Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1178-80-000 (2)
Wisconsi>` Department of Commerce PRIVATE SEWAGE SYSTEM • Safety and~uilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Maruska, Donald ~ Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ~'(~ ~ LS ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~gb}- Co Dosing esc,`, 4 ~F ~' s ~ ~o Aeration no `~ ~ 525 Prbl i' ,ti,~,,,~.~. Holding TANK SETBACK INFORMATION ELEVATION DATA county: St. Croix Sanitary Permit No: 506125 0 State Plan ID No: . Parcel Tax No: 020-1178-80-000 Section/Town/Range/Map No 28.29.19.1127 STATION BS HI FS ELEV. Benchmark 2. I b /oZ • la /aa Alt. BM F,• t Gooe.~. ~ •~ l ~~ , Bldg. Sewer x ~ ~-~ ~ SbHt Inlet ~~(i ~ ; J~ SUHt outlet 7.73 9~ - ~ 7 Dt Inlet 7.83 9y•z-~ Dt Bottom Q•a~ 9y. o(o Header/Man. ~ .58 93 -SZ Dist. Pipe 1~e5}- •7~ .'? I 93 •''I 9 . 3 9 Bot. System 1,,.9e6•(•- 9• (O`~ 9 • ~3 92 • y(A 9z • ~{ ~ Final Grade St Cover TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~: ~ c.f~ > Sp ~ ILJ 7 e' 7Z ~ - Aeration ~joJ F ~' Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number -'--~ TDH Lif Friction Loss System Head TDH Ft Forcemain th Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 df3 D I~ Z ~~`~ `- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~~~ L ~~~ N CHAMBER OR r ~ INFORMATIO Type Of V stemlI : COJ1 ~~h~ 6 ~~ 7d ~ `~ ~ J > •75 ~ ~ ~ UNIT Model Number J 1 ~~ IIISTRIRI ITI(1N SYSTEM 5_ .1J GG ~ l 7. %~}~ ~-v ~d U Header/Manifold ~ I Distribution x Hole Size x Hole Spacing Vent to r Int e '~ ~ ~ / ~ / ~ Pipe(s) ` ~ ~ \ '( '~'~, 3 f Dia Length Spacing Length Dia e/~. Sell C(~VFR Y Drncc~~ro Svc4nmc only YY Mnund nr At-Grade Systems Only 1 Z rr3-- t'turl e...~ Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / QS( Bed/Trench Edges ` Topsoil Yes ~' No Yes Iii No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / / ~/ ~~ Location: 788 Larsen Lane Hudson, WI 54016 (NW 1/4 NE 1/4 28 T29N R19W)1 Cedar Hills Estates Lot 27 1.) Alt BM Description = 2.) Bldg sewer length = ~~ ~~-~'~ /Q~( i~, 4 Q,~ -amount of cover = t (~ ~ Plan revision Required? 'Yes No ~ ~~ b`' Use other side for additional information: Date Insepctor' ignature SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 28.29.19.1127 4 ~g3 S Cert. No. " COmmeroe.Wi.gov Safety and Buildings Division county 201 W. Washington Ave., P.O. Box 7162 st. CrO1X i sco n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce SO (p ~ Sanitary Permit Applicatio State Transaction Number _ ~,^ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo ropriate gove mental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for sta ~ - POWTS are submitted to the Department of Commerce. Personal information you provide may be used for ndary LQ (-~~ same # 70 u oses in accordance with the Privac Law, s. 15.04 1 m , Stats. 0 G ~ ~~ I. A lication Information -Please Print All Information Property Owner's Name / Parcel # Don & Deborah Maruska APR 0 5 2007 020-1178-80-000 Property Owner's Mailing Address Properly Location /l Z 7 ST. CROIX COUNTY ~ 7$8 Larsen Lane Govt. Lot City, State Zip Code Phone Number NW ''/a, NE '/., Section _?8 (circle one) Hudson, WI 54016 (715) 386-0779 T 29 N; R 19 w II. Type of Building (check all that apply) j, 4 ~ ^ 1 or 2 Family Dwelling -Number of Bedrooms 27 Subdivision Name ~ J. ock # Cedar Hills Estates ^ Public/Commercial -Describe Use ^ Na c;ty of ^ State Owned -Describe Use CSM Number ^ Village of ^ Town of Hudson Z ~/ ZZ + ZZ G~ta tC Na III. Type of Permit: (Check ty one box on line A. Complete line B if applicable) A. ^ New System Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component ^ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information 44 Infiltrator "Q-4 W 'chambers 20.0 s .ft EISA /chamber + 2pair end caps 5.8 EISA = 891.60 s . ft. Design Flow (gpd) Design Soil Application Rate tspers ea Regwred (~ ispersal Area Proposed (s0 System Elevation 600 gpd 0.7 in-situ soil / 857.15 sq. ft. / 891.60 sq. ft. 92.50' ,/ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ c •o = New Tanks Existing Tanks ,~ ~ ~ U ~ ~~ 1~ ~J~ s~ ~ ~ ~ ~. ~ ~ ~ ~ ~ w ~ ~ ~ 0 . . Septic orxoldingTank 1,000 1,750 2 Midwest rnPre-cast X 750 Wieser Concrete X Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass a responsibility for ins lation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe s Sign MP/MPRS Number Business Phone Number James K. Thom son ~-~-- 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceo WI 54020-5413 VIII. Coun /De artment Use Onl Approved ^ rsairp a Permit Fee Date I sue ,Issuing t Signatur Given Re r Denial V 6b a 7 IX. Cond' ' easons for Disapproval 3~ ~ (~` C ~~ ~w3ttiG4wvw o~ ,~. , o,r`. oc; ,...55 4,~- ~~~ I~oln.. d ( t f n effl er an ~ ~ i uen ,. Septic tank, dispersal cell must all be services / mairttaifted Gv,. ~ 0~ ~ Q~ '~-~`-~ 0.L re. '~ ' (~'~ q' as per management plan provided by plumber _ 2. All setback regttirements rntat ba mairttsinsd ~~ ~_ a (c` tan. e~~ ~ ~ . CS l ~"o W(^T~t.. ss ap(pik~ code 1 ordinatttxs. Attach to complete plans for the system and submit to the County only on paper not less than S t/2 x 11 inches in size ,~ p (` ; /~~ C NO SBD-6398 (R. 01/07) Valid thru 01/09 / G0• ®~ ~~_ ------- -- --- - r= S~a1t~"/ =~XG cC,riJ~i•~7q ~: uc,~e e i(c //~,, ~~~G.Ceir~e~ ~i~sfl6/.5~ Cell. ~ i~ `,L ~ S(a~ `T~o (i) fi'cnC-,(ss 4t~ 3 i~ ~4'=~/ _-' ------------__--9sw, q , 1 /, ,~L brr,~/a. ~;/E~Sion V4/ e ~ 1~'Ey~~d° _ - - tiS' EXi3~~ dr'~~3o.,P EX~sG' ~ 3 98.51' elc% : y1.85 ". abax' ~ rrU fl0.1 R-C~~~C Se/ lanC. - - "- _ ~ ~gSC•i~,psrzyf%e. ~--__~Xi3~~!yiy~iaweS~f-r~i~JJ'cC_kd~ ) -~a„ ~ :ay /Dog /oaf' COnGrY~e Se~oE: ctn+,.E~l/ ~~./ j~~-sZse~c~u~~E E/ev~a.~-E~j~'oF~„a~~~_ 9y S,. r,•rc~~a,-tou.~/cE. C3enc.~. 13e~,om o~°5.di~. ~l COY/:S ~~ny i ~ ~~2 ,Q ss«..T c d t /GcJ: ~ ic~•d? ' p 6 ~,Gr~o~ ~ ~ ~ i ~ r'e sic~e~c ~' y8.o' I 0 ~Xi.St~in~' the// ~~ a .` py '~ ~ ~ a~ .~ i'C~Dr~Ecc/ 6 y,<.! 70%x. iYl<<,~c-/i /,i /99G ~L=,~'iJfi•~I~i yi'civ~r ~r'C ~FIlcCe/rlGrr~ Cli S~JL/~S~f C~~ - _ - Chian ti4~s Far ~~YnC/t . ._ ' - - - _. - - - - -' --- -- -- 9560' o w Ji/t~Sivn I/Q/ e •- - - -- ---- ~'' N~'iscr4'.~ o~r•~~Ja.,P rc',C/Sfi~~~- - - C ~ F"CeI/fL~7/X"X Sz~ SyS~-t r r ..~750•in,psapf;c ~~EXi's~i'%,~j l~~ac..JesEf•i.i~/t'QCA.~~ s-C~-n ,C' u; /~O I ~Y" ~o~ CC7n G/'~'~t S ep ~..'C t~n•+.~~/, ~ ~~ /~~,-SZSt~F/u~nt E/Qv~Q.E Eu/u ofy,!„oc.-t~/c~r J~yYS =, f,-(c'~/a.-Eou-E/c~~. utc.~. ~o~{,orn Of ~i~i~. ~J G`,Y/.S fi'n~ i ~ ~, 2 ,Q ssu i-9 c d t /Gvt ~ /~ • ~ ~ q i r,e sic~e,~c ~ 'jcP. o ' I 0 E,Yi.3~in4 c~ie//~ ~~ .` Q ~~ y ~ g8 ~~ -- --- -- :PARTMENT OF DIVISION R~EPO~T C?N SatL B4RING3 AND SAFETY & BUILDINGS OX ~~69 ~C1ST1#Y, D MAQiSON, WI 53707 pEFtCpLATtON TESTS (115) ~~~ B >,gQR AN JMAN REkA._'GI~.>' {ILNR 63.09(1} 6t Chapter 14S) ' I 6 O UBDI V7 I HtP/ ~7' C~ E'1"4 1 LL 5 ~ i >! iw NIC Z~ /Tz9 u4sa~ N Ri E (qr w r / 9 ° : o c 1-r u u t-1c,esa~. s4o- 6 E ~~ ~ ~'~ s y `rt L~ DATES 06SfiRVATtON3 MAD `~ S: 3 "` '' p Re let:e M n~ J 3 Q o ~• ~JNdW P ~MAQcI~ f~ ~94b ~Restdenca tit N ~ ~- ' 'So-4s ~c r, 6~ ° Sort z ~~, ,~c~ Rr -ilaJ2 4-i' ,o.71NC3: S• Ske witabls for sYetem TI N ; 1V1 V • U~ tits urteYitabls for aystem -I N- 1 DI ANK: RE ENDED S EM:lopti~ojnsll IN• ~ ~ S O S OS afJtl 10 ram TJE S .CIU ~~i Percolation Test: are NOT roquired D A : If ony portion of the tested ,roe is in the ~~ djs ~ Floodplain, indlesta Ploodplaift elav^tion~ ~ ~ndar s. ILHR 83,09151Ib1, lnCiceta: (, PROFILE DESCRIPTIONS ~ 3 IN AL VlXv18ER DEPRi'~I, ELEVATIQN .INCHES A OF S I M HI N EX U AN EPTH T ROCK IF V D E ABBRV' N'BA K.1 ~ s".sctics 4Z Z- ~ 3D 9g 4~ s 1-?S~Gt f4 " tM er 32'$2• /tits ~Gr ~a 7 9 . B- , ~ . i s- ~' o. ~ s~ .54 99 o' b. Ce b Ca r-~ O 8 !~ ` y i o 5 ~z B 4 i1.os -~.a+ > r~,ae ~~ Z' ,.$a~,c~~~ ~ ~~~ r~s q'8~„c~~t , r B- S 8 ,Sa 9S. 7 ~ ~ S •so L-rs GS•tG< 7z" ~ Y-~51 C~ t¢ /~-. B- ~~ ,~ PERCOLATION TESTS - D PTH WA 1 ` TffST T1M t W -1 APER j NUH ES NT R V t NI.IPrHER 3a ) R 6 W N - ~ L I N t a > > > t . P. P- Z 7,tx> . 99.5 ~ a ~~ a < ~x `3 _ ~ ~ _ _....~ agar, >•Z > PLOT PLAN: Show looations of pe rcolatton teats, soil borings end the dimensions of suitable soft cross. Indicate soots or tlistan ces. Describe what arc tha hoi zontal and yart ieal ovation roferonce points and chow their location on the plot plan. Shaw the surface elevation ^t all borlnQs and the directio nl~and parcai of lond slope. Ba~-yCti.- M sEQ k.= r0 P G1F "'~~tL6P I~CN fr ri~rfST k SYSTEM E EVATIDN _ 4 ~_ ~S© 4~ N1~ r~°rY' eae.~er~ - ~ __ : X43 -- -- .- -- , - _ _.. _, _. --~-----T-~ ___r._. _.. _-'---- -...____-_..... ---.. _ ___. _ .~ . _ _ ~__ I __ .. .. rt -- 1 -~- . --.-~ ..-t ~.._ -~.__ ___i --t I .-.. , . . ~~ _ ` I __ ~I i c' LY I ~~ ~cdtC ~ I- ~ _.i_ . ~ . _ ... - - _ QRS. i. _.. r'..~. 1` ~ '_'~- - s i i., ~ '~ ~ - 30 / ~ •. 1 _._1_~_- - - - --~ _ . _ ) _ __ , :~ - -- ... i ~ ~ ~ i ~._ _. - ~ y _ ... r- .-+-. .~ ... i .. . . _~~i.~ .._.. .....~r~... .~..._~... .. ~. _...._ _.... ___.1.__ ..._ .~. _ _ .... f ~ ~ I I I l.. I I I i ~ -~ II -•. ~.. --- , _y_ _ __..-(_. _._._._._ _._ ... ~ ~~ t __ ; ..-F-- . ~ s G ~ RQ _ __..L t, the under~gna d, ereby certify that the soil tests reported qn this` TOF"m wsro madtrby Qta~t~OOO~w~ tt+e proee res~and nuthods spec', cad in the Wisconsi Administrative Cod , aid that the data reeprded and the location of the lasts are correct t0 the best OI my knpwledge and belief. A pr.nt WERE OMPLETED N: TIFI A N NUMBER: P ONE NUMB R op~ional ~A 4a S~S~a~~ S-r l~lup 4 1d ~C-d ~o r w~2Qn/4+ ~L.f.VATION u5E d ON TURF: acv rsE ~ S~ Zl4 ca ~~~~g~. DISTRIBUTIONS prep, net enA one copy to Locnl AulhOnly, Property Owne+ end Soil Tearer, "' ~i~raw-S80~6395 IR 101871 ^•~<<^ NEI/4. THE Sw1/4 ~ OF MIiOiON UNPLATTED LANDS OWNED BY OT~\H^ER-S ~ 1 ~ ~ It ~ ! • 9 w ~ AA • \. O O O N 1 50~fi/ W + ' ~ ~ i ~ , N o ~ M pRAINA OE N EASEMENT_ _' 26 WEST LINE ~ 358.p0'- 27 W V 0 n ;~ .r N ~' trI ~; 28 """ E ~`~ N 1O° 5T 2 ;.` ~o~ , pp , m ~ ~_ ~LARSEN LANE _ ~.~ ~ ~-- _ S~3°~3'p .~ ~~.oo- - - - - - - - - - - -- 3 ry 9 s ~o° s7 23 E 3 ~N O~ O ~/ F p., ry ~ O f . ~• O ~0 ~ o ~O ~ ~ P O. I r" to ,n ~ z I f sa.oo~ I N4°5~~33"E ,o g3 ~' ~' ~ 23 W 2 2 ~ o W 2~°F 2 o 4 Ol N 29s o ?, f ~ ~, 0 °a o m, \I~~ `------"-~"- ~---" -- D R A I N A G E 0 ---- EASEMENT ---- -------- ~ /2 N .~/'Oo8~53 W N m 95 0~~ N O ~ ~ ~, ~ O i 1 f ~ 1 _ 1 O O O ~ O .., ~ .:. , ;.~` ~ t ' - ~ ~ I^n - :;`: ; " CEDAR HILLS ESTATES y dIM awalhM9a 6wfte^ M Nw r fW ~: a91a71 •4 rW. IN9 Afh ~ '~ +IT r.fKlwuf.dlswulhrer~a~raetwdl.rtr~~r,IMMfirglR A A, RMM /aa~tt ~ wuMM- ' l9PkA7110 lMp~dINP K IeN~ ~.,' - CL71YE'JAT6 tA5! 3 EE:J9 N[EL9 I.,'1 E419ot c"'-^~~-YIIS~ tl~:a 1~W Oe eSC7XM/.~C1 e1"' T+rw la 3rCw Godrd Ate Ehlld slori 3yRy hG. i, ,lply Lfoael 4re~l M.n- 1payM '~-lr6tf .._ •; S - hf. CC :MM'N° ife, SS' 31S Ir 3Ne 737 M 3gry{ISf"f tMldv"e r ~ Gs' 3s; ~1.ro' Itltwr J6t f2' n u' 9rlhp3J7 i~fl't37 W4rlt^G mw- I 2u.?I' f'oru° l:+.a' is*~' ~}e167T7 ~ ' Mf.al 1 p tl :u.a af.5d' IN~4t4d7 ~Yr ~ ~ ' 9t 9a' t~7r a )1 af' Ef x' 391/fS'21Y IHI'fl't `W2J^r.. a N~d! let N Ie Jet.tf' 17111' Nl1/11`II'e MNYQI4 ~'lin : t C.k'. Ul3K .i3, H' IIf.X' 16e91'pR ~ µ~,`' w aa• tJ•as~ a6Y J}. n• Jlfl•d)1Wj (` tS ~' d 28 27 28 '9 !r K.1r ay'tf'u~ U.dY J2Ir ~I'~ 'Iy~, ~ i 7 a _ q.)7 S9°N'M" 1i Vl' 6l. U' il6`eWfl'[ ~ ~ jii~ ' r. 96 6f•u•al• 11 N' 13.u' f}J/Wlri sM99'N~ I{PM'IS'1 ~ ' ""' ~ .~tr)rl6 w G IN a 3s1.9orFlt AP1eY6^e welrlaw w.. ~ ~ 1 - 7 tti h~317P' 127 E6 tN 6' a71°5^}I"I 12, N )u.a9 It°lE4Y 11 L -11.t ° lO)efPl:'t ~. a rm.9a' a'a'w ss M s• a, ayaa'u'7 ~ ~+. 3a,03A lfinew• e9lf ia,u• GJaal°JS'sr3 `,,,_.--- ' _ a a..99' Je11kb1' s3 Ir Gt.lr wiw9rs,~7 d } ~ . i.~~~- -° ,. r00. CQ' II / ~6' t43 .! aSa.dM ~' 'SR SO°di'R'R 9N•lP23"C ^,,.~'^~ y ~ •r IJL<.99 " 1+76' 11t..r lW.S!' S2'4~ ~!'2 x" +• ~~ ~ - ..,,.....-` ~,,,~- ..~_ ~_ ~. g dl [SW.BS' S'eN16"..I}3 Y IfA f:' N13J'M'C ,`~ s ,.,~'.. _ (. a ir!6.u~ n`trt0" t}Ltt t. rp x°as'It'c aie°er73'+•w414}S- '1,.,;tIR1EM k4t~ .. _ !'n.!r9 - St !;. G Je Jewl.wr t T '~' v I 'xe.un I ek 7n n tr, r t6hdwrl ' M'~h'e ' e _ p c° •~ i " 700.Orr 1 Il 1 Sitfl SS'.tt allld'S1'Y IW°1J'21R 61J1SS'A°!/ _~~ ~ r i, ! tJF, O6 t.. :. 77 it.:4' !4'U'ir'{ y?. ~ .. { av,pp rv«J'1,. ;nf rfr a7•m'9J•6 1 . ~;: :c.99 .:Ari aJ ~ n2..' !n,'- dJe@'}f • - J J ~ ~ r ti i1.L1 /°1k 27 11..1 lf,+' pl°Gt'SI•[ Iff°f^U"'1 el}rIS'!f'i .~ ~ ~ a 1139.36` @ell'6 S t' +INf14: ~ 1 ' rK' y .1 ~ ~ ' ~"~ ' ~ "17 ie ~ .. 18.30 1 ) '},f r.JJ' N"17 N"e !!! -.f I Ji-N I f 23 .82,9 It_ !~?'1f'71'E < ~y ~~~ • _J J ° tev' IeY.r rn r,, k'n!s•E Su°'smfK aw r s~) 24 ,.' ~ `' 33 c} f~j 2[ ~~ -+tax~ In•fe'la au.1a :n •r v~t3a61 mJ•IS'3sT a.d~s,as•c : ~' ~< i~r A<tll iiurr 4N i<m ''1 a f11 d~~ p161.... :.9f1 -. l1 '37A186 S.N. 1. n" a ;,r : oa 1^8sd 1.efl~ I .t.v i a ~a.J ate rlfaro i.~ ~r N6 Riki; 2.931 'R } _ 7LE R NS1? k, 917 _ ;~,. ~ t a ~.a r me 2S :#7762 - d.3W ~'- _ ., : t ,x xt Id'!% d.tST - ~let.~I,.~,,,~.~ ~~' ~ro .f %"361 3.M] __' , ...-.._""'^ ~- e« w .. ~I r'J r aam a.tx '.-mH ,, ..~ 1 I i I9 ' 14611 J.IiS 3`/Lwr Yd tee I ;~y .. :9 4173f 1.119 Ili aneelal ic_k_~y~ee~pgfe .4:..~ ~ ~u I'ne -14.HR }.?!J UNRAEIW i191Y _ I,~ y x v. I• ~ ,} e.2. Id16 • ~ Ih, i.~, ~. sae rr.rr oxw, `.• ~~'S h ` yr tam rwfeR ep ue I ~iGF a rrt,ar, r 11t619eGar 9rvr7 ~ / i ~ *J'a}I 1 ur ~r '~ ~ Ma97 filar ~ S7CfTK11 suta - '~r rawssrrrl4awr. ~.'~ u!4f ~Al I p YIr'~r19M tIrM11 I,IN/U pr dQ ~, 4 I h r_~ - KdORrllrrMlMMArGIYlrb y ` 1• ~I 1 ' //I 1A fgMOyetdR/WIG ~j f f lt !3 31 t I 72w ~ u a' ~ e.'. rloMlll'1* J _. I ;~' I . w9ru19n14w1eMwlw i ~"~.,,,.^ 1 - 1n /pw111e 911M9999f 7 I } >t i r l ~ .• f elG e 'I x ~' !: ~ f ~ ~ dr ~3 .} ; I ks ~ ~ t ~: ~V~~ SU1lfilinl~ ~RVa 1 ~. • ~ , INRTIf1Y ' i it'° ~ t Y~ . ..d ..w• 1~.yy r ..J..:~.'..~ :'i.~.';..: i , ~ ST. CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~ h ~~~ /~ ~1 !~ l> 5 K 14 Mailing Address 7 Qj ~3 L ~ X12 oN ~~rl~L Property Address 7 ~ ~ ~ ~ ~~ S o ,y ~ ~} ~~/ ,[; (Verification required from Planning & Zoning Department for new construction.) City/State N u~ s o,ti i/i/ / Parcel Identification Number ° z U ~~ / ' ~ o r ~ ~ ~-- LEGAL DESCRIPTION Property Location ~VV '/4 , r r ~ '/4 ,Sec. ~ `~ , T ~2 % N R / 9 Town of f~u ~ 5 o N Subdivision ~crZ ~ ~. ~ ~-{ ; ~ ~ 5 ,Lot # ~ 7 Certified Survey Map # ~Q ,Volume ,Page # Warranty Deed # Spec house yes t~ Volume I d ~ ~ ,Page # Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 3 S °7 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a'treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in propel operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system--has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of f)te three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. N of bedrooms ~`~ SIGNATURE OF APPLICANT(S) /~/~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ~or~ ~.C~1a~c~ ~~i/,cs~ residence located at: ~_ '/4, ~~ '/a, Section ?.~' , Town~_N, Range__ f~___W, Town of _~u~c~--, , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) .appear(s) to be functioning properly. r Most recent date of service %~~~,, 2~7 Did flow back occur from absorption system? Yes No ~ (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: ~ ,~.~ Construction: Prefab Concrete ~ Steel Other Manufacturer (if known): /~~~% Ct~eS~~'r~ ~r~ca ~ A e of. Tank (if known): ~/ ~Vp~~S f - ~ e ~ ~s ~~~~~ icensed Plumber Signature) (Print Name) (Title) ~~-/ (License Number) MP/MPRS (Date) Foi-m to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) ~, , Quick4~ STANDARD CHAMBER -- ---- -- -sr' Quick4 Standard Chamber T ,''2, MultiPort End Cap ;_ I~-~ -_ - - ~r~ '~ __ a° f ~ 1 I I ~ i =_ i'~~ :~-- _--- 48" - (EFFECTIVE LENGTH) '_ - E I ';e ~ ~_ a ~I ~ ~s ~~ ski ~~ i~ I ~I~ =,3 =1~ ~I ~~~ ~~~ ~I SIDE VIEW ~ _ --- -- T~,. 2.. ~ r / ~\ ~ i it ~" '~ ~ ii' ~ ~ -~ ` ~ ~ ~ _- - _ _ __ --- -- 34° ------- -- ~ SIDE VIEW FRONT VIEW ~,.. ;,, , Quick4 Standard,Chamber;~NominalESpecifications MultiPort End Cap Nominal Specifications Size (W x L"x H) ~~ ~;.- ~~~~, r<34" x,52° x 12" Size (W xL~x H) ~ 34" x t6"x 12' Effective Length F .~,~.~~ L 48" Invert Height 8" or 1.25' Invert Height' x.~,, ~~~~ a 8.. _ , ~. ~. s ~,•, INFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY -~ ,'ry of ea h , hambnr. end plate. wedge and ocher accessory niai ufactr and by i ooo- e~n .. nstr I ~" i ui , r.nc ~, - -.re sari! r svetem i~i iccordance with Inftlmtor's insWChons anted co u~ < ;rci , , J~ r ,. n.3fe~-r. - -~ for e e year I o~n the dalp Ihal the Seplic pBIRI I a SR~ed ~o ~h :pp~~~. _~~ it i „„ nwev~- ,ot req, .red by applicable law, the warranty Period w II begin ~r fhe da n tl~ ;,i , ~~en~a ~ ~~,hi-. Fbl ter mu :f nofity Infiltrator in writing at Ifs Co po ale h ~aadgi ant. s m ~ r ,a w w t f fteci~ I15! d- k<;t. Infotr ipr wit! supply mplaooment Units for Units determined by InfVraiu~ io , en We~~~aiN. i~•'~I~%~i, .. ,~ ~. , ~allV exc:Udes the Cost of removal and/or ins(allalion of the ~Jni;.. r @Alrr;~ ~~,rAPf ~AN'TV AND 17EM('~IES IN SUBPARAGRAPH (a) ARE EXLI_USNE. TIihHl- f• 'F NC: ~ li ~~ '.- - ~NI IFS ~'J~. fl1 NE SPC~ ~' 7-~ JNITS INC;I.UI!ING NO IMPLIED NJARRANTIES OF MERCHANTABILITY OR FITNESS FOR ~~ :~~Pl li it AI t :'~ i, ~;F l nie<, V p y shall by widil any pan of the chamber system 's manutac~ured by en ionn ~ i nr it ,fi r.~,~ i in i f W.irrairy d~ 1'p m~ ;, ~a Cn lipq e I al. SPeCa{ o~ Indreci (Damages. Inlif /alor shall not hp table ~o pnr t ~ ~-.; '~' ~ tn~l t cld nq loss'.' ~ zr.U p ~~fAS. '~abo~ and rnatar als. overhead costs, or other losses or expensE?s incurred b f loln~ ., y i ' i y. x'fcall Y Irum ', i ,:led `Jlananty coverage ere damage to the Units due to ordinary we»~ a ~d tear. Otte I ~ _ •ien. _ r egipe:t of ~;~, ~, t-eta subjM'~ed to vehicle traffic or other condtions which are not nennilted by the ~ ,ia ~, .; I,uli ~. is r a rile i r~~ , -o id Co e:.sel fort) 'n 'he ns~allal0 netroollon9 The placement of mpm~er n101er alti it L. ~ IhFl l LS fat e of -~ 1, u,e ,r of c system d. e ro Trip o per s frig or Improper srzing. excess ve water i sage np~, r gr ~ rn~, mpmi opcr,nt on, -> ~~ „~ n 1 car-;ed by 1Niltrato~- This Limited Warraty shall be w!d i1 the Holdea )ails Ia rnnp y ,u.. ~, 'f II . ;el lone i this Limuu ~, n ~r, ~ ~, ~ ir, ~,e e~-e a, i filtritrr Ue respo ~shle tnr any TOSS or damage to the Holder 'he Un is ~.r a.. ih it~, ~, r•y ~~ i . . om ii -~, Ilnt on r~r sh~i, ~ ai y .Y hl~ ~ci iiabil tv cIA nu ul Holder or any third parry. For t~ -s L.Imlfed Warranty ~o ~~~~~ i in tailed ~ ~ ;oafancn ~~ ~ [(J~'[1 ~ OAS ~ UI i~9d hV dale and b~:a COdP.S', all other appiC3b6 laws' and i( fl( f f,. r :I.' n 1 i ~...,c .. N e5r•~,la v..i Inlltiatc- h 3; the a thnrly I ~ Change p~ extend Ins L i~,ed W~irranty. Nr ,v,t by ii ~i r.. ..:. lio'd~~~ rte nl, ~.. ~;tn Ihn on~i~. eor~ < .re Stand +rd l in cited Wnrmnfv otlered by Infiltrator. A fm tad ri i ~ b-.r of 5' ~ : ; i, ~: ~. ~ , ty - ~ . ~ t., ,~- p~„rcl astir ~,~ Units .houd eo nart inOgramrs Corpo~afe Headquarters in nid Sayb~ -, i ~. ~~~~~ ~ uur -E.. 4.:,btan _ ~e. ap~.5c i0... e:aranty, and shnwd carefully read that warranty poor to Pie pu;~-h~sr, of Unn=. • O sYST~MS i Nc Environmental Onsite Wastewater Solutions'" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 06475 860-577-7000 • FAX 860-577-7001 800-221-4436 ISi r~ a:',3 uF1-:i,01-, )41:i,156,48fl.5,336,017; 5,401,116; 5,401459~>.S~ 30a ]'C .,538 ~8~. 5,839 -t4 ~~~. 7 ears 1 3 9 X59 7 00 .564 Other patents pending. i drr E~ .i• n,E ~.nc SideVf ind~r are registered trademarks o1 Infiltrator Svstems Inc-'~ ~ e~1 t remark in ;u~C(:. !n4ltrator Systems Inc. e a ~.d "a 1e.m~d~k is Mexico. Contour, Contour Swivel Connect;on, MicroLeachin;:. d k. C^amberSpa~ . F osiLrcK OuickCut, OuIckPl;Dy aeeve~eo anverr ,fm ~r.uiemarks of Infiltrator Systems Inc. ©2003 Infiltrator Sysems Inc 1'n. ,J n JO ~, ;?~,~;F-~.,i SECTION VIEW :1 it .t ;~ li 1~ I II ~~ ~~ OOGUMENT NG 501638 ;- ~~ -- - -. -- . , -- II `i II II ~~ `~,A ~~i~~y~Ty I1~t•!1 li iN,6 6MACE RE6ERVEU FEIN REGOR6rI:G DATA ~i ~~ STATG Br'1R iOiFri v. tF'i`.OtEy1SiN TFfO~RE1 2 - 1982 ji it 11 i' Brian ]l. Nelson. a single man .. .-- -- cunveys snd warrants Lo _..~??~a..~e.-3~~~-.~?I~..~'~'--_E---.----• ..... Maxusk~a, .husband.and.wife .as..slu~rivorship_mari..tal_ ..R~C?~.Y---------------- ---- - -- - - - ---......- -- ------------ the following described real escatr_ in ..............' O1Y ................_.CountY. 5txte of ~Visr_onsin: 5Z: GRf3IX CC1., ti-, i R. c'd fcr Recu,~ j J U'L 2 ~99~ I 1 r . R@glster of ~:~., F tl ----~ Ar'TVAN 'T&x farce) Too: l17A-71^io_Dr~ Lot 27, Cedar Hills F,states in the Zbwn of Hudson, St. Croix cJounty, v+Yisonn:4in. V`«~~ F k~ '. ~- 'This ........~~j ................. homestead proparty. (is) ~~ Exception to warranties: ~ ~flTI'I'H AND Sir 'I'O ant' other easements, ProtECt7-vE• :Hants, reservations or restrictions of record, if an}•, but this shall Imt be deemed ~o ;Hd any such otlaPx recorded e.HCCt~rr~,ranc:es beyond the terms established by law therefor. crated ttlis .... ..2~~ ...................... ......... day of .......`~Ltl1e...... ..... .. .... ........... ..... ........, 19.. ..4j -~'_'~..~y-..~x.~1~..-dam")..(SEAL) .. .... .... ..... ....... ..... (SEAL) ..can L. Nelson - ...._ ...................................... .... .(SEAL) _ _ .... _.. _. ._ .._(SEAf.) I~ AUTBENTICATION ACHNOW LEDf3MENT Signature(s) STATE OF WISCONSIN $~. Cr01X ss. ----•--..._..--•-••---------------------••--------------------•---•------------- County. --°---••--••---••-•-----•--•°---•-•• ,cJ, ~~ authenticated this ____.___day of__________________ ________ 19.__... Personally camp before me tt.is ______.._day of 'I II vane _ TP__-- 93 the above nel;:e•1 I~ ~ ----- ....--•---._.....-------------•----•-----------------•-••----------•------ Br~.a:n L. _Nelson i , --------------------------------------------.._-----------------------...----- ---.._.. -- --------------------------------...--------------•--------......... ii TITLE: 11dEDdBER STATE BAR OF WISCONSIN i -----------------•---------• ~~ (Tf not . ........................ .. ..------.. .--... .. . --- ---- - - -- ---- -- - ~I~Co -~-------------- -- authorizes b ~ ~ - ~ - i~ y $ ?06.06, Wis_ Stats.) to__me known to be the person _. ._ who executed the II ."r'~~ = in inst. •iment and acknowledge the sae:ie. .r.~ IN~TgU MENT WA6 DRAFTED BY ,,,•• . ;~ T ,.. Atioorne_y Hugh H. (~warT--------------- ----• -:G - ~~, ly~0!;~.--- - - ......._... ..... . 430 2nd St. , Hud~n, WI 54016 ~ :' ,._-•' ,~'•4~riknrs Public _St.e L'Y'Q?-?( Counts, wis. ~~ S~ TT 1 !i (Signatures may he authenticated or arknOwTpelgp~ •~aoYh Q Y 1~!•~- Commis3ion is permanent. t if not• state expQiration .: are not nececsnry.l - daii% ~~ ~ ~ . ..... ......... 19.7~~ .i ~' . r_ ......... ....... i; i. '~`~' ' W ~ Li ` t~ 1• _. ----_-------_ .._- - ~- -- --_-- - - •--- -_ .a •1`10.mM o[ DenfoM d,rT10Y In snr canac ltT 6h4U:» he :rni°•1 r ,-S r,~r» tKlJyc •1~<~> r~ir=-n:;:in. WP SRA NTY DEBD STATrv BA$ OF WISCONSIN W~sCOn6ar: r_Qgal 91ank Go .Inc .~ •. ~• ~. ... . ....;F61Aa[,•~:s:.]~....itlfl2 ... ... ...: ... ... .:AMhunru.cwNf.:IN.rscnAS„•. i ~ I I I I I ~ n C1 ` a to 0 W 7 ~ ~ C ~ 3 o m ~ N Q ~ ~ p N CO O ~ ~ y 7 (p ~ W N c ID = CY ~ O I v ~ ~ u> ~ D m ~ N m I ~ a W I 3 O I ~ I I I ~ o_ ~ .D I o =' ~ ~~ I N°o o ~ ~ I °' m I ~ N -. I a pi I o 3 I ~i O I o ~ I ~ m ~1 I ~ I ~ W I a N Z ~ I ~ N I ~ O I I d Q I O I ~ I OZ I ~ m I I I I I I I I I o ~ ~ ~ ~ ~ I °o ~- C1 N O c °.: ~ o ~ co ~ ~ ~ ',, ~ 3 ~_ l o =i N D7 f~D_ N '', N N v '' ~ ~ ', ~. a a .. o o r -~ co w ', m c°~r, o~ 0 0 0 O O O ~ ~~~~ ~ v v, ~ ~ ~ a 1 ~_ ~1 3 m ~o ,.~,. D ~ o n ~ m ~. N ~ C N ~ fD ~ d 7 O C 7 d ~ !~D a °o :' 3 y Z N W G T C 7 a ~ ~ O ~ ~ o = N O C OD N O ~ ~ CO v ~ O O ~ W O ~ O ti ° c 3 .. W C) a m y m m m ~ ~ N p Z n ~ A .~ A fZ ~ m N ONo ~ Z ~ ~ m A V ~' HI rO R ~• 0 !~ l'r t~ ~• ~~yy lAi 0 ~• fi a fi m 0 N i O O a A w Op 7Q A A W ti ~ ~°, y 'r w1 Y. Form - 8 T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ ~~~ ~~~`~Cfrl r~zr'/e~/ TOWNSHIP h'y ~ ~~ ~~ ~-~ SEC. ~ T ~N-R1~W ADDRESS ,~ dc.tt'=;,,~~:~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION ;~~ dam ~';%'`- LOT ~ LOT SIZE „~,~ _4_~yY'-~~, PLAN VIEW Distances and dimensions to meet requirements of I?LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ..~,.. a_~, s • tt s ,~ ' ~~~ ;~ ~ E ~, •~~. ~:, :fir {z~, P` . .~.. + ~~~' let; 3: ` .. ~ '° ~ X' ~y~n, Y ,ice G' ~~ ~ ~ ~ , Y` ~~ _ ~ ~.. 7 w i ~J k t z' . INDICATE NORTH ARROW a. BENCHMARK: Describe the vertical reference point used S~ ~., ~ a ~ /r.-:'-- Elevation of vertical reference point: CC o ~ ~ Proposed slope at site: ~ PUMP CHAMBER Manufacturer: ,~ • .~ Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest- property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: ~ Trench: Width: l ~ Len$'th:~~~ Number of Lines: ~ Area Built: `~ `/ Fill depth to top of pipe: Lyv? ~' Number of feet from nearest property line: Front, O Side, ® Rear,O Ft.~ Number of feet from well: ~? o ?" ~~ ~'l .c~ ~/ Number of feet from building : ~ / y p (Include distances on plot plan). t; -. SEEPAGE PIT ~ s. 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 sytems? (Check one). -;; HOLDING TANK ~" Manufacturer: Capacity: x. 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• 's DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY 8 BUILDING LABOR 8 HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: Se4,NE4,Sec.28-,T29-R19 CONVENTIONAL ^ ALTERATIVE (If assigned) Town of Hudson ~-oT A Holding Tank ^ In-Ground Pressure ^ Mound F LDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: William Harwell Co. Rd. UU, Hudson, WI OS' l~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: s ~~ . .ELEV.: CST REF. PT. ELEV.: ~~ ~a/ . Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: William Schumaker 6382 St. C _ 128778 c~rnr~n rwuviun~ nu~n_ siww./r' f'T, _ f~ ~.A 1 _l.. /'_,w ~- W_ G ' / A'/''/.P' J 'C7 (L%/~ J MANUFACTURER: ,~~~ LIQUID CAPACITY: , TANK INL ~ / 8 TANK OUTLET V.: '/ ~ 7`~ ag WARNING LABEL PROVIDED: YES ^ NO LOCKING COVE PROVIDED: ^ YES NO BEDDING: ^ YES NO `dLhfT DIA.: Gr ~O. A 1[SPF~MATL.: C•O. HIGH WATE ALARM: ^ YES NO UMBER OF FEET FROM NEAREST-~ ROAD: PROPERT LINE: r >~ WELL: ~ BUILDING: / ~ VENT T ESH AIR INLET: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: NO ^ YES ^ NO ^ YES ^ NO GALLO R CYCLE: PUMP AND CON PERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (D RENCE BETWEEN FEET FROM LINE: AIR INLET: MP ON AND OFF ^ YES ^ NO NEAREST ~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE DIAMETER: MATERIAL A ARKING: or excavation. (If soil can be r In o a construction shall cease until MAIN the soil is dry enough to Conti ue.) rnuvcurtnue~ eveTC ~? ini/'/ 'S.,cle_w. o r 0 , L : /. 7~ ~ BEDITRENCH WIDTH: ( LENGT 1 NO.O TRENCHES: DISTR. PIPE SPACING: COVER MATERIAL: INSIDE DIA.: # PITS: LIQUID DEP DIMENSIONS l a lj ~ (ir GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: O D TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVE t E V. INLET: ELEV. END: / ~` J C 4 ~ ~~ PIPES: LINE: ' / AIR INLET: ~ ~ ~~ 2- ~. -~~ ~' NEAREST ~l O 11IIn111J11 CVCTRIIA• /a+~3ir ll S%'i/)i.' 1 / LLJJ ` 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 PRESSURIZE TRIBUT ION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: EL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRE TRENCHES: DIMEN NS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELE ATION AND ~ DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: INFORMATION APPROVED PLAN ^ YES ^ NO ^ YES ^ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ^ YES ^ NO ^ YES ^ NO NEAREST-- -rte CA0-IITefQV D~RIIAIT ODDI Ilt_OTIAN ~ ~ILF1R . In accord with ILHR 83.05, Wis Adm. Code .d:..,,..v.....,..,.~..,~ CouN . STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ~~ 8'/z x 11 inches in size. ^ cn~ck"f ~eJlsion to rev ous application See reverse Sld@ for InstrUCtIOnS fof COmpl@ting th13 application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ~ ~ ~Gt CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~ J~~®l~ ~ ~ ~ ~a r+ II. TYPE OF BUILDING: (Check One) ^ State Owned ^ VILLAGE ~ NEAREST ROAD ~~11 ~ ~ ~ ^ Public L-'J-1 or 2 Fam. Dwelling~# of bedrooms ~ P L NUM R( ) 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 ^ RestauranUBar/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 Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 11 ~ 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) ~ G ~ ELEVATION Sd ~ ~ ~ Feet (` Feet ~ ~~'~ ( ~ ~ ~ VII. TANK CAPACITY in allons Total # of 's Name M f t Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks urer 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 sho n on the attached plans. bet's Name (Print): um P ber's Signature: (No S m ) PI um MPRSW No.: Business Phone Number: l // lit/s' ~r~Q' eb~' II ~ l~/f ~ f v~T 's Address (Street, City, State, Zip Code): Piumber O IX. COUNTY/DEPARTM T USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) a e ssue Issuin gent Signature (No Stamps) Approved ^ Owner Given Initial _ A verse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 pit 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(:) 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 ~~our local code administrator or the State of Wisconsin, Safety 8~ Buildings Division, 608-266-3815. 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 bedrocros 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, I~st 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 nurnber 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 S'f~ x 11 inches mus~: 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 ~alevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction toss; 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 SUROHARGE 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) ~_!'~/ ~ IK ~Ql- u/~~~~ S ~~~{ ~F ~ ~'~/~ 3 ~Y G t t G~ 9 /d/.~.I~ OF C'~(L~-6~ .S'D.,!/ ~~ i b` ,2~ d` ~J I3d f ~ ~" S1°T're D . ~~ ~~D ,~~ J~2 o~S~ ,!3 u ..~~~ ~ 0 6 ~ ~.b~ :~ p~ ~ ~ ~Y ~ ~ ~ ~~~ ~~ ~ ~ ~~ ,, _~ _ ~~ ` ~< D~P/cRTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDING •' INDUSTRY, DIVISIO LABOR AND PERCOLATION TESTS (115) MADISON W 537( HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP//11I.K: LOT NO.: BLK. NO.: SU DIVISION NA E: sE ~/ ~~ ~/ ze /TZ9 N/R~~~lor W ~,l udsof./ _ 3 -- ~~4~a r s ~ rev >d I~Residence NO. BEDRMS.: u tiK. COMM R AL D SCRIPTION: ~~, a New RATING: S= Site suitable for m Ua Site unsuitable for system DATES OBSERVATIONS MADE IONS: L 10 TESTS: Replace I ~/ ~~ 9 Q 9 l~~ T ~-~, (` BORING TOTAL PTH T GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTF NUMBER DEPTH ffi. ELEVATION OBSERVED ES I HET TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.1 B- l 7,r7 46-~$ -~oN~ >Z~7 ~~BL~Ys z8~$~2N-~hs ~8"' ~r, c ~-a~„~ B- ~ 9.~s 9.48 No > ~.~ zs"$«-~ z$"e~>,, ~ z "BeN Ms 4o"e~yC~ ~fG,le B- ~ Ss.33 g~,63 I~la~i,>r > .33 Z~~"~~T~ ~9"',~~~, ~~. ~o~8~e -MS~G~ B- 4 ,5~ r`-~ •3g b E > 7,58 / ''BLOTS ~~'~BQ..~ ~.~~. 6S""8a w,~. ~G B- ~ ~~ q7,2~ nl ~ ~ g.l? ,Z" eLL'TS ~4"BaNS~ 3z"a~., r~s~Ec~~~:B~~,c,~ B- ~~~. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER 14V~irtES AFTER SW LLING INTERVAL-MIN. p I p P RI D2 P R PER INCH P- .ba o x.60 3 ~Z > >Z < P- P- EL~vp ~ ~ n, ~~- ~.~. 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 he zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percE of land slope. SYSTEM ELEVATION ~~-- QU Lo-r Z zoo Z~~ ioo'-- ~ _-- g-5 ~ ~ $- ~ ~ C~-.~E~LIN~ of ~,~.~ ~ AST ~ ~-J~T~ /~ ~ ~ a ~ ~>Po Le~N~ ~ 53, 53 i $ENc.-.tM AQ.1< - I o P p,z Ei SQ ~ I~I~Pr,fONla PQO6LT-4tr AT sW LoT Co~aa ~ R . $-3 ~ ~~.~.vb-now = ~oo.oa ^ &4 a 3 ~Z ~ ~r 4 , ., ~ B Z ~~ , ScA[.~ .. ~-3~' If Percolation Tests are NOT required DESIGN RATE: / I If any portion of the tested area is in the under s. ILHR 83.0915)Ib), indicate: (_'L~Q'SS / Floodplain, indicate Floodplain elevation: ~y~ ~~ ~~, PROFILE DESCRIPTIONS ' ,~~ A1'P1»ICATION FOR SANITARY PEItMI`f STC- 140 '!'hi:{ appilcation furtq 1s to be completed is full and signed by the owner(s) of the pcut,erty being developed. Aay inadequacies will Daly result in delays of the permit ia5uance. Should thly developeent b+~ latended for resale by owner/coatractoY,("spec house"), then a second forty should be retaiasd sad completed when•the property is sold and submitted to this offic® with the appropriate deed recording.. (?weer of Property G/c~`a_w~ l.ucuric-n of Property Sz~ ~ = ~, Sectiaa .,~, T ,~gN - R 1,;~! W r ~ruw{{at~lp ~~~~ -. w I~{ i 1 ing Address ~ /Pig ~~ LL ~,~ ` ,,._ :;ubJivision Name ~ ~~//~^~ t.~.~t Number Yr~~viuut~ Owner of Property ~~(~Q,ya- ~a~S~.[~ Total. Size of Parcel ~aL~Gr~~ Uac~~ Parcel vas Created _...._:1L`.v-~ ~~ A,-r: a.tl corners and lot^lines ,identifiable? ~~ Yea No r..._...-..... is tills proi~erty being developed for resale (opec house) ? _ D~,,,_ Yes Nu Valwne ~~ and Page Huwber 1..JG.-~-~- 4a~aceeorded with the Register of Deeds d INCLUDE WTTH THIS APPLICATIOlt .OD18 O$ Ttita FOLLO{iING» 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the ttegiatar of Detada Office in addition. a certified survey, if available. trould bs helpful sa as to avoid delays of the reviewing proce~e. T! the deed dNCriptiota rsfereacsa to a Certified Survey M:.it,, the the Certified Survey !!ap shall also be raquirsd. PROPERTY OWNER CERTI~'IG710N T Iwe I eenti, y #at a,P,t b,tat¢~wtd an .thtb o~nw she #~eut #o xiee beet o 6 ~y (Dun I hrtow.tedge; i (wel sun (anei ,des owretalj~ o/ #t pto dteehtbed .cue .thi,d ~,n~anmati.on 6unm, by v.i~.ttte o~ a wwerrar~ty deed ,ue ,the 06~cee o~ #e Caun-ty Reg~ielten a 6 fleede ae Doeuwent No. ~ ; a~td #a.t 1 Iwe l ~eaently own .the pn.opoeed b.i,t¢ `an take ear~Gi~aTay~#.eun tah 1 Iwi1 have ob~,i.ned an eaaen+e.nat, xo dun acLtlt #e above d~ecx~ibed p+t~opP,/taty, fox #e eone.tit.ueti.on o~ ea.i.d 4ye~e-n, a,nd the eanee has bee~e duly neeonded .cn #e O~6.iee u~ ate Cou-tity Reg~ie.teh. o~ Ueeds, ab Oo~eret No. I .% ~ S T C LU5 5liP'1'LC '.YANK MAIN't'I:NANCti Al;ltl?l:Mt:N't' Sc. Cruix l:u-tury ~, W .. 1•: It / 13 U Y !•: It ..~, ., ~~t ~c ~'t ~._ ._i~_..... I ,~• It,111't'I:/ liOX NUMlililt _-~~~~~/_LG__ _ l~ i re Numhu r l: 1 'I' 1' / ti'l' A,1. L' ~QS'st~ --~---- 'L C l' ~0~ ~ . .. I~It+;1'lilt'I'Y LUCA't'IUN: ~~~ (,,. w~ _ta. tiecC iuu .~, 't'_QJ~.___N, K/9'. W, 'l'awn ur~/ .__ .__.._., SC. Crul_x County, Subdlvlisi.un_~-~`d/~j''...____r [:ot t-umber__.~___-- lwl,ruper usu and wuintenuuc~~ ul yuuC supti~• sytite,n could result in !t.>; prewaturu'"luLlure to tutudle wastes. L'ruper maiutenun.:e cun- si:~cs ul Numl~,iug out the sepC is tank every tl-rec: years ur suuucr, it nc:edr.d, by a Licensed sul,tic Cask 1>uu,p~r. WI-at you put into ,.he system can ulluct the ('unction of t. 1, a: sc~ptiu tank u:~ a tr4at- n,~:,-t stake to CI-c waste disposal systew. ;;t Cruix County rasideu[:3 uw~r. ~, wuxia-uan of 6U~ of Ct1e cos[. of wl,icl- was lu op~rutiun prior to ,ic:c.:lit4d this prograut lu Auf;ust uwu-~rs ut all u4w ~_steu-s ugrre be eligible to receive a l;ru,-t lur r4plactm~ut of u ful.llnb System, .lul.y 1, 197H. St. (;ruix County of 198U, witl- the ruqulr~munt that to ket•p their systewti prupurly 'I'I,u property uwnur agrees Cu subatit to St. Cruix Ci,unty "Luuinb a ccc~tiEicatiun turu-, signed -,y the owndr and by a u-aster plu-nber, journeyman plumber, restri.~ced plumber ur a licensed pumper veri- fying Chat (1) tt-e ou-bite wustawaCer disposal system'is in,prupm.r operating coc-dition and (2) after inspection and puu-pir-g (if nec- essary), the septic tank 15 lets than 1/3 full of sludge and scum. Ce:rti.flcatiun fur-n will be sun[ approximately 30 days prior to thee.: year expiration. 7/tJF., the undersil;ned, have read the ab{,ve requirements and ul;ree t.u maintain tt-e private sewa~;u disposal. system in accordance with th,~ standards set forth, herr;in, as set by the Wisconsin Uepart- ment of Natural ltesourcea. Curtlficatiuu lurm must be completed and returned to the 5t. Cruix County lunLng Ulfi~ce within 3U days uE the Chree yeac expiration date.. /J/JQQ ~ . 5 I G N E U._ ~LL~~ -.. _ --..__ 1) A'I' E Sc. C.•uix Cc,unty 'Loning'Uffice P.Q.. ,tox 9~~ Ilauuna'~~d~ WI 54015_ _ 715-7 ~6-2239 or 715-425-8363 Sign, date and return to above address. ,... d~w+.!r'-'~w~ ': aV~. •' ~ V ~~ ~ ! ~`~ ~ ~ s/ ~Mt i~tQO~~IN DATA ' ~ . ~c-x,uM~NT NG: !` ~,rAT~ pF '1-)1900Niitihl- ~,ry~ TNia ages aaeawls :--." ~1Yv-1.`~ ~` it~s~~i°a'~°~>~o" ~ ~ s ours $TER~ C~FFt':~ .: acs ~-xaAaeco>Mal iT. CROIX CO., WIS. by and between .. ..~~~X4..1r~X~@1}..~/.~5~~!.~I4~}J9~..~~.~.-rQ.~:1f.~41~4.~.~:~.Sg~l.~..A*.. ("Vendor"• whether one os•. more) and.,. ~~~~:~.ill..~S,...~XN~~:1: ................................. *sn$le..man .................................. ~"Pnrahaier". whether os-e or more). Vendor Sella and agrees to convey to Parohases, upon the prompt tad 8nU per• formaace o! this eoatraat by Purchases. the following property, toptber with tbs rents, prodts~ Mures and other appnrteatat lateswts (ail called the "PsoDcety"). in....... ., 3.t 1. Croix ........... .....................County, State of Wisoonsiq: ii See legal Description on Addendum 386 _ q~~j R~c'd fay R~oord Mlis 11th of ~ M. James 0 onnell .s. a r~ . aep~cy a[TYRN TO Tax Parcel Na ................::................ .sue FBE Thu ......~&..11R>i_......... homestead property. 7~i{# (is not) Purchaser agrees to purchass the Property and to pay to Vendor at ouch -place as. he shall .ltame-, _~ the sum of;..1~2,x500.00 ......................:............. to the rollov~ing manner: (a) ;...64.,X09.a0Q.......:.:................ at the execution of thin Cantrpet;' sad (b) tho balance of ~.~r~~e+~QQ.•QQ •-••--•••••••••-. togotlier with lntseeat from date hereof on the balance outstanding from time to time at the rate ot ..............k~Q..~).Q~).•••••••••• par tat per annum until paid 1n toll, y follows See Payment Terms on Addendum Provided. however, the entire outstanding balance shall be paid in full on or before the..._... 11th dy of -•--.•---.113I1P... g --~--.....---., iii p~Q _ (the maturity date). . . Followin a default in symeat, interest shall uxrue at the rate of ...~Q....9i, 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, ndess excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual 'taxes, special assessments. fire and required ins uraned premiums when due. To the extent received by Vendor. Vendor agrees to apply payments to then obllgntioas when due. 13nsY amounb received by the Vendor for payment of taxes, atessmsats and insurance will M deposited into an escrow toad or trustee account, but shall sot boas interest unless otherwise requird by law. Payments shall be applied Aret to iateru~ oa the unpaid balance at the rate speciAed and then to psindpsrl• Any amount i,~ay b~ prepaid without prwatnm or ie~ upon yrineipal at say time tbts~~usoc In the event of any prepayment, this ooatract shall not be~ treYtsd as in default with respect, to payment eo long as the unpaid balance of prindpal. and interest (and in such case accruing interest from month to month shall be treatsd as unpaid principal) is less than the amount that said indebtedness would have been had the paym•nw ban made as lint spscifled above; provided that monthly payments shall be continued ip the event of audit of say proceeds of insurance- or condemnation, the condemned premises being thetwttel' excluded herefrom. Purchaser states that Purchaser b satis8ad with the title •s t6owa by the title evidence submitted to Purchases ~. _ _ ' 'i Purchaser p y , prOnt~ ~ a when due W rates and aweasmen4 bvied on the Property or upon Vendor's inL•~r~iat 'f# -~ ' ~ it if and to deliver to Vendor on demand recei • pts showing sack payment. Purchaser shall keep the improvements on the Property insured against loss or edamage occasioned by Are, ex- .. tet~;iid coverage perils and such other hattards as Vendor may royuire, without co-insurance, through insurers approved bb' Vendor. in the sum of =.........:....n/.a.......,••-...._ .. „but Vendor shall not require coverage in an amount more than the balance owed under thin Contract. Purchaser shall pay the insurance premiums ~1hen due. The policiq shall c~~ntuin flee etundard clause in favor of the Vendor's interest and, wiles Vendor otherwise a the on fuel of all policies covering the Property shall be depalted with Vendor. Purchaser shall g~ in wrltin , g in::~~rur,ce companies and Vendor. Unless purchaser rod Vendor otherwise agree in wrti R,tinsura~nee pr~oce~soahall he applied to testoration or repair. of the Property demaged, provided the Vendor deems the restoration or repair to be <' .ewmic;cll)• feasible. Purchaser eovennnta not to commit waste nor allow waato to be committed on the Property, to keep the Propert;• in frond tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and to cnmpl~• with all laws, ordinance and regula ions aRecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all oonditiona shall be fully performed at the times and In the manner above s fete ~urchaser a 1 i[ elm le, of the pro peciAad, Vendor will on demand, euecub and deliver to srsona~ Re~res n a lv~ p party. free and clear of aU liens and encumbrances, a:cept any tens or oncum sacs crea y act oe default of Purchaser. and except:....aasaooenzB...glcotertixie._ . ~covp.~..c~..reCntd,_.i.f._any.,,_.and..l~nniag--axdi aaacB..rsquixaa-ante. .............................. Purchaser agrees that time is of ~ the essence and (a) in rho event of a default in the payment of .ny principal or interest which continues for a period of ...(xQ... days following the spoeifted due date or (b) in the event of s default in performance of any other obligation of Purchaser which continues for a thereat' h~• Vondor (delivered period of ..!•2Q.... days tollowin written notice personally or mailed by certified mail), then tl~e entire ougtanding balance un~er this contract shall become immediately due and payable in full, at Vendor's option 'and without notice (which Purchaser hereby n-ai~•csl, and Vendor shnil ciao have the following rights and remedies (subject to any )imitations provided by law) in ncldilion to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's ri¢ht~, title suet interest in the Property and recover the Property i-ack through strict foreclosure with any egnity of redc,,,i,tion to be conditioned ufion Purchaser's full payment of tlto entire outstanding balance, with interest thereon from the ~i:itc of defan}t nt thc~ rntc to effect on such dateandotheramountsduehereunder(lnwhicheventall amounts previously ppni~l bg I'urcltnacr shall be foreteited as liquidated dttmutms for fniluro to fulfill this Contract and as rental for the !'ropcrt}• if purchaser fails to redeem); or (;i) Vendor may sue for specific performance of this Contract to compel imm~~~liatc and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of defniiit and other amounts due hereunder, in which event the Property shall be auctioned at judicial silo and Purchaser shall i,e liable for any deficiency; or (iii) Vendor may auc at law to the entire unpaid purchase price or any portion tlu~r~:~f; or (iv) Vendor may declare this Contract at an end and remove this Contractasacloud on title in a quiet-title tteli~~n i[ the equitab}e interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of thc~ Property and have a receiver appointed to collect any rents, issuer or profits during the pendency of any action under (i), (ii) or (iv) above. Notwititetnnding any oral or written statements or actions of Vendor sn election of any of the foregoing r~mediea shall only be binding upon Vendor if and when pursued in litigation and alb cosh and expenses including reasonnhle attorneys fees of Vendor incurred to erdorceanv remedy hereunder (whether abated or not) to the extent not prohibited b~ law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of s receiver of the Property. including homestead interest, to collect the rents, iwuea, and proAts of . the Property during the pendency of each action, sad such .rents. issues, and proAta when so collected shall be Ndd and applied ns the court shall direct. Purchaser shall not transfer. sell or convey any tegal orec~affable interest in the Pro r,f Purchaser's rights under this Contract or by option, long-term lease or in any other way)~rv thout Ehe priortwritten consent of Vendor unless either rho outstanding balance prayabls under .this Contract is first aid in roll or the interest conve~•ed is a sledge or assignment of Purchaser's interest under this Contract solely as security for sn indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately dtte and payable in full, at Vendor's option without notice. Vendor shall make all pavmente when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make env such payments directly to the Mortgaged it Vendor fails to do so and all pa~•menb so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subaoquent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benaAts of the heirs, legal representatives, aucressora and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a rytluable consideration joins herein to release hoettestead rights in the subject Property and agrees to join in the eteention o! the deed to'be made in fulAllment hetreot.l Rated this 11th ' ...---• ..................... ....:. day of •June .............. .............._. .....-•----.......................---..........., 19..86... ........_... _ .................. ........... (SEAL) .. ................................ (SEAL) AVTBSNTIOATION Signature(s) ............................ ...... authenticated fhb ........day of............ .............. i9...... 1 • ..Ha>`ry..,J....Steetart... ' .. •~ ...~ ~iAL ... - William C. Harwell s"~t Q J • .- ....:~~..~ Cr: ~0.,~ ~ ~ ACKNOWLSDC~>a[BNT~'~,'~~ `•~ ,~, STATrE_ OF~ Wti'$CONSIN ~~~' .,a * C t~~a...ri)4St~# ...................County. ~ Personally came before me thin ..~.~.G.~.......day at ....... ~!~g.-....-..• .............. 19..$x.. the above named Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arcnrdancP with Cnmm R5 Wis Ar1m Crxfp 2076 Page 1 of 2 A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8%: Inches in siz Plan must include but n t limit d to: v l rti d h ri BM i St. Croix , o e e ca an o zo erence~q~( ), on and percent slope, scale or dimemsions, crow, a n and dista ~ to nearest road. parcel 1. . ~ 02 178- 0-000 Pleas rint ~ 4 p ~ orma ti oq,~ h~. Revie By Dat gq -- Persons information you provide be used for purposes (Privacy Law, .15.04 (1) (m)). ` J! ?i J Property Owner ~ Property Location Don & Deborah Maruska ~~ Govt Lot NW 1/ NE 1 S 28 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 788 Larsen Lane 27 Cedar Hills City State Zip Code Phone Number J City J Village .~ Town Nearest Road Hudson ~ WI 54016 (715) 386-0779 Hudson 788 Larsen Lane J New Construction lJse: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ~ Public or commercial -Describe: Parent material Gtaciai Outwash Flood plain elevation, if applicable Na General comments and recommendations: Soil evalautaion completed to verify soil suitability as reported on original Soil test by Harvey Johnson 3/13/90. Boring # J Boring ~~ Pit Ground Surface elev. 98.86 ff. Depth to limiting factor >104 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-38 mixed none sl/Is fill na na aw 2f na na 2 38-75 10yr5/6 none s & gr 0 sg dl cw - 0.7 1.6 3 75-104 10yr5l6 none r s & co 0 sg dl - - 0.7 1.6 -~ H#3 contains approx. 20 /o gravel & 20% cobble 8~ stone by volume (40% coarse fragments) . Boring # J Boring Pit Ground Surface elev. 99.41 ff. >125" in. Soil Depth to limiting factor Application Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr4/3 none Is 0 sg dl gs 2f 0.7 1.6 2 4-29 10yr4/4 none gr sl 0 sg mvir aw 1f 0.6 1.0 3 29-76 10yr5/6 none s & gr 0 sg dl cs - 0.7 1.6 4 76-125 10yr6l4 none s ~ gr 0 sg dl - - 0.7 1.6 ~}7 t Zp * Effluent #1 = BODS> 30 < 220 mg/L nd TSS >30 <_ 50 mglL * Effluent #2 = BOD < 30 mg/Land TSS < 30 mg/L CST Name (Please Print) Signat CST Number James K. Thompson 5-~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Os ola, Wi 54020 4/17/2007 715-248-7767 ~~7 OUP m~ • .rfP~O~aX. /oca.~'on of ~i eva./ccc.~~~~-,~~, ~f ~~~~ 6 yN .s ~,~ ~'1arc~i /3, /9y0 ~ 'ly ,~ ~/ • ~;/c~si~n va/ a--~i. ~ I~/ Pov~ ~ ~ P,-o~~<d~~~s~/ conc. ".~ 750 • ~Q sapf,'c ~,L-S2St~f~y-~ ?Z Inf./Eiafvr "Q-f/~° --------- 9s6~~ 9 ,~• ~^ z - - 99.0 ~,t.~' 9B.ss' ¢/cam : Q1.85'±. :~_E,ri's v' ~'Pi d~esE4.-n /orc c_k.s E Cp„Gr, S(~O~.~C~DnJ~~/,GQ~~~ E/e~ A.L~- X7/0 of i'~'OG~/t~ r 9y S~e?S"', ~v- DQ'~Arn O•f' ~~ di ~ E,ris~{i~9 ~~zcti e%~ y/I7/0 7. ~ ~• V i ~ o.rct9 5/b~, ~., , 2 ~~ i rc Slc/enc ` ~ 0 E,Yi.S~ixJ Wt//~ yrf. o ~~ .` ~~ ~~ . ~,C.r/s e~ .~a n2 ~- 2 °{~-