HomeMy WebLinkAbout236-1622-00-000
Safety and Buildings Division County I
201 W. Washington Ave., P.O. Box 7162
nsin l t - Madison, WI 53707-7162 Sanitary Permit Number (to fled in by Co.)
tot _S&373
• 1 State Transapti~n Number
n aa;ex ce wrtlt s. ofriin. 83.21(2), Wis. Adm. Cade, siibmissi~ bf this foim to the appri►priate govemnrattal
unit is required prior to obtaining a sanitary permit Note: Application forms for stateowned PO j Addr6ss (ifditTerent than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for„
Purposes in accordance with the Privacy Law, s. 15.04(l m Stets.
L A 1' u I fo a' t N lpf a00 ?r
Property Owner's Name Parse! " -
Property Owner's Malting Address Property Location
- Govt Lot 119
city, state Zip Code Phone Number
h, Section ~S
(circle o
y T49 N; R A _ E W
1. Type of B ing (check all that apply) Lot #
0 1 or 2 Family Dwelling -Number of Bedr. Subdivision Name
Block #
❑ Public/C ommerciaL- DescFibe Use o 2 3
e5k
r U cityof ~u2rnst/
❑ State owned - Describe use CSM Number ❑ Village of
Q Town of
Iil. Ty only Me-box owliae A. Compktrfine lfif applieaW
A ® New System ❑
Replaoamart System ❑ Treatrrrent/Holding Tank Replacement Only ❑ Outer Modification to Fainting System (explain)
❑ Permit Transfer to New List Previous a it Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber
Before Expiration . Owner
IV. Type of POWTS S steasJCo® t/Devcee: Cbeck all that
® Non-Pressurized 1, Caouad ❑ P ..iced In-Ground AtGri~e Q M > 24 in. f stli so Q Mound <24 in. of suitable soft
❑ Holding Tank ❑ Other Dispersal Component (expl ' t Device (explain)
V-I?
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System 9ySatc= 9.X.30
= 3.=~v
VI. Tank Info Capacity in Total # of ]Manufacturer
Gallons Gallons Units
New Tanks Tanks
rn w C7 Cti
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statemeat-1, the aadasigecd, assume respaasitd W for fosrailatioa of the POWTS Awwa as the attached plans.
Plumber's Name (Print) Plumber's- MPAeRS Number Business Phone Number
Plumber' Address (Street, City, State, Zip Code)
M. oaa /ISc rtmeiit use
PProved ❑ Disapproved P l~ t-F7ee~ Date Ivued I g Agent Si 40 ❑ Owner Given Reason for Dena} $ / / l r
L~iS>~itd6rovaUReasoas for Daapproval
WW .2164
1. Septic tank, effluent filter and d~-
dispersal cell must be serviced / maintained Vk ` b
as per management plan provided by plumber.
2. All setback requirements must be maintained S l
Mheh-we..spkee plaetrr /6e we./oif ra 6.rMr «~b` ••/^1Ul"~ 1Mo s x 3i r~e6ea-irame_.J~%Lel'- ~.1'✓T (/U" r`-'
SBD-6398 (R. 02/09) Valid thm 02/11
CONVENTIONAL POWTS DESIGN
INDEX AND TITLE SHEET
Project Name: Haillev 4 Bedroom Conventional Powts
Owners Name: Michael and Haillev Leverty
Owners Address: 19 Birkmose Park Lane, Hudson, WI 54016
Site Address: Same
Project Location: City of Hudson, St. Croix Co., WI
Subdivision: Lot #4 Assessor's Plat, Vol. 892, Pg. 79
Legal Description: (govt Lot 4 Sec. 25, T29, NR 20 W
Parcel ID Number: 236-1622-00-000
Plan Transaction Number:
Index and Title Sheet Page 1
Site Plan Page 2
Dispersal Cell Sizing Calculations Page 3
System Cross Section Page 4
System Management Plan Page 5
Filter Specifications Page 6
Treatment &/or Filter Tank Cross Section Page 7
Parcel Map Page 8
Septic Tank Maintenance Agreement Page 9
Warranty Deed Page 10
Attachments:
Designer/Plumber: Gary Zappa, Dept of Comm. Credential #222373
Signature: Phone No: (715) 386-2850
Date:
Page 1 of 10
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.DISPERSAL CELL SIZING CALCULATIONS
L (4 bedrooms) (100 gallons estimated flow)(1.5 design factor) = 600 Gpd design flow
2. Infiltrative capacity of native soil= 0.7 gpg /sq.ft.
3. Absorption area required: 857.15 sq.ft.
4. Absorption area as proposed: 857.40 sq.ft. (42 chambers total)
Infiltrator "Quick 4"=20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA
./857.40 sq.ft = (2 pair endcaps)(5.80) = 840 sq.ft.
840.00 sq.ft/20.00 = 42 chambqrs required
Number of trenches: 3) (a 14 chambers Qer trench
Trench Width: 2.83'
Trench Length: 58.67'
Trench Spacing: 7.00' on ce
nter
Total system w/4' trench spacing 17.00' x 59.00'
Pg. 3 of 10
Soil AbsL) ion System Cross Section
o. ft /vv.,yo
ro
9~ oo n
4' Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ft
A 9y3o~
Leaching 93 30
Chamber ~C .3o f.
System Elevator,
ad.-? ft O ft xooft
Soil Absorption System Plan Wew
r r~69 ft
83 ft
o ft Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Mode
Fii]R.oT ~ ~ " Y fTiy BARD
I EISA Rating _ ?p .o sq ft per chamber Soil Application Rate 0,2 gpd/sq ft
~Zi e o gpd Design Flow 4,-j2--2- Soil Application Rate + joy EISA Chambers
I
rows of - / y chambers each.-,
_
T - ,y
Page of ~D
cotiwadoitai Septic systeitt Management Plait
Pursuant to Comm 83.54, Wis. Adm. Code
Genes[
The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be
maintained is accordance with component manual SBD-10705-P (ROM I). All local and/or state rules pertaining to
system maintenance and maintenance reporting shall be compiled with,
` Septic Task
Septic tank servicing mechanics comply with Comm. 83.54(IX4 Septic tank to be located within 150' of service
pad, with bottom of tank to be < 15' below service pad elevation. The operating condition of the septic tank shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and
scum in the tank exceed J/3 the liquid voJume of the tank. The contents of the septic tank shall be disposed of in
accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281 AS, Stns. if
the contents of the tank are not removed at the time of assessment, maintenance personnel shall advise the owner of
when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The operating
condition of the 6Udet filter shall be assessed every six months for the first two years of system operation and once
every two years or as needed after that The outlet filer shall be cleaned as necessary to ensure proper operation.
The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off
the filter when removed from its emloan. If the fiker is equipped with an alarm, the filter shall be serviced if the
alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and
soundness. Access openings used fix service and assessment shall be sealed water tight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings
greater than 8 mcha in diameter shall be secured by an effective locking device to prevent accidental or
unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present
that could cause death. Septic teak abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when
the tank is no longer used as a POWTS componnnit. The addition ofbioiogical or chemical additives to enhance
septic tank performance is generally not
by • the required. If such products are used they shall be approved for septic tank
use Department of Commerce. Safety and Buildings Division.
Soil Ahwrydoa Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system
should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic
(other than for vegetative maintenance) over the system is not recommended, Soil compaction may hinder aeration
of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold
weather installations (October-February) dictate that the system be heavily mulched fcx frost protection.
Influent QUahtY =O the system May not exceed 220mg/L BODE, 150 MG/L TSS, and 30 mg/L FOG. Influent flow
may not exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to
the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent
monitoring,
contiBaericv Plait
if the septic tank or any of its components become defective the tank or component shall be
keep the system in repaired or replaced to
p proper operating condition. Excessive ponding within the dispersal cell will be eliminated by
installing a new soil absorption cell to bring the system into proper operating condition.
Questlons an the operation ar maintenance of the system should be directed to installing plumber, Gary Zappa at
(715) 386-2850, or the St. Croix County Zoning Department.
i
i
i
t
PageS of /o
EFFLUENT
FILTERS PGLYdOX
"The PL-525 has 525 linear feet of 1/16"
slots. It has an automatic shut off ball. When
the filter is removed for cleaning, the ball will
ecee.albilflV Aeceplt PVC
float up and temporarily shut off the system ` e.rln3ienh.°"'`
so the effluent won't leave the tank. No other
filter on the market can make that claim!" ~S1resrl
I VII
IllHatlon Club ~_e R.ted for o.•u
10.000 GPO
Acwpta ~ 0.. r .
SCHD 40 pip.",
.C
f G.a deneaa
~A.1-ic shut ..H
ball wh.. 611.r
i Is remo.ea
"The PL-122 has over 122 linear feet of 1/16"
slots. Rated for 1500 gallons per day, and
can be manifolded together with other PL- AL.-
122's to double or triple the GPD. It has an Swlt,
Swhch
automatic shut off ball that stops flow when Fil 122 U.-h
yinch
r
the filter cartridge is removed for cleaning. ofaf 16 Slol
Comes complete with it's own housing, no
gluing of tee or pipe and no extra parts to pip Fill., .r AaDt dapt.,y
wrlh 7"d a`
buy.
r
I
Atom"lie
S Ul'
. Ba0 when
Fih.r is
R.mDV.d
From 7enY
Order # Mo I # De ri ion •
List Price
PK-525 PL-525 Effluent Filter System
PK-122 PL-122 Effluent Filter System 6 22 50
62 50
6-10
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UP 52"
A 4" CAS
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W1250-mR
RE-POU
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AAW By'. SUE MEIER IDDDDETE , . -
V. k
SEPTIC MANUAL W3714 US HWY 10 4UIOEN ROCK, WI 94750
\ 2 DH JANUARY 01 7-ROUR:
°
REVISED JAN. 2010 800-325-8456 wuaw
:rte
/-ioae , or /O
s
• RECEIVE-Do-
ECEIV -D
2240
Wisconsin Departme:t of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety an Buildi"OU L 15 2 04 ~ccord ce with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Cou
Attach complet site pla8mno8pdL'AdCuaw 8%x 1 inches in size. Plan must St. Croix
include, but not point (BM), direction and
percent slope, lion and distance to nearest road.
6-1622-00-000
Please print all information. eviewed Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / s 2.0 It
Property Owner Property Location
Robin & Maryanne Berg Govt. Lot 4 1/4 1/4 S 25 T 29 N R 20 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
prt 239 Assessor's Plat, Vol. 892, Pg. 79
City State Zip Code Phone Number 6?1 City J Village J Town Nearest Road
Hudson Birkmose Drive
ar New Construction Use: y~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
J Replacement J Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable Na
General comments
and recommendations: Site suitable for in-ground POWTS with 0.7 gpd loading rate.n~ ~~PJJn~u'mp station may be needed to reach
system installation elevation. - / S SYri E WiJ
Boring # J Boring
0 Pit Ground Surface elev. 97.28 ft. Depth to limiting factor >135" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-18 1Oyr3/2 none sit 2fsbk mvfr cs lfmc 0.6 0.8
2 18-36 1Oyr3/4 none sl 2fsbk mvfr cw 2fmc 0.6 1.0
3 36-45 7.5yr4/4 none I &gr(20° Osg ml cw 2fm,1 c 0.5 1.0
4 45-66 1Oyr4/4 none I &gr(30°/) Osg mi gw 1fm 0 1.6
5 66-135 10yr4/4 none r s(10% Osg ml - - 1.6
2.3
Evaluation of soil from 113" -135" completed by extracting sampl s with hand augering through bottom of excavated pit.
Boring # - I Boring
1/ Pit Ground Surface elev. 100.05 ft. Depth to limiting factor >158" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 1Oyr3/2 none sit 2fsbk mvfr cs 2fmc 0.6 0.8
2 10-24 1 Oyr4/4 none r sl(25% 2fsbk mvfr cw 2fmc 0.6 1.0
3 24-45 7.5yr4/6 none I &gr(35Osg ml cw 2fm 0.7 1.6
4 45-70 1 Oyr4/4 none r s(25% Osg ml gw 1f 0.7 1.6
5 70-158 10yr5/4 none r s(10% Osg ml - - 0.7 1.6
30~
Evaluation of soil from 108" - pleted by extracting sa le wit and augering through bottom of excavated pit.
* Effluent #1 = BODS> 30 < 220 mg/ and TSS >30 <)50 L * Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signal e: CST Number
James K. Thompson S 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 3/31/2011 715-248-7767
Property Owner Robin & Maryanne Berg Parcel ID # 236-1622-00-000 Page 2 of 3
3] Boring # J Boring
Pit Ground Surface elev. 102.12 ft. Depth to limiting factor >162" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10yr3/2 none sil 2fsbk mvfr as 2fmc 0.6 0.8
2 8-19 10yr4/4 none sl 2fsbk mvfr cw 2fmc 0.6 1.0
3 19-32 7.5yr4/6 none &gr(350/Osg ml gw 1fm 0.7 1.6
4 32-62 10yr4/4 none )r s(40% Osg ml cw 1f 0.7 1.6
5 62-162 10yr5/4 none ]r s(10% Osg ml - - 0.7 1.6
Evaluation of soil from 123" - 162" completed by extracting samples with hand augering through bottom of excavated pit.
❑ Boring # J Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00) A.C.E. Soil & Site Evaluations
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer '1C '4e L//"
Mailing Address AZ_ 6
Property Address
(Verification required from Planning Department for new construction)
City/StateParcel Identification Number ;Z.?6 -av - 000
LEGAL DESCRIPTION
CzrY
Property Location Sec. , Tly _N-R~ _W, +mm of
Subdivision A c c rrt,A's 10~1 X9,2 z , Lot # .11
Certified Survey Map # Volume , Page #
Warranty Deed # LkI2112~11, Volume , Page #
Spec house O yes 9 no Lot lines identifiable R] yes O no
SYSTEM MAINTENANCE gouye-
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.
The property owner agrees to submit to St. Croix 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 wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/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 Zoning Office within 30
days of the thr e ye2f expiration date.
le) /3y/?_
SIGNA OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the prope described above, by virtue of a warranty deed recorded in Register of Deeds Office.
la l..Tv l
SIGNATURE OF APPLICANT DATE
Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
STATE BAR OF WISCONSIN FORM 2 - 2000
Document Number WARRANTY DEED 937905
THIS DEED, made between Robin L. Berg and Maryann Elizabeth Berg, Bf-1'11 PABI i
husband and wife, Grantor, and Michael Leverty and Hailley Leverty, tt4- . 1 i L.R 01- ULLUS
husband and wife, as Survivorship Marital Property, Grantee. S -f C Roi x Co.,, Y.V 3
Grantor for a valuable consideration, conveys and warrants to Grantee the 0,6/21/ 2011 2:zq PM
following described real estate in St. Croix County, Wisconsin: E.XE-MP'F*: NA
SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF Uc FEE' 30'00
TRANS Irl:E; 387.00
PAGES, 2
Recording Area
Name and Return Address:
Edina Realty Title, Inc.
400 South Second Street, Suite 115
Hudson, WI 54016
981212
Exceptions to warranties: 236-1622-00-000
Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number (PIN)
This is not homestead property.
Dated this June 15, 2011
Robin L. Berg
Maryann;Elizabeth Berg
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
STATE OF ,:V ' ` : ; ' ~ I i
COUNTY OF
authenticated this June 15, 2011
Personally came before me this the above
Robin L. Berg and Maryann Elizabeth Berg, husband and wife to
TITLE: MEMBER STATE BAR OFQIrIilli, 0 ---..ti me known to be the
(If not, ! a person or persons who executed the
oregoing instrument and acknowledged the same.
authorized by §706.06, t ° USLIC
.X11!3 _'i•P
THIS INSTRUMENT WAS DRAFT NSIN
Martin D. Henschel CHERI BROWN
6800 France Avenue South, Suite 410
Edina, MN 55435 Notary Public, State of Wisconsin
My commission is permanent. (If not, state the expiration date:
(Signatures may be authenticated or acknowledged. Both are 03/01/2015)
not necessary.)
"Names of persons signing in any capacity must be typed or
printed below their signature.
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2-2000
/AGE ~O(QJ e lO
EXHIBIT "A"
Parcel I:
Part of Outlot "239" of the Assessor's Plat of the City of Hudson described as follows:
A parcel of land located in the S '/2 of Section 25, Township 29 North, Range 20, City of Hudson, St. Croix County,
Wisconsin, being part of Outlot "239" of the Assessor's Plat of the City of Hudson, further described as follows:
Beginning at a point 718.0 feet due North of the South Quarter (S 1/4) corner of said Section 25; thence N62°17'E a
distance of 211.5 feet; thence N36°36'W, a distance of 199.9 feet on a line that is parallel with and 50 feet West of the
West boundary line of Outlot "240"; thence S64°20'W a distance of 400 feet more or less along the South boundary line of
that parcel sold to Burkholder and described in Volume 298, Page 74 to High Street, thence Southeasterly along High
Street to a point that is S62°17'W of the point of beginning; thence N62017E a distance of 188.5 feet more or less to point
of beginning.
EXCEPTING from the above parcel the North 25 feet thereof.
AND
Parcel 2:
TOGETHER WITH an easement for an access road to the above described parcel Southeasterly along the present
driveway to connect to old S.T.Highway "35", or the Coulee Road as now traveled, and over the 50 foot strip of land
Easterly of the above described parcel.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000
~c~ /Ol6J or-~o
I
State Bar of Wisconsin Form 1-2003
WARRANTY DEED
Document Number Document Name
THIS DEED, made between Eric D. Rolland, a single person C 3 : 0 t 2f
9 9- ~ t t r iL
L?KtMPI fir. t" rr
("Grantor," whether one or more), and Michael T. Leverty & Hailley S. Leverty, "PANS F~!E:
husband and wife, as survivorship marital property PAjG 1
("Grantee," whether one or more).
Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address
St. Croix County, State of Wisconsin ("Property") (if more space is Ryan C. Cari
needed, please attach addendum): Heywood, Cari & Anderson, S.C.
Outlot Six (6) of St. Croix County Certified Survey Maps recorded in Volume 25, 816 Dominion Dr., Ste. 100
Page 5795, recorded on September 22, 2011 as Document Number 941919, which Hudson, WI 54016
is located in Government Lot 4 of Section 25, T29N, R20W, being part of Outlot
239 of the Assess ' Plat and also being part of Outlot 2 of Certified Survey Map
Volui a 22, Page 545 , ity of Hudson, St. Croix County, Wisconsin. 236-1617-06-000
Parcel Identification Number (PIN)
This is not homestead property.
lax) (is not)
Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except:
None.
Dated March 1, 2012
(SEAL) (SEAL)
Eric D. Rolland
(SEAL) (SEAL)
_ -r•
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Eric D. Rolland STATE OF )
) ss.
authenticaley! on March 1, 2012 COUNTY)
Personally came before me on _
Ryan *MEER the above -named
TITLE: TATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
Ryan C. Cari, Heywood, Cari & Anderson, S.C. Notary Public, State of
816 Dominion Dr., Ste. 100, Hudson, WI 54016 My commission (iKlaormanextJ) (expires: )
(Signatures may he authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 1-2003
"ryhc name below signatures. INFO-PRO'" Legal Forms "(800)655-2021 • intoproforms.com
/ACd /OCe) 6, /O
Parcel 236-1622-00-000 07/15/2011 01:16 PM
PAGE 1 OF 1
Alt. Parcel M 236 - CITY OF HUDSON
Current T. CROIX COUNTY, WISCONSIN
❑X S
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - BERG, ROBIN L/MARYANN E
ROBIN UMARYANN E BERG
1088 NELSON FARM RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description BIRKMOSE PK
SC 2611 SCH DIST OF HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: 03-008-HUDSON ASSESSORS OUTLOT PLAT
HUDSON ASSESSORS OUTLOT PLAT PT OF Block/Condo Bldg: OUTLOT 239
OUTLOT 239 AS DESC IN 892/77 EXC THE
N25' THEREOF Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
25-29N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
2011 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 02/21/2008
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 195,000 0 195,000 NO
Totals for 2011:
General Property 0.000 195,000 0 195,000
Woodland 0.000 0 0
Totals for 2010:
General Property 0.000 195,000 0 195,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
isc I in Department of Industry,
SOIL AND SITE EVALUATION REPORT P 1
and Human Relations Z
Division 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 St. Croix
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. Z 3( - I --Q(j-a) c-)
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
OT SW 1/4 SE 1/4,,75 T, ;:.-%N,R20 xF[(or) W
PROPERTY 0 ER':S MAILING A ESS Ln/a T # BLOCK # SUBD. NAME OR CS
1022 NT-IgGp FLa= Rd- n/a n/a /Jp Cj
S ZIP CODE PHONE NUMBER CI ❑VILLAGE ❑fOWN NEAREST ROAD
Hudson Wi. 54016 (715)386-9457 Hudson {
U New Construction Use [Xk Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd . Recommended design loading rate ~ _bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 98.35,#1-95.65,#2 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material outwash Flood plain elevation, if applicable n/a ft
S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem S❑ U f S❑ U )a S El U iRS ❑ U El S :&[I El S ~U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botu>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed
Trench
1 0-14 10 r3/1 none L. 2/m/sbk mvfr c/s 2/f .5 .6
1
2 14-41 10yr4/4 none Co. S 0./sg ml g/w 1/f .7 .8
Ground 3 41-90 10yr5/4 none Co. S 0./sg ml n/a 1/f .7 .8
elev.
98 -95- ft.
Depth to
limiting
factor
>90
Remarks:
Boring #
1 0-22 10yr3/1 none L. 2/m/sbk mvfr c/s 2/d .5 .6
2 22-52 1 4/4 none Co. S 0/ag ml g/w 1/f .7 .8
3 52-92 10yr5/4 none Co. S 0./sg ml n/a 1/f .7 .8
Ground
elev. 8
98.35 ft.
Depth to
limiting
factor
C', .3 i TD
A
Remarks: h~
CST Name:-Please Print Phon'b,
Address:
j Signature: Date: CST Number:
10-24-92 2298
PERTYOWNER Robin Berg SOIL DESCRIPTION REPORT Page 3
ARCEL I.D. #
Szre Consistence Boundary F2f GPD/ft
Boring # Horizon in. Depth Dominant Munsell Color Qu. Sz. Mottles Gr
Cont. Color Texture Structu Sh .
. . Bed Trench
0-12 1 r3 1 none L. 2 m sbk mvfr C /S .5 .6
3
2 12-36 1 4/4 none co.s. O.s ml /w 1/f .7 .8
Ground 3 36-84 10yr5/4 none co.s. O.sg ml n/a 1/f .7 .8
elev.
97.45---ft.
Depth to
limiting
factor
X84
Remarks:
Boring #
1 0-28 10yr3/1 none L. 2/m/sbk mvfr c/s 2/f .5 .6
4
2 28-80 10yr4/4 none co.s. O.sg ml n/a 1/f .7 .8
U
Ground
elev.
95.5 5ft.
Depth to
limiting
factor
>80
Remarks:
Boring #
1 0-15 10 3/1 none L. 2.m.sbk mvfr c/s 2/f .5 .6
S 2 15-32 10yr4/4 none co.s. WSW ml g/w 1/f .7 .8
3 32-84 10yr5/4 none co.s. 0/sg ml n/a 1/f .7 .8
Ground
elev.
95--h5ft.
Depth to
limiting
factor
'R4
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
S13D-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 200th . ve .
C.S.T. 2298 Robin Berg New Richmond, WI 54017
MPRSW-3254 SW4SE4 S.25-T29N-R20W (715) 246-6200
City of Hudson
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