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)
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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
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Sc_..ICN VI(-`.r'
~wg oNsj~~ GRAVITY
FILTRATION
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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 ,
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an_d . w-i.fe as- survivorship marital property
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Oasntee, , rl boblar Oasd.
f' W1tIleSSettl. That the said Grantor, for a valuable eonaiderstlon
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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
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ble in fee simple and free and clear of encumlirances except
easements, restrictions and rights-of-way of record, if .any..
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- and willwarrant and defend the same.
Dated this - day of . Qc.tob.er 1e._-9.7
e
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° Murray /A_,-- Knecht _ - -
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AUTIi,E11iTICA,TI0I1T - ACKNOWLBDGKRNT I
Sigliature(s) STATE OF WISCONSIN
N.
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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
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1 to r ~y Kn e tt>< r -as Lerian t------
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TITLE MEMBER STATE BAR OF WISC6*-§IN
LCI.- lir.
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(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
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I, THIS INSTRUMENT WAS DRAFTED BY
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. _11al-_-Ms0_ae.r o_f._.Mo _~r.-•I~olne;,, Iy4c.; , i
~~,~ScPt._ yal,lr M Maser !L
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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.
WARRANTY DE&D - aTATR BAR OE' WISCONSIN Wisconsin hail Blank C• Inc.
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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