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020-1178-60-000
-t ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner 6 ~•ew l~/pArKM~ 3 ~~ ' ~ S7 2-- Address SS Z D~2?ti ~ - City/State ~vI~SD-v lc,/ • Sy0/ 4~ Legal Description: C~~ ,J/~S Lot ~ Block Subdivision/CSM # /l~ '/4,~ '/. ~, Sec.- 2~, T~N-RJ,~,W, Town of ~~D.SC~ ,. PIN # D20 •/!?~ ~ O ~Orl~ ~ Tank manufacturer ~/~~/ Size ST/PC / Setback from: House Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road _ Meter location Alarm location Vent to fresh air intake Water Line SOIL ABSORPTION SYSTEM: Type of system: ~'~~' Width _ Setback from: House SD Well >~oa zv,~%~r~~,e /nom. cr~~~,-ry sow- w.;~v~e ~~s ~ 2 `3 Length li ~ Number of Trenches P/L ~i~ Vent to fresh air intake > SD ELEVATIONS: D~q;,v,~-~~- GiitN...e. . Description of benchmazk !~ i P~ f . t ~ /: ~ - r, , ~ ' s idD•d Elevation Description of alternate benchmark _To/o OF SE~T/'G Tifti~'S y" Elevation/D~ l Building Sewer ~/ ~ ST/HT Inlet Nl~ ST Outlet 97 y~ - PC Inlet r- PC Bottom ~ Header/Manifold ~ Top of ST/PC Manhole Cover Distribution Lines ( ) S~ a~ ~L;..O //~(/~ ~~]~'~i~ ~.S Bottom of System ( ) ( ) Final Grade ( ) ( ) vr~•~y-3i- a-~r Date of installation / / Permit number `37 ~~~/ ( ) State plan number ~~Z~*-~!i Z zG3 7 S ~ ~~ y ~v Plumber's signature ~ License number Date / / Inspector _ ~~.e/1/~ ~~I~/~/~ ~frl ~. P ~' . Complete plot plan +' ORIGINAL ~. 3~ b~iSti~l~ 3 ~~~. ~~ ~ y~ 0 ~~`~ ~ ~ H ~ ,~ ~ /D~ ~ ~ ~ q~ i ~~~sr~ S,T. ova-~?- ~'~ ~~~ ~ ti~ ~~. ~~~~ r~ s yS~'y , s ~ .v~v G " ~v// vr'/ate J 7, iy ~ ~"j'G7~e .YoD~ I i"' ~--- - -- -- - - ~~~~ ~ ~~cisri~ ~ ~ ~ ~l ~ / = ro~ \ ~ /~'~3G ~` ~ -. T 4 ~ Typo's) vt~v Sao, ~ ~------ -- -- I ~ -..~ Tvp - s~ s '~. s yST-~- yG, a ~--~ ~s - ~~ 1 ----- ~ ~~.~ ~ [~-~- a-- --- - ----- ----- -o -- ~ r SJNSjz, OJT p ~°K -------------g~----------- gs!Ss~ I --- Ysr~~ ~ ~' (ii sus) 9a ~ ~~ . ~, •r~ 7~0~ of j,vf ~ ~'~Ta~ s ~.~. ~y , Se ~ Q~fc,~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORIIAATION (ATTACH TO PERMIT) Personal information you Drovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. emtit Holder's Name: City Village x Township Kramer, Allen Hudson Townshi ST BM Elev: 1 Insp. BM Elev: BM Description: (JD.o X00• c~' ~ o•~•.a.~c. 6 =~ST'ew~#~ 'A X11! I~ICn~11AAT1/1N FI FVOTInN DATA TYPE MANUFACTURER CAPACITY Septic ~~ ~~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~s 1 ~ ~ ~ ~~f _~_ Dosing Aeration Holding PUMP/SIPHON INFORMATION Ft I SOIL ORPTION SYSTEM ' RE C idth ~ Length t DIM ONS '3 `g,~ SETBACK SYSTEM TO INFORMATION Type Of System: nICTQIQ11T1n1~1 CVCTt`11A to Weli '/L BLDG WELL ~I~r ~~I ~ (~/ county: St. Croix Sanitary Permit No: 399411 State Plan ID No: e Parcel Tax No: 020-1178-60-000 STATION BS HI FS ELEV. Benchmark 3• (0 1~3• ~ Jc, o Alt. BM Bldg. Sewer ~ ~ SUHt Inlet SUHt Outlet 5~ ~ 8 q~,~ f Dt Inlet Dt Bottom Header/Man. Dist. Pipe ; ~ 9,sy s' ~ 93.9f Bot. System ]a,~ • ~ Io,B ' Z•L ' Final Grade w~ St Cover aS~J 1 ,~~1 v f~ e.`~" 4.3 `$ 9,08, f.n,~,Q~ ~ ~ •'~o ~b. llor DIMENSIONS No. Of Pits Inside Dfa. uqui <E/STREAM LEACHING Ma~uf cturer~ . CHAMBER OR s ,Si ~ UNIT M I Number. Header/Manif d Distribution x Hole Size x Hole Spacing Vent to Air Intake ' ~ U . ' e ~ ~ ~~ Dia a gth Dia Spacing Length0 ' cnu rn\/CO ~cr. __ .,____..__ ~.._....,,... n..i.• ..., iu.,,~...~ n. nr_ararla systems umv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~ /~/_~ Inspection #2: Location: 552 Dru Drive Hudson, WI 54016 (SW 1/4 NE 1/4 28 T29N R19W) Cedar H[Ils Estates Lot Parcel No: 28.29.19.1125 1.) Alt BM Description = 2.) Bldg sewer length = ~ f"f•o~ ~ / f~~ -amount of cover - ~ "'~ cA~t 3~.~ 9_~e 4 dues ~4t ~~\, i Plan revision Required? ^ Yes No 3 ~ ~ r dditional i formation. -~ ~ -- ~^~ l~ ther si~Ie fo ~~ '}) ~ /97,j,.~,.~,~, ~ ~; r~(wF,~, - I_ ~ D~te p Insepctor's Signature Cert. No. gb~~tw~_~pj Qa~-~' °~IR~` ~ °I° cQV~~'u^^5v~( ~. 5~.. J t. _ I' '~ ~ - Safety and Buildings Division 201 ii... ~ . r J J . ~~ County S~ ~~, x ~ „ W. Washington Ave., P.O. Box 7162 ~ S~O M di ' s , nsl ~ a son, WI 53707 - 7162 ~ ite Address De artment of Commerce /~ .. Sanitary Permit Applic ~ ri~ Sanitary Permit Number ,va, In accord with Conan 83.21, Wis. Adm. Code, personal ' o lion ~' ~ ~~' 3~~~~ -~ ^ Check if Revisi ma be used for second ses Privac 1 on I. Application Information -Please Prlnt All Information .-. ~ 001 rate Plan I.D. Number N/~ Q 2 Property Owner's Name ~jpQtX ~'~/.e>ti, ~ S~lSrfcJ ~it~fi"i'~ ~oou~~ arcel Number a2.o• ~~ ~•Lo • Q'~ Property Owner's Mailing Address ~ ~ • s SS Z ~ ~Ru Property Location - . , ~ ~ ~ .f~ ~, /UG ~,~ S a~ T Z` N R ~! E Ci State tY. Zip Code Phone ' ' Lot Ntunber 2 ,5 Bl~umber /~ ~ ~ /~ ~SQ~ • L~C/~' ~ j ~f O~/ 7iS'' 3 (~/. ~s7 ~ Sub di v i sio n Name CSM N mber u ~ y / / ~ / ~ II. Type oP Building (check all that apply) 3 ~ OCiry ~1 or 2 Family Dwelling -Number of Bedrooms ^Villa e 8 ^ Public/Commercial -Describe Use ~To~vrtship ~V n~'O~ `J ^ S O d tate wne Nearest Road `jf- jON III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Comple~ lin B iP applicable) A. 1 ^ New 2 (Replacement System 3 ^ Replacement of 6 ^ Addition to For Cotmty use S stem Tank Onl Existin S stem B • ^ Check if Sanitary permit Previously Issued Permtt Number Date Issued lv. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 2 d ~ (~ f~/7 44 Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter SO ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line ~''2'S~ 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ R c' ulating 30 ^ Other 6~ o » dj ~~ V. Dis ersaUTreatment Area Information: ' ~t, g. 7 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed R t G l /D S a e( a s. ays/ q.Ft.) (Min./Inch) ~j/ ~ Elevation ~ y VI. Tank Info Capacity in Gallons .Total Gallons Number of Tanks Manufacturer Prefab Concrete Site Constructed Steel Fiber plastic New Tanks Existing Tanks of Glass Septic or Holding Tank ~~ ~~ / ~ ~ . Dosing Chamber ~ ~ ., J~ ~'~'~i('. VII. Responsibility Statement- I, the undersigned, assume responsibwty for hutallatton of the POWTS shown on the attached plans, ' Plumber s Name (Print) Plumber's Signature -MP/MPRS Number R• 2ttt3 R -~Gt T- ~J?x ~ z ~ 3 ~ S Business Phone Number ' . ,,, ~ •~~~s 7~S •3d PltunbePs Address (Street, City, State, Zip Code) !oS S D~veiC. ~~_ f),1'O.J ~~• 5~01~ VIII. Coun /De artment Use Onl Approved ^ Disapproved ~tarY Permit Fee (includes Groundwater Surcharge Fee) ^ Owner Given Initial Adverse . ~~- S ~~ Date Issued Issuing Agent Signature (No Stamps) - l ~ I~ r ~~ Determination '0 ~ ~~ ! (r t I.X. Conditions of Appproyal/Reasons for Disa rove! 1. Effluent filter fo be installed and matntattte~ per manufacturer's recommendations. 2. All setbacks must be verified by the installer prior the installation. 3. The POWTS inspector shall verify that the system is not installed in the drainage way as identified in the survey by Northland Surveying. 4. Floodplain mapping =Zone "C" Attach complete plena (to the Comp on17) ror the statem on paper not less than 8]/2 x 11 hscha m stze SBDy6398 (R. 05!01) -Uh~RICI-I1' & A~~OCIATES~ CU. _ 655 O'Neil Road • F-Judson, WI 54016 715-386-$185 PROJECT INDEX FLAN I U JF OWNEF2 ~lrEN ~ Sj ~~ Abi)RCSS ss Z ~- LEGAL UE5CItI~'TIO geg..Deslgners of F.ng-noering Systems PlIVAfC Sewr-ge COIISU~~An~3 DATE `~~~ ~ ~ ~ / S~I.S/9'.y /~. /P/4'/t'~LC/~ PHONE 7/ $' • 3~~' /S'7 Z 'T'OWN OF /7 ~/OSD^J COUNTY s7~' ~I~ cs'r.r~ /~• Z!_ ~/P%C,li% Z2 (0375 LOCAL AU'TNORI'I'Y/ SUPERVISION ~'~OiX G'?~!'~'~~'y~'" f ROJEC'I' DESCRIE'TION: ~- R s~~T;~ sys~ . Q 3 ~~ ~~- . ~~ so,•~ s ~ v ~,•~,~ ~ . ~~ ._ ~ ~ p ~~~,~. ~~~ ~~ ~ ' 2G~ . ~ ~~ • ~,~ ~ ©v ,~`~- ~ ~ S s ~ ~ s ~~' ~ dl~ DAN-~i~~o ~~~G~ ~~" k~~ ~,~~ G~,vve c7~,eo~ ~Ibclcht & Assootiateu prlvato Sewase O°neulta-~ 865 O'Neil Rd• ~~~ ~~~~ Nudaon. Wls' ~~~5 ~~ ~~.~1 Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM. WITH FT.FVATTnirc 1 ~ ~ y ~ ~~ ~. o M y '~~ ~~ ~~ ., -~ ~ v ., n ~ ~ ~ ~ b ~ ~ ,~ ~ ~N ., ~, m ~~ ~ "~. 0 ~. ~ ~~ ~. ~ o ~~ ~ ~ ~ O g G c~ ~ ~ ~l n ~~~~~ ~ ~ ~ ~ ~°~ ~' ~ ~ y o ~~ s ~° ~~ ~~ .~ ~, --- ..~ O m N ~~ -~ Ct-~ c w ~ y ;~ N ~ ~' s~ Q ~~ n( 1 w O 1 d ~ c ~ ~M ~ ~~~ ~ ~_~ ,~ o , ~ ~ ~ ohm ~ zN~ ~ o~ ~ '' ' ~ P ~ ~, ~ ,__J, /~~` U '•e N D ~, ~~ ~~ ~ ;~ C N ,, ~. b -~ Z .~ I ~~~~ C `. Z o o ~ ,~ ~. c~ ~ Z ~ ~ ~~ ~ ~i~ l_ ~~>=~ .. r~ 7~ ~'' ' .___ ,_, - -~ ~ ,~~ o, ' tw 1 ~W j 1 ~~ ~ ~x ~ ~ i ~ ~ I w -it~ ~~ ~ hl c ~, ~~ ~ o-~ ~ ~ i ~ ~ ~ ~ ~ ~ ~ ~ o i~ ~ ~,~~ I ~ _ ~ w ~ 3 ( W~ l 1 1 ~ ~'C ~ ti ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ o Y ~~~ ~m ~ ~ ~ o V, 0 ~ '' ~ ~ Q ~ ~ ~`. ~~ _~ Ian ~, ~ ,- °~ -- N- ~~ I~~W ~ O -~m y~ ~ ~- ~~~ ~~~ .v W. 01 ~~_ R~ r G ~~'G Q~< W 3 Z ® ?" m~~ ~am~ ~ ~ m o °w m~ ~~ ' ' ~PPr~a~~ oe v~~T" 1 /~ ,y~,v. , l ,, ,, M 1~ ~.ZS L~ UAL. ~'/1 ~~D TIC'~~t.Y.ti, ~r~ -~. F,;~~s ~~-r~ 9 d'. ~ y~~f»c= D T~~~ ~~ ,/n , •~ ~ s ysT~M ~"i~v, 9 ~ D Cho SS Sic ~o~ o T~'~"tiG~ls T ~ ,~ ' ?~~`~iv (J- lN~i ~ 7~~4- 7-0~'S ,~,~, ~,4 pA~,~ ~y -~s,~Ew,.~~,~ ,, ~o~~L 3 ,x ~ -~. ~ ~ d~~ . w X51,,, sQ ~T, r~ia~~'ov~j c~ilclr j/ ~ S~~ Ti'o.v ~, .yiv . ~ 2 ' ~~~ 1 C,~/c v ~h~ED ~ i Sfi~NU. ~, ~~~ ~~ ,~~ ~pC ~~ ~9Pp~orr~l~ v~.~ 7- c,4~' U,v ~,vspErT~ov ~~~ I I/// Sc~ , Qo h-~~c :~ ~ .~ ~9P~~orr~l~ Usti T c~4 jd U.v ~N-r/~.~c T/ov ~~~, /// ~ r -~._ FiiV ~S QED ~,7 S-d 5c~ . ~0 9iP,4-~L~ 'Z- ~~ C r '' N 2.~ s ~~.~~ ~,v~~~x~r-off' 1, t.ZS ~~ ~~_ T~~~ ~ ~ -, ~~ An observation pipe may serve as a combination observation/vent pipe providing it terminates in the same manner as required for vent pipes. See Figure 6. Vent cap Return bend ~~ 12 gmin. 12" min. Fbral rade I I~. ~ I A Aggregate ~~, Distribution lateral Zj gin. .~~, [I ~. h-p• fr h-I-• ~Sysiem elevation Figure fi- Vent and combination observativn/vent pipes Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative surface for stone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance z flinches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure 5. (~ ~ Water tight csp 1 4" nrin. dia. Top ai ' leaching Repair couplings chamber ~~,~ Slot 6" min, s.. min. Infiltrative surface 4"min' Water Closet Collar Bart3/8" min. dia.) PAGE 6 REVERSE SIDE OWN'ER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by .code to submit all necessary maintenance/inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: ST Gto% X ~~ Zo.t!/ti~j-- ~• 3 ~'~ ~ y~ ~o * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: * Licensed servd~ce / inspection agent other than installer: * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1. Winter traffic (sledding, shove ring, etc.) across the area shall not be permitted, or frost can/will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also ~`" lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This sys(Cem was designed for a maximum wastewater flow of Lfs-a gals. daily. 3. POWTS ar.e not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. ;. 9. If a power .outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (lealckge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'PEM!! Effluent in the system beneath IS NOT sufficient alone t0 maintain a grass cover. :.. ~~ q -~o-~s ~Nisconsin Department of Commerce SOIL EVALUATION REPORT 3 rtvtsion of Safety and Buildings Page / of in accordance with Comm 85, Wis. Adm. Code Attach complete site plan`on paper not less than 8 1/ x,1 inches i County !~• C~CI /• v Include, but not limited to: vertical and horizontal reference • ~. ~ fie' Plan must •7 /~. too' .direction and p~ I I b percent slope, scale or dimensions, north arrow{ and location and dista~e toitiearest road. Please print all•fnformatiort.• Reviewed by Personal Inrormatton you provide may be used for seconds ~ Date ry Purposes (Privacylaw, s. A$Od (t) (m)), •~ Property Owner ~ IL 0~ d//~ /./d~~C~ _ ,~..~• Property Location [ (~ q jJ ! ` /~ G •,` ~:S`~`,,.; Gott. Lot S w 1/4 ~G1/4 S Z d T ~' / N R ~9 .E'(or) W Property Owner's Mailing Address SS ~ ~ ~ u . ~ ~ ~,a~M''" Lz 5 Blo~ # Subd. Na/mje~or CSM# City State Zip Code Phone Number - ~ r/~S f f (>1~,j~~J ~ ^ City ^ Village (~ Town Nearest Road /. Syo~(o (7/5) 3g/• !57 hl uDS.o N - • ,~~tC 1~~i L SOS L.N . ^ New Construction Use: ~ Residential /Number of bedrooms Code~derived design flow rate ~ GPD • ~ Replacement ^ PubNc or commercial -Describe: Parent material S/¢,y~ y ~y~+ mil,', ~ ~~-~ Flood Plain elevation if applicable /~' E L O General comments ~E~ SO/L tl% T /V ft. and recommendations: /_ ~ ~~ ~/~{ ~XI.rTI•iP~ (r.. ~~/f%N f •~~~~ j,•f• ~~ ~oDE ~o'`f~li'~,"T .s'o//s' j ~•~,r`, age ~.~`>'~' iu • j,'1<<T Boring # ^ Boring U ~ ~ T FS ~~~ ~ ~, Pit Ground surface elev. ~~ • ~ y ~-f) ft. Depth to limiting factor ~`•' " in. Horizon Depth Dominant Color Redox Descri lion Sofl AppNcation Rale P Texture Structure Consistence Boundary Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / Q •~~ /o t/~ 3/ ,F~ ~ ~ ~ Eif#1 Eff#2 ! s ~ ~fs~dk ~s c's 2 f , y , ~ Z //•~g /o Z ~ v ~'t~p '~~ SQL / •e ~f~' 4, _ Z. 3 ho~P~•2a,~ - 3 ~~• ~ /a R 3 --- s c h~ 3~ ~o y~P s ~ r,~,-fe w -- . Z.. . 3 L s'h ~ ~: a s . ~ ~~ ~ yz• ~ /o y sj - s o.s d,2 •7 iZ Boring # ^ Boring 3~O/~2. y~ . L d ylO Q Corr fau,,~ C~•t ~~ a 10 ® PIt Ground surface elev. R. Depth to limiting factor r+ In, f Horizon Depth Dominant Color P Soil Application Rate ~ Redox Descri lion Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color / D • ~O vQ 3 f? Gr. Sz. Sh. 'Efi#1 'Eff#2 1/~ ~7 -- ~c ~~~ sc. ~fsh,~ s ~s Z ~' y . ~ ti d~P~~e,~ S ~ r` . Z 3 . ,~ ~o ~ ~ Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 m /l. CST Name (Please Print) - g 'Effluent #2 =GODS < 30 m nd TSS < 30 mg/L Signature CST Number 2~6 ~ T l btu{cG,-~ Zz 43 7 S Address Date Evaluation Conducted Telephone Number Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 ~ ~I1o jE', /f',v ~C'S~y~-~~.~Q a ~'ECo,~i? j>~ Sl~,t~f,¢ CE' v~'~fi;v rt ~•E' Lv ~~/ .• - - ~ , .. - C ~O~ h~i~ls ZS • Property Ownei (r _ ~' "" ' /~'~ ~ ~ ~„ ~ • l~, 8 • ~ ~ • ~ 2 B oring # ^ Boring ~~.~ ParcellD # ~j p y Page of Pil Ground gurfaCe elev. iL Depth to limiting factor / C! in • ' Horizon ~~ ~~'~ ~ ~'~ Depth Dominant Color Redox Description " r Texlure . Structure Consistence Bounc~ary~ Soil Application Rate Roots GPD/ftt in. Qu. Sf i. Cont. Color Mu~r/lQeil ~/ ' ~ 5 ~~T /~ .q ~ l ~ ` ) C - J ~. Gr. Sz. S/h. I_ c~ ~iIW-' C .Q ' ~l' C 7 r 'Eff#1, , 1 ~' 'Eff#2 Y .. ~ i . ~~ ~~ - iot~ 5 S ~~ s ~ , 7 ~. . , ' Borfrigr# . ~ Boring ~ r Ground surface elev. ^ PiC ft. Depth to limiting factor in. Horizon Depth Dominant C l R d In. o or Munsell e ox Description Qu. Sz. Conl. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots s~ • I ' ~ Boring # U Boring u ^ Pit Ground surface elev. ft. Depth tD limitng factor Horizon Depth Dominant C l R ~ in. o or Munsell _ edox Description Qu. Sz. Cont. Color Texture Stru Ure Gr. Sz. Sh. Consistence Bou ry .. ~ .. F Soil Application Rale GPD/ttr 'Eft#1 •Etf#2 ~. ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =BODY < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider end employer. If you rie~d' assistance~to access services or need ineterial in an alternate format, please contact the department at G08-266-3151 or TTY 608-264-8777. • .~ -SAD-6170 (R.6/00) ~ - • _ in. nda Roots P a ~ D ~r • ,i ~~ ~ ~ ~ ~ ~ ~ ~- d ~ ~S ~ ~ c ~ r~ ~~~c ~~ ~ ~ ~ ~ d ~ ~ ~~ o o ~~ ~~~ i QG ~ _~_ p _ ~' ~ ~ ~~ ~cr 1I~ 1I ~I II I I I ~ ~ W 1W ~ ~ ~ , iI~I16` 11~1i~ II ~ _ ~1 1 ~ ~ j ~~ ( ~ ~ ~ ~~ 11 ~ ~ ~ m ~I ~ a~ ~ ~ I I 1 I• ~ ~ _. O ._. J d I I ~ I °~ ~ 1 ~ I I ~ W p ~ `` :~ ' ~ ~ I ~ ~ ~ ~ ~ ~~. ~ ~ ~ ~ ~ ~, ~6~ ~ ~ ~~ ~~ ~ ~m ~' ~ i ~ ~ ~ 'dam ~- ,~ ~. -., ~ ~- °~ N . - N ---~ ~W . ~ W. O ` ~~ - O R~ r y ~~ ~ ~. y ~\ n~ ~~ d~ ,V =~bc ~~p~ ~Zg~ m~~ ma~~ m gi o O E; ~ ~~ ~, ~1 ~~ ~ ~ ~; ~. ~' _~ 3 ~y9 i718 9~~s ~' ~ EDAR HILLS ESTATES LOCATtO IN TNt Ntl/1 O' TNt N!1/4; TNt Nwl/1 O- TNt Ntl/4, TNt i1N1/1 rNt st 1/• O/ TNt Nt 1/t O/ ltCTION ![. TtlN . 111l~. TO~11 O' N11000N • wllCONSIN. SI/4 CORNER h p~ ~ ( .. • o a N ~~~ ~ ~ 1 ~~ ~~ ~ ~ ~~ zeQb;o2°w ~. i g ~~ d 8 ~~ ~ ~ ~ $ ~ ~~ d~ ~ ; ORAINIf6E 1 ~ s ~ j~ _ ~a~ EAS[MENT ' . ~ y ~-- a~~. ~ ~ ~~ _ _ _ - NI3el sip ~E~''.ev 3, 12 _ ~pl,pp, _. -~-~ . ~ j~.oo -- N i 3 ~M s e ^ ry~ f~' ~ ~~,, r V N ; t. 8 24/0, ~, :' ~.~~ ~ ,, r ~4 ~ 4 ~ (~ .!+ _~Ir~ ~X~l~i~~N~ ,. ., ~ ST CItOIX COUNTY ' SEPTIC 'TANK MAINTENANCE AGREEMENT ,~. ' AND .- OWNERSI~IP CERTIFICATION FORM . Owner/Buyer ~' ~~~~ ~ $' USN /~. /~7/ffi~ ?j' Q ~' ! S7 'Z Mailing Address SSZ- ~~ ' ~R ff?J~~d`~- .S ~1a/~ Property Address J ,. (Verification required from Planning Department for new construction) City/Staff' Parcel Identification Number O Z ~ ' l ~ ? ~ ~ !off ~ ~~ LEGAL DESCRIPTION Property Location s~ '/,, N~'/.,, Sec. Zg , T ~~ N-R l7 W, Town of ~/ ~~~! Subdivision __ C~~~ ~r~~s ,Lot # 2 Certified Survey Map # ~~ ,Volume ,Page # ~} r, ~y Warranty heed # /~ y~ I~~C 2- ,Volume ~l 7 d' ,Page # ~~ d Spec (rouse O yes [~no Lot lines identifiable ~ yes O no SYS'T'EM MAINTENANCE lmpropet use and maintenance of your septic system could result in its prematwe failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, iC needed by a licensed pumper. What you put into the system can affect the function of flue septic tank as a treatment stage in the waste disposal system. . The property owtrer 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) alter 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 oC Natural Resources, State of Wisconsin. Certification staling that your septic system lras been mairutained must be completed and returned to flue St. Croix County Zoning Office within 30 days of the three year piratiour date. ~" ~ ~~ GI~I~L ~, SIGNA RE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify float all statements on tluis form are true to flue best of my (our) knowledge. the y describe a ove, by virtue oC a warranty deed recorded in Register of Deeds Office. ~. ~ , SIGNA'T'URE OF APPLICANT I (we)~9m (are) the owner(s) oC /~/2u'( DATE ****** Any information that is mis-represented nuay result in flue sanitary permit being revoked by the Zoning Department. ****** ** lnclurde witty lluis application: a stamped warranty deed from the Register of Deeds office a copy of the certi[ied survey map if reference is made in the warranty deed . ... ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certif//y that I have inspected the septic tank presently serving the ~ll~'.~/ J~/P/~'~t~i residence located at: Sw 1/4, N~ 1/4, Sec. 2v T Z( N, R /~ W, Town of ~Ul~ SD~ _ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced S~~i~,l,L Z©D Did flow back occur from absorption system? Yes y No (if no, skip l next line) Approximate volume or length of time: f / ~ gallons minutes Capacity: JD's O" ~` Construction: Prefab Concrete ~ Steel Other Manuf,acurer ( i f known) : (~j~ E'.SE7P ~O~ Cc.L~~_ Age of Tank ( i f known) : ~ ' /d ~'~~ S (Signature) (Name) Please Print tfiitle) (License Number) (Date) Form to he comi?leted by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). ~J r ~ ~~Z°s.~G ZZ ~ ~ ~~' Name 1~Z~~ u ~b ~ l G~S ignature -H~P/MPRS p~ ORIGINAL . ,.. 's~a~~~ ' DOCi3MENT NO. ti4~ 118 PACE l68 WA~~t~NTY D~:~D 7'hie Spece Reeervad Por Reco[d ing Deca THIS DEED made between BANK ST. CROIX, a Wisconsin banking corporation, Grantor and ALLEN N. KRAMER and SUSAN M. KRAMER, husband and wife as survivorship marital property, Grantees, Witnesseth, That the said Gra..tor, conveys to Grantees the following described real estate in St. Croix County, State of Wisconsin: REGISTER S C>=~ICE ST. CppuuROyylX~},C~O..~,., Wl f101,J ~N f1W~Y SEP 3 1996 at g: is A. M ~ ~ ~~~ Rer~sttKOft ids /D Lot 25 Cedar Hills Estate in the Town of Hudson, St. Croix County, Wisconsin. ~ ~ftA ~~ER This is not homestead property. ~~''aa TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights-or way of record, if any. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Bank St. Croix warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this, ~~7/day of August, 1996. BANK ST. CROIX (SEAL) By: teve J. Hirsch, President ~~~~~-~i (SEAL) By: Sandra L. Bolfo~n, Yice President STATE OF WISCON,`'~ ss. ST. CROIX COUNTY ) Personally came before me tlti~,~~"! day of August, 1996, the above-named Steven I. Hirsch and Sandra L. Bollom, to me known to rsons who executed the foregoing inswment and acknowledged the same. ,~M_~ ~ -~ MQTw~ r ~ o Pudic, State of Wisconsin ~~~L~C ommission Expires: ~-»-O+1 ~1 "'~ THIS INSTRUMET~i'T DRAFTED BY: RETURN TO: Barry C. Lundeen ^~ ~ ~~ MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. ~ ~~ 1 l lf3 Second Street V 2~ / ~~~ -~ Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT Ta ~• ~ _.~l, ~.i~ OWNER~~1/~~.~:ti ~~-~,~'rc/-~~~ TOWNSHIP ~!,CC~~',~./1/ SEC. ,~'~ T o~>N-R /~_W ADDRESS iL~~G~-~,S'o.~/ u~~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~~ ~= r j~~l/S LOT ~2~ LOT SIZE ~ ~1'Gt ct.r a ~° PLAN VIEW Distances and dimensions to meet requirements of I•Z,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM BENCHMARK: Describe the vertical reference point used ~"~ rst ~ Q ~ /_= ~/ j /S Elevation of vertical reference point: lll", ~ ~ Proposed slope at site: /l''%.~' PUt~ CHAMBER Manufacturer: Liquid Capacity: Pump. Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Pump off switch elevation: Bottom of tank elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ~ Trench• Width: ~~ Length: r ~,_ Number of Lines:J~_ Area Built:~~..>~ Fill depth to top of pipe: ?L' ~~ Number of feet from nearest property line: Front, ~ Side, O Rear,O Pt ~~G Number of feet from well: _ Ci U~-~~` ~~ Number of feet from building: _~ '~ ' (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems2 (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector• DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING ~ LABOR ~ HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: Nt~,1VE4,S28,T29N-R19W ®CONVENTIONAL ^ ALTERATIVE (If assigned) Town of Hudson ^ Holding Tank ^ In-Ground Pressure ^ Mound BAs E E D ADDRESS OF PERMIT HOLDER: INSP William Harwell Count W Hudson WI 54016 _ - BENCH MARK (Permanent reference point) DESCRIBE IF DIFFEREN FROM PLAN: REF. PT. ELEV . ~ J ST REF. PT. ELE .: 3 -- . ,~. . - ~o~~ mss= ,. ~ ~ S,de. e ~o%a ice, l~ Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: William SchLnnaker 6382 St. Croix 119432 SEPTIC TANK/ Z' ' ~': ~s~' 8 ' MANUFACTURER: LIQUID CAPACITY: TANK INLET EL TANK OUTLE WARNING LABEL LOCKING COVER ' " r~~(~e~~ /I N / LL., ~ ~ ~ / ~ . ~ PROVIDED: YES ^ NO PROVIDED: ^ YES NO BEDDING: VGPF~DIA. : ATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T RESH C. d, // G O . ALARM: FEET FROM LINE: ~ ~ AIR IN ET: ^ YES NO ^ YES NO NEAREST ~~ ~ ~0~5 DOSING HAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^ YES ^ NO ^ YES ^ NO ^ YES ^ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ^ YES ^ NO NEAREST ~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.)~~ CONVENTION AL SYSTEM ./o" a~ 5 -~ ~ _ ~,, _ ~ " BEDITRENCH WIDTH: LENGTH: NO. OF DIST .PIPES CING: COV R INSIDE DIA.: # PITS: LIQUID DIMENSIONS ~ / ~~ ~ TRENCHES: / MATERIAL: PIT DEPTH: G ~ GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PI E DISTR. PIPE M TERIA ~ ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: r~ ABOVE COVE ~ i~ -- // 9j ELEV. INLET / ELEV. END' / ~~~ S • ~/O ~!~ ~ ~~ IPES: FEET FROM LINE: i ~ ` . i .~ {~ AIR INLET: / ~~ 8 "o+v ~, NEAREST ~ ' as / o~~/ ~~ MOUND SYST EM: S, oz' ,~./ ~i57~-D-17~5- Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ^ YES ^ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ^ YES ^ NO ^ YES ^ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ^ YES ^ NO ^ YES ^ NO ^ YES ^ NO PRESSURIZED DISTRIBUT ION SYSTEM: BED~TAENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ^ YES ^ NO ^ YES ^ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY LINE WELL: BUILDING: S FEET FROM : il~tA< « h.P e ~~ . ~ ^ YES ^ NO ^ YES ^ NO NEAREST ~ Sketch System on Reverse Side. SBD-6710 (R. 06/88) @AI-IITADV DCDwA1T ADDI IIr`ATIIAIAI HR .,~.... ~.... _....... ~_.. ---- - - ---- DIL In accord with ILHR 83.05, Wis. Adm. Code ~~ _ .d„M,._. ~~_ ~ STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than J~ ~ ~~07 8'fs x 11 inches in size. ^ Check if revision to previous application -See reverse Slde for InStrUCt10f1S fOf Completing thlS appllCatlOn. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ' ,l~Gt/'/a ~'/a, S 2 Tom? , N, R l E or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # C C! G ~.rJ !.~ ~~ ~'~/4/ ~. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER G/ , ~ D G `"- ~ t~ Y l~ ' is II. TYPE OF BUILDING: (Check one) CITY ~ NEAREST ROAD ^ State OWned !] VILLAGE ^ Public ~.-1 or 2 Fam. Dwelling~# of bedrooms PAR TAX N MBER ~ ~ °~`5 III. BUILDING USE: (If building type is public, check all that apply) 1 ^ Apt/Condo 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. ^ 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 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ELEVATION REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~l ea y.J d ~ ~2. .~ 7 , Feet ~I~~~ Feet VII. TANK CAPACITY in allons Total # of Name ' f t M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks urer s anu ac oncrete structed glass App. Tanks Tanks Se tic Tank or Holdin Tank ~ Lift Pum Tank/Si hon Chamber 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 Sta ) PRSW No.: Business Phone Number: . ~/. ~a e GJ ~ ~'3 d''~ 3~ 3 /02 Plumber's Address (Street. City, State, Zlp Code): ~ c r s~• ~ ~~.,~ ~ ~~. o~ IX. COUNTY/DEPARTMENT U ONLY ® Approved Disapproved ^ Owner Given Initial Sanitary Permit Fee (Includes Groundwater Surcharge Fee) ~ a e ssue / ~/ ~~' Issuing Agent Signature (No Stamps) f-~ ~ / ~~ ~© / ~ ~ h!7 ~ d A v eter i ti , ~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety fl 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 i~ Buildings Division, 60&266-3815. To be complete and accurate this sanitary permit application must include: :>: I. 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'r~ 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) ~. ~~ ~~~ ,~ ~ ~~ v w e i ~~ ik~ t- ~~~TG ~~ ~~ ~ a ~° `~ V ~ ~~ '~~ i h ~ ~~' ~ ~' ~~ ,~ n , ~ ~ ~~ tc ~ ~ 1~ `~ x ~~ ~ ~ ~~ L ~~ b ~ ~ ~~ ' ,~ b.4 1°t /~ ~ 0 \ ~ ~ b~ ~~~ ------ T',;v•'3l~ L,,C~J /Da. s~ htv-X ..~-`... _ _ _ ~ ya "rn-~ - .~' _ '; ~3 ~'~ y/~/ fi'r' Q~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSfiRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 FtUPc4AN RELATIONS 1 ~ MADISON, WI 53707 (H63.0911) & Chapter 145.0451 A I ,/~ ,/ SZB I %TZ N/R-9 E w TOW / F{ /M~l~ 8J3i.V: / \ , 2 ~0.: BLKVNO.: ~ED S~ ION,,`LS / / ! (or C, y( J ~ } ~ ~ Y C. ! COUNTY: SiC~OI~t OWNER'S BU ER'S NAME: OM S-r~dN& A M I S: ' / ' NU~sSO'V c SIr L 7 C ( b .Jti ) • L ~a~ NO. B DRMS.: CO M R RIPTIO ' Residence r INK ,,,~,~~ ,New ^Replace VI ~=~1~+ ~oai. 4 ~6 fl n DATES OBSERVATIONS MADE M,nRcu 3a~ r~7 Md~eu~ 3>- X98 ..- RATING: S~ Site suitable for system U~ Site unsuitable for system "'D~t-' Ok L' ~~ ~ ~~ 1 ' NV~ ^ ~. S'a~ M IN- ~ L - G ' Mapptional) _ ,4C1.J ~J Y DU S ~J IdJY ~ NW£S Cd vGNT ~AL If Percolation Tests are NOT required DESIG~RATE: I If any portion of the tested area is in the ~~ under s.H63.09(51(bl, indicate: LQS'$ ~ Floodplain, indicate Floodplain elevation: pt2 ~- PROFILE DESCRIPTIONS BORING NUMBER TOTAL DEPTH TN, ELEVATION H T R UN OBSERV D D ATER-INCHES C ARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) B 1 ~~v~ Ivz.9S oNl= } 8.d0 i2" lI.TS IZ"$PNStt'_ ~2~ @4.•t C-MS'~C>Q B- Z p.17 iUU.~f oNLr > /U.1 /2""Q~s~TS 7~U"Q~n, G-M SAC>re B- 3 9.67 /OO,OZ ~ ~ 9.67 iz'' I_i5 ih"$+2~5~ 33~"8~N~1s ~tG>~ 2~ "$atics~lGr< 34 ~ ' CIS B' 4 •7~ ~S.$~ f~1orV ~ !•7~ 17''+~~ITS /Z~e~Nr!. Tf'~QN ~-C'S~tGvQ a- S g,33 y7.~4 0 ~ > 8.33 ,Z'"~«TS l4"6aNSc. ~ '' 8R~1 v-'-S B- ~~~ ~ PERCOLATION TESTS NUMBER DEPTH IBS WATER IN HOLE AFTE S TEST TIME D RATE MI UTES R WELLING INTERVAL-MIN. PER INCH P- 3 Aso o /~•~ ~ Z > 12 t 3 P- TI ill CRS. P- P• PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- eontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction end percent of land slope. SYSTEM ELEVATION ~~ ~~ (3 Z ~ D ~ ,. 7' ~p-~ o D6.NCN~AR~'. / is VOfl of ENq d~ I~" ~ M IP 6S Cu t VEST. p ~ ' h~(~WL)NI; ~ (8.54.. ~ _ $- I ~~ -- - g- 4 ~ - P-'~ j I ~ ~~~ I ~ I S~p~ , - j __~~ /U- ~Z ~ ' ~~ 1 7 P-1 i ` _----- q6. BS Sc~l.6 x,30. FvRTU>~Q StTt ri-gN CAS/ B~. ~UfJ~ tJV ~EVEd~S~ , TN I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods slwcilieei in Ilia Wisconsin AJ~.~.-.-~....~ ~.__._ __~ -~_. -~_ ._._ _ . . _. _. _ ~ .- 7.~ ~, ~ ~~ o ~ APPLICATION FOR SANITARY PERMIT STC- 100 This application forte is to be completed in .full and signed by the owner(s) of the ; property being developed. Any inadequacies sill only result in delays of the permit issuance. Should this development b+~ intended for resale by owner/cont><actq;.("spec house"), then a second fdrm should be retained and completed when•the property is sold and submitted to this office with the approp>Kiate deed recording.. (saner of Property ~,~11:_K s~-t- ~~.r w.~~ Luc:ariorti of Property ~~~ i!/~. ~, Section ~~ , T o2p N - R /~ W r `Pownahip M:3 .i. i. ing Address ~ ~ ,C ` G O ` ~-~_________..._, SuUdivision Name: ~ ~.~ 1..~.~c Number ~ ` Yr~,~vioua Owner of Property ~`~,~-G+ ~a~'S'c~ Total. Size ,uf Parcel ;?-> ~ry-e s UaCe Parcel was Created l 7,( A~-a a.tl corners and lot lines identifiable? Yea DIo ___ Is this property being developed for resale (spec house) ? ~~ Yes No Valwae ~ ~~3 and Pbge Number l ~ G aa:reeordad with the Register of Deeds ;, a ~-~- j INCLUDE WITH THIS APPLICATION .ONE OF THE FOLLOWING» 1. Warranty Deed 7. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if availabl®, would be helpful sa as to avoid. delays of the reviewing process. If the deed description refereacea to a Certified Survey Map, the the Certified Survey Map shall sleo bta required. PROP~RTy OWNER C~R7YFICA7ION X IWe) cewti. y .that aQt' a.taate~en.td an .this o~ua she ..to .the beds o~ ~ {sun! hnc,u>.bedge: 1 {we! am {.cure! .flee owneh{a~ o~ the p~ope~.ty deac~bed .ere .th.i,a ~.n~on»IaLion ~onrn, by vcntere a~ a w~archanaty deed xee~aded .c.re ,the 0~6.i.ee o~ .the County Reg.%apte~ a~ Deeds ab Docuaent No. _~~~'~ l ~ j -; and .thaat 1 (we! ~aa ea enfi~ y own .the pn.opoe ed a.eate ban .the d swage pea b ye.tem ton 1 twe! have ot~-tcuned an easement, ~to sure with .the above deseh.~Ged pAwpeaty, ~aa xhe eona.t~t.uc~i.on ud aa.i.d 4yazem, and .the same had beers duly necoau¢ed .in flee OS~.ice a ~ .the C u u.nt y Reg.id ~tt1t" o ~ Deeds , as Document 'No . ~'l.9 / 7 ~ ! . .. -' S 'C C - l U5 SIiN'i'1C 'LANK MAIN'l'L:NANCI: A(~I(l:I~:P1l;N'1' 5t. Ct•uLx l:uuncy ~, W ~ . I~: it / ti U Y L It ._~, ~l_l- `ct.~xt _ _~o!rY_!t: Cl~- -.- It,)I1'l'I:/B(1X Nl1MBEK ~! ,<(a.~f'.S L~i,.•e Nurnh~~r ------.___.~~___._..__._.~n_~~~.r~-1_ =____.__ __ __ _._. _ !,,, tic:cC iuu dl'` 'I__~ .__N, k l_~ W. I'I<ul'l:lt'l'Y Ll1l;A'1' LUN : ~~ la, . _ ... .. ~- - - 'l'awn of ~ ._._ __.._• 5t. Cruix County, i 5ubdivi'Isl.uu~e~~r._.'l"~1~'.:S__.._._._~, [:ut uumbt:r_.~,~~__--• liul,ruper use and wulntenuttcu ul your s~pt it•. tiy~[uu- ~:uuid result in Itcs L,r~.u-a[uru'lullure Cu )t~tudl~ wa~tc:s. t'rup~r mxtintc:nun~:u cun- sitits ul: pumplub out the aaptic took every tl-ree: yuar5 ur yuuuc~r, i.l needr.d, by u licensed s~tic tank puu~Lur. What you put into tl,e :system can atluct the fuuctlou of (.hu ~upCic tank us a tr~ut- u„~.nc stake in the waste dixpusal systmu,. . `.t Cruix County residents utu~ ~t n,uximuut of 6U% ut the curt of which^way lu ul,uruCiun prlur to .lt:calitc;cl Chis prul;ran- it- August uwnur~ of ull_ ucw ~_steuis al;ree ,Utl1tlCFtlilCd-, _ '-_ hu elil;ihlt to r~cuivu a l;runt fur replacewuut uC a fai.Ltnl; 5yst~m, .luly 1, 19711. St. Cruix County of 1980, wltlt the ruqulr~:mt:ttt tl-ut to keep their systeois properly Thu property uwnur u~,rees to suba-it to St. Cruix County ''/.uninb a cc:rtificatiun Eurut, sign'ud by the owner and by a utctster plumber, jourueyntan plumber, rrstri~~ted plumber ur v licensed pumper vuri- fyi[tb that (1) tl-e ou-Sltc: wust~water disposal :;ysCem'is in ~prupmr uperating condition and (2) utter insp~:ctLun and puutpinl; (if nec- essary), the septic tank is less; than 1/3 full of slud~t: uucl scum• (:urtlficatiun form will be cunt approximately 30 days prior to thrt:~ year expiration. • !/WF:, the undt:rslEned, have read th4 above recluiremt:nts and al;ree ru maintaln tL-e privatd eewuKu disposal syatt:m in accordance with cht:..standards het Earth, herein, as i~et by the Wisconsin Uepurt- m~nt uf: Natural kesourcra. Ct:rtiflcatiuu iurm must be cumpletc:d dnd returned to the St. Croix County ZuttinE Ulfi,l:e within 3U days uE the three year expiration date. ~, 7 ~ SIGNED ~ _ :- - - --..__ UA'I'E ~~ -( -~~ St. C.•oix County `LonLng 'Office 1'.U, . ,tux. 96~ llatnmu'jtd, WI 54015. . 715-7 ~6-2239 or 715-425-8363 SiKn, date and return to abuv~ address. • ~' ~ ,,C.:,UMENT NO. ~ STATE 13AB OF WISCONSIN F M i1-1988? T~ a~Aee EatRVED /OR RECORDING DATA. ', ~ LAND CONTRACT ~~. ~1 y ~~~y1J ' Indlvldnal and Corporate ~~CTtoC O~F;tr• 71 J ITO IIE USED FOR ALi. TRANSACTIONS WHERE OVER V ~ GlW ~` -~. ~. ~ 126,000 19 FINANCED AND IN OT}IF.It NON-CONSUMER ACT TRANSACTION:SI ST. CROIX CO., WIS. Contract, by and between ... Harr_y__ J .__ Stewart, __as_ Personal ._lte~resentative of .tl}e Estate of Aldro Larsen arks John ._A1drg__Larsen afkJa John Aldro Myren_Lar:?en}__~*_ ("Vendor", whether one or• more) snd_.. William_ C.__ Harwell ___________________________ *single man ("purchaser", whether one or more).. 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 rents, profits, fixtures and other appurtenant interests (all called the "Property"), • St. Croix ______________________ ___ County, State of Wisconsin: tn .................•--....... ._........_ . See legal Description on Addendum 3~6 _ q~~s This ......1~~..Tlot.......... homestead property. X>a# (is not ) Recd. for Record Ibis 11th day of Ju_ n_e__q~D, 1 S~ 86 af_1~45 A ,M. James O~Connell ...• ~~ e/ Deed . • ~!/~ ~!/ deputy RETURN TO Tax Parcel No .................:................ ;~tSF! ~~-~---- FFF Purchaser agrees to purchase the Property and to pay to Vendor at ,such Place as he shall name the sum of;..192.,,500.00 ............. ...................... in t1~e follov~ing manner: (a) ;...~Q.,~Qn~.4Q.......~..............~...~ at the execution of thin Contract; and (b) the balance of ;.131., 5Q0_~(~Q_________________~ togotlrer with interest from date heregt on the balance outstanding from time to time at the rate of ..............C:~A._f`i.QY)........... per cent per annum until paid in full, ss follows: See Payment Terms on Addendum Provided, however, the entire outstanding balance shall be paid in full on or before the....... llth__.___ _, day of ....._....113nE ........................ 19...Q.Q. (the maturity date). Following any default in payment, interest shall accrue rat the rate of ...1Q....~o per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insuranco premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, aaseaamenta and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law, Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount tnay be prepaid without premium or fee upon principal rat uny time. iY?tifdiX?i?i?cJiXXX~X~~~4?f~~SE~SX~cX~~ tkane:~:a,;;~x x~c ~x~toart~md~cRaitcoi~lxvcitbaotat~s~mi~orlrufxlEe~l~iaik In t}le event of ally prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing 'interest from month to month shall be treated as unpaid principal) is leas than the amount that said indebtedness would Dave been had the ltpgr~ijyxpaymenta been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purcheaer states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: ev4~.. tl ~t~PasE .L~h ~y ~' ~ `~~-. ' Purchaser promises to psy when due all taxes and asseessments levied on the Property or upon Vendor's. in":r:Kt m it and W deliver to Vendor on demand receipts showing such payment, Purchaser shall keep the improvements on the .Property insured against loss or damage occasioned by fire, cx- -c•r•~It~ri coverat,~e perils and such other Hazards us Vendor may rcyurrc, without co-insurance, through insurers approved I,.r• ~'errclc,r, in the sum o! ;............n/.a .......................... l,ut Verrrlor shall not require coverage in nn amount mere than ilir t alance owed under this Contract. Purchaser shall pay the incur:u-c~ premiums when due. The policies shall c~,rrt:cirr tare st:-ndard clause in favor of the Vendor's interest urrcl, unless Vendor otherwise agrees in writing, the original of all policies covering fire Property shall be deposited with Vendor. Purchaser shall promptly give notice of Ins, Ln in::r,r:r,r~•e companies and Vendor. Unleaa Purchaser r-nd Vendor otherwise agree in writing, insurance proceeds shall I,n aplrlicd to restoration or repair of the Property damaged, pt•ovicicd the Vendor deems the. restoration or repair to he • •• ::wraicalh• feasible. Purchaser covenants not to commit waste nor allo« waste to he committed on the Property, to keep the Propcrt;• iii ttvucl tenantable condition and repair, to keep the Property free from liens sul,erior to the lien of this Contract, and tc, cemplc with sll laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the limes and in the manner above specified, Vendor will on demand, execute and deliver to flee 'urchaser a 9t~rx De d in ~'ee simple, of the Property, free and clear of all liens and encumbrances, except ersona'1 Rgpres~nga"tivg s any yens or encumtJrancea created by the act or default of Purchaser, and except: ...sa&twtDaAt&.,..p]COt>r~X~Yt'.. ..covenanta..af...zecnLd,..if ..any.,--and..zan:ing..a.xd i.nancs..raqu~.xsmsnfa ~ ........................................ i'urchaaer agrees that time is ot• the essence and (a) in the event of a default in the payment of any principal or intere><L which continues for a period of ...CtQ... days following the specified due date. or (b) in the event of a default in perfnrmnncc' of any other obligation at Purchaser whleh continues for a period of ..~Q..., days following written notice tliercol' ht• Vendor (delivered personally or mailed by certified mail), then tiro entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby a•aieesl, clad 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: (i) Vendor may, at his option, terminate .this Contract and Purchaser's rightQ, title and interest in the I'ropert}• and recover the Ih•aperty hack through strict foreclosure with any equity of redc,nl,tion to be conditioned upon Purchaser's full payment o[ the entire outstanding balance, with interest thereon from the d;itr of default at the rate in offset on such date andothernmountsduohercunder(inwhicheventall amounts previously pai•1 by 1'urchascr shall he forefeited as liquidated d:rma_r•s fur I'oiluro ic, fulfill this Contract and as rental for the 11•operh• it purchaser fails to redeem) ; or (ii) Vendor may .sue for specific performance of this Contract to compel imm,•dinte and full payment of the entire outstanding balance, ~~•ith interest thereon at the rate in effect on the date of rlefaii;t and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall he liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion tLrrr:,f: or (iv) Vendor may declare this Contract at nn end sail remove this Contract asacloud on title in a quiet-title arti~~n if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from poasessinn of the Property and have n receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) nbrwe.Nohrilhst:uiding am• oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be hireling upon Vendor if and when pursued in litigation and all coats and expenses inclurlinR rcasnnaiblo ntt.orneys fees of Vendor incurred to enforce an>• remedy hereunder (whether abated or not) to the extent not prohibited b~~ law and expenses of title evidence shall t,e added to principal and paid by Purchaser, as in- vurmd. and shall he included in any jndgnient. Upon the commencement or during the pendency of any action of foreclosure of this Contract Purchaser conaenta to the appointment of s receiver of the Property, including homestead interest, to collect the rents, ~saues, and profits of the Property during the pendency of such action, and such rents. issues, and profile when ao collected shall De held and applied ns the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (bv assignment of any cf Piirchnger's rights under this Contract or by option, long-term lease or in any other way) •rithout the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in Hill or the interest con0e}•ed is a pledge or assignment of I'iirch:~scr's i:terest under this Contract solely ns security for an indebtedness of Purchaser. In the event of any such transfer, sale m• conveyance without Vendor's written consent, the entire outstanding balance pa~•ahle under this Contract shall become immedintelydrre and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under nm• mortgage outstanding against the Property on the date of thi. Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes t.iinely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor tails to do so and all pa}•ments so made by Purchaser shall be considered payments made on thin Contract. Vencior may waive any default without waiving any other subsequent or prior default of Purchaser. A11 tPrma of this Contract shall he binding upon and inure to the benefits of the heirs, legal re reaentatives, successors and assigns of Vendor and Purchaser. (lf 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.) bated this .......11th. ........ day of June ........., 19..86... ........................ ........................................................... ..... _ ........................................,............... (SEAL) .. .......................................................... (SEAL) AUTHENTICATION authenticated thin ........day of.. ................:.._...., 18...... ~~ LL .~ ~ * ..Harry..J.....~tewart .............. .. .... ..... ...~: rv (,. r , ~ ,. .1....... ... ................~,~~ - ~ L ~ A William C. Harwell ~"~~ Q -J ' ~ .•..~- '•O;O ~ ~. ACKAi U1?ii LEDCiMENT~',~'~~.' ~,~ STATE OF WISCONSIN ''~, .. " aa. . St .-,Croix .............. .County. .... Personally came before me this .11th,.-_--day of .......... June ................•-----., 19.86.. the above named .Harry-_J-t„Stewart and William C,,.~,~pwell