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022-1080-50-002
O 5'i c y O 0 d f5 c A M n eD I 1 I ' _ n O y Z A W 'y `� '� H O 'a co --FOND N• S �. N C rt e0 I S �. N N C .'* C71 =r 7 N N 0ti I j o o n Z H o 3 I _N a m < y 000 3 pr �° O O lA\ (D m OD W eD II 7 A eD IY w y _O G N N a O ?C O < N a Z 0 0o CO o H' I ° �a w o R Q 000 A g N3 0 o g �! CD C e0 c `° O Cl) - D a 5 v> v D eo m (� a m m eo ? y a m co CL o CL N O C CO 3 O 1 0 .. j N O L W ( ` O 0 L A O Ul N N c�rtn a, g N 0 c CD 000v a 000o �• cn < N Z S 3 u>v>tn�l m 3 rncntn� D O CD e O f cg e�D O c°n zr OD * — !? o Z z O A Z OD Z O Z D a o y O � O , O < o — • m CD c� m rn 7 O y 1 y y C (D y C /L� f0 fD �/OI C CD N C �. n (D a N c6 + -i CO) y C y T C n, Q f CL A Z I � j " N CL A a 00 0 Z a ;u I 3 3 Z w I y z w z I wCD I � f i s I I :1 o D Leo � N D I a ova�N n 00 o m m c m y m c ° o Z o m o Z a moo o m o o c, oy y a >> y O y O p CL cOj a �0.ci � smccO' >r S d O_ N y O 0 7�c O N e p O Q p ' N I I r eT c <D N fD N X y S e S 0 ' O OD I O rA ry O p = ' O . 3 I Ota f. y 0 j p W '00 Isi S Ip O � - a eD p I aeD m N s c O No m 0 o b a CD (D DQ w r A rn O o 0 0 a 0 CL i.. WiscOnsinb County: epartmentofCommerce PRIVATE SEWAGE SYSTEM St. Croix 'Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515208 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Bluhm, Kevin Kinnickinnic, Town of 022 - 1080 -50 -002 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: J� r ✓Vl Z C- S - T 28.28.18.438H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,,f CAPACITY STATION BS HI FS ELEV. Septic :rh 2 Benchmark 3/ 7sd 0, 3 v 166 - 3 /Do Dosing 5� ) /d Al t. M ? . g�• 3 Aeration Bldg. Sewer Z •Z 58, Or;� Holding St/Ht Inlet 5, Q_ �1s Z3 2 7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet i 7 Septic 7 56 7 lbo S , 54 _ Dt Bottom _ Dosing Header /Man. (� 57 93 83 Aeration Dist. Pipe ,5 93 . g3 Holding Bot. System , q PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand Vi6bu St Cover Z Z. 6 C P Model Number TDH Lift Friction oss Syste ad TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth / � �_ DIMENSIONS 3 c7b I Tj - �,,�� �•• SETBACK SYSTEM TO t7 P/L B WELL LAKE /STREAM LEACHING Manufacture Ez INFORMATION ((�� CHAMBER OR q T yp C en ✓ c,.s. ° vk --Q 150 S`{ /b0 Ri• UNIT Model Number. DISTRIBUTION SYSTEM ,«�,,, 4—Q Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake �1 N. Pipe(s) � ` Ne t 4A e, . Length Dia Length Dia Spacing /o Gt-- . SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Z 65 BedlTrench Edges Topsoil ` ; Yes _j No - I& Yes ❑ No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1109 Pine Rid Drive River Falls, WI 54022 (NW 1/4 NW 1/4 28 T28N R18W) NA Lot 2 Parcel No: 28.28.18.438H a 1 i ,, Cau ,_ 71 L� 1.) Alt BM Description = 2.) Bldg sewer length = rj 6, A5 - amount of cover = �/ r Plan revision Required? Yes W/No �, v Q� Use other side for additional information. Date Ins#Sigture Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County / 201 W. Washington Ave., P.O. Box 7162 '5 `t. � ) ro N viscons i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 G 2aS Sanitary Permit Application Plan I.D. Nu mber In accord with Comm 83.21 Wis. Adm. Code, personal information you prove may be used for secondary purposes Privacy Law, s 5.04(1 Xm) Project Address (if different than mailing address) L Application Information - Please Print All Information REC E IVEU 1 0 , (� t Property Owner's Name Parcel # Lot # Block # lieu ° DEC 0 $ 2009 622 - /D o- 56 . 002 Property Owner's Mailing Address Property Location ST. CROIX COUNTY /`O _ iN? i' 'Zia PLANNING & ZONING OFFICE City, City, State Zip Code one Number r /A' Vi '/ Section Vi 7- 1c , Ff> S f�1 `fOr� - �/� ��.� -.5// (circle e) II. Type of Building (check all that apply) q T N; R iO_E o�Ly �Dt.i f N z �{' _ / � ° �k¢ Subdivision Name M� ber 1 or 2 Family Dwelling - Number of Bedrooms '94Ai /1" "t A 5` 5�e l �� /'" 1 j c ---- 11 Public/Commercial - Describe Use 3 O v ❑ State Owned - Describe Use ❑City ❑village W-whip of /Fi tnrlc ki.cx: c I11. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. J<New System ❑ Re System y ep y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑ Permit Transfer to New List Previous Permit Number and Date Iss'tted Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) i ' Iex Ct./ f. 7 - , i= e - U Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pas�ilter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line A Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatioent Area Information: Design Flow (gpd) Design Soil Application Ra gpdsf) Dispersal Area Required f) Dispersal Area Proposed (yf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units j 5 t S•T� _ Concrete Constructed led Glass New Existing i�� Tanks Tanks IC Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume response ility for installation of the POVM shown on the attached plans. Plumber's Name (Print) Plumber's Sigma RS umber Business Phone Number 93136/ Plumber's Address (Street, City, State, Zip Code) 42e ;2 D SS / F A ..✓ -Tye? Z VIII ona artment Use Onl Approved Q�7 roved Sanitary Permit Fee (includes Groundwater Date I Issuin ent Si (No s) Surcharge Fee) y 7 J Oo '� b Giv on for Dema "� J / IX. Conditions of Approval/Reasons for Disapproval D SYSTEM OWNER: e3 , Per- 1. Septic tank, effluent filter and t n dispersal cell must all be services / maintained • IV 5 �GOc O as per management plan provided by plumber. 2. All setback requirements must be maintained A)A e) (�a(bp (W as per applicable code / ordinances. Attach complete plans (to the Comity only) for the system on paper not W" then 41fA a is W-ew BD (R- 01A311 5V7,��,. Il k ct �o NI i c COPY I I a wNa-R :� Si1 ra keuin: RIu 4.14 AW lup q"4,t Ire p i� . Sd..�A . J /bQ �liv�' ���. pEZ►uE TNT �� /['lAAtV�t, /C /r✓Nt(r I I� c � �• 0 c� 1! c �► B '�rN� � O � sp � 1► .o v • a ,r, IF 7 70 7 v01. 5 PC, 1 h 5$S °ys- ��s.r� 7 41.63' T Wisconsin Department of Commerce SOIL EVALUATION REPORT page of Division of Safety and Build n with Comm 85, Wis. Adm. Code County 5 T Attach complete site plan on paper than 81/2 x 11 Inches In 51ze. Plan must Include. but not limited to: verb d horizontai reference point (BM), direction and parcel i,p percent slope, scale or dimensions, nor h Rai R � aad l l o to nearest road. Please prl t all flflOT!l AlY ew Date Personal InfonnaUon you provide may be us od for secondary purposes (Privacy La s. 15.04 (1) (m)). ` 3 0 Property Owner Property Location G0,4jot LJ1 /4 lij(,t�1/4 sag T a $ N R) q E (or) 1�► C - RW I X PAWN Property Owners Mailing Address t # Block # rSu Name ^ or CSM# Civ � n . State Zip Gbde Phone Number �} YI wn Nearest Road S , vcr - { [s w c Pr-t ) e New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement // Public or commercial - D tribe: Paront material 1 `L• Flood Plain elevation if applicable N It erat° men datlons: and tecornmen 105TALL CONYOTIOAAL CE05� 807T AS SHALLOW As.P0518LE and C v - 44 1,�� b�/n �,n 6-,-t �� lfj,�VV Boring # Boring pit Ground surface elev. q/�. / 7 ft Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOIfF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - Eff#1 'Et'f#2 3A 1 5 OS 2 4 - 32 Ir Y &C, M CL s o 3 3 .2 - 0a I - o,Q , 2 Boring # p Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' In. Munsell Qu. Sz Cont Color Gr. Sz. Sh. - Eff#1 -Eff#2 5 s 2 i 4 - 3 1 10 YP 3 i. 5 rn C) ,t 5 Elf luent #1 = BOD > 30 220 mg1L and TSS >30 < 150 mglL ' Effluent #2 = BOO < 30 mgA- and TSS < 30 mglL CST 1a ( ase P Signatur o CST Number e15e Address Date Evaluall acted Telephone Number I DQ S . YA ' 5 : � t�� �a1�� l,�l �/3 9 �- rid d i Property 0.. e) I �l Q y�- h IYI Parcel ID # ° eJ 54 _ Page L Of ©Boring # ❑ 8onnp l� Pit Ground surface elev. �S� 1 tl. Depth to limiting factor In Sod Application rate i Horizon Cepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots OPClif In. Munseli Ou. Sz. Cont. Color Gr. SL Sh• *M1 I ' 0 3 �� L yn g 2 1 7 2- If N # C] Boring F Gr Pit Ground surface elay. _ ft. Depth to limiting factor In. Soli Rats Horizon Depth Dominant Col Redox Descnnticn Texture Structure Consistence Boundary Roots GPD/N in. Munseli Ou. Sz. Cont. Color Gr. Sz. Sh. '£il`#1 'Eff#2 I I a Being # ❑ Boring. Ground surface elev, __ _. �___ ft. Depth to limiting factor !n. 0 Pit Rate Hortzcr: Cepth Dominant Colod Redox Description Texture Stricture Consistence Boundary Roots In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 1011112 Effluent #1 = SOD, > 30 1 220 mgll and TSS >30 1150 mgll ' Effluent #2 = 800, 130 mgA. and TSS 130 rnWL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SHC•I]30(R,6i901 PTOP" Owner C y tfy (Lb h Y✓ 1 psrcei fD # vevd i si G Page d 7 ❑ Sonng 3 Pit Ground surface elev. D 1 tt. Depth to ! rnt(Ing factor �t _ In r-E!l poi{cation Rate i Horizon Cepth Oominent Color Redox Description Texture Structure Consistence Boundary Roots OPCIff In. Munseil Ou. Sz. Cont. Co Gr. Sz. Sh. 1 0#2 2 )4•3Z )OY9 3111 L S s a.9 1. ' U14 a F Baring C] Boring _ 0 Pit Ground surface alay. n. Depth to !Irniting factor In. Soil Amplic3tion Rate Honor Depth Dominant Co! Redox Descmeon Texture Structure Consistence Boundary Roots GPDAY in. m Cu. Sz. Cont. Color Gr. Sz. Sh. I 'Eif# 'Eff#2 1 i I j I I F ��na # ❑Boring . - -- ❑ Pit Ground staiace elev. _. _. ` ft. Depth to limiting factor fn. Sotl Applik=don Rate Horizcr. Cepth Octrinam Cm' Redox Description Texture StnxWre Coneistence Boundary Roots I POM In. Mumem Cu. Sz. Cont. Color Gr. Sz. Sh. 'EA#1 - Eff#2 i i 6 { - Effluent ill SOD > 30 _< 220 s i r*xyl. and T,SS >30 < 150 mg1L ' Effluent #2 800,:S 30 ntglL and TSS 130 rr>gtl. The Department of Commerce is an equal opportunity service provider and employer. if you need assiStanae to access services or aecd material in an alternate format, pteaae` contact the department at 608 266 - 3151 or TTY 603. 264 - 8777. - sac•�oca.w�ai r • i KEVIN BL. U HM PLOT PL A N PG 3 OF 3 3C -40' I.96 ACRES i Fxis'�Srr� POL 514E1 ehI 1 8OMn ST EE L AT CORNER OF B'Dr , EL. 100.00 P o P ►(¢• (n W o o.])EV AF FR i 2 S K E ` INE TREE' EL .100.00 WOO nip A PP 9'0 I ' 4 5.89 i Z i 4 5,o a pf a i ORS yE. 39'7708 CERTIFIED SURVEY MAP LOCATED IN THE NW1 /4 OF THE NW1 /4 AND THE SW1 /4 OF THE NW1 /4 OF SECTION 28, T28N, R18W, TOWN OF K1NNICKINNIC, ST. CROIX COUNTY, WISCONSIN NW CORNER � SECTION 28 _ / T28N, R18W O °� �~ FILED CO o CIO Nv) I NOV 21984 r- I I I U N P L A_ T T E D L A' N — D S — JADES o CONNELL — Rogltla of Deeds V� I S 8 9 9" E 1321_8 Or SA Croix c� wise _.lo _ LOT �Q LOT I L Nt R io ---_` �ROAD�''��Q / (j . Tp cat Z1 POINT OF N Z z BEGINNING ( ¢1 L -' O 1 J1O �L� ) �x `�� N88 °47'20 "E 570.07' I 4 �G�� v �•' mo o, A o w I _' I _ to LOT 5 w W 1 1 - I Ln mss.- - — '�� 5.0 4 Acres t 1-II I I tea' 219,471 S.F. cnM ~1 Q I- �o N o M Q1 Q Cl 1 _j �n , LOT _1_ W Z N i I IL Ln a t Zi I /> r. S88 047'20 "W 5 0.7.7 6' ♦ ` -- )v I NORTH LINE OF V11 /4 CORNER LOT 3 w 00 SECTION 28 T28N, R18W LOT SURVEY MAP y/ - ------- - - - - -- Mme, RECORDED iN VOL. 2, PAGE 345 0 -- — — — — — — — — — — — — — — — LEGEND 0 1 "x24" IRON PIPE, SET, WEIGHING 1.68# /LINEAL FOOT. z • 1" IRON PIPE, FOUND. ¢ 0 1 1/4" IRON PIPE, FOUND. ua �r ---:. EXISTING FENCE.. m �� c�rir @J i , aulnZOA loot IOOZ 10 uap60 laeyaiW 1333 NI 31VOS - "�► Aq palde -ip juawn.aisul sly_L 33111WWOJ JNINOZ aNY ONINNYId S)IdYd 3AISN]N32'dWO� kiNnoD x102iz) '1S ZZ04S. NISNOOSIM U3n1?l 133211S H1h *N £Oh AON l nano ' VIVO 3 '0 N3A31S N 233fflAloens GNV 2I3NMO m _ n 08/24/05 DYED 08:12 FAX 715 386 4686 11001 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _�? ,.� �u A 1 14 Mailing Address "z2 Property Address��' (Verification required from Planning & Zoning Department for new construction.) City /State iJ m 41 Parccl Identi fication Number LEGAL DESCRIPTION Property Location tti' '/ , JJ,,kj %a , Sec. '.0 �' N R _�LW, Town of Subdivision , Lot # Certi>led Survey Map # M7 7L - 7 _ , Volume __. _ _,.Page # _/��__• Warranty Deed # 0 Volume _, Page # _ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Dcpartmcut a certification form, signed by the owner and by a master plu►nbe.r, .journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if .necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements -and agree to maintain the private sewage disposal system with die standards set forth, herein, as set by the Department of C:onurterce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic systeni has been maintained must be completed and returned to the St. Croix County Planning Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of nny /our knowledge. I /we anVare the owner(s) of the property described above, by virtue of a wa7dfity deed recorded in Register of Deeds Office. -71 Lx SIGNATURE M APPLICANT 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. (RF,V. 08105) �,' r A/ 4 �4• f 1 r w 4 x Ae t j , lit jmwwr 1 t r T a n 4 ^ 4 F � fv n• 469; !1 "' Parcel #: 022 - 1080 -50 -002 12/1012009 09:34 AM PAGE 1 OF 1 Alt. Parcel M 28.28.18.438H 022 - TOWN OF KINNICKINNIC Current IX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - BLUHM, KEVIN W KEVIN W BLUHM 1109 PINE RIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1109 PINE RIDGE DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 4.210 Plat: N/A -NOT AVAILABLE SEC 28 T28N R18W 4.21A NW NW LOT 2 CSM Block/Condo Bldg: VOL 5/1487 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 28- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 10/08/2004 776503 2672/063 QC 07/23/1997 9431128 07/23/1997 878/614 07/23/1997 839/226 more... 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 12334 327,900 Valuations: Last Changed: 08108/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.210 85,000 289,000 374,000 NO Totals for 2009: General Property 4.210 85,000 289,000 374,000 Woodland 0.000 0 0 Totals for 2008: General Property 4.210 85,000 289,000 374,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 If , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'INDUCTRY, r DIVISION EABOR HUMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 ( &Chapter 145.045) LWPON: SECTION: TOWNSHIP/ OT NO.: BLK. NO.: SUBDIVISION NAME: . i / ; % 2 {� / j28 H jR18, (or fl�NNic/%N�✓ /c 2 — �'E�eTifiBo sa op,�y /SAP COUNTY: OWNER'S BtrfER"5'NAME: MAI LING ADDRESS: ST C� yE.2.fE.27' «'t<y_O.D iP ft%c,2 FAGLs W�. j`9�D Z Z_ USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCIAL DESCRIPTION: ,�/� PROFILE DE RI TIONS: LA ION TESTS: esidence 3 IV //1 V_�New ❑Replace I r'7 Z RATING: S= Site suitable for system U= Site o n�suitable for system / ! /� CO IST M��.�t uired ING�� P� :SYS�TEM-1N -FILL ❑�G� e'a l✓l_0N'T /oN�01(op,90.0 If Percolation Tests are NOT re DESIGN RATE: I�/�I{� q I If any portion of the tested area is in the ^ / under s.H63.09(5) (b), indicate: e1z"o 5_ 5 Floodplain, indicate Floodplain elevation: P 9/ RM PRbFILE DESCRIPTIONS BORIN69 TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 18, e�ri ; /! B- 2 > g 3 49-Ts Za ; xe �,�, ✓ B- 3 90 Ne�E > 9d 4� -Yd 1912. B- �- 96 B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- g O P- 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- 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 percent of land slope. A a ew 9/, o0 o,e /�'i�q � SYSTEM ELEVATION Qos-o _ _.vim r�.e�a r� •,s r/w _'__a0 �' 110 ! 4-d / �' �' ' �. _ - B z _T/ M j i ,(P Aid f _ 618 f o . - 'o � � 96 _ _ ''gym F ;0 10 B4o , f + I - I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (printl: TESTS WERE COMPLETED ON' �A TE.P ✓. �' R o e - o GoE�v Eiv ��v�E,e��vy Co, 7/Z 7�A� ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): /Z,? E. EL s7; .el4E,e i4 2- Lf All _r4d2 SS J CST SIRE: INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To br, a complete and acc0 ate sail test, your report mast include: 1 . Complete legal descriptions; 2. The use section must clearly indicate whether this is a residence or cornmercial proje6t; 3. MAXIMUM number of bedroonns or commercial use planned; 4. Is this a new or replacement systern; `5, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating yqur test locations. Drawing to scale is preferred. A separate sheet may be used it desire�J, S, Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9_ Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exernp- tion, if appropriate; 10, If the information (such as flood plain, elevation) does not apply, placer N,A. in the appropriate box; 1 1 , Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TEST'S MUST BE FILED VVITH THE LOCAL- AU fHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols St -- Stone (over 10 ") 13R - Bedrock Cub — Gobbie (3 - 10 ") SS — sandstone qt' -- Gravel (under 3 LS Limestone s _. Stan=.. HGVV - High Gvorri vv t. f rs - C oarse Sand P"r rc _ Pr�tcolatie r raje(% S sant:l t"tt' ll t,> _ First S 00' %' = =icf< _ B lrl r;ca Sand G��.t,ir 3 sl Sandy s wl Gray t_o�anl i` sct _.- qtly Ck',i y Load R ; > sicl .. Sii'ty cla , Loam' ` :,dy Clay ts.Giy _ :',"€ -. -'. C!)111 n = =_ f s, (SF;nii.r�i 4c.il t x iU;'P:S J' l;#ti" s f tisE" o ('€ l;1 1 i"r?osal t ?Mi rat' T,'i fvl VRP v( 1ttc <1 p n'n' TO TH E OWNER; T his - ,00 - test ; sport is th1E Cit 54 .t.,L'k !i f,tll.rrM a sanital y p ?i l at. T c`' (iAmv or fll£ Deq)a:'t lun wquest V'enflcatiiin t)" this soil t €?s "; ! +l th€ field ()?iol 1 t7 porinit 14 t.,1 £, t i;C7(t1kil.,tE see nl plal6l;s 1()r th)' l'71"rU %ati'. 4 U£)de sy'sk'm and to permit al ph(i a'imn mt.asl he silk' llted ,U _tire ,rt,.lopisa;c itwDl awhovity in order to of - — Ld u of YQ '!)u ; - "i- ,,f- X)v C(Jtl$ %r�.aCti(3n. ietiub� yd 3xT 91l��S3t3 ' A U, 2 6? 2 P 0 6 3 7765103 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 3 .2000 REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST. CROIX CO., VI RECEIVED FOR RECORD This Deed, made between Samantha L. Bluhm a/k/a Samantha 19/08/2M 08 :15AN Bluhm Grantor, and Kevin W. Bluhm Grantee. Grantor quit claims to Grantee the following described real estate in St. QUIT CLAIM DEED Croix County, State of Wisconsin (if more space is needed, please attach EXEMPT # 8M addendum): REC FEE: 11.00 LOT TWO (2) OF CERTIFIED SURVEY MAP IN VOLUME FIVE (5) TRANS FEE: OF CERTIFIED SURVEY MAPS, PAGE 1487, AS DOCUMENT COPY FEE: CC FEE: NUMBER 397707, FILED IN ST. CROIX COUNTY REGISTER OF PAGES: 1 DEEDS OFFICE ON NOVEMBER 12,1984, BEING LOCATED IN THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER (NW 114 OF NW 114) AND THE SOUTHWEST QUARTER OF THE NORTHWEST QUARTER (SW 114 OF NW 114) OF SECTION TWENTY EIGHT (28), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. Subject to Liberty Recording Area Road right of way. Name and turn Odnss� The grantor by executing this deed both (1) conveys to the grantee all right, Al title and interest in the property, and (2) joins in by separate conveyance that mortgage granted by the grantee to M & I Mortgage Corp. in the _ amount of $160,000.00, in order to comply with Sec. 706.02(1)(1), /ti Wisconsin Statutes. 022 - 1080 -50 -002 Together with all appurtenant rights, title and interests. parcel Identification Number (PIN) +h This is homestead property. Dated this day of September. 2004 (is) (is not) * * amantha L. Bluhm a/k/a Samantha Bluhm AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) SS. ear-- County ) authenticated this day of Personalty came before me this k 4-"') day of September 2004 the above named Of Samantha L. Bluhm a/k/a Samantha Bluhm TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the Derson(s) who exe r es . • ,, authorized by §706.06, Wis. Stats.) instrument and acknowledged the Sam ;tu...,r CI► A. THIS INSTRUMENT WAS DRAFTED BY c LJ Joseph D. Boles - Attornev at Law * -t 6 � 167 •�'��a River Falls, WI 54022 Notary Public, State of W -r •....•••' My Commission is Dermanent. (If not, state expa4t'� (Signatures may be authenticated or acknowledged. Both are not necessary.) 2 .) * Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO (800)655 - 202t www.bifoprofoms.com STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3 - 2000 i L i 4 • 4k 0to O! 3v0 r� 0 3 n 3 d 0 O y n O ° A W OD N `C • '�, j IV N H co ca z ° �_ x 00 o .O+ C.3 CD _ m co ` 1 N O w O O (�O N n 7 w ° w 00 as 7 N F N O � i cP� C D a CD co y N a m co 0) Tl C r N r' p N C, CL O cn N CO O fD Cn C C 3 a Zol co 0 I ° A o O O O I z O C N N y N O N 3 a O I N fp CD N 3 N N N � 3 N A 00 Cl - N z 0 O D a j o m m m �. m y CD v N c m m a z � �zm A C !, M 0 M A z 0 v O I a. .. a m Z w w I I a - o a CD I y I ,I y A F I i I Li C, O I ' w 0 A I o I ~ N 6q A ° O CD ',I a Parcel #: 022 - 1080 -50 -002 02/2012007 11:45 AM PAGE 1 OF 1 Alt. Parcel #: 28.28.18.438H 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BLUHM, KEVIN W KEVIN W BLUHM 1109 PINE RIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 1109 PINE RIDGE DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 4.210 Plat: N/A -NOT AVAILABLE SEC 28 T28N R18W 4.21A NW NW LOT 2 CSM Block/Condo Bldg: VOL 5/1487 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 28- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 10/08/2004 776503 2672/063 QC 07/23/1997 943/128 07/23/1997 878/614 07/23/1997 839/226 more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.210 70,000 289,000 359,000 NO Totals for 2007: General Property 4.210 70,000 289,000 359,000 Woodland 0.000 0 0 Totals for 2006: General Property 4.210 70,000 289,000 359,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 217 Specials: User Special Code Category Amount t Special Char a Delinquent Char Special Assessments Charges es q g Total 0.00 0.00 0.00 • FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER _ TOWNSHIP SECTION _ T -R / W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION 7 - /, LOT_ .? LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW BENCHMARK: Elevation and description: C';y/ „2 ds� .4W`116_ Alternate benchmark SEPTIC TANK: Manufacturer: y •Y. _ Liquid Cap. Rings used: t Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Sided, Rear Ft. % 9-D From nearest prop. line:Front , Side, Rear Ft. /P69' No. of feet from: Well 'S r Building: 1.2 ` (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons /cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Seepage Pit: Width: Length a &I Number of Lines: !:Z Area Built 9�O Exist. Grade Elev. Z ?w 5 Proposed Final Grade Elev. Fill depth to top -of pipe: No. feet from nearest prop. line:Front , Side , Rear3, Ft.S` No. feet from well: No. feet from building HOLDING TANK Manufacturer:, Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE: Yl' PLUMBER ON JOB : C- -G=-�� LICENSE NUMBER: l� 6 /90:cj Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County: Labor and Haman Relations INSPECTION REPORT St. Croix Safety and Bpildings Division ' (ATTACH TO PERMIT) sanitary Permit No -: GENERAL INFORMATIONNW Q,NW %, Sec . 28 , T28 -R18 , 149108 Permit Holder's Name: ❑ City ❑ Village 10 Town of: State Plan ID No.: Kevin Bluhm Kinnickinnic ,CST BM Elev.: Linsp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w�� � �/ra Benchmark 70/-0 - 7.o2�S Dosi ng Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic Igo) &r i /c' NA Dt Bottom Dosing NA Header / Man. 2 93./ 7 Aeration NA Dist. Pipe Holding Bot. System g0. q( PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft ead oss Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /01 8Q / DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of Mod Number: System: BS / � / oS OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepanc#sl, ° p rsons present, etc.) i L j f Plan revision required? ❑ Yes No - Use other side for additional information. SBD -6710 (R 05/91) Date , , Inspector's Signature Cert. No- ADDITIONAL COMMENTS AND SKETCH L , SANITARY PERMIT NUMBER: i - i E . T • SANITARY PERMIT APPLICATION ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY Ili 7 STATE SANITARY PERMIT - Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 41 g 111k 8% X 11 inches in size. Check i revision to previous application – See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFO PROPERTY OWNER PROPERTY LOCATION E° / T 2 , N, R CC E (ora PROPERTY OWNER'S MAILING ADD ESS LOT # BLOCK # ea.IL,Y owy' h 2 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER -6 7,4 g . / e s 11. TYPE OF BUILDING: (Check one) El State Owned CITY NEAREST , NEAREST ROAD ❑ Public 111 or 2 Fam. Dwelling -# of bedrooms 1- P ARCEL TAX NUMBE Ill. BUILDING USE: (If building type is public, check all that apply) d ;Z 2 ldFJ SQ Od Z 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. 9i 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 1 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE Aj� REQUI�R�ED�(sq. ft.) % PWSE D (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) C� a ELE Feet 9 0 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Sep tic Tank or Holding Tank OA Lift Pump Tank/Siphon Chamber Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number: l i `✓1 %/ c S'e i 4 ," slSei 1 4)_ ' Plumber's Address (Street, City, State, Zip Code): �� ,�2? �4 pit l•4lr.,,v t " �'Y IX. COUNTY /DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) 0 Surcharge Fee) Approved El Owner Given Initial � Adve a Det rmina ion — X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety S Buildings Division, Owner, Plumber INSTRUCTIONS r 1. A, sanitary permit is valid for two (2) years. 2. Your'san)tar§ 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 a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: 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 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. SBO -6398 (R.11/88) AMICATIOH FOR SAHITUT PIRHIT 9TC -100 This application form is to be conpintod In full and signed by the ovntr(t) of the property being developed. R ny lnadoquacles will only re3ult In delays of the pit ralt lssuance, •Should thla development be Intended for rttalt by ovntc /contrsctor,(spoc house), thon a second form should be retained and completed vhan the property is sold and submitted to this aLIIca with the ■ppropclatt died rteording. ------------------------------------------------------------------------------- O m: r at p r o p e r t y /��: W4 y'A1 - L/ A 4v..✓ g4 yA� Location of p roperty 4/w /4 A Bactlon - T ZZ Ak R Ar v Tovnshlp Al' 1 rA Halling address CVO4 o" Mdress of alto 1 /a�> 4116 n y e, �° tubdtv1sIon mar►a�f�+/E Lot nueber--tt --9— Ptevlous owner of property , A p GjSj� 2D ' Total 5118 of parcel I Date parcel vas created Af! all cornets and lot lints ldentlflablel ---'<" _ Yea Is this property being developed for resale (Epic house)? ye x No Yalnr.e X 77 end page Iturnbar 11 as tdcarded with the Reylatet of Deeds. . - - - - - - - - - . - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I14CLVD6 VITII TH18 APPLICXTIOII Tilit FOLLOVIHct A VAAR"TT OVID vhtcli tncludos a DOCVHRHT IIVNORR, VOL"K AND PAOt 11VK1rR, and the OrA.L or Tilt. RROIOTRR Of D911Dl1, In addition, a certified ■utvty, f available, would be helpful so as to avoid delays of the tevitving process. it the deed description teterencas to a Cettlflod Survey lisp, the Cert Survey Hip shall also be required, - - PROPERTY O WER CBRTIFICXTIOH - - - - - -- flvt) certify that 811 statements on this town are true to the best of ■y tout) >novl1dge1 that 1 eve) am (are) the owner(s) of the property dtectlbtd In thle inlotmatIon form, by virtu, of a warranty deed roe rded In the Office of the county Register of Deeds an Document Ho. pttatntly own the ent, prop osed alto for the newags disposal System (or havI obtalncd an e•aeement, to tun the conattucl with the above daacrIbtd property, Iar Ion of sold nystem, and the ram■ ties b n duly recorded In the office of the county egfrt r o'f Deeds, as Documen No ) {9natute of Owner g ature a —co—ow—nor III Applicable) Date of signatute Data oA L qnji tu r a r1 ri te s• SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER r tip✓ &'�' 'k a iv -1 ADDRESS: y f G &jAggT e T FIRE NO: LOCATION: w/ sA) 1/4, 1/4, SEC. .2Q T � F N-R_LF4�p TOWN OF: k,', w,'c 4 ,', A, 1 ST. CROIX COUNTY SUBDIVISION: T"Lj eo" V'tz LOT NO. ;Z Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning 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 proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED:" 1 DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 IHOU ST 1TMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS IN[)UfiY ,' DIVISION LAJM AN RELATIONS MADISON, 5 R AN° PERCOLATION TESTS ( 115 ) P.O. ° °X 3707 � il1PA ` 1 3707 (H63.090) & Chapter 145.045) L ION. N � SECTION; _ TOWNS IIIP /M� LOT NO. BLK. NO.: Sl)1)D - 1w5i N NAME: — — ((VV'NN 1/ / 2 9 /TZ9 N /R /e ®(or fliNN�cfI�NN /c �'��r,���o su��• �a�� COUNTY: OWNER'S Bt3YERS`NAME: MAI NG ADDRESS: ST )SE DATES_ OBSERVATIONS MADE NO. BEDRMS.: COMPnERCTA DESCRIPTION:1 PROF LE DESCR11'TTONS: PERT OL%1 I I(jN ! ES1'S: — KIesidence I CNew ❑Replace - I A T ING: S= Site S system U= Site unsuita for system Or f NTINAL. M Ly S 0U IN G� P RE SYSTEM- IN•FILL FiO�L�DING NK : COMMENDED SYSTEM: If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.1163.09(5)1b1, indicate n cate: CL,q $ Flood indicate Floodplain elevation: / ✓ /� __ PROFILE DESCRIPTIONS 3OHI TUTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION O BSERVE D ES — T. H GHE T TO BED ROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 2- 8 tie N > 21i, Q, , iz� 1 'nuw Q-; g Bn � NQ�IE B - - 7 _ 9 96 , 96 B - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WAI ER LEVEL - INCHES RAT E MINU I ES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIO t PERT D 2 p RTas3 PER INCA P _ p 8 J 0 �� -- P- P. P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- w1al and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent I land slope. 4 — a END 9/. DD o,2 /Giy q �. ;YSTEM ELEVATION 90, 0 !/LTE,2/7/A • e5Y /5 T 14 �" heO 4 / I SC A L E � = �,D 0 ! I /Re �v P /RE SC- � Xx A 1 o LocAr i i 1 1 9 DIRECT" /d �Aq/O v V I C It/7 of :SSL � 4j l ' i i I f "Ieonl PIPE , 0 l l y r r , B 1 6 8 i i O ` I 0 ��o v to•t7 E LE+/ ¢ o F 9 Fos �o N R /,f %1/A.4 ; 2 77_f -7 96,22 e.-2 - - I l 1 ■ - i , the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin dministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. IAPAI; (pr'�nt1: TEST S WERE COMPLETED ON 'a/ FN Lr,V, j , ,V- - E 1'414 \l)DRESS; CERTIFICAT1gW UUM'ff, I WHABEIll'-wion -0) S7, .P / t� .P F� G L �/i �4o s Z .S"S -13 7 /-f 763 CSI jI�RE: A Jo ,9 No A 4 -/474 CERTIFIED SURVEY MAP — LOCATED IN THE NWI /4 OF THE NW1 / AND THE SW1 /4 OF THE NW1 /4 OF SECTION 28, T28N, 1118W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN NW CORNER SECTION 28 w T28N, R181Y �Z_ UNPLATTED LANDS -- — — — —— -- co 0 POINT OF I 1/13 EGINN ING 6 '13l1.8W �) S89 "E 1288 .79' O 33.01' 6 644.00 M LOT 3 w ,: 3.40A.± 148,238 S.F.± o 1- LOT u w y1, *3.5 154,143 S.F.± in iv r` ° o 1S * N80 ° 57' `^ o c o 6.00 Acres# w �, .1 I 52S 801 n Z z N 261,266 S.F.± c 55 g. 31 1 " , �i 80 547.6 51 6 R /l� 1 0 q- 161 �; - I � LOT 2 S88 ° 47'20 "W 3. 9GA . ± 172,580 S.F. # 570.07' M c JIrn ch N *4.21A.± 183,440 S.F.± e 6� w lz l c* 704.63' 3 6. 79,. 2 ' I- S88 °47'20 "W 67163' M UNPLATTED I F-I� 430.63' 241.00' — — — I 1 0 F_ 33 1 . lD N LOT t` w I f1 y a J I?�Z ,., �' * 4.09A.± 177; 957 S.F.± .° F ° N I a IJ c; c. : ; 4.29A.± 186,827 S:F.± 8 (D Z N N Ol (n 4 Z�I ' 1 _ w 33' _1 ��3� 1135.63' -- 18 9.00' - - 5 ----- . +.r - -_ 1 6 1 8 8 4V2 0" 6 4.63' 8d PART OF LOT 3 1 657.63' l NORTH LINE OF LOT. 3 _LOT _3 CERTIFIED _ SURVEY MAP_ W1 /4 CORNER RECORDED rl V0_1_. 2 PAGE 345 _ SECTION 28 T28N, R18W LEGEND V 0 1 "x24" IRON PIPE, SET, WEIGHING 1.68# /LINEAL FOOT. z • 1" IRON PIPE, FOUND. Q ' m 0 1 1/4's IRON PIPE, FOUND. 14 EXISTING FENCE. AREA INCLUDING LIBERTY ROAD RIGHT --OF -WAY. v) 0 This Instrument drafted by Q Michael Ogden SCALE IN FEET 80 rra (Map dated in dicates) one part) (all) of the property is located in a flood plain (Strike as 81' app:.kelier 8'2 rrant HMap dated indicates (part) (all) of the property is located in a wetland (Strike as 83 applicable). 84 Seller represents that the property is zoned ZLl 85 Seller warrants and represents to Buyer that Selle as no notice or knowledge of any: 86 (a)planned or commenced public improvements which may result in special assessments or otherwise materially affect the 87 property. 88 (b) government agency or court order requiring repair, alteration, or correction of any existing condition. 89 (c) shoreland or special land use regulations affecting the property. 90 (d) underground storage tanks and the presence of any dangerous or toxic materials or conditions affecting the property. 91 EXCEPTIONS TO WARRANTIES AND REPRESENTATIONS STATED IN LINES 80 to 90: 92 93 _,W J G71t 94 95 96 The following items shall be prorated as f the day of closing: general taxes, rents, water and sewer use charges, homeowners' 97 association assessments, fuel, and 61..1 98 Any income, taxes, or expenses through the day of closing accrue to Seller. 99 General taxes shall be prorated at the time of closing based on the net general taxes for the current year, if known, otherwise 100 on the net general taxes for the preceding year. 101 CAUTION: If property has not been fully assessed for t �ur s s, r reassessment is completed or pending, tax proration shall 102 be on the basis of $ estimated annual tax. 103 Special assessments, if any, for work on site actual) commence or levied prior to date of this offer shall be paid by Seller. All 104 other special assessments shall be paid by Buyer. (Caution: Consider a special agreement if area assessments or homeowners' 105 association assessments are contemplated.) 106 Seller shall provide to Buyer at Seller's expense at least three (3) business days before closing, Seller's choice of: 107 On abstract of title prepared by an attorney or abstract company; or 108 A commitment from a title Insurance company licensed In Wisconsin to Issue title Insurance In the amount 109 of the purchase price upon recording of proper documents; 110 showing title to the property as of a date no more than 15 days before such title proof is provided to Buyer to be in the condition 111 called for in this offer, and further subject only to liens which will be paid out of the proceeds of the closing and standard title 112 insurance exceptions or abstract certificate limitations, as appropriate. Buyer shall notify Seiler of any valid objection to title in 113 writing by closing. Seller shall have a reasonable time, but not exceeding 15 days, to remove the objections, and closing shall be 114 extended as necessary for this purpose. 115 It this offer provides for a land contract, prior to execution of the land contract Seller shall provide the same evidence of title as 116 required above and written proof, at or before execution, that the total underlying indebtedness, if any, is not in excess of the 117 proposed balance of the land contract, and that the payments on this land contract are sufficient to meet all of the obligations of 118 Seller on the underlying indebtedness. 119 If the transaction fails to close and the parties fail to agree on the disposition of earnest money, then earnest money held by 120 broker shall be disbursed as follows: 121 1. To Buyer, unless Seller notifies Buyer and Broker in writing no later than 15 days after the earlier of the Buyer's written 122 demand for return of the earnest money or the date set for closing, that Seller elects to consider the earnest money as 123 liquidated damages or partial payment for specific performance. 124 2. To Seller, subject to amounts payable to broker, provided the above notice is given and neither party commences a lawsuit 125 on this matter within 30 days after receipt of the notice. 126 In making the disbursement, the broker shall follow procedures in Section RL 18.09(4), Wis. Adm. Code. 127 Disbursement of earnest money does not determine the legal rights of the parties in relation to this agreement. 128 Both parties agree to hold the Broker harmless from any liability for good faith disbursement of earnest money in accordance 129 with this agreement or present Department of Regulation and Licensing regulations concerning earnest money. 130 If the property is damaged by fire or elements prior to time of closing in an amount which exceeds five per cent of the selling price, 131 this contract may be cancelled at option of Buyer. Should Buyer elect to carry out this agreement despite such damage, Buyer shall 132 be entitled to the insurance proceeds relating to damage to property. 133 SPECIAL PROVISIONS:_ ) 134 135 136 137 138 Seller and Buyer agree to act in good faith and use diligence In completing t rms istoreement. This agreement binds 139 and lntj!re s to the benefit of the parties to his agreement and their successors in i 140 141 a (Buyer) (Buyer) 142 Buyer's Social Security No. �� 5 � ��' SS3� Buyer's Q Social Security N o .X — f 143 THIS OFFER IS HEREBY ACCEPTED, THE WARRANTIES AND REPRESENTATIONS MADE 144 HEREIN SURVIVE THE CLOSING OF THIS TRANSACTION. THE UNDERSIGNED HEREBY AGREES 145 TO SELL AND CONVEY THE ABOVE - MENTIONED PROPERTY , ON THE TERMS AND CONDITIONS ! 146 AS SET FORTH AND ACKNOWLEDGES RECEIPT OF A COPY OF THIS AGREEMENT. 147 Dated: , 148 19 (Seller) 149 Offer is rejected (Seller initial.) Seller's Social Security No, 150 Offer is countered (Seller initial.) 151 (Seller) 152 Seller's Social Security No. ! 153 This offer was drafted by (Licensee and firm) t 154 It was presented to Seller by on 19 at m, 155 EARNEST MONEY RECEIPT 156 Broker acknowledges receipt of initial earnest money as per line 13 of the above offer. 157 Broker 158 , 19 159 (BY F Approved by Wisconsin Department of Regulation and Licensing WISCONSIN REALTORS® ASSOCIATION' . 10 -26 -87 (optional use date) 3 -1 -88 (mandatory use date) 4801 Hayes Road, Madison, Wisconin 53704 WO-13 VACANT LAND OFFER TO PURCHASE 1 / �, Z1 1 2d Wisconsin, /l . 19 LL% 2 THE BROKER DRAFTING THIS OFFER IS THE AGENT OF (SEL R) (OVI'M) (Strike as applicable). 3 IF ACCEPTED, THIS OFFER CAN CREATE A LEGALLY ENFORCEABLE CONTRACT. BOTH PARTIES 4 SHOULD READ THIS DOCUME T CAREFUL)_ AN UN ERSTAND IT BEFORE SI NING. 5 The undersigned Buyer, Ail 6 hereb ers to DUrChase the property known as (Skeet Addrgss) 7 in the of ,�'� � • , Wisconsin, 8 mo e p rticuladyd ees�cribed as• 9 10 11 at the price of �' Dollars ($). 12 and the terms E d condi i ns s foilo s: 13 Earnest money of /AL in the form of ��� tendered with this offer. Additional earnest --, 14 money of $ • an the form of gea efAe to be paid within days of acceptance of this offer or 15 .1 and the balance in cash at closing. 16 Failure of Buyer to make earnest money payments as provided voids offer at Seller's option. Earnest money, if held by broker, 17 shall be held in selling broker's trust account prior to acceptance of offer and thereafter in listing broker's trust account or until 18 applied to the purchase price at closing or disbursed as provided herein or permitted by law. 19 TIME IS OF THE ESSENCE AS TO: ADDITIONAL EARNEST MONEY PAYMENT, ACCEPTANCE, LEGAL POSSESSION, 20 OCCUPANCY, DATE OF CLOSING AND AS TO ALL DATES INSERTED IN THIS OFFER EXCEPT: e k,r 21 22 'THE BUYER'S OBLIGATION TO CONCLUDE THIS TRANSACTION IS CONDITIONED UPON THE CONSUMMATION 23 OF THE FOLLOWING: 24 (if this offer,Js subject to financing, survey, percolation test, specific zoning or use, approval of recorded building and use 25 restrictions and covenants, or any other contingency, it must be stated here. If none, so state.) 26 27 L� u 1& 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 Buyer agrees that unless otherwise specified, Buyer will, in good faith, pay all costs of securing any financing to the extent 48 permitted by law, and will perform all acts necessary to expedite such financing. 49 Included in the purchase price are such of the following items as may be on the property on the date of this offer, which will be 50 delivered free and clear of encumbrances: all fixtures; a4arde bulbs, plants, shrubs and trees. 51 ADDITIONAL ITEMS INCLUDED IN THE SALE: 52 53 54 ITEMS NOT INCLUDED IN THE SALE: 55 56 57 Seller shall, upon payment of the purchase price, convey the property by warranty deed, or other conveyance provided herein, 58 free and clear of all liens and encumbrances, excepting: municipal and zoning ordinances, recorded easements for public utilities 59 serving the property, recor d but ing and u e restrictions d covenants, general taxes levied in the year of closing and 60 provided none of the foregoing prohibit present use, 61 and Seller shall complete and execute the d ments necessary to record the conveyance. (WARNING: Recorded building and use 62 restrictions and covenants can have material impact on the use of or improvements to the property.) 63 This offer is binding upon both parties only if a copyJ the accepted offer is deposited, postag gr fees, pre aid, in the U.S. mail 64 or a commercial delivery system, addressed to Buyer at or by personal 65 delivery of the accepted offer to Buyer on or before Otherwise this offer 66 is void and all earnest money shall be promptly returned to Myer. 67 This transaction is to be closed at the office of Buyer's mortgagee or t the office of 68 on or before ��� / , 19 q or at such other time and place as may l agreed in writing. 69 Legal possession of property shall be delivered to Buyer on date of closing. 70 It is understood the property is now occupied by 71 under (oral lease) (written lease), which terms are: 72 73 Occupancy of shall be given to Buyer on 74 If Seller is permitte o occupy property after closing, Seller shall prepay occupancy charge of $ per day, which 75 (shall) (shall not) be refundable based on actual occupancy. 76 The sum of $ shall be withheld from the purchase price to be escrowed with 77 78 to guarantee delivery of occupancy to Buyer AND FOR NO OTHER PURPOSE, which sum upon Seller's faiture to deliver 79 occupancy shall be paid to Buyer as liquidated damages or returned to Seller if occupancy is delivered to Buyer on the agreed date. ADLIF;NDUM /i I'lii.s ,gdcler,dum is made part of the offer to�}lurchnse darted C�- for the,,, ty known a � in the of ^� L, - _ -_ -� — .� - - -- - -, County of - -- DF.LIVERY OF CONTRACTS AND NOTICES Delivery of contracts and notices as described in the subject, offer to purchase and this addendum shall be deemed to he clel ivered to I.hc buyer upon personal delivery to the selling broker, or delivered i;o the scile1 upon personal delivery to the li.sf -Ing broker, or as otherwise provided iil the offer to purchase. Sellers and Buyers agree that receipt by Ptirer or Sel l.er of a fax copy of an Offer to Purchase signed by Sc? I l er or Bi.iY(Ir shall constitute a binding agreement.An original signed copy shall he obtained within 7 days of receipt of fax copy. FINANCING This offer to_ purchase is contingent upon the Buyer obtaining a (Fined, ARM, FEIA, VA, HB ) mortgage loan for initial interest not to exceed S,lc % per annum for a term of riot less than .36' years. Monthly mortgage payments on said mortgage not to exceed $ X1 5_ for principal and interest, plus 1 /12th of the estimated annual general real estate taxes X. 1 /12th of the annual premium for fire and extended casualty insurance and 1 /12th of the annual premilun for mortgage insurance, if applicable. Buyer shall. furnish Seller with mortgage loan commitment for stated financing, or may furnish Seller with firm mortgage loan commitment for financing with firm terms that. may he different than above, within 7j days of acceptance of this offer to purchase. Buyer waives the right to cancel. this contract on the basis of such difference(s) in the terms of said financing. Buyer and Seller ngrco to cooperate in fulfilling this contingency. Seller agrees to credit Buyer at closing $ to be used t.os;nrft closing costs /discount points. Buyer agrees to pay to Buyer's lender, loan procurement; fee riot to exceed % of Buyer's mortgage amount not including customarily charged out of pocket expenses, and survey if required by lender. Should Buyer be unable to provide Seller, at Seller's request, verifi - cation of having made formal written application for financing within I days after acceptance of this offer,Seller may, at Seller's option, declare this offer to purchase null and void with all earnest money returned to the buyer herein. /f GG�'L�CI� C'C'G�, . C� / te'l ILC�I��c EC !fit i � �' r` ~ f�� u �l � !�' .�/� .d O � a �✓ /�O �.2 �L�f� OP r" .tis�Grr .6.t/1 �a f s� rte - 0 ed b I ss - 4 d a S7' oa E' V 3a6 , it 0 a � � c w N S p, to tQ Ln o p rJ z '-N- -a (, 2 I T r A � 36.78 l i W m t � Q I I