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CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /00 'q R o fed ~1 e INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. +Y 72 ANjtaZjt f BENCHMARK: - I C;11 ALTERNATE BM: SEPTIC TANKPUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: `(jam Liquid Capacity: Setback from: Well House ! Other Pump: Manufacturer Model #S Size Float seperation Gallons/cycle: Alarm Location ,0:~ -;SOIL ABSORPTION SYSTEM Width: Length_ Number of trenches i Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Z9T Pump off _4 8 Header/Manifold 9 .G Bottom of system q Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: te_;7v 3/93: jt I ~ ~s artr~T~r1 TY, 21.30.15 PANAWtN NOW t STEM County: Labor and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 193432 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: JOANN lenwood CST BM Elev.: Insp. BM Elev.- BM Description: Parcel Tax No.: 4 / C(~, r QCt~; -`Ca 016-1046-60-000, TANK INFORMATION ELEVATION DATA A93000922 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r Septic Benchmark C; ~1, Dosing ' C 57 6,'v y 57 ~r ~J Aeratio Bldg. Sewer ~ e 3 F lding St/ Inlet l a, TANK SETBACK INFORMATION Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD ^ - Ar Septic NA Dt Bottom 7. ie Dosing ~i NA / Man. Aeration NA Dist. Pipe 27 06 Holding Bot. Systems';: PUMP INFORMATION Final Grade Manufacturer r ~ nr. D ~ and Model Number ;1) 'T GPM TDH Lift Friction )S) Syeaem T D H Ft Loss d Forcemain Length 7~3 Dia. H Dist. To Well SOIL ABSORPTION SYSTEM TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI EN I N 5 DImrN 1 SYSTEM TO P/L BLDG WELL LAKE/STREAM LEALtIING Manufacturer: SETBACK INFORMATION Type Of/`_,,_,' 1 OR UNIT Model N er: System: OR UNIT DISTRIBUTION SYSTEM -fir / Manifold i Distribution Pipe(s) R, x Hole Size x Hole Spacing Vent To Air Intake Length _j~~is Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx See Sodded xx Mulched -8**VTrench Center 4M+d /Trench Edges Topsoil es ❑ No ❑ Yes ~IVo COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: GLENWOOD 21.30.15.337,nw,nw,150th ave. d. ✓.i /f'. .t. Ly l r'n=~..! >_k Plan revision required? ❑ Yes 0 NO l Use other side for additional information. SBD-6710 (R 05/91), i5 / * Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: =1LHF SANITARY PERMIT APPLICATION , ,71 In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~ C~~ 8%x 11 inches in size. ❑ Check If -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. .Z 3 PROPERTY OWNER PROPERTY LOCATION t~ NW t/4 N4-1/4,S;1/ T 4,N,R 1,5- Wr) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # . V e, CITY, STATE IV r ZIP CODE PHONE NUMBER CSM NUMBER G e ~v o t7/ S a/3 7r~ O/~ 6 - 60 II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD r~p'pII ) ❑ State Owned VILLA GE CL c°/SI41®Od ~~Jf/f V , WN OF: ❑Public U1or2Fam.Dwelling-# of bedrooms PARCEL TAX NUMER III. BUILDING USE: (If building type is public, check all that apply) O 0 0 1 ❑ Apt/Condo 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. IN New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 Repair of an System System Tank OnI . ' 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 ini 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 2. 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) ELEVATION ;7,, ! p-,;2 Feet ,rG Feet CAPACITY VII. TANK allons Total Site It of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION in New istin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank o 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) MPS Business Phone Number: 6 0 ~`3 6s p~ 42-A,l La SM 45~dlz.-, ZLZI.511~ lumber's Address (Street, City, State, Zip Code): 3 w 70 1 e1Vr-u oa o1 7L IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S ry ~ it Fee (Includes Groundwater Date s ue issuing A em Signa No S psi Surcharge Fee) J Approved ❑ Owner Given initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: `98 (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 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'f 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 meanies collected through these surcharges are used for monitoring groundwater, ground water contamination investigations and establishment of standards. ` SBD-6398 (R.11/88) SOIL AND SITE EVALUATION REPORT Page jof2 D1 HR in accord with ILHR 83.05, Wis. Adm. Code t"1W.tAG 1M6NMWIHATCM VOIJI\I I 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 GOVT, LOT At,, 1/4 1/4,SA/ T N,R for) W PROPERTY OWNER: 'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # O 7 O - " V O_/X- 0 -~O CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD CL eAtw-d od djAY. 41i J a/ (;W it od /5d 7`~Y ~l y a [ New Construction Use (nj Residential / Number of bedrooms (j Addition to existing building [ ] Replacement (j Public or commercial describe Code derived daily flow 46$nQ gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required 11S"~* bed, ft2 f0O Yench, ft2 Maximum design loading rate 22 ed, gpd/ft2. trench, gpd'ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Q Additional design / site considerations &)q4d~ ,EL-e V, '01:''? ""eR _5 o f MU 41vd _X -A M Parent material 64_4 0 iA L 7`144 Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem EIS RU ®S ❑ U EIS ®U ❑ S NU ❑ S ®U .®S 11U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bound ry Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 40 ;2- S'/C 4 '2 %1 rq C .5- A7 Ground 9•S 5 C L-r vC -.r elev. ft. aid S C M F 2. S Rea KS Depth to limiting factor „ _ Remarks: Boring # s S i G S Z. YR -yq - i 6 3/ 5 c G s6 c s w I i ":5- Ground elev. /-4 5- ~li C o/ 6 S ~40~~ f 02 ft. 3't/9eII KS ~ Depth to limping tact C oo ~ Remarks:' CST Name:-Please Print e S^M ~S ' 0> Address: .2 7 G~ e 0 6 d Q ' G 7 /S Signature: p Date: CST Number- PRJRERTY*WNER aktI1e ,oeXeN=15- SOIL DESCRIPTION REPORT Page2of tPARCEL IA.! O f6- 1.4 -~O Depth Dominant Color. Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr, Sz. Sh. Consistence Boundary Roots Bed mnch 1 O- /O R ;212 $ L s6XM M rj-f 4-7 ;vM '6 Ground 7.s" SG' L S6k e M~= t Gti . .,s" V ' elev. Depth 2 . to limiting factor i Remarks: Boring # t Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: 1 i I 1 r l 5,0 a AQ I ~ Flo 1'F'o~3 d1 I _ I I ; ~ I I f !JI I ~ t I I ~ I I i I ! r I I I - - - - - - - - L-- - _-I - - - - - I I I -I ~ I I I t ~ I 1 ~I j ~ i I t I i , L i I I I I _ ~ - I r I I I i i . r I x - - --r - - _ - - - - I--- - - i - I I I i I I I i I 1 I ~ I I I I - - is - -I - ~ _-ljr __f v i I -'I 71 0r I , PIP , .l - - 16' jr - - S - `a I I ~ III; 1 R_ye' I i 1 1 ~ ~ I I T~-~. ! . ( I i I I M i mow 7 3 - , 931- -1- _ - . 1 - - - - - - - - - - - - - - - , - - - - I I I I i I 1 i i Oft 9A , 4- 3; 4 jiO 4 Page L Of Straw, Marsh Nay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoll - F D 3 E % Slope Bed Of 2~- 2 %2 Force Main Plowed Aggregate From Pump Layer D / E ~ Cross Section Of A Mound System Using F , 83 A Bed For The Absorption Area , G .O jjSigned: A Ft. H Gk/ B I/ Ft. License Number: Il~~Ft. J Ft. Date: 71f -q.- K/o,V Ft. L//, ,O Ft. W: WFt. L Observation Pipe--,,., j Kq nAA • SY E Force Main ~o pTR SEWAGE From Pump Distribution v' Pipe A P ~ E TtttrlK MAN R Observation Pipe 0 ~ or ers 8 C RI Plan View Of Mound Using A Bed For The Absorption Areo S93-20322 f` crl A f r Page Of Perforated Pipe Detail 0 End View )Perforated End Cop PVC Pipe Holes Located On Bottom, Are Equally Spaced P' P t ~~[1islribution Pipe Lost Hole Should Be Next To End Car End Cop D-stribution Pipe Layout P VA Ft. S _s X I nches Y ~Z Inches Signed Hole Diameter _ Inch .d al 2, Inc1) e,, License Number: MPS Ye sgwo SYManifold Inches p A Date: Main Inches C,,,&-fjb#W1fjclrce 43VED01 es/pi Pe 2. Y- p ' 10tis AP re 16 Laterals 9 Ft. W1. INDO s Nw ~ of wlsloN of e E C RESpQNDENCE SE S93-20323 -116- PAGE OF- PUMP CHAMBER CROSS SECTION AU Q_ ICATIOIUS ' VENT CAP. 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR, WINDOW OR FRESH 12•MIU. AIR INTAKE GRADE ay. 4 MIN. 18" 1''IIN. COWDUIT- _ INLET PROVIDt AIRTIGHT SAL Ir I I APPROVED JOINT A I III APPROVED JOI'JI W/C.I. PIPE I I I ( W/C.I. PIPE EXTENDING 3' ( II ALARMI EXTENDING 3' OVJT0 SOLID SOIL B I 1I ONTO SOLID S-I I 1 ~'rE S c PRIVATE ELEV. FT, puM D MtlMAM S CONCRET • UdOA RISER EXIT PERMITTED GfJL`1 IF TANK MAIJUF AL SEPTIC f loo-e SPEGIFICATIOmSEE 'R-SP0~ DOSE TANKS MANUFACTURER: IJUMBER OF DOSES: _T PER DAy TANK SIZE: OD GALLONS DOSE VOLUME ALARM MANUFACTURER: S.T ~C'i9O INICLUOINC> SACKIFLOW: GALLONS MODEL I.IUMBER: /O / /yw CAPACITIES: A= INCHES OR ~GALLOUS SWITCH TYPE: Me~~ yA? V B= INCHQSOR GALLOUS PUMP MANUFACTURER: C=IMCHES OR GALLOUSz MODEL NUMBER: pn °DImcif OR GALLONS SWITCH TYPE: S.7"~L~ _7tR0 F C' fL ~ .~lil'E: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION p1pE..;-~` FEET + MINIMUM NETWORK SUPPLY P~RE~SSSLIKC . . , F.LET + FEET OF FORCE MAIN X F 100FTFRlCT1OM FACT't11t..__ FEET TOTAL 091JAMIG HEAD = y . REST S93 2032,1 INTERNAL DIMENSIONS OF TANK: LENGTH ;wiDTN ~ LIQUID DEPTH 01 SIGNED: "v/ - -e 1 -1, LICEM J /7 SE 41UMBER: J ~ _ DATE: EFFLUENT SP OSP 3AB SPD50H 100H MAX. SOLI S5 / "SPHERE MAX. SOLID /8" SPHERE 3/4" SPHERE 1 P 1 3 P 1 /2 AND 1 HP 1750 PM 1 0 R , M 3450 RPM -Ink • Availabl in automatic r manual • Avai ble in au omatic • Available in manual or automatic • Non-clo bronze impel r • All br nze con truction • Automatics feature reliable • No sucti screens to lean • Non-c g bro ze impeller diaphragm pressure switch (1 /2 HP), • Oil-filled, ouble ball earing motor • No suc ion s reens to clean wide-angle float switch (1 HP), both with built- n overload protection • Oil-fille , d ble ball bearing motor with piggyback plug-in • Carbon/ce amic fac mechanical with bui -i overload protection • Dual shaft seals standard. Seal fail- shaft seal • Carbon/ amic faced mechanical ure sensor capability available (wired • Great for s tic tan effluent, shafts eal to alarm device) on manual pumps elevator pit high pacity sump • Reliable I phragm switch • Non-clogging 2-vane cast iron service, ind stria) irculators • Complet ly field serviceable sewage-type impeller • Reliable dia rag switch with • 1-1/4" P discharge ed c nstruction piggyback pl g-in • 1 /3 HP lo 15V • (SPD50H d 1 HP -44, • Rugged cast i on onstruction (SPD10 ors. Ball bearing • Completely fi Id erviceable construction and oil-filled • 1-1 /2" NPT d harge • 2" NPT discharge (3" flange opt.) • 1 /3 HP, 1 o 11 or 230V _1/2 HP, 1 o 115V or 230V and 3o 200V, 460V or 575V - 1 HP, 1 to 230V and 200V, 3o 230V, 460V or 575V 32- 82 64 w -r .-t' --1- I i - - U. N - { + t 1 C 24 624 W 48 w u~ tt } NP 216 i 216 2 32 Ll Z t g t J1 6 4 o f a -Lid a 0 0 0 10 20 30 40 50 60 0 10 20 30 40 50 60 0 24 48 72 96 120 144 CAPACITY-U.S. G.P.M. CAPACITY-U.S. G.P.M. CAPACITY-U.S. G.P.M. 4 93~. 0323 I ~ ~ ~ ~ I I N o 1yy 1 I I ~ ~ j i I i I ~ ~ ~ ~ f I I i V, 'Pill Irv Owe! t~,4v ; i- I i 14 , L i J. , I ~ II i l- i 4- ism I #A ISM lol. - i J-] . i 931M 1 ST. CROIX COUNTY ' WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ~ 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386-4680 May 10, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Dale Berends property, located in the NW-,NW;, S.21, T.30N., R.15W., Town of Glenwood, St. Croix County, WI., has been conducted with the assistance of Gale Smith, CSTM# 1768. This onsite revealed suitable soil for onsite sewage disposal to a depth of 28" while meeting the requirements of the A + 4" rule. This site should be suitable for new construction utilizing a mound septic system having 12" of sand fill. Should you have any questions, please feel free to contact me at this office. Since ely, mes K. Thom 7S. Assistant Zoning Administrator cc: file SEPTIC TANK MAINTENANCE AGREEIIENT St. Croix County OWNER/ BUYER ~ eN r 0 ROUTE/BOX NUMBER 7~"y 14 Fire Number 4 73 d CITY/ STATE ZIP _5yo /_T PROPERTY LOCATION:'.'YGy', Section, TAN, R W, Town of 1 E'Nl-v ®o d~,~, St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. - Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed' 's'ept'ic tank pumper. What you put into the system can affect the .unct on of the septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents-M!IX .be eligible to recieve 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 County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2).after inspection and pumping (if nec- essary), the septic-.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year-expiration. y I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with N the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property 0.441a- Location of propertyyCfl1/4 _&,~.1/4, Section v2/ , T_,;Teg N-R_ZyW Township Mailing address V g- C~ Lv CJ O Q~ G~/* Address of site subdivision name Lot no. Other homes on property? yes- No Previous owner of property G Total size of parcel E, Date parcel was created Are all corners and lot lines identifiable? Yes x No Is this property being developed for (spec house)? Yes XNo volume and Page Number 47 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 REGISTJ~R OF DEEDS. certified surve In addition, a y, it 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 the property described in this information f(are) h orm tb a owner(s) of warranty deed recorded ► Y virtue of a he office of the County Register of Deeds as Document No.35d own the proposed site for the sewage disposal t system ) orr Ie(we) obtained an easement, to run the above described ro ert the construction o p P Y, for f said sstem, and ha recorded in the office of County Registers ofadeeds sa been duly No. s Document signature of apVli.cant p Go a ppl cant Date of Signature Da Date 00 f signs ure DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 11 r LAND CONTRACT-Indi.,Jual and Corporate 'f ` i7 'VOL , 9/l j~~ THIS SPACE RESERVED FOR RECORDING DATA 351,154o I O John E. Ohman and Ann M. REGISTERS OFFICE .Ohman~1man T, by and between ST, CRO IX CO., WIS. , husb and and wife, as ioint tenants kec'd. for Record this 5 ("Vendor", whether one or more) and _Oale A. Berends and JoAnn M. tlay of July A.D. 1979 Berends, hus5and and wife ,as joint tenants M. ("Purchaser", whether one or more). bt 8:30 Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the R~Qy rents, rt. fixtures and other appurtenant interests (all callad the "Property"), is rt. CroiX County, State of Wisconsin: RETURN TO The North One Half (NJ) of the Northwest Quarter (NW}) of Section Twenty-one (21), Township Thirty (30) North, Range Fifteen (15) West' EXCEPT that part of the above Northwest Quarter (NW}) of the Northwes Qes QQuarter (NW+) described as follows: Beginning at the Southwest corner of said forty with the West border of said forty assumed to be the centerline of the public highway; thence North 955 feet along the centerline of the public highway; thence East 673 feet parallel with South line of said forty; thence South 669 feet parallel with West line of said forty; thence West 200 feet parallel with South line of said forty; thence South 286 feet to the South line of said forty parallel with West line of said forty; thence West 473 feet along the South line of the forty to the point of beginnirg.Said South line is assumed to be the line fence. i This is no t homestead property. W (is not) Purchaser agrees to purchase the Property, and to pay to Vendor at premises the sum of S 73, 000, 00 in the following manner: $ 54.000.00 at the exec,Ition of this Contract, afwrtiefosterfteor-$tXXXXXXXXXXXXXXXXXXXXX4*N4c,XA-W*fe MA?%te 24 f~S7f f )gYCfid4ffr?Fxt?l:fl*Lx iAxA>E XVxxxxxxxxxxx ?t&1Slx NP%id the receipt whereof is hereby acknowledged and t e balance of $69,000.00 togetner with interest upon such portions as shall remain from time to time unpaid at the rate of eight (0%) per cent per annum until paid in full as follows: Said principal and interest shall be payable in monthly installments of not less than $529.03 per month beginning on the 25th day of July 1979 provided the entire purchase money and interest shall be fully paid within 20 years from the date hereof. * the purchaser agrees to pay an additional $16,000.00 on January 5, 198 RakXboxdtxxatatx xeltlrJrlra %XV4M",xXdWXXxp"xllfd )aft x((xdtllfat)¢2(yXdpxtit~ttLtXiX dt aralEariHlA~1xt!{ 1{p1a a(~e xa~p~ocvfx~~~~r~c1~x~Ia~tata~,x~ iK~x~xat i►s~,a~t ~tarxa~ ~x~xl~txxcar tsa a~~tt» x~x~~acdyx~sat~~cxa~x 76&Xft t06XJPP# "gh"W." X%ftK XbZWM"Xah!&ac Al" x'tkk AacatlftX&%at A*X " XkWXat►tla*X1XJK V.VM*c[ ARM", >asraexsaoelrat ~dt iasencalot~e )a+oi M X~1t xDepoyeft txDc lnlwc atoc ac~e>'oaexbtabcoo-xtxoaex 7aoaotaftxbox slteli l4att)QfeXt)QIQkAE IaXmSexst bteltaadme xegpt>x~>y X ~nx ~~fyl4rLtelF~~t~a19~f1~~n~Df?f34iHS7kl1~Eb4X~?F~Qr1E~41~~aX~F~eKe~~4~ft~S~pL~~~f~24~5rTdteaS~4►xt2S~5?4r1E~fptSf<~SMi~@t ~ ~ k~ ~~p4~~1C ~1'D~TX tQ'L~)6St ~1XXXXXXXXXXXX YYYYYYY ARx~ XOCW* there j may be no prepayment of principal without permission of '-!ndor. * YJkM"*>b*x4>> 6 Xtpilm62Sd4rl<r2fc~f)Stfa~SP4+`btt'.je'r"M)64&Xe'fei<alblfX,• X,-T"" "M1trClrl "16(VMM ~xpakl~loltoex~t:peta~ekxt~tarlmet~tXatvdxa>Iaccxxas~taeeravta~ci~toe>!e:cocfYaaflcrntta~u¢oc~estritbcxyeSd~Exs>~ltatrr3cas~aavlcatt0t ~p>~iatxPel~xut~iea~s~akactxobec~ea4aoaec~tceoc~taid•icviabxadxesxx~toddcfcavx~oeaao~tu~tdcDbrcxutotbdx~a4xueot~ckeexxulldaasxSiaeet 76P(eCifiel{7~bP}c9GXlXt±x -4)tbot monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except? Real estate taxes shall be prorated as of date of occupancy. Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitle to take possession of the Property 1979 *Cross Out One. { (To Be Used in Non-Consumer Act Transactions) i LAND CONTRACT-Individu.I -Z C-M-te-STATE BAR OF WISCONSIN, FORM NO. 11-1977 Wi...o2nsi jepartment of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Lii~f and T uman Relations . ; Division of Safety Buildings in accord with ILHR 83.05,, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 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: A J APPLICANT INFORMATION- LEA E PRINT ALL INFORMATI REVI DBY ATE e sm~ PROPERTY OWNER: C T3uti tms PROPERTY LOCATION C~PctZ.~t L .4 So Y\IVIv QL312Lh►p S GOVT. LOT Sw 114 SK31/4,S 2-T Zg ,R 17 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1 Ll 0 M "LC Sr-. - - PU.QPo SQb " e s " "J~ r, A CITY, STATE ZIP CODE PHONE NUMBE ❑CITY ❑VILLAGE ®rOWN NEAREST ROAD ~3t~L~wIN WI SgOoZ (-)15)68 5/- 182 1~ pip )9L hA ST, N New Construction Use [~Q Residential / Number of bedroo 3 [ J Addition to existing building j ] Replaoement [ ] Public or commercial describe . Code derived daily flow ~1 S 0 gpd Recomme ign baling rate - bed, gpolft2 o3D trenc ft2 Absorption area required 3'1 S bed, 112 3'f 5 trench, ft2 Mabmum design o. G d bed trench, gpdt t2 Recommended infiltration surface elevation(s) °t°t -a' it (as referred to site plan benchmark) Additional design /site considerations `f'~ ovlU~ t4j/ S 'K S -TJ~VCF{ 0 t►v • 1 or s Rk+t FI Parent material Flood plain elevation, if applicable It S=S Ultdble for SySt2n1 CONVENTIONAL MOUND "ROUND PRESSURE AT-GRADE . SYSTEM IN FILL' ._._HOLDING TANK U=Unsuitable for tem ❑ S NU INS ❑ U ❑ S C$U ❑ S E U ❑ S ENU ❑ S w SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure Car>s -s --VGPD/ft Texture ~ence Baniiary Root in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. Bed IenCh 13- b-b ~o~t~ z/i - s i t Z'F 1, rin via ra S o s 0.16 Z 6-31 ►o~1Q y!y - s, 1 Z 'Q`s Vt ►~v ta.S o.6 Ground 3 _ '8)-6o . W `tom SF l y ~ SYe s /6 S ~ b s lwrs s _ , elev._ qb•5 ft bb-66 ~.5'yR s!~ TS Owe >rtU1~ Depth to limilifactor:, 31 ~ Remarks: _ Boring # o-6 1t4(Z Z.[Z s: I Z 9V- vr~uf k a-S Z 6-Z6 1u ytz y/y - st Z-~S'V~t M vik 0_13 13 3 U-4 S to I tZ 3 /6 - c l I Q s bk ~ h. Ground elev. con. ni s 10M R l./ sfr►W aoRys RS• S it ~k tia ON3 CotvsIS o>= so► - Pm-sicouTS s P RT 6N D". to limiting fac Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-425-0165 ress: " egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: ~Z- -Za 3 A net- ?_y, 199 Z M00576 PROPERTY OWNER I3ilS SOIL DESCRIPTION REPORT Pages Z qf,•3 PARCEL I.D. # Boring # Depth Dominant Color Mottles Tex ture Structure Consistence Bax>dary Roots GPD/ft rHorizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch naLot\z zIz OL.S 1`12 ~//y .S_l U L Ground -Y 0 I o `9 R y~y C 1 s dk w► `F I ~-S o. Z o .3 elev. Cq S ft. yb-S3 . SyR 3/ - G~ s C S bit m U TF G S o ~1 0. S . C -Z s -t r2- 51s Depth to 5 53-6S ~•S4R31y limiting 10`t R 5/y ez 7SY2 3/~1:,.. factor=~ 6SAe, IO4R 5/~ 4 ~o'rrz6/3 FS 0►►~ >r►u{~~, C IV S ~,U 4 CL 1-6- S RM~ utl-rS Remarks: Boring # i Ground elev. ft. Depth to 'i limiting factor Remarks: Boring # r.3. Ground elev. ft. Depth to limiting factor ` F Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 30 C>2~P~1tty LINE, O W N II1'~ - L00•p Ot~ 6 ~~t-41~1{ 9/y~P~C 7 )12(0 6.3 eL 99 S J 115 ~ B N 8~~~ ~ t.qs s cF e8.0 . J g be R . ` j LL96S 4900 of NI Vl I NOT CAMPAc-T OR 19Tu1L6 ` *is 1\1Zt1q 7 Zo%p ~1ZRlAjA G E W k S Clt vii 1JUTC~ 1iwaE -n ae PrT ~T z. s/ F Lom Mow~,j-4. °Pw d wL.L so « ~~LFtC3,p ~ Woo»p t / q z_z83 B 2t4r l99 2. (715 ) 4 .5-01 69 - M00576 CST Signature Date Signed Telephone No. CST #