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HomeMy WebLinkAbout020-1180-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 538864 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Elhorn, Donald & Nanc Hudson, Town of 020-1180-30-000 CST BM Elev: Insp. BM Ele IBM Description: Section/Town/Range/Map No: °l `f . ~ r P ~~.M..,~y¢i Q pA,t•~ Z Lk.& aQ z 14 r 28.29.19.1133 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar A")- W E~K-S 2& If b4SWA y.15 t 99,1) 9T ?s' Alt. BM Aeratio Bldg. Sewer Holding St/Ht Inlet ~•D~ •S TANK SETBACK INFORMATION St/Ht Outlet / Sb TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 36 ( Dt Bottom Header/Man. Aerati pist.pr`~1 , /m. Ip CAVA-*6 r5 B S e • Uzi Holding Bot. System PUMP/SIPHON INFORMATION Final Grade aN Manufactu er mand S over GP ~ E-r c~ 3•S~ . 09 1 Model Number 4•03 . S'f' TDH Lift ion Loss System Head TDH Ft Forcemain Length IDia. SOIL ABSORPTION SYSTEM 3 - w BED/TRENCH Width Length No. O Tren hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 51.1 es'. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manyfxturer: INFORMATION CHAMBER OR :j F/~-7M*PV2 Type Of System: ' / UNIT O 3 Q / Mo umber: DISTRIBUTIO SYSTE Header/MM Iifol5 f Distribution x Hole Size Ix Hole Spacing Vent to Air Intake AA ` t~ Pipe(s) rs, / Length G~ Di a Length Dia Spacing ' , (J 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 0 No E] Yes 7MN. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: to /Inspection Location: 766 Larsen Lane Hudson, WI 54016 (SW 1/4 NE 1/4 28 T29N R19W) Cedar Hills Estates II Lot 32 Parcel No: 28.29.19.1133 1.) Alt BM Description (do% as /]~~'v) 2.) Bldg sewer length = ~ C7) ~ / (~Jel~[etG - amount of cover = Plan revision Required? Yes No ®p Use other side for additional information. SBD-6710 (R.3/97) D to Insepctor's Signature Cert. Nr Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 538864 0 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Elhorn, Donald & Nanc Hudson, Town of 020-1180-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 28.29.19.1133 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number [Forcemain Friction Loss System Head TDH Ft Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width LOf Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold [Dise(s) tribution x Hole Size x Hole S acing Ten~r Intake Length Dia ngth 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 discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 766 Larsen Lane Hudson, WI 54016 (SW 1/4 NE 1/4 28 T29N R19W) Cedar Hills Estates II Lot 32 Parcel No: 28.29.19.1133 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 0 Yes No No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. commerce.vvi.gov Safety and Buildings Division County S 201 W. Washington Ave., P.O. Box 7162 iMadison, WI 33707-7162 Sanitary Pennit Number (to be filled in b% C o Department of Commerce 5 3 Kg Sanitary Permit Applica n state TransacCio°" N .;,ben In accordance with s. Comm. $3.21(2), Wis. Adm. Code, submission of this fo n to t rope go m I ~ unit is required prior to obtaining a sanitary permit. Note: Application rms f~ ~ned O ~ Project Address (if different than mailing add s) i~ary submitted to the Department of Commerce. Personal information you rovide ina s Oil l purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. 7(,(, l..Ct^Q 1. Application Information - Please Prin nformation 1 Property Owner's Name D Parcel # - ~o h J51. 14 O AIV p~ykNTLRp 0/ ®~D_ 1180 - 30 - oop Property y Owner's Mailing Address ?O 'UUAM~ Property Location / /133 (0G y- f Sfr~l 1- dLne- GOFFj +l Govt. Lot City, State Zip Code Phone Number LJ A, OV E Section U !q P-d $ o S"'tfn t !P 7 is-- 396 II. Type of Building (check all that apply) ` Lot # T q N. R q ~e 92 1 or2 Family Dwelling-Number of Bedrooms Subdivision Name ee .6 Block # CR r4-~, 14 A Lu -f-+-E - - ❑ Public/Commercial - Describe Use Pe-Al # ❑ City of CSM State O ed - Describe Use Number El Village of ❑ lt,/ ~3 C 14". Vt Town of Ill. Type of Permit: (Check only on box on line A. Complete line B if applicable) ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only .Other Modification to Laistirr~ ~%,ic.m B. ❑ Permit Renewal El Permit Revision ❑ Change of Plumber 11 L P Pei umber and Dat Issuzr Permit Transfer to New ist e~ revious j Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) dNar-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable sell ❑ Holding Tani Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat.. ment Area Information: _ ~Ot7r.. Design Flow (gpd) Design Soil Application Rate pdsf) Dispersal Area Required (so Dispersal Area Prop ed sl)r 111 System ?Flevat! 'I 10 0 0 . !o ,As /000 10 J61 p 8 - ~ncwL Y ° - - VI. Tank Info Capacity in Ix "f' Total # of Manufacturer Gallons Gallons Units i = - New Taak' Existing Tani ^ J = - U cn s / 1 / ^ Septic or Holding Tank O J DO O /,160 WJf 0~ l _ Dosing Chamber - VII. Responsibility Statement- I, the undersigned, assurne responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. Count /De ap rtment Use Onl s<Approve.d Disappr Permit Fe'e~j Date Issued ; Issuinb ,ent Signat re er Given Reason for Denial $ Z _ IX. Condiv$Zeasons for Disapproval G~*~C~ 1.: `epte tank, cell muss Iter ser ~ .11 dispersal cell must all all be be servk:es ! maintained as per management plan provided by plumber. Z sa ckTequitemertts must be maintained as pbr appUcablo code / arnaKCes. l ~vu { rv~ l.~J 1 ~tMOJ_ 4~ Attach to complete plans for the system and submit to the County only on { .per not less than 3 1/2 s I I inches in size SBD-6398 (R. 02/09) ti i - e f 15o t ~ 9 V t 4 ~ F `~e41 f f }r ~ /n I CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 0 cr►,. R ~y.,. ` ` p,1 Owner's Name: ,~ppLk+. pto Owner's Address: -7 Legal Description: V&1 ! R (-J Township: County: Subdivision Name: Lot Number. Parcel ID Number: O A0 - 1180 _ ° a Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. (A) License Number. 4,2 7 Date: /,;t - tit Phone Number 7 Signature ~ ~ sz \ n n Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 ~ Jam. O O i IN <~yo V a 0 a w T H • 8a` P r €e ~ ~ at Lf t!I 4tA- , x k" 4# 9 { a A o ~ Q kfichv4T ~,,=.R STANDARD CHAI✓IBcR T 9 ` 52" Quick4 Standard " amber -as° (EFFECTIVE LENGTH) L,_Z"a_ SIDE VIEW 1 Sc_..ICN VI(-`.r' ~wg oNsj~~ GRAVITY FILTRATION A _r. 2 Low Pressure/Gravity Filtration Order # Model # Description List Price EFB-ML3-916 ML3-916 Residential Effluent Filter 176.84 See Catalog Section (4) for Effluent Filter Alarm Switch! LOW PRESSURE/GRAVITY FILTRATION MODEL: ML3-916 & ML3-932 DESCRIPTION: The MI-3-916 and ML3-932 are gravity fed, natural flow filters designed to be placed in line with standard single home residential and commercial application septic treatment systems. Both filter models aid in the operation and longevity of Advanced Treatment Units, pump tanks, and drain fields alike by removing solids and semisolids from the progressive waste stream in. order to reduce _particulate and organic overloading of the downstream treatment components. It's uniaue.use of a large "Quiet Zone" to reduce flow velocity and high filtration inlet flow area help to reduce the opportunity for many solids to be forced through the filtration steps and beyond. FEATURES AND APPLICATIONS ■ Gas and high velocity vertical flow diverter plates. ■ Two velocity, reducing "Quiet Zones". • Three distinct levels of sequential filtration. ■ Nigh Level/maintenance alarm receptacles. ■ Cartridge easy maintenance access and alignment handle. ■ One optional 3/4" support pipe to reduce stress on the outlet pipe- N Single Home Residential. • Multi-Home Cluster Systems. ■ Pre-filtration for ATU'S. FILTER SIZEING IN GALLONS PER DAY • Small and large business septic applications. o Large and small scale industrial septic applications. Model Application <300 300-600 >600 CBODS 'CBODS CBOD~ (ML3-9:16) Residential 2750 2000 1500 INSTALLATION AND OPERATION The ML3-916 and MI-3-932 are each to be assembled with standard ABS/PVC plastic ML3-932 Commeraai 1875 glues to septic tank outlet pipes or adapter of standard 4-inch Schedule 40 PVC. /Industrial Each filter is to be assembled such that the filter cartridge can be removed for regularly scheduled maintenance cleaning as dictated by the system's design. An optional 3/4 inch schedule 40 PVC pipe can also be assembled into the lower support SPECIFICATIONS receptacle to reduce the moment stress otherwise placed on the outlet pipes from the weight of such filters. ED ML3-932 The ML3-916 and MI-3-932 both received clarified effluent from the clear zone of a septic tank by way of the lower inlet of the filter case. Clarified effluent enters the Primary Filtration size (in) 311611i . 1,12011 "Quiet Zone" where dense solids reduce in velocity and fall back into the septic tank. Remaining solids that make their way into the filters undergo three progressively finer secondary Filtration size (in) 1/81h 1,1261h filtration steps before entering to yet another small "Quiet Zone" to allow denser solds Tertiary Filtration Size (in) 1/161, 1,/32117 again to "slough" back into the tank during rest periods. This design is aimed to ensure that only solids smaller than the tertiary filtration step can continue on to the Total Weir Length (ft) 236 49 248.93 next steps of the treatment process. Settling Area (in2) 527.63 555.40 Outlet Size 4" SCH 40 4" SCH 40 - Materials PP/ABS/PVC PP/ABSiPVC Revised 2-1541 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner c~ Septic Tank Capacity app gal ❑ NA C. Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model j,. ❑ NA Number of Public Facility Units NA Pump Tank Capacity gal J14 NA Estimated flow (average) ~0 gal/day Pump Tank Manufacturer Of NA Design flow (peak), (Estimated x 1.5) 4150 gal/day Pump Manufacturer W NA Soil Application Rate . So gal/day/ftz Pump Model 611 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Df NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) 530 mg/L bon-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L X NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: N7NA Other: ❑ NA Other: CJ NA *Values typical for domestic wastewater and septic tank effluent. Other: Iff NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 15t year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA year(s) y Clean effluent filter At least once every: ❑ month(s) ❑ NA 6iLyear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) Rf NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ ❑ month( yeaarr((s) s) ► 19 NA Other: ❑ month(s) At least once every: ❑ year(s) ®NA Other: I? NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or part/ over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name q \ Name L") " Phone `7!$ - 114 Q- -33 ;L Phone -7 j 5 . -7Y`~- 7j -j aZs~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S T. Pt 7-'S-- ~F $ - l0~ Phone 15 - 3 _ (0 8 0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. A ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer pv-r, cAXV,,t" Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) I4 City/State a Y o Parcel Identification Number LEGAL DESCRIPTION Property Location S'^) '/4 1/4 , Sec. , T N R 15 W, Town of Subdivision Plat:, Lot # 3Z. Certified Survey Map # , Volume , Page # Warranty Deed # 'y 3 3 (before 2007)Volume ? 43 , Page # Spec house yes>(no Lot lines identifiable )(yes i i no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 frill of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF ~APPLICANT(S) /vDATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 1017 ASi t~w~=aglgcjorTyIN_.FOR~d.1-i~_i-~` THI• •rALt *&SXrV/Q POR "CORCIr ; DATA WARRANTY DEED 431013---- II Th* Deed, made between I(d~yC1@ F Mower and ii WIS. - •yl.tr.ray A Knechts ~s tenants in common e= r»3_i~ r#v6~ 12th : r arralitorr.: t~ •ra°e -Oct, y. Li. ➢ri'$% and_ D.cznald. Q---.Elhorri and Nanc y L Elhorn hixsband , 9:00 , - 1L an_d . w-i.fe as- survivorship marital property - ~I ,jam Oasntee, , rl boblar Oasd. f' W1tIleSSettl. That the said Grantor, for a valuable eonaiderstlon ( v conveys to Grantee the fo11 wing described real estate in C li_ Q-rQa X__..._ raauaei To i County, State of Wisconsin. Lot 3P, Cedar Hills Estates in the Town of Dip ~[80_30_oaDl - ~i Hudson. St. Croix County, Wisconsin Tax Parcel No , This 1 5 not homestead - Property. !i Together with all and singular the hi reditamenta and appurtenances thereunto belonging, (is, is not) - ~ - - - And.. - I]_0 n'e - warrants that, the title is good, indefeasi I. ble in fee simple and free and clear of encumlirances except easements, restrictions and rights-of-way of record, if .any.. i - and willwarrant and defend the same. Dated this - day of . Qc.tob.er 1e._-9.7 e - 11 -.-(SEAL) -------(SEAL) a M . - _ ---(SEAL) '--(SEAL) it ° Murray /A_,-- Knecht _ - - - - I~. AUTIi,E11iTICA,TI0I1T - ACKNOWLBDGKRNT I Sigliature(s) STATE OF WISCONSIN N. ~U ~.s3_>Couaty. authenticated this;- -_---day of__ _ , 19 ` Personally came-before me tbJA t h day Of October > 19 ..8 I_ the above named ( i '9 Moyer ._~,nd _ - 1 to r ~y Kn e tt>< r -as Lerian t------ _s { TITLE MEMBER STATE BAR OF WISC6*-§IN LCI.- lir. l ` common (If not _ authorized ~i r 4? ~Y § 706.06, Wis. Stata ) Gj Y i v _ tdina known to be the person -5 . who executed the j - Q 0 Y(=,going instrument and aai.,...: 6eme• II l eds_ 16 I, THIS INSTRUMENT WAS DRAFTED BY u j 91 . _11al-_-Ms0_ae.r o_f._.Mo _~r.-•I~olne;,, Iy4c.; , i ~~,~ScPt._ yal,lr M Maser !L • - Notary Public - - - E a U _ C-7 r3.11-e County. Wis. (Signatures may he authenticated or acknowledged. Beth My Commission is permanent (if not, state expiration are not necessary.) ~ date AJUZU SIv .2D--------- la-$ °Names of pereo". eiq ~.,ns in -p;,City should be typed or prlat~d below their I' _ s3anaturee. 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O = N a a m 3 7 3 (=D3 p z M 5; 0 to ;a = C' < d A (Z 7 CL O O W ! < ( ^ in d l Q ~ A Z1 f~ O z fD p g m I ~ z A CD w 1 w n a n I o 3 ~ c \ 'o o ° ~0 N I a zs A O4 O N O ti Q I ~ I~ ti w ti CD CL Y INDysT DTPART;AENT Ry, Or REPORT ON SOIL WRINGS AND SAFETY & BUILDINGS tNC1US TESTS DIVISION LABOR AND P.O. BOX 796 HUMAN RELATIONS PERCOLATION (115) MADISON, WI 537097 (H63.09(i) & Chapter 1455.045) t.p(:Artf ti N~'T` , t~PiON: TC}WIY 1 UNIIPALITY: OT NO.: BLK. NO.: SUBDIVISIO NAME: - jz~J/R/9/9104, COUNTY: gVJNE AM nNG f'W NN Et- USE DATES OBSERVATIONS MADE ~ j~7rCIO. B(-_° O MMWA' -bTgr ' ON: I'R R15FI LE-6E CRIPTIONS: N TESTS: Xl_~i~951(ierlGG ^ NK New Replace C Z -7 2-4 /9,V-7 "Sc~lcs &>o►c~a~r~ 66 ~It_S ~n~-Y RATING: S- Site suitable for system U- Site unsuitable for system 1*jZ ` Pup Y N p itxs T t. V~~r~~T~: M~ UN!~D: 1(V-G(I~ : S -I V`~-FILL OLgING~T K: RECOMMENDED SVSTEM:In tionat) If Poraolation Tests are Np"P requireds IGN RATE: If any portion of the tested area is in the under s }ffi3.09(S)(h), indicate: ~R DES C 1 ►ySS ' Floodptein cate Floodplain elevation 4A PROFILE DESCRIPTIONS BORING TOTAL _ P ~ U DWAT R-INCH C A A R O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER UE F?ll-1.E ELEVATION b S RV D E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) c. `~X B- - `Q'~ 7. /7 /?"F3cCrS - . 7:9 7.: ` .:~._l > -7 9Z b f BSc c 7's `'`1' ry /I?`a~~i ~l ~Gv {'r N 1r't , B ~3 tx , Nnu,~~J._._ 12"~«'rs ~2 ~NNI~~C,cola.'►~~L~ ►~N.-/`1?__ B. 146 rq • 58 2 1~ CTS If S -riei_5 B ! M~. c)f I1"6LL7-5 16"IRr4 MS,6P, 11"A0,„i m N Lr ISO "7 1,; PERCOLATION TESTS 'r l b"T OEPTH WATER IN HOLE TEST TIME -I H RA MINUTES NUMBER If MS AFTERS ELLING INTERVAL-MIN. PER INC14 >2 I PLOT PLAN; Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the. plot plan. Show the surface elevation at all borings and the direction and percent of land slops. \ SYSTEM ELE"TION 94 ,/o km wz y ko~T J.-'`✓~ Q-Z 41r p ov- ON SOIL BO IN S AND SAFETY & BU1IVISIO s f~EpARTPltE~iT OF REPORT DIVISION INDUSTRY, ,.0, BOX 7969 LASOR AND PERCOLATION TESTS (115) MADISON, wi 53707 HUMAN RELATIONS (H63.090) & ChaPtet 145.045) NAM ro- F, -N 5 eCTION. 7OW I UNICiPALITY: OT NO.. BLBL : MCSF,46 DIVISTt LOCAT s~ f ~8 R 4e ~ SCOUNTY: WNE AM£: A L . DATES pBSEI~t'VATit1NSMAtiE USE+_ _ L ! TS: na co an ERCIAL R! tonf:Jfve w Z4 G~Rep+a~e Jun1 t~ z 3 !9 7 'VC 1 & 7 Residence UNK RATING: Ss Site suitable for system W Site unsuitab(o fo► stnte+n -IN-FiL OLQING K: !N ECOMMENDEDSYSTEM:( tionat) V'" 1 :MOUND: •G t~ Ou S ❑V nV ~S ' 4& r10V4L A 's S If percolation Tests are NOT required DESIGN RATE: if any portion of the tasted area is in the ~A under s.ti63.09{5)(b1, indicate: CL+4SS ' Floodpiain, indicate Ftoodplain elevation: PROFILE DESCRIPTIONS * BORING TOTAL P t1 R U Q AT R INCH S CHARA R OF SOtL WITH THiC+GNE .COLOR. TEX iURE, A DEPTH Idt ER PIH ELEVATION OBS RV g TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) j 71.? 94_: W 1-7kLLTS /4 gi SL r- B- ~S L7 : Q - "7. r Z cl 3 ~ 1 V o 1V~ ~ ! 7 9 G. o Q E. x.75 fS ~t - B- _ g p8 ib 37 NoNt 9 4iP08 12"9LL-rS ~Z"~aryl~!s#f~ - Gb i -4'&r AN M __j . B . b N0NC > 7 s8 z"8LCTS A""131:'ntMSdGR4C~s Lrge4,~ m-`>~--- ~ .__y - 1l p$C LTS 16' UN AIS $CaT;'. 11 r$li,^J M ~ B• i '`7`~,rt i~f i ~.SO " PERCOLATION TESTS -ES ! 5E TN WATER IN HOLE TEST TIME DROP IN WATER CEVEL-4NCH RAT MIN '-rES Nt ER i S AFTERSWEL/LING INTERVAL-MtN. PERiNCI{ P. _z 7.x-7 96.37 3 1 P. 3 ~~9~ 9 04 3 > 3 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what we the hori xontal and vertical Wevation reference points and show their location on the. plot plan. Show the surfsce elevation at all borings and the direction and perwni of land slope. SYSTEM ELEVATON 9 q,/ o P O WZ Y C. 1,40- ALTEMATi DoT 3 ~ .1q