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HomeMy WebLinkAbout032-2148-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division * INSPECTION REPORT Sanitary Permit No: 420417 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: Smith, geraid I Somerset Township 032 - 2148 -30 -000 CST BY Elev: Insp. B BM Description: �) TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben mark lei (o v ( D 09 P 110-01 f • Dosing ' Alt. BM Aeration Bldg. Sewer Holding t/ Inlet St/ TANK SETBACK INFORMATION Outlet TANK TO / 01- WELL BLDG. V ^nt t Air Intake ROAD Dt Inlet Septic N1 ,91 s) Dt B m Dosing H der /Man. 1 S � VLk 2 [ Aeration Di Pi Holding Bot. stem 'D ' 3 , O Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM dr Model Number TDH Lift riction Loss System Head 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 U f �� SETBACK SYSTEM TO jP/LA/ JBLDG JWEL LAKE/STREAM E G MaKft our r: r INFORMATION / CHAMBE OR ( A Typ f System: f— } UNIT Model Number: � I O V `T DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacin Vent it Intake I i Pipe(s) Jn / Length Dia _ Lengt Dia aG, SOIL COVER x Pressure Systems Only xx M and Or At - Grade Systems Only Depth Over / epth Over epth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoi� _ No _ Yes i nvo COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:� 2- / /()2- Inspection #2: Location: 2116 54th Street Somerset, WI 54025 (SE 1/4 SW 1/4 15 T31N R1�9W � ) Oak Haven Lot 23 �P�ar�cell -No: 15.31.19.1296 � 1.) Alt BM Description = �� C - /� V -v6 x.B Vve,4 Q'K- (Ot CJr,�' 4 & Lwf 2.) Bldg sewer length = 4-Qr• �0 - amount of cover =, V� a* Plan revision Required? Yes Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Agnature Cart. No. I Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 ao i X C -� Iv Madison, WI 53707 - 7162 Site Address Department of Commerce 9-:�d � 3 �ODS:3 211('a Sanitary Permit Application Sanitar Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 11 Check if Revision tna be used for secondary purposes Privacy Law, s15. 1 m t I. Application Information - Please Print All Information State Plan I. D. Number N �- roperty Owner's Name Parcel Number ` S . 3/, / 9 • / yC f U) G era ..). Sm. F'h a " ®akS �des,Ixc C3�Z. -21 -3 v Property Owner's Mailing Address Property Location jWeo 1 t) AVM . 5 E -A 5L"j A;S ) T 31 N.R 19 City, State Zip Code Phone Number Lot Numb 3 Block Number F1 K 1z" `� e f ' (Y SS 3 3 ( 3) 888$ Subdivision N1156 CSM Number H. Type of Building (check all that ate) - ❑City �1 or 2 Family Dwelling - N ber of ` �-'" ❑Village ❑ Public/Commercial - Descri Use ownship 5B'111 e r 5 s ) � 7 1 �1 G��'� Nearesl ❑ state owned /;' -1 r 6� AL-e M. Type of Permit: (Chet only *fie box on line A (num ring scheme for internal use). Complexeune B if applicable) A 1 1 " For County use 1 KNew 2 ❑ Repla item Q Replacement of 6 ❑ Addition to System Tank Onl Exis ' stem B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use '/7179 K ��( 44'K-Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ pressurized In..Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line R/, 0 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V. D' tment Area Information: or Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevatio Final Grade Required Proposed Rate( Gals. /Days /Sq.Ft.) (Min./Imh) �. ` e17 p0' Elevation G 1 = 101. .25 ysc 6py 0� 0. / Ta - 96. 7 - 5 Q2 _ 100. - 75' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks l•� t��� Septic or Holding Tank 1 a ( p I C {C S Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ber's Signature MP/MPRS Number Business Phone Number Ivy/ a�a A p (4,50 - S 7 - O Bo Go J gllleS �rC�1 �e �� 4 f Y83 - 75 Plumber's Address (Street, City, State, Zip e) L, � m Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Da Issued Issu Signature (No Stamps) Approved ❑ Disapproved Surchar e Fee) / ❑ Owner Given Initial Adverse 2 2 � Determination Conditio of Approval/Reasons for Disapproval � m. �3,5�5°- 3 � �.t.� 7W wc;Q.Q rlc?2t cx&— t-A ,llttach tom a' the County ody) for the on pap not less 5112 x 11 es in size - 6� SBD -6398 (R. 05101) f�? �z2lin lQ'�' 3'q3 tL 1 kA N j IA ° f , S f o C a is o � p � O 3 �5► KP RV\ 1� hi �fA 4 A � N x J* +s T Qn { � �- J S F ►ch �.., C v— -a IA 3 ` i Al f r j , . o� - ti ► 1 a 3 Sti W f7` v _ ,n a ° 0 3 � Q!1 � � �► th SOW v T g r ' Joafes F ►ch-t ► -r 'I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 2(t,`�� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. viewe by O Date nn Personal information you provide may be used r secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner �� -� A (� S Property Locatio Gerald J. Smith Z Corsi DGS 7 G- Govt. Lot SE 1/4 SW /4 S 15 T 31 N R 19 E%or)w Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# 11160 190th Ave. 23 1 na I Oak Haven City State Zip Code Phone Number ❑ City ❑ Village {] Town Nearest Road Elk River, IMN 1 553301(612)441-8888 Somerset I 210th. Ave. G1 New Construction Use: IR Residential / Number of bedrooms 4 Code derived design flow rate k f5`7� GPD ❑ Replacement ❑ Public or commercial - Describe: % Parent material outwash Flood Plain elevation if applicable na ��a,� ft. General comments and recommendations: V trenches @ el. 97.30', spaced to cod 3.50' below grade ` COUNTY 5-1 Boring # Boring 101 .50 c� ZONINGOFFICE Ground surface elev. ft. Depth to limiting factor 90 . ® Pit i Soil A ' ` t I ijg Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda ;Roof's in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - 1 'Eff #2 1 -8 0 r4 3 none sl 2m 2 8 -16 .5 r4 4 none is 3 16 -90 .5 r4 6 none :::: ; ;r ms os ml 1 na 1-2 2] Boring # Boring 2 Ground surface elev. 101 h t limiting fa ft. Depth mng ctor 90 in. ® Pit Soil Application Rate Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 10 -2810 r4 4 none sl k mfr gw 3 28 -90 5 r4 non P8 ��•(O� $ �� Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " E e = BOD < mg/L a TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel 02298 Address DatP.E4a uation Con cted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6 -3 -2001 715 - 246 -6200 Property Owner Gerald J. Smi th Parcel ID# pendins Page 2 _of 3 3] Borin g # El Boring ® Pit Ground surface elev. 98' 4 ft. Depth to limiting factor 90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 D-10 0 r3/3 none sl 2msbk mfr qw 2f .5 .9 none na F-1 Boring # F] E] ❑ 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 /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or an alternate format lease contact the department at 608-266-3151 1 or TTY 608 - 264 -8777. need material m , p p SBD -8330 (R.6 /00) t l , , STEEL'S SOIL SERVICE Gary L. Steel SE'' S SW'' S15- T31N -x19w 1554 200th Ave. CSTM2298 Gerald J. Smith New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 lot #23 -Oak Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 11 =40' BM.= top of SW lot stake @ el. 100.00' alt. BM.= top of 1" pvc pipe @ el 96.80' 1 d 5 � ' � II Q Q . Gary L. Stee 6 -3 -2001 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FILE INFORMATION Z I (O 6q 4 ST- SYSTEM SPECIFICATIONS Owner 11 f(3, hrS�kS �� Septic Tank Capacity �� (o p al ❑ NA Permit # � Septic Tank Manufacturer 60'e V_ S # 13 44 DESIGN PARAMETERS Effluent Filter Manufacturer — ,7 ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A _ ❑ NA Number of Public Facility Units NA Pump Tank Capacity al VCNA Estimated flow (average) 30 gal /day Pump Tank Manufacturer gNA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer (141 NA Soil Application Rate 0. gal/day/ft' Pump Model - ANA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit -,fifNA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ?6 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) _ <30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: NA Other: ❑ NA Other: NA "Values typical for domestic was and septic tank effluent. Other: NA MAINTENANCE SCHEDULE I`7i Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ m onth y ear( s) `(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third 1 ) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ ear( m onth ( (Maximum 3 years) NA Clean effluent filter S 60 At least once every: ❑Yon, ,Is1 ❑ NA ear Inspect um um controls & alarm At least once every: ❑ mo year(s) NA Ins P pump, pump ❑ yearls) Flush laterals and pressure test At least once every: ea�� A Y Other: At least once every: ❑ month(s) NA ❑ year(s) Other: I b C NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. filters mechanical or pressurized components, pretreatment including but not limited to the servicing P P All other services, c g g of effluent units and any 9 servicin at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Gyre C Name Phone (�7 15 - / 7 S 1 I ;157-- 0 PO4 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Nam Phone Phone]! 7 / S This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. From PHONE No. : 441 8727 Sep.16 2082 12:10PM P02 ST CROIX COVN W SBPnC TANK MAnT 5NANCB AGRL3UMBNi' AND OWN11RSjUp CER UgCATION FORM tie, / Gb y Owner /Buyer es&.1 d . S S tv �'h /, -ores# �� 5 Ca►1 c� a �� ►� / wu - Malllrtg Addrt:as i -- T = .'......_��K Propetty Addr*S& mss► 1 tp 5 ,? �S (Voririeatlea roquimd tram PfouaioS DoparO...ot roc mow oaa.ttuetlen� ry/SUte r-te,-4a:� , W Parcel Mentificatluu Number n3� — sa l y S - 30 L ,GAL D - WQ.R Property LoCati011 �� ' /•. tom) %., Sex. _!� . T 3LN -R l Town of ��me r Subdivision �)� — Lot # „ 3 Certiticd Survey Map N N I Volume �`- . Psgo t! Warranty Deed u 6 - 7 JZ 7 S . V.I.,, _1 - 7.-; ) a . Pago # S8y Spoo house yes ❑ no Lot linos identifiable 19 yes ❑ no SYSTEM MJX AANiCE Improper use end maiatenancenf your rcpt cyscau could result in ib Vruuah"ro failam to handle waslos. raper tnaiotet►asee towiss of pumplug (jut the scpdc tsllk every 1111GC Yom or ioaacr, if atx�odby a lioeusod pamper. W1rat rut+ put into kite System can arrect kite functio:s of rite a eptio tank as a ut atrncnt 41a9e in the waste dispusai aystow. The proptM owner agrees to submit to SL Croix Zoning DeputdWilt a cerdticedon form. sigttod by the owner and by a namorplumber ,)ouroeyrnonplumber, M. triotedpiumbu or a licetuedpamperrenfytog chat (t) tbeon4lte wastewaterdisposel systeut is in proper operating condition andlor (2) after impaction and pumping (if necesStay), the septic tank's less than 113 full of sludge. 1/we, d c undersigned have road the above mquimmentr and agree to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Deputment of Commerce and the Department of Natural Resources, State of V §0003in. Gettiftcation stating that our septic system has been maintained roust be coatpleted and =turned to the St- Croix County Zoning OIFes within 30 days of three y data. 0 L DAini IONATUPE O - PLICANP Q-NYM XI CA—Un et►r knnwleYt e i we ant are the owacKa) of i (we) certify t1191 all stntomcnts on thin facto arc twc to the best of toy ( ) e l ) the prop dcaGribo •itwe of • �varrmty da.d reoorderd in Regltler of Deeds Ogee. ^ II IICANC n A7'li 640, A inlonttatioo tWt is mis- ropresentcd may result in dw saoltuy permit being revnlced by the 7eeing Depatu em. as Ke elude w4t4 ibis apptleatloW • staugmd warranty dead fmae the RABMer or Deeds ofnoa a copy of the aerdIrted tatrvoy sap if r�efhttmw 4 made In ft waraaty deed T - d b00L BbZ S T L NO I 13nmisW03 a00M3W01S e90 c t+0 20 i Z unC vul..11 28PAGE584 STATE BAR OF WISCONSIN FORM 2 - 1999 657875 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, made between Leslie A. Coo RECEIVED FOR RECORD - 10 -01- 2001 9:45 AM WARRANTY DEED Grantor, and Fo rest Oaks Condos, Inc., a Minnesota Corporation, EXEMPT M 17 — CERT COPY FEE: - -- COPY FEE: _ TRANSFER FEE: RECORDING FEE: 11.00 — - - - - - -- PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lots 7, 8, 9, 10, 12, 22 &234 and z5, Oak Haven, St. Croix County, Name � and Return A re � I J'r1 Wisconsin. f I V x 0 N t♦t -Ra10 �i1& f O q FAA ',--u � I O �S 15K 11 9 This deed is given in partial fulfillment of that certain Land Contract I i� t 1 M tn�cJ 5'E O 17 between the parties hereto dated September 22, 2000, recorded September 032. 1043 -40- 000;032- 1043 -50 -OW 032- 1043 -80 -000 27, 2000, in Vol. 1545, page 571, as Doc. No. 530634. and 032 - 1043 -90 -00 Parcel Identification Number (PIN) This is not _ homestead property. CK) (is not) Exceptions ��t o��warranties: Easements, restrictions and rights -of -way ofrecord, ifany. // Dated this `/ % day of August 2001 • Lesl A. Cook AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WiSCONSIN ) ss. St. Cr oix County ) — P. authenticated this day of _ personally came before me jtiik. day of August 20a1Z: dhe above named Leslie A Cook — f TITLE: MEMBER STATE BAR OF WISCONSIN = — (Ifnot, to me known to be the person(s) i,e ex utiteyl,the forgoing — nst un t nd ackn ed the 4 -'i' authorized by $ 706.06, Wis. Stats.) f THIS INSTRUMENT WAS DRAFTED BY — Attorney K ristina Og_lan_d__ Notary Public, State of Wisconsin Hudson_ WI 54016 � .. _ My Commission . / It 'not, not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) — .� -t A // Q W c ! ) Names of persons signing in any capacity must be typed or printed below their signature. kdu —uul Prone — ts company. Fuld do tw, mn STATE BAR OF WISCONSIN 800-655 -2021 WARRANTY DEED FORM No. 2 - 1999 SCRIVENER'S AFFIDAVIT vF 6 1 64625 H VOL 1786no 17 5 tCROIXOCO., WI RECEIVED FOR RECORD Document Number. 12 - 10 - 2001 9:30 AM AFFIDAVIT C:,3T COPY FEE: Retum Address: TFMFE; FEE: R- '-iRDIHG FEE: 13,00 bCr��c,^ti 05 • AGE5: 2 Sd �„d -sa., Parcel I.D. Number. Pt of 032 - 1043 -80 -000 & 032 - 104340 -000 KRISTINA OGLAND, being first duty sworn, on oath, deposes and says as follows: 1. That I am an Attomey at Law duly licensed and qualified to practice in the State of Wisconsin; 2. That I drafted Warranty Deed from Leslie A. Cook to Forest Oaks Condos, Inc., a Minnesota Corporation, dated August 16, 2001, recorded October 1, 2001, in Vol. 1728, Page 584, Doc. No. 657875, covering the following described real estate: Lots 7, 8, 9, 10, 12, 22, 23, 24 and 25, Oak Haven, St. Croix County, Wisconsin. 3. That the Warranty Deed contained the following language: This deed is given in partial fulfilment of that certain Land Contract between the parties hereto dated September 22, 2000, recorded September 27, 2000, in Vol. 1545, page 571, as Doc. No. 530634. 4. That the language referred to in Paragraph 3 above contained an incorrect Document Number and that the correct language with correct Document Number is as follows: This deed is given in partial fulfilment of that certain Land Contract between the parties hereto dated September 22, 2000, recorded September 27, 2000, in Vol. 1545, page 571, as Doc. No. 630634. 4. That this Affidavit is made for the purpose of correcting the Document Number of the Land Contract referenced in Paragraph 3 above. Dated this day of November, 2001 Kristina Ogland Subscribed and sworn to before me VOl 17S6w6t 15 this 1°.� day of November, 2001 Mary E..Ca � } Nptary Public Pfierce'CotJI'lli�! S&sin My corni�issi0�p?Cpires 12/26/04. Ilk This instrument drafted by: Attorney Kristina Ogland ESTREEN & OGLAND 304 Locust Hudson, WI 54016 V 0i. 15 4 51111_ 571 1ZlL, S - fA'I E BAR OF WISCONSIN FORM 11 - 1982 KATHLEEN 6,30634 H LAND CONTRACT REGISTER OF DEEDS Individual and Corporate ST. CROIX CO., WI (TO BE USED FOR ALL TRANSACTIONS WHERE OVER $25,00015 FINANCED AND IN OTHER NON-CONSUMER RECEIVED FOR RECORD Document Number ACT TRANSACTIONS) 09-27 -2000 9:30 AM CONTRACT, AND CONTRACT ACT, by and between Leslie A. Cook _ EXEMPT Il CERT COPY FEE: — COPY FEE: _--- -- __----- _-------- --- _.. - - --- — — — TRANSFER FEE: 964.80 ---- - - - - -- --- -- — RECORDING FEE: 12.00 ( "Vendor ", whether one or more) and Forest Oaks Condos, Inc. PAGES: 2 -- r9mflZ, ( "Purchaser ", whether one or more). Vendor sells and agrees to convey to ddress Purchaser, upon the prompt and full performance of this contract by Purchaser, NA OGLAND the following property, together with the rents, profits, fixtures and other treen & Ogland appurtenant interests (all called the "Property "), in St. Croix ._ P- Box 359 County, State of Wisconsin: FludsOn, WI 54016 032 - 1043 -40- 000;032 - 1043 -50 -000 0 1043 -80- 000;032 - 10 -9 -000 (Parcel Identification Number) El/2 ofSWI14 of Section 15,31 -19, St. Croix County, Wisconsin. 'this is not homestead property. not) Purchaser agrees to purchase the Property and to pay to Vendor at place Vendor directs the sum of $ 321,520.00 in the following manner: (a) $ at the execution of this Contract; and (b) the balance of $ 221,520.00 , together with interest from date hereof on the balance outstanding from time to time at the rate of 8 (eight) —% percent per annum until paid in full, as follows: Commencing on the 22nd day of September 2001, and on the 22nd day of each and every September thereafter, annual payments of $100,000.00 plus interest. Provided, however, the entire outstanding balance shall be paid in full on or before the 22nd day of September , 2002 (the maturity date). Following any default in payment, interest shall accrue at the rate of 10 % per annual on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to princi Any amount may be prepaid without premium or fee upon principal at any time after day of closing. ( ) there may be no prepayment of principal without permission of Vendor.' In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the armor that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom- Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: None Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on day of closing. XXXXX I Cross out one. LAND CONTRACT • Individual and State Bar o1 Wisconsin Corporate Farm No. I i - 1982 Information Professionals Company, Fond au Lac, WI 900- 555-2021 V9t 1545 fla 572 Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by tire, ex- tended coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vcndor, in the sum of s N/A , but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property tree from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and ail conditions shall be fully perforated at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: Easements, restrictions and T ri ghts -of -way of record, if any. Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 30 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 30 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment ol'Lhe entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment ofthe entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by 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 a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event ofany such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments 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 any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this ay of September 2000 r Forc s Cond�t c. (SEAL) (SEA " Leslie A. Cook (((��� Vendor " by Gerald J. San esiden t Purchaser (SEAL) _ _ (SEAL) _ _ Vendor ' Purchaser AUTHENTICATION ACKNOWLEDGMENT Signature(s) Leslie A. Cook; and Forest Oaks Condos, Inc., STATE OF WISCONSIN ) by Gerald J. Smith, President ) ss. , d _ COUNTY) authenticated this 'l7?e ky of September 2000 Personally came before me this day the above named f�= — " Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledge the same. authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY • Attorney Kristina Ogland Notary Public County, Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not _ ) necessary.) • Names of persons signing in any capacity should be typed or printed below their signatures. 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