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HomeMy WebLinkAbout020-1282-60-000 N -0 CD C) C:) C 3 3 6 6 0 0 M N Q e» Q u3 e» y h 0. 0 0 0 0 N ti I M h aD 5 III' i ~ I ~ o a~ o C Z M z of O~ - 7 (O (0 LL O O O N a "O C O' I Q Q D I 3 v Z' wII E rn y o v p z r a W ~ 04 0 0 m o Z v u O V e- N .O rn 'O N Z d C z z H N N E -2 N (D co N co CL O ~ C a) N N ~ O N • L' = p L O Q O - a Q Q w Z I- Z o 0 N - z E E z T ED 'o ED _0 r_ c L1J N > N IC O O N V L1 M L Y Y C LO In Y Y C In In lA Vl y d fU O cz 0 O O (0 m .0 O O > N N N O L L vU. N N Q U O O O O O a cn cn o° a cn cn o v v Z o o Z C) O •ti a aaa a _ fn J U rn O Z } z 0 (D T" O LO O U') CD C) CD (c a C) C) O O E N N Q Q E N N a) (U IL (n Q N N Vf Q a) N 0! Q Z w>- 0 m Q Z w> to D 7 r"r C V' O O E rn c O O C On U N O O C3 = 0 0 O C O O CI 0 0 Q o 3 N S C N w c~ n rn O o m rn o O rn Tr (D D- CL O > d O. C 'O N N N E E E E N N N M R r- C 6py N 7t r-- C~ D ~p N N L L N O (h M_ LP) N_ L L M M Lo O N C N _ N O F- F- C N O w O O H F- O N t1) c0 t=y~,l ~ O N 'j 06 CO O N O O E E V p N O O E E t9 Q C) C4 C) z z =3 1=i Y! U)i z O ,~k Q is a w CL m d tt`wN y E 3 3 .2 o `1 A Ua~ '.0 y0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,~,e fV ADDRESS SUBDIVISION / CSM#~~~/,`~~~~r~ LOT # SECTION T N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r 1-2 - r- i Y a I° `J - I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM• i II! SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model#~/ Size Float seperation l% Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: --:5 Length Number of trenches 3 Distance & Direction to nearest prop. line: Setback from: well:. House 5 Qt- Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: j J~ PLUMBER ON JOB:, LICENSE NUMBER: INSPECTOR: 3/93:jt LIQ1%?'s V,,t0 #1c Q , jy7.29.19W, AT SEW GJ~I STEI'rlook P unty: P% F A- ti Labor-and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan D o.: DrVIRLOR Hudson CS B Elev.: Insp. Elev.: Bpy De caption: Parcel Tax No.: 16 , l a , &D .D 'e el - TANK INFORMATION ELEVATION DATA A9400037 ] TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1-2 1,M , 06 Dosi ng G- i Aeratio Bldg. Sewer Holding St/kWINet 9/ a TANK SETBACK INFORMATION St/)W Outlet 1/,171 9C7, TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet Septic 75D~ ° NA Dt Bottom a 17 7flD Dosi ng NA Header kAlaR, 7 e ° Aeration Dist. Pipe ` --Y- 97/2 Holding Bot. System P- 9(. 33 PUMP / StIFORMATION Final Grade ' Manufacturer Demand Model Number GPM /q/ I TDH Lift Friction S tern TDH Ft Force main Length Dia. Ha'~ Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT - No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC Manufacturer: SETBACK CHAMBER INFORMATION TypeO ne,.- oae °S':5. o ber: System:ed;ZZ' C. ~o OR DISTRIBUTION SYSTEM Header / Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length_ Dia. Spacing 62t:9- _Zz~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade System nl Depth Ove a I/ Depth Over xx Depth Of x odded xx Mulched -7m~ i o 1 01 Bed /Trench Center `?~a S Bed/ Trench Edges Topsoil [E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.17.29.19W, SW, SE, Lot 107, OverlooX Pass f ° r ,f- ~ef ~r d~ ~ ,j~ fi / ta- .,.•~-{J-'_ 1'" ~ 'C.•'C'''~.-~ /'~crt _ 6-"f~~w' -`-t' - • /i Plan revision required? ❑ Yes No Use other side for additional information. / SBD y740 (R 05/91) o Date Inspe r s Signature Cert . No SANITARY PERMIT APPLICATION COUNTY v~~■'■■7 In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY P MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than r~C7 xV 8% X 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ,e>>,. Aa tl.-,,> S T,,?_ rh N, R E (or) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) ❑ State Owned VILLAGE : TOWN OF: Z/ ct~ ' ❑ Public N 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo o'er ~P ~--CJU 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 in line A. Check line B if applicable) A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System E fisting System -3L-3 B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution ~xpeT1~15elttaf - they 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ing Tank 12 C~ Seepage Trench 22 ❑ In-Gr and ) 42 El Pit Prl y 13 ❑ Seepage Pit Pres re 43 ❑ Vault rivy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOA ERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/da /sq. ft.) (Min./inch) ELEVATION 711 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank F-1 77 F-1 F-1 Lift Pump Tank/Si hon Chamber l VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) M )MPRSW No.: Business Phone Number: 1 Plumber's Address (Street, City, State, Zip Code): Ile, r, ' IX. COUNTY/DEP RTMEN US ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing ent Sign ur (No S Surcharge Fee) Q Approved ❑ Owner Given Initial 7 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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 the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ~j i i r - ~c:tos -5- J I I . t2, _3 PAGE OF PUMP CHAMBER CROSS SECTION AKJD SPECIFICATIONS VENT CAP 4°C. I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER Z5~ FRCM DOOR, WINDOW OR FRESH 12 M"`~ I AIR INTAKE i GRADE I `1° MIN. IB"MIN. CONDUIT I~11..F 1 PROVIDE I - T AIRTIGHT SEAL I III II APPROVED JOINT A I III APPROVED JOINTS W/C.l. PIPE. I III W/C.I. PIPE EXTENDINC. 3' I II EXTENDING 3' ONTO SOLID SCt:. ALARM B I II ONTO SOLID SOIL I I I ON C I i 1 PUMP ~ OFF ~ D CONCRETE BLOCK RISER EXIT PERMITTED OML'J IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS SEPTIC AND DOSE TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy TANK SIZE /LL) y GALLONS DOSE VOLUME ALARM MAWUFACTUR.ER: S f iCc cri ~c.C ~sINCLUDING BACKFI.OW: yC /L'c ~ GALLONS MODEL NUMBER: --1'2 y CAPACITIES: A= IUCHES OR GALLOWS SWITCH TYPE: %77iY~ B=INCHES OR GA'_LOIJS PUMP MANUFACTURER: C = INCHES OR ,Ll 4tA!_L0 NS MODEL NUMBER: D= ll INCHES OR `~LEI GALLONS SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHA.RVE RATE y~ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE Bt`liwr w PUMP OFF AND DISTRIBUTION PIPE.. ~ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . FEET + FEET OF FORCE MAIN X F j li FEET 100 fT.FRICTION FACTOR. ~ TOTAL DYNAMIC HEAD FEET IKJTERNAL DIMILMSIOKJS OF TANK: LENGTH ;WIDTH G -;LIQUID DEPTH 51GUED:_/L LICEWSE 1JUMBER: DATE: ~ -11~- Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of .Labor and Human Relations Divi pion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPS TY E ~ II/ PROPERTY LOCATION UG h/G» rL GOVT. LOT(~.1 1/4,54C 1/4,S P7T 7_. N,R/9(1 PROP? TY WN MAI NG ADDR SS BLOCK # SU AME R M # CI gE ZIP CODE PHONE NUMB ❑CITY ❑VILLAGE OWN NEAREST ROAD New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow' gpd, Recommended design loading rate 7 bed, gpd/ft2 • trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 • 8r trench, gpd/ft2 Recommended infiltration surface elevati (s) ' It (as referred to site plan benchmark) 9-3 arc J- - n Additional design / site considerations Parent material Flood plain elevation, if applicable ft S =Suitable for system ONVENTIONAL 0 ND I GROUND PRESSURE 7 T GRADE SYSTEM IN FILL HOLDINCL NK U =Unsuitable fors stem S ❑ U , S C1 U I ;n ❑ U S El U ❑ S ~tJ ❑ S NPU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench { 77 777- 7 Ground " C L-J . S t! -27 7, A eld"~-7 I 7.35,E ,-V rX 04 5 ~ Depth to =/O Q M 2. :rywllelf s e 00" 49 Y H'J -.7 limiting fact t+ 5 o J10, 6 el^- / " l's Remarks:/ 11 JFVvr- IV 7-- Boring # 1 ~9 o Q .BSIr m r~' y c ! 5 •:ti•::\E~:::i:::~:ii::: /0 1~ 0Yd $ Y~~ /M r ~wt S 1 7 Ground e ev. ' ~ ao~ t. 5 a A~ S/ A, C4, 4s~ ` Jf . - , -1 - / I Depth to limiting r ar fact > If Remarks: & ZO^ 4 •Z r ~i^oG.. u I ~1 {ta CST Name: P e P nt ~j1, Phone: Address ~a 3,s'/!/l sa+j. 4.11 SS~~✓.l IS RWIXI Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page ?-Of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 13- fl Ground ` Z~ D /e 6 y 49 S i Depth to QG/r .3 %S ✓ a'~' dwl,- G w " limiting ~f I Remarks: Boring # Zvi • y s to Y,e ! , 7 603 s ! s 04 Ground Depth to limiting ~O Remarks: Boring # 0"2f loyleZI) i o K Of Y Ground LLB fC r~~~s~ Depth to roots CAW fe / ~ p limiting, /d2n "2;b- fay. Remarks: Boring # a Q Y'r Z /IdbY~- J/ ~la G" Aw 2vi , y j 0-"z 7 1- 7,1-53- 0 YX .513 F Ground VIV liev._ ft. q7-40 1,7 1.9 Depth to limiting \fpcjor 'r 1/0 , 0 Remarks: SBD-8330(8.05/92) FoN.,,(~F,m• ~L = too 4S5 - _ i 4 ~ t r 1 1 ~i r , 83 i l a SANITARY PERMIT APPLICATION co . DILHR u TY In accord with ILHR 83.05, Wis. Adm. Code 0-ya ' X STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION of e v ~.C o /ylt,~ Z'- Y4 /4, S TA V , N, R ¢ E (or) PROPERTY OWNER'S MAILIN ADDRESS LOT # BLOCK # m,tc-A e,4 s CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER h~~4_T,g A-lLgJ -S`tO/td "ClC G.) it T 9 -171 II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) El State Owned ❑ VILLAGE o d~~ ~sS ❑ Public 5a1 or 2 Fam. Dwelling-## of bedrooms -~4 PARCEL X NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) ~q a (a per- t:~' O 1 ❑ Apt/Condo v It 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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 in line A. Check line B if applicable) A) 1. E.New 2. ❑ Replacement 3.E1 Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) !ti^ M LEVATION A; m- 0 d 7 Feet fFl- Y 2 Feet VII. TANK CAPACITY Prefab. Site in gallons Total # of Manufacturer's Name Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App. Septic Tank or Holding Tank Tanks Tanks Q~ Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: 42 Plumber's Address (Street, City, State, Zip Code): IA70 c ` IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (Includes Groundwater Ca e sue Is Agent Si ture ( ) Approved E-1 Owner Given Initial Surcharge Fee) /1 y 31t Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R.11/88) 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 the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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 systE?m. 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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) l 4 • d8Y { Ei Sr' ~ e A ~s .tea ~ccc -e I yQ ' pyr x e 0 Yy~ 02 Vµi' rtment of Industry, SOIL AND SITE EVALUATION REPORT Page of , Relations ty & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION e . eX GOVT. LOT 5'cj 1/4 5,r-'114,S /7T N,R E (orLV p M # PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # 7BD NYE CjLg~ Z10 _2Z- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VI GFr WN NEAREST ROAD ( 7r % / elk~,of clgy _4 -71 H~ _ 1 7 11,91, L°i- ~c.C t~ s s ~]r New Construction Use Residential / Number of bedrooms [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate -bed, gpd/0i'trench, gpd/ft2 Absorption area required d ~(3 bed, ft2 S~3 trench, ft2 Maximum design loading rate _17 bed, gpd/ft2 : g trench, gpd/ft2 Recommended infiltration surface elevation(s), 9Z ft (as referred to site plan benchmark) Additional design / site considerations 16, " m C,- t j Z To ow f- • ,r f- ~o. n y-u l~S Parent material Flood plain elevation, if applicable ft S = Suitable for system ONVENTIONAL W' I -GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S❑ U ❑ U S❑ U Cgs ❑ U ❑ S JR ❑ S ZU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Pont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground 3 c" ! /7 / dK i%~I cJ / 7 elev. Depth to limiting Remarks: Boring # J / Z`.ti. Z 2' yf i G, S 3 S s l /''9 yr C L Z. Ground '3 l It 7 y ` ? 5' ~Z AX 14 Yy' ~ S G ZIA ft. Depth to r /c y2 S/`~ 7 .1 limiting 7 f ctor Remariz 7, o-r, 7 7o r'ior r4lr~ <~'l ;4), ^ r+c~C~rn~u CST Name:-PI e P Ant Phone:. "7 Ve J Address: a 7 75 Signature: Date: CS tuber: PROPERTY OWNER SOIL DESCRIPTION REPORT P 3~- PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends Z-5 lAt 0' n C iv v~ Ground 3 :41.5 6 q4 l fl bK 01 T r w itr S elev. & -t) ft. y 56-70" /V 5 5• ~'!1 #~v A/ J~ S~3 S M l Depth to 70'J7 limiting ~ac r0 Remarks: Boring # o- i t ire 5% lc v ZY f s 2 3 /C A 53 5 S Cv~ v C, l✓~ g eU G Ground q4 l 21~/f iC v`~ ~ • S l~ l+fl lev. -71 l Z y S l ✓ 5= L kyl S~ft. Depth 5 7/ m to limiting \ fact , 417 Remarks: Boring # -17 'G7 z arc. S / / mV - few : S Ground Depth to /0 rX 5 3 5 , X limiting actor - Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PC oor lu \ j a P le 7 sy , 'Y' cis i jrc, 3S 10 I •r° s~ az ~ i i e G i ~ I I i Wiscon,pin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Labor, and Human Relations Derision of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY 'Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OW ER: PROPERTY LOCATION GOVT. LOT 5*~,-,> 1/4 i C 114,S 17 T 19 N,R E (or6V PROPERTY OWNER':~ AILL NG ADDRESS$ n LOT # BLOCK # SUBD. NAME OR CSM # V, S02 CI TgTE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [jfOWN NEAREST ROAD New Construction Use rJ Residential / Number of bedrooms [ ] Addition to existing building J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate __2__bed, gpd/ft21~_trench, gpd/ft2 Absorption area required bed, ft2 S j trench, ft2 Maximum design loading rate -7 bed, gpd/ft2 $ trench, gpd/ft2 Recommended infiltration surface elevation(s) L, ~j " / ~rft (as referred to site plan benchmark) Additional design / site considerations X17 "i f}G L f k r ~J l lJ I lc i' Y , - i cc t Parent material Flood plain elevation, if applicable ft S = Suitable for system ONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system S0 U EN'S ❑ U S❑ U MS ❑ U ❑ S D.U ❑ S IA U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground yl,7 (f 4" elev Depth to :°y' limiting - - Remarks: Boring # L ~ is ~ ~ Ground - - - - - elev. I,/L ft. - Depth to limiting factor - Remarks: //A: CST Name =PI ase Print Phone: Address: ~t- Signature: ' , Dater CS tuber: PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3~ "PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrerxh' Ground elev. j /~LL ft. It Depth to -~j~' - ✓1<=,~' - limiting Jac - - - - Remarks: Boring # Ground elev. q 5,5 ft. j 7/ Depth to limiting factor Remarks: _ Boring # r] r Ground - Depth to limiting actor ILI Remarks: Boring # Ground elev. ft. Depth to - limiting factor Remarks: _ SBD-8330(8.05/92) P 01 Kl IV, //0 /e,~~~ %z y ~ 11 J-z S vv o t BEARINGS REFERENCED TO THE SOUTH LINE OF THE SW I/4 OF SECTION 17, ASSUMED S89009' 27"W. 1 411 I Ult 1 K VIEW ESTATES FIFTH ADDITION- ' 211 ZQ1 11 -3, N 89'09'270E I) 1029.31' 66. 209.31' 204.00' 15' 176.00' 8000' 949.31'- 104 105 106_ 57357 SQ. FT. :L 54641 SO. FT 55799 SO. FT. 1.317 AC. N W 1.281 AC. N 1.254 AC. 0 fD N I O> 'y to ~ ' q w N O 0. M to -N N 0 cn N 0 Ot (D M O to rn 0 O cn 15' 3 5q' S 2► _ o - _ 22 X92 .F j,2 s /34 2O u Qo 5?6oni'31W 24 23 / 344;3 f 1 \ 25 26 15' N~30 /"3 423"W / 28 t~0 27 W to 1 N Q a 110 0 N 'r a Ncn, 0 Iw aDo N 66.00 53 708 S0. FT. CIO Q4F Q o 0 1. 2 3 3 AC. N m 55T ~D J (n N 'co N 1.267 AC. co N zi .4 If) 0 al 1 N 4 N 89'43'37'E I of Z N 231.07' 0 z w I 0 co ~ It M z O Q 14 1 15 N 89'43'37"E v zl 240.00' :D 47260 SO FT `r Z W 3 - / 1 085 AC 0 = z 0 w 0 _ - cu 108 t" I ~ O (V li w is m 59222 S Q. FT to N O cn P- N (D w w ~ 1.360 AC 0 a z 0 v0 - 0 S N 8p17•07" E to 1- \ 213. 3q • a w / / wI S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER / l cJ1 t?. Id ve ADDRESS .FIRE UMBE CITY/STATE #v(~ /an, /V/~ _ZIP PROPERTY LOCLA~TION : SGL 1/4, J 1/4, SECTION L/ , T L N-R_./~-_`W TOWN of AJ , St. Croix *County, SUBDIVISIONA jleiu' ild-7C k l , LOT NUMBER. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into tAe system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix county residents may be eligible to receive a grant for a maximum of 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 system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification'form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1). the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration d te. r SIGNED: DATE : St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 S T C - 100 I This application form is to be completed in full and signed by fthe owner(s) of the property being developed. Any inadequacies will only result ~n delays of the permit issuance. , Should this development be intended for resale by owner/contractor,(spec house), then Iasecond form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. l Owner of property .~ii C Location of•property 54ti 1/4 1/4, Section Township /C)CACI/ 1 Mailing address A Address of site Z" /c/ 6111ex-'1004 <A'r' Sor A11 ~yQ/6 7 117 Subdivision name- Lot no. 1~ 't Other homes on property? es No Prev ous owner of proper y Total size of parcel /C?C,-e f Date parcel -was created !'Are all corners and lot lines identifiable? ~._Yes No Is this property being developed for (spec house)? Yes X_No Volume L/o~'3 and. Page Number y~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register of Deeds as Document No.-3f5-020 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No ._39.saZD signature of a icant Co-applicant Date of Sig ature Date of Signature • 5r. CROIX Co., W4 23 YY # AY K'u N 7t r ~~~1 ~ KA W4 Rewd N& rd c ~ ~R✓ fiN,.• ~ e ~e ~ 1~rY 7iivlwi°" ~"~M 21 d " h<•~- a Codtraft, b and between Arpald >t..,; 3ertelsea a/k/a b~ R Y firgia>~a A.: Bertelsen. ` b ebond `and - i#r,Y'ihadOr, SOW % lopme t ' lob `w • - a i~iscopsia op r • `~.1►andos "sells' sad' agrees-~ toE. y to . Pwrohassr, ~ upon,~ths p~c.~t aadlull f "pertoz+ssace of this Contract by 1 =the.following`property, together with ;tht "ata," profits and other a erese called the ."fowty"), in 8t. Croix County, State of,Wiscossin:' - South 53 1 /3 rods of Month Hal;, p t...8outbftst Quarter, (SjSWk) MW South 53 1/3 rods ol::Sou F . . tbw*t`~ Qiwrtsr of Southeast Quarter (SWtSA) of Section _17 &19W. That part of Northwest Qur of Northeast Quarter (NWT 17 NEU and of Northeast gwrter ;of NWtW"t qusrter (1t S, NWU of Section 20, ;ZMi.kIL19W. lying Northerly of the }+~~~ti b a centerline of St sCro37c Cowmtty Trmk'Rishvny "O-(formerly lentt+n as Hudson-New Richmond $igb y), EXCEPT the following parts of the above described tracts: All land included witLin the Plat of Willow Ridge Second JFEE Addition to the Town of iludson as described in Vol. 4 of Plate, page 25; Parcel deeded to Marlin 0. Andshl and Ruth L. Amdahl as described in Vol. 517, pags 26, Document No. 324368; Parcel deeded to )Roger 3. Hetchler as described in Vol. 517, page 114, Document. Number 324430. TOGETHER with an easement for street purposes over the Easterly 33 feet of said parcel deeded to Roger E. Hetchler as described in Vol. 517, Page 114, Document Number 324430. h SUBJECT TO the right-of-tray of said St. Croix County Truok Highway "e and to telephone easement adjacent to said highway as recorded 3 in the office of said Register of Deeds. ' Purchaser agrees to purchase the Property and to pay to Vendor at: St. Croix Heights, Hudson, Wisconsin, the Base Purchase Price of $100,000.00, together with additional payments per lot, as follows: 1. Base Purchase Price. The base purchase pr'ce of $100,000.00 she paid in the following manner: $15,000.00 at the execution of this Contract, and the balance of $85,000.00 together with interest on such portions thereof as shall P remain from time to time unpaid, at the rate of 10% per annum, until paid in full, as follows: i (a) For each individual lot developed and sold by the Purchaser, Purchaser shall pay to Vendor a $2,000.00 principal payment, to be applied to the $85,000.00 base contract balance outstanding. (b) A minimum annual payment of $15,000.00 principal shall be paid each year, excluding the year of sale. Each per lot principal payment required above, shall be credited toward this $15,000.00 annual payment. (c) On December 1, 1985, and on December lot of each year thereafter, Purchaser shall pay to Vendor the differential between the.required minimum principal payment of $15,000.00 and the total $2,000.00 per lot payments made during the preceding twelve (112) months, until the Base Purchase Price has been paid .;n iull. (d) Interest on the principal balance of $85,000.00 shall accrue from the date of closing, with annual payments of interest due on the 1st day of December, each year, commencing December 1, 1984. q,ky 2. Additional Per Lot Payments. In addition to the foregoing Base Purchase AIMM,•.r,Aw Price payments, Purchaser shall pay to Vendor additional per lot payments totaling not less than $150,000.00, as follows: Tugren Sgwe $02SecomSt (a) No interest shall accrue on the principal sums paid to Vendor Hudson. Wn under the terms of this Paragraph. 51016 715 386 6231 s VOL, er-' e +F ~1 9~ , . (b)_;,8wcxbaser shall pay to Vendor the sum of $3,000.00 per q~~\ lot an 411 residential lots developed and'sold by Purchaser, subject to the condition that the minimum amount of payments to be so" to Bertelsen under this Paragraph shall total _ at least $150,000.00. _ (c) Dar' ssg each year of this Contract that there is an outstanding contract balance of the Base Purchase Price (Paragraph 1(a)) there shall be no minimum annual principal payments under this paragraph. Commencing with the year following completion of payment of the Base Purchase Price, Purchaser shall pay to Vendor a minimum annual sum of $15,000.00 per year. (d) On the lot day of December of each year, Purchaser shall pay to Vendor the differential between the minimum annual payment of $15,000.00 as provided in this Paragraph, and the total $3,000.00 per lot payments made during the preceding twelve months, until the entire $150,000.00 minimum stn has been paid. Thereafter, if Purchaser sells any lots in excess of 50 lots, Purchaser shall pay to Vendor the sum of $3,000.00 for any such additional lot sold, up to a total of 53 lots. ($159,000.00 total hereunder) Purchaser shall not be required to pay monthly payments to Vendor sufficient to pay reasonably anticipated annual taxes and special assessments. Any amount may 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 long as the entire balance of principal, and interest where required, is less than the amount that said indebtedness would have been had the monthly payments been made as set forth above. Purchaser states that Purchaser is satisfied with the title as shown by the Abstract of Title submitted to Purchaser for examination, except: Real estate mortgage to Sam E. Miller, dated February 1, 1980, recorded in Volume "608", Page 152, Document Number 362685. This mortgage shall remain the obligation of Vendor, who shall keep said mortgage current and in good standing. In the event Vendor fails to pay any required mortgage payment, Purchaser shall have the right to make such payment, and to deduct any payment so made from the sums due under the terns of this Contract. Purchaser agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the property on Closing. Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances a.ud regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditons shall be full performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except, subject to utility easements and covenants and restrictions of record. Bertelsen shall have the right to purchase one (1) lot from B b H for the sum of lt5,000.00. Bertelsen may select his lot after B b H picks its first five lots. I -2- .;5 0 L Mm, 49 ®.t Vendor shall consent to the platting of the premises into residential subdivisions by Purchaser and Vendor shall be under an obligation to approve and execute subdivision plats prepared and submitted by Purchaser. In addition to the Warranty Deed which Vendor shall deliver at time of ultimate closing, Vendor shall execute and deliver to Purchaser, individual Warranty Deeds covering the separate residential lots which Purchaser may sell, F' upon payment of the per lot payments set forth above. All costs of platting and " costs incurred in preparation of individual deeds shall be Purchaser's expense. Purchaser at-*as that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 60 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 60 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), than the entire outstanding balance under this contract shall become immediately i due and payable in full at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity; M Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through y strict foreclosure with any ecuity'of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the L date of default at the rate in tffec: on such date and other amounts due hereunder (in which event all amounts prev:o+:sly paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific peformance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this t Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under M, 61) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. R Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the Court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or aseignment of Purchaser's interest under this Contract solely as security for an indebt3dness 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 may waive any default without waiving any other subsequen~ or prior default of Purchaser. -3- j S %i ~A •1 r 10~ft 683"K 49, All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this 29th day of Hay, 1984. VENDOR: PURCHASER: B• S H EVELOPt~ENvT, INC. BY. C \ t' Arnold R. Bertelsen f,;•~f a/k/a A. R. Bertelsen Donald E. Bjornst President t ATTEST: Virg a A. Bertelsen William C. Harwell, Secretary v c •'t-0 Authentication: Signature(s) of Arnold R. Bertelsen, y o Viryinin A_ Barra Lan_ his wife, and nenwtd F_ Bjamatad and William C. © w~ Harwell. President and Secretary re, ctively of B_6 H_Develonment, Ipc., authentic day of May, 19 William J. Radosevich 1 Member State Bar of Wisconsin. This instrument drafted by: William J. Radosevich Attorney at Law Hudson, Wisconsin 54016. i I