ��. O� 9,y9 UMP / SIPHON INFORMATION Final Grade Manuf turer and St cover 6• G 3. S Model Numbe G M TDH Lift � ion System TDH Ft Fi FW main Length Dia. ell SOIL ABSORPTION SYSTEM q I i T ENCH Width Le 1 No. f enches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING =_ i Manu ct ur r: SETBACK - S- �J n INFORMATION Type of 7 7 •�-�-' OR UNIT System: 3 (o CHAMBER M ` el Number: DISTRIBUTION SYSTEM Header / nifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length At.� Dia. a gt 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 Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / (v/ 40 Inspection #2: "tT Location: 349 West Grove oad, ud WWI SEl 4 , SW1 /4 ecti 7 T28N -R19W - 7.28.19.1000 1.) Alt BM Description= 1 "�" ���"� O�'SI►t^ C �t� �2 suj ) 2.) Bldg sewer length = � 3 O - amount of cover Plan revision required? ❑ Yes No Use other side for additional information. O O 0 ( 1 ( :1 ) 4A SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: __ t F } d s f 7 a I � 3 = a _ t k � [ g ggp n s t s FJ i g 7 3 I LIT- . _ .._ ... .. ... _ - 1 e -- : -------- :. T J CO RECETE0 \ �§a and Buildings Division � ,, SANITARY PERMIT APPLIC Washington Avenue 1i Consjn �, In accord with ILHR 83.05, Wis. Adm. C de i " � ? ' ? p O- ox 7302 Department of Commerce . "' Vadi on, WI 53707 -7302 �' �� S I �pt71M r .� • Attach complete plans (to the county copy only) for the system, on paper less44 r than 8 1/2 x 11 inches in size. , • See reverse side for instructions for completing this application % t"' a it Number pq Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. AP INFORMATION -PLEASE PRINT ALL INF RMATION Prope wner Name Property Location 1 /a r t /a, S T , N, R lor�N Property Owner's M iling Address Lot Number ` Block Number City, S to Zip co a Phone Number Subdivision Name r CSM Number T YPE OF BUILDING: (check one) ❑ State Owned v ri C It ge Near t Road 1 Public 1 or 2 Family Dwelling ❑Villa - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) �. A r ,000 1 ❑ Apartment/ Condo ® ®— ©© a 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: (Check only one box on line A. Check box on line B, if applicable) A) 1 [21 New 2. Q Replacement 3_ Q Replacement of 4_ Q Reconnection of 5 Q Repair of an - ----- System -- - - - - -- System --- - - - - -- - -- Tank Only - - - - -- - Existing System -- - - - - -- Exlstlna System 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 Q Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [d Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 K (g cR 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. R to 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i h) / Elevation AW4 Feet Feet Capacit VII TANK in Ca allons Total # Of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank — ❑ 1 0 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst Alation of the onsite sewage system shown on the attached plans. Plumb is ame: Print / Plumbe ' atu d MP /MPRSW No.: Business Phone Number: Plum er's Ad ress ( treet, Ci , State, Zip C IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved 4�3 as - , Permit Fee (Includes Groundwater ate Issued Issuin Agent Sign u (No Stamps) % Approved Q Owner Given Initial Surcharge Fee) Adverse Determination dt� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11I97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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 -3151. 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. 111. 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 is to 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. A D n � 1 tz 1 �r Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - 21 Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope ner Property Location _ Govt. Lot 1/4 1/4,S T N,R E (or )p Property Owner's Mailing Address Lot # r lock# Subd. Name or CSM# f City tate Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ( ) } New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/fF _ trench, gpd/ft Absorption area required /5"OPi bed, ft f�0Q trench, ft Maximum design loading rate bed, gpd /ft - trench, gpd /ft Recommended infiltration surface elevation(s) q s` ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system ,R S ❑ U 0 S ❑ U ®S ❑ U ® S ❑ U I ❑ s ® U ❑ S ,® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. Depth to limiting factor ` Remarks: Boring # a ,. 7 9 Ground ele ft. Depth to limiting factor ,!Nf��in. Remarks: CST Name (P ase Pr'nt) Si ature Telephone No. Address Date CST Number PROPERTY OWNER A_4414EZ / — ,�al��� SOIL DESCRIPTION REPORT Page — _-:;�of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench - / Ground elev. ft. Depth to Z , s limiting factor ,71- . Remarks: Boring # I Zill F Ground 1 elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ; Ground elev. �tt• . Depth to limiting factor Remarks: Boring # ;!1101 , Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) o � M M n h r — � � I v I s � 3 �� I i e, SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Chamber Soil Absorption Systems Permit Number 10/25/99 Date x "x" Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil 1 Note 1: Bury depth as per manufacturer 18 in Chamber Height 2 8 ft Maximum Bury Depth 3 600 gpd Estimated Daily Peak Flow 0.50 gpd /ft Wastewater Infiltration Rate 1200.0 ft Code SAS Size 40 % Down Sizing Credit 480.0 ft Reduction ( -) 720.0 ft Min. SAS Size 89.50 ft Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum I Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 92.50 99.00 1 92.50 98 87.33 90.33 Yes 2 94.04 104 88.37 91.87 Yes 3 96.23 122 89.06 94.06 Yes 4 95.50 110 89.33 93.33 5 97.85 110 91.68 95.6 No 1 � Y 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. I Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is equivalent to top of aggregate. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. SBD- 10553 -E (R.05/98) 10/01, 11:29 FAX 715738615099 GILBERT MOTORS _493 °; �d „�. SOH AND SITE EVALUATION REPORT r aw DWI* of a.ray & euld wo in a=rd wilt ILHR 89.0& %V*. Adm. CAft AtZaala agrtplata airs plan dirt paper not Iran ttt.rs 0112 x 7 inelap In sin. Plan mud Indk4e. but not Irr ed to ver" wd heri=nW rwfwnrw point (MM". draion and % of a", aoair ax PARCU I.D. d d"I cow. Wo anew. ww rnoaf nn am dif*&** d faal'e0t noel. #.to X0 TC APPi, ;ANT INFORMATION- PLEASE PRINT ALL INFORMATION �✓ REVWMllv Z - Z - 3 - 3 2-W 77r~ lb.v a T3 ,4• e . Gam+ v t G6/A>L Q�! <iO�r.L0 114-fAv IAA 7 T Ze ^A 1`r EW)W PAOi 3fTY CMVKR -3 MuJN 0 AM L T # BLOCK a SLOD, NAIYME Qpt t w r IE ST' aeatJW` z".lTji' t ; fv.�► S�Y'GtI { Ti�i - 7G S.i rfa A iciE UFO" INU FUT ��pA+F ,dam kj N >r OardAnruapon Lh { J Raddtla¢sMOrf 1 Nuerdar d h.dymna ( 1 so • iaaed�p (1 v Oman or wmn@Fm desaibe coal N" d* bw Gn 0 wd taarca�mne�4w duip �D raw � bad. __' a S** Ahila Iron 11W lagW d $0 O' W. lls SO tends. ItS Mdidneda dtdipn ba ft fSM l b . Ww ' (' tenant ppw Real coo ft irsl eflan aurtaoa ala►aeDOn(aj _ - 3 R (85161 ld to lw *p bwxWr i lQ Aldl "* *0Nn l oil WfWderefio % r6 .W S 7 G ui'T Q /F ®s► I �I/ri�4r Peru fatSMfi W 3 W' rd V-':4 40rS .t fl?klt dw Flaoa plSi SISa+edofl, !f S�lgia011 �i R r . 3umm y� �,T .ow�+c 9 •'i �tat>k �MOr ❑ S U 87 S flu � s u 6 s�� Q v � HO MI __% u e� MOIL DESCRIPTION REPORT Jq�0r40^, 1T rwavS 9a=rrrrp Horizon DOW Dominant Color �Aom at To3dure SMOSirO fro[ - IN" - 0 - ROOMS D in. 1Nunaail 4u. SL Carat 0dw ar. Sz. W. 3K 5p. /O 3 �' ?.J. s d � C J / f • S . G' G+ouFw 13 - i a y,e _ s / ,-f sir P - f . Y . - j-.. 1-11 f� -3y f slur Aft C 40 . z . 3 Daplhi 7 �� / Oy ri` ..5 JL Remarks: L1- 9 / cam 1. f, Sjoe 6-1 j q 5 If . C • .dls t�aafRt �� ,(S' f`7ye. �,/1�► -�-- S/ >+,f s,�X r:+^�`R C 5 /t . y � S 2 " l o Sle S C9 . C, S � .�' 4 �✓ .�' . 7 l War RafftSaris3: prw uts'acSllCr CiM'llAlilY �Mq Ftww 7l S_- a e M V N EIL IMD„ WL9WN, Will, 504 j 3 4. Wgrel �LUa>dle afar left, Do: 3 -.2- f3 IW e. rNN I aW5TALIAR 9 ttESa(itialM UC. 40. oft 10;01/99 11.29 FAX 715 +:588+5099 GILBERT MOTORS �j05 SOIL DESCRIPTION REPORT p„ Z 3 ty AGattLr W / Ltl i'7 G�!°dltrOE" ap N flop * 14orl2on Dopth Dominant GCIOr trblloo TfA[htli $ �� m sm Oar1�16r10� eft Roo11 in. IMucis" pw SL Ca ft 00or Or. ft Sh_ Z3 /9 1 -3 -A J Q1 3 S�/ A f X ...,f S � i� . S . G t � ,ww 13s. 3�•s" /oJ�.� �y �s •s S�/ G ��t' w.+r�'. � taw � . � , 3 ip a ZIL Sf [{ tlro i RMns _ aVA/ 4C A trs es inq N 0 -/2- ---�-- xf / t. f, sit 13 A, " "L 1 00 3 13 sr 2,•[ sik * S . S . G /3 - f -7, XY,# flee -- S! /, , , rf a .,�f a es C iiL 4 f !'7 /Q S ,z «, 3 r �� 7,S ' S S i/ 4f SiK �n�," 6sa CO of In C _ j 1 oY� s/G .2, 4 _V & Nf to w I t bi W A f� - %marka: 13 Cs If- . s G � "3 if / o Y x y G ----- S / J, , i 4 o i ..M t 4 a s /vf , y . s s d.n,s dx G'S .7 i,p IN a �i o• �oY�! S/ r �' s 3 �, of . S oil kv 4I V M - 1 io s/3 ,�..,_ S a ,f, s A,r •�,� S hF s . G tc _n �. � fl- �' G s�P S, 1, f tdrfc .,,�,f� 4 ka r- • y 's Df m ID /O YA f /d� �.._ _. S a, d, s , ,.� a w ,.r 1. , p Aomarks: �t'6•f O� r T Lr-la f' /�tC•v /�1'� /g/O�/yD •f V !9e' -f /°i+' /ice A . E0 3�tld 31t+i53 V�i3� �Mt31 EEElE /9E65CL iH�6H i,66T /0Z /t0 l f 10 /01, 11:29 FAX 715 +386 +5099 GILBERT MOTORS [a04 TWA' APII- septic system. COPY f� i .I i� i I 4i 'I r - 81/2811992 03:07 718996732333 LOWRY REAL ESTA?E PAGE ov a �' ; r p G w Ifi sar. ad tl �- Em i r r i r �t it ?� 0 lie vi r J 41 O d b N j ° N LU W `^' 9Olj MIN SAHT1IJ 6639 +99tt9TL IVA WIT 66 /70/OT 1 - 10%01.99 11:28 FAX 715 +386 +5099 GILBERT MOTORS Q10: i j ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ' AND OWNERSHIP CERTIFICATION FORM C)wncrJHuyer �� A M.D LZ W ,T• Cif �r i Mailing Address Property Address (Venfication TcquircJ helm i'lanning Deparvwt nt for new construction,) :'It !State [�`TU — 2 11 Y � 1 Parcel .dentilication Number ! f_,F DESCRIPTION ' roperty Location � ' AS '�a, Scc. f , T, N - R I q W, Town of subdivision 1)�9�'' , Lot #! :ertified Survey Map # � , Volume , rage # X'arranty deed #t Volume Page # '"T6 d i iI)cc house ❑ yesx no Lot lines identifiable Wyes ❑ no I WSTEM MAINTENA:�'C1r Improper use and maintenartceof yacr Septic system could res0 to its premature failure to handle wastes. Proper maintenance CnSiSIS of pumping Out the septic tank cvcry three years or sooner, if needed by a licensed purn:per What you put into the sysiern an affect the function of the septic tank as a trcatmeni stage in the waste disposal system. I ' The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a taster pi umber, joumey-inan plumber, restricted plumberor a licensed pumper venfying that (1) the on-site wastewater disposal system in proper operating condition ond'or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge i t t �.c the undersigned lia►c read the iibuvc reyuir menu anJ agree to maintain (lic private sewage disposal system with the standanis rt forth, herein, as set by the Department of Commerce and the Dcpirtrrient of Natural Resources, State of Wisconsin. Certtfieation acing that your septi- sy m has been maintained must be completed and returned to the St. Croix County Zoning office within 30 kys of heohnrec year p' ation date 10 TO OF AP ?CANT DATE i NER CERTFICATION I (we) certify that all statements un this form are tnte to (fie best or my (our) knowledge. 1 (we) am (are) the owrer(s) of e erty describe bovp, by virtue of u warranty decd r.-corded in Register of Deeds Offlce.. r q e ( NA C Of' APPLICANT DATE "`• Any information that is mis•rcpresentcd may result in the sanitary permit being revoked by the Zoning Department • " "` Include with this application: a siampcd - warranty deed from the Register of Deeds office a copy of the certilred survey map if reference is made in the warranty deed S t - MY ♦ ♦ ♦ .. • U8644 ��L ft d 1br f Bawd LIMITED WARRANTY DEED JUL 5 1994 10 e 45� THIS INDENTURE, made as of the � day of June, 1994, 'us" i Eau Claire, N.A., party of the first part, and Alexander 1. Cavalier and Bridget A. Cavalier, a_ collectively, party of the second part. WITNESSETH, that the party of the fast part, in consideration of the sum of One and 00/100 Dollars ($1.00) and other good and valuable consideration to it in hand paid by the party of the second part, the receipt whereof is hereby acknowledged, does hereby grant, bargain, sell, '. and convey unto the said party of the second part, its successors and assigns, forever, all the tracts or parcels of land lying and being in the County of St. Croix an State of Wisconsin, ' described as follows: a k Lot 1, West Grove Estates, Town of Troy, together with pertinent interests in :Tz Outlots 1 and 5. TO HAVE AND TO HOLD THE SAME, together with all the hereditaments and * appurtenances thereunto belonging r�. PP grog or in anywise appertaining, to the said party of the second part, its successors and assigns, forever, and the said party of the first part, for itself and its n successors, does cG,venant with the said party of the second part, its successors and assigns, that it has not made, done, or executed any act or thing whatsoever whereby the above described premises or any part thereof, now or at any time hereafter, shall or may be imperiled, charged or encumbered in any manner whatsoever, and the title to the above granted premises against ' all persons lawfully claiming the same from, through, or under it, except items, if any, hereinbefore mentioned, the said party of the first part will warranty and defend. This conveyance is subject to all easements, exceptions, and restrictions of record. ' ~ ; IN TESTIMONY WHEREOF, the said party has caused these presents to be executed 3 in its corporate name the day and year fast above written. FIRSTAR BAND EAU CLAIRE, N.A. �t E ` E B k ,Its r CF K el t I ' By: Its 4 0. . ; 4s. . ;j" � ', •' F f .'r,' ..o>sn+�w - "A;N� �r.�;.� °f, - ,; . � r ,� �� , �� s� ,,.: ' �* µ d.. STATE OF WISCONSIN ) ss. Eau Claire County On this 19th day of June, 1994, before me a Notary Public within and for said County and State, personally appeared Thomas P. Mihajlov and David B. Pokrandt to me personally known, who, being by me duly sworn did say that they are the Vice President and Assistant Vice President of Firstar Bank Eau Claire, N.A, respectively, the corporation named in the foregoing instrument, and that the seal affixed to said instrument is the corporate seal of said corporation, and that said instrument was signed and sealed on b.._�If of said corporation by authority of its Board of Directors and said officers acknowledge said instrument to be the free act and deed of said corporation. Mary H. er, 446tary Public + Eau Claire County, Wisconsin My commission expires: 08106/95£ ti This instrument drafted by: Jeffrey W. Guettinger Q Danielson, Guettinger, Richie, Manydeeds & Weinke, S.C. 3410 Oakwood Mall Drive Post Office Box 1457 A Eau Claire, WI 54702 -1457 : 3 1 fV •� :.� 3 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of • Bureau of Integrated services in accordance with Comm 83.09, 1Nis. Adm. Code �c. /99 p Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County J / include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, noqh arrow, and location and distance to nearest road. / Parcel I.D. If APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location i � Cc, v a, I, e Govt. Lot 1/4 1/4,S T N,R E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number ❑ City Village J�I_Town Nearest Road New Construction Use: DKesidential / Number of bedrooms 3 ddition to existing building ❑ Replacement ❑ Public or commercial - Describe: D Code derived daily flow �S Recommended design loading rate bed, gpd /ft 2 —. _�>_ trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rat bed, gpd/ft S trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material ©v� W- 't h 'k O ✓' s—(j !1-ed / ova Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system I ❑ s ❑ u ❑ s ❑ u I ❑ s ❑ u I ❑ S ❑ u I ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots r , in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench mw a 44 o7,5 low S Ground % J, S C' elev. _ Q J Depth to 4) 5/ 0 S limiting j factor eZ in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page o� R PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure GepI in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench son Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. , Depth to limiting ; factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) 1 6 V. 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