Loading...
HomeMy WebLinkAbout032-2104-00-000 0 m o <■ 2 0 @ § : § ; 3 a / \ n \ � CD ki )/ § fT ^ f / / n f ° j 0 \ 0 � § * / ~ \ § § § $ -4 $ / \ \ { / = S g g = e § 0 8 2 2 § &^ 0§ e Q ° ® ; \ k K 8 - � � ° \ / §f %'� 0) § § CD \ z \ k f 7 S \ ° ± \ Cl) . 2 5 / o 0 0 2\ � a J \} § k q cr o o i\ � G 9 \ k g d \\ > 3 } _ ; - c _ > > o \ EEEo : ( / "0 -0 \ - \7 /I / E >ƒ� . E Cl) j&«) CD w z 0 w =5 \ I z m \ _ \ \ CL ° ■ & �aa X 77 \ ®77 . g E m / # J E E m - z : g ; G \ \ 2 E a ° < m o §@ /z § . qZ ; � \ : EE± fCD ■ e&& § ; §a[ 2 7// % ; eCD ( z C D ° 3 \ \ . \@ / \\ � §§ \ 4C \ / ! i \ \ b / 7 , _ ( 0 @ � \ \ ~ ; / \ \ \ \ / : z � 0 J CO , o ° \ ƒ $ / O � \ {� K$ �k \ § CL R § ¥ k 3 k C k C O, � k Ci / o �\ ( m t < \ §S/ C 4 § \ n \ \ ƒ ° 0 \ - E . z 0 0 0 7 Oro 7 § 7 2 V) � % ƒ § ) m � \ ' - g .0 O > § � \ 3 7 E , z O E z � 7 > § � $ D § CL g _ /� g ( 0 > a 3 _�■ / % § i ■ ? m R § { 0 «7 } i ■ V $ § # � J CL � z k �■ \§ \\ 7 (D / SCL �■ � (D § A E C % z % § U 0 � $ � > � § � 2 � � 2 � K 0 ~ G Al % o � \i �\ � � • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. 370215 Permit Holder's Name: ❑ City ❑ Village ❑ jown of: State Plan ID No.: Holt, Todd I Somerset Townshi CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: l? t le O /1/4/ 032- 2104 -00 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L Benchmark Dosi ng d G a Alt. BM 0 5 Bldg. Sewer 3 1 - H ng St Ht Inlet A TANK SETBACK IN ORMATION Ht Outlet y o TANKTO P/L WELL BLDG. i Intake ROAD Dt Inlet Septic '710 b ' 3 / 3 W7 NA Dt Bottom D . 0 2 Dosing 7 (do / >10 1 -� ��/ / NA Header / Man. 3.2� ) o$ I, x.34 A A Dist. Pipe 1 i {' I Holding- olding Bot. System /0(o,c / D� 2b- PUMP / SIPHON INFORMATION Final Grade Manufacturer (°S QK Demand St cover �,� Model Number W�.p�j(� L ?.J�PM S d 0 °�' Frictio - r� S ystem DH Lift • 7 L 3� Head TDH / V3 1M �N �•� T (c?o.J i Forcemain Length Dia. 2 Dist. To Well SOIL ABSORPTION SYSTEM Yn�6v?rn BED/TRENCH Width !! -- Leng r / No. renches PIT No. Of Pits Insid Liquid Depth DIMENSIONS l� 7 DI SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM L Manufacturer: INFORMATION Type Of CH BER IVIo r: System: 26b >2m OR'UNIT DIST N SYSTEM ,- Header Manifold Distribution Pipe(s) ^^� a x Hole Size x Hole Spacing Vent To Air Intake Length Dia 2 Length A 1 . (9 7 Dia- G Spacing 3 ZS qq' 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 COMMENTS (Include code discrepancies, persons present, etc.) Ins ection #1: / / nspection #2: N- II Location: 1520 Hidden Valley Circle, Houlton, Wl 54082 (SE 1/4 SE 1/4 14 T30N W) - 14. .20.983 Green cre tr_y Estates -Lot 21 ���y� 1.) Alt BM Description = °op o � C �ee lv c 1 6,X 41f 2.) Bldg sewer length = 3 7 ' -am over =?� " y yL n o 3.) contour f " Plan revision required? ❑ Yes ❑ No p� Use other side for additional information. -5 30 (�6 _ / SBD -6710 (R.3/97) Date n ector's Silgature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , 2 i t - i j r . .., , e... _. ..,.., a .... .. .e. .. a ... ... ... ... a i i 1 i E e E e i r f �S,Z b �l � o�✓ l`>a -ALE; � , 2 «� Safety and Buildings Division Vi sconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7162 Department of Commerce In accord with Comm . 6, i . caic Madison, WI 53707 -7162 — I_ I? • Attach complete plans (to the county copy only) for em, *pa er S County than 8 1/2 x 11 inches in size. RNN�� s • See reverse side for instructions for completing thi lication �r State Sa(litary Permit Number Personal information you provide may be used for secondary purpo X cn [] Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. gT C State Plan Review Transaction Number I. APPLICATION INFORMATION - PLEASE PRIN I Property Own r Name Pro y'1 o ation 6 / ` va, S T , N, E (orte Property Owner's Mai ing ddress Lbt1N u mr Wt er Block Numb City, S ip Code Phone Number Subdivisi or CSM N mber II. 'TYPE OF BUILDING: (check one) ❑ State Owned Nearest oad Public 1 or 2 Family Dwelling - No. of bedrooms ow OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1<4 36� 010 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B. if applicable) A) 1. (Z New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________ System_____________ Tank Only______________ Existing System ________ Existing System j B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 5kMound 3 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r 42 ❑ Pit Privy 13 ❑ Seepage Pit ° 43 ❑ Vault Privy 14 ❑ System -In -Fill ( � (� 9 0 Vl. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i h) Elevation Feet 1,4e. q Feet Capacity VII TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber / ❑ I ❑ I ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the yndersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans. Plumb r' ame: rin Plumb e s S" nature: o Vps) MP /MPRSW No.: Business Phone Number: u ber's A dress r et, Cit tate, ip e): C � � IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved 4 Permit Fee (Includes Groundwater ate Issued Llssuingnt Sig ture (No Stamps) Approved []Owner Given Initial jtd Surcharge Fee) Adverse Determination "C S - X. CONDITIONS OF APPROVAL / R ASONS FOR pDIIS SAPPR VA SPA N � —� I's, / �� SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS H 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local cods* administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and Farcel tax number(s) of where the system is to be installed. IL 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Co nplete for all septic, purnp /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 1/2 x 11 inches must be suL °pitted to the county. The plans . must include the follQwirig: �) plot plan, drawn to scale or,with complete dimens:ors, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water ser ;ce; streams and lakes; pump or siphon tanks, distribution boxes; soil absorption systems; replacement system areas, ar .1 the location of the building served; B) horizontal and vertical elevation reference points; C) complete specification 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 reciulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. f - Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 22, 2000 CUST ID No.224263 ATTN: POWTS INSPECTOR ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/22/2002 Identificati" ers Transaction ED No 316822 Site ID No. 192268 SITE• Please refer to both identification numbers Site ID: 192268, TODD HOLT above, in all correspondence with the agency ST CROIX County, Town of SOMERSET; HIDDEN VALLEY CREEK SE1A, SE 1/4, S14, T30N, R20W Lot: 21, Subdivision: GREEN ACRE CTY ES FIRST ADD FOR: Description: NEW MOUND DWELLING 600 GPD Object Type: POWT System Regulated Object ID No.: 663873 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. / CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date P of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of Cn3l`d system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otp ential for a law suit that may delay the effective date of the code so this AP I status may or may not change. OE T IN ONI ON SAE The following conditions shall be met during construction or installation and prior to occupancy or use: A copy of the approved plans, specifications and this letter shall be on -site during construction and open to SEE CORRI inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/15/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 ROBERT KANTER , POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (608)261-7735, 8:OOAM - 4 :30PM, MON -FRI RKANTER @COMMERCE.STATE.WI.US cc: TODD HOLT e RECEIVED MOUND SYSTEM DESIGN MAY 12 2000 Residential Application SAFETY & BLOGS. DIV. INDEX AND TITLE SHEET Project TODD HOLT Owner TODD HOLT Address 13375 91 ST PLACE N MAPLE GROVE MN 55369 Legal Description SE- SE- SEC14- T30N -R20W Township SOMERSET County ST. CROIX Subdivision Name GREEN ACRES Lot No. #### o 2l Parcel ID Number Plan Transaction Number Index and title sheet Page 1 W.T.S. Mound calculations Page 2 rtionally Mound drawings Page 3 ZOVED Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 T OF COMVE PUMP CURVES Page 6 ETA AND UILDIN PLOT PLAN Pane 7 `i VL-1� SPONDENCE Designer KIM A. O E License Number 224263 Signature Phone No. 715- 755 -3145 Date 5-7-00 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 146.10, VA& Slats. Personal Information you provide maybe used for secondary purposes [Privacy Law, x.15.04 (1)(m)]. SBD- 10482 -E (R.05M) Page i of 7 MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metric Residential or commercial? R (r or c) (y or n) �� Replacement system? Creviced bedrock site? N (y or n) Slope 1 % Wastewater flow rate 600 gpd 2271 Lpd Depth to limiting factor 30 in 76.2 cm In situ soil infiltration rate 0.4 gpd/ft 16.3 Lpd/m Contour line elevation 105.9 ft 32.28 m Use standard fill depths? x OR Design depth? L -J incm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold (core) 0.125, 0.156, 0.188, 0.219, 0.25, e> Hole diameter 0.25 in o.2s1, or 0.313 ln�n only. Lateral spacing 3 Use 0 lateral spacing for trenches. Estimated hole space 4.00 ft Not a final calculation. Number of laterals 2 Pump tank elevation 99 ft Outside bottom of tank Forcemain length 160.0 ft Forcemain diameter 2.0 in 1 .5, 2 ,3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 115 =0.125 114 =0.MD SYSTEM SOLUTIONS Inch -pounds Metric 5M =0.155 9M= 0.251 Estimated daily flow gpd 2271 Lpd 3116=0.188 5f18 =0.313 7%32 = 0.219 Absorption cell Design load rate & area 1.2 gpd/e 500.0 ft 46.45 m Linear loading rate (LLR) 7.14 gpd/ft 88.5 Lpd/rn Design width (A) 6.00 ft 1.83 m Celt length (B) 84.0 ft 25.60 m Depth of cell (F) 10.0 in 25.4 cm Sand fiiter Upslope fill depth (D) Eft, in 30.5 cm Downsiope fill depth (E) in 32.3 cm Basal area required (gpd/infiltration rate) 139.35 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.09 ft 3.08 m Up slope toe length (J) 8.30 ft 2.53 m Down slope toe length (1) 11.90 ft 3.63 m Basal adjustment made. Total mound length (L) 104.18 ft 31.75 m Total mound width (W) 26.20 ft 7.99 m Project: TODD HOLLT Transaction Number: Page 2 of 7 MOUND PLAN VIEW observation pipes (typical) E f 26.2 ft A Q = 6.00 ft 1.83 m 7.99 m B = 84.0 ft 25.60 m W B J 8.30 ft 2.53 m K I T1.90 ft 3.63 m K = 10.09 ft 1 3.08 m 1t?4.18 ft L 31.75 m typ. obS. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (LxW) K = end slope dimension 0'(152 mm) T MOUND CROSS SECTION subsoil ca p 12.05., 30.5 cm lateral topsoil G H E . in 32.3 cm invert 107.40 1 ft _ _ _ _ F = 10.0 in 25.4 cm elev. 32.74 mF G 12.0 in 30.5 cm ASTM C33 H= 18.0 in I 45.7 cm C Sand Fill E Sys. 106.90 ft W elev. 32.58 m 105.90 ft contour 32.28 m elev. 1 % slope L1= upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = Subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: TODD HOLT Transaction Number: Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch- pounds Metric Width (A) 6 ft 1 1.83 Im Length (B) 84.0 I ft 25.6 - m Lateral specifications Number laterals 2 Holestlateral 21 Doles Lateral length (P) 81.67 ft 24.89 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 24.47 gpm 1.54 Us Sys. dis. rate 48.84 gpm 3.09 Us Hole spacing (X) 49 in 124.5 cm Lateral diameter Pipe diameter D"m op. Design deice Designer rrwst 1 in (25 mm) Place X in red 'x' one choice 1 1/4 in (32 mm) box of chosen from the options 1 1 r in (40 mm) diameter. provided. 2 in (50 mm) x X 3 in (75 mm) x Manifold diameter. Pipe diameter one w opti— D— gnalwice Designer must 1 in (25 mm) . 'X" one choice 11/4 in (32 mm� Place X in red from the options 1 12 in (40 mm) box of chosen provided. 2 in (5D mm) x X diameter 3 in (75 mm) x 4 in (100 mm) x Distribution system contains: 2 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Laterals centered over the A & B dimension Last hole drilled next to end cap ena c Ap P All laterals are identical I¢ ){ I Holes drilled on the bottom of the lateral S equaNy, spaced Force main oonnection via tee or cross to.manifold at any point. Laterals & foroe main of PVC soh 40 • = permanent end marker (per COMM Table 84.30 -5) Inch- pounds Metric Lateral length (P) 81.67 ft 24.89 m Lateral spacing (S) 3.00 ft 0.91 m Hole spacing (X) 49 in 124.5 cm Manifold length 3.00 ft 0.91 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 lin 50 mm Forcemain diameter 2.00 in 50 mm Project: TODD HOLT Transaction Number: Page 4 of 7 i A , TDH and Pump Tank Drawing Total Dynamic Head. Operational head 2.50 ft 0.76 m Vertical lift 7.50 ft 2.29 m Are laterals the highest pant in the Friction loss 6.14 ft 1.87 m system Yes ")C here.. Total dynamic head 16.14 4.92 m if no,.what is the highest elevation Dose Volume downstream of pump? o Dose Is > 10 times lateral volume Forcemain drain Lateral void volume 28.5 gal 107.9 L back to tank? ( °x" one) Minimum dose 285.0 gal 1078.8 L Yes Drain back 27.9 gal 105.6 L F=:� Dose volume 312.9 gal 1184.5 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with T weather proof warning label and locking device grade-levels junction box - � g rade levels disconnect alternate 4" vent pipe eadric as per NEC 300 and !r-- outlet Comm 16.28 WAC . \ location 18" (46 cm) min, t wall of pump approved chamber or outlet joint � combination tank A - Provide 1 /4' weep hole or anti- alarm on siphon device as necessary pump on B C Grade levels pump 99.9 ft -,pump tank manhole = 4'(10 cm) Off elev. 30.4 m minimum above finished grade D - vent =12" (3D.5 cm) minimum above finished grade 99.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 30.2 in bottom of tank Tank manufacturer WEEKS CONCRETE PRODUCTS Pump tank capacity %'231galfin Pump tank volume 1000 gal Pump manufacturer JGOULDS Inches Gallons Pump model number IWE311 L_ o A E25. 494.8 'o B 38.5 Alarm manufacturer S.J. ELEC SYST EMS C 312.9 Alarm model number HW 101 p D 1 153.8 . Project: TODD H04T Transaction Numb Page 5 of 7 %Curves Pumps �� 7 mcrt" FEET MODEL 3885 SIZE /4" So►ids wEt;H )0 i YU WE1pH - O wE0)M -- r 15 � 10 wtwm I N IL I I' wE0.11 ?0 D 10 i Q U 0 t0 70 00 �0 �9 G4 70 d0 Ski IQt7 110 I:v GrM CAP 1 _ uLD:) PUf,lPS. ir„C MUM FEC T 1 - -�— —r DEL 3305 E 3 ,/ SulldS - t !I$ t, I, I � ao 20 0 j. I `__.— t5 71, , 30 , Q o tc 29 CAPAC T I •,w0 Ow1w 1wnp�, Ino. ttiwn.vy. i�.i C)1�' .� ,C�,�.,i.�/ ��.(iS� }1�0 ®� J✓W ��s�.fiS'F ,� /lYJ.O � � / ° Q ,S 8y A�aua/.o S%Z.6 /GB oar ®,��E i✓l.a 30� A Qi6� Goa Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety &Buildings in accord with ILHR 83.05, Wis. Ad - 1 UNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan t ude but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of s ale or'�` I.D. # dimensioned, north arrow, and location and distance to nearest road. pending APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION �� _ 5 19g RE BY 5 - -3D DAT 2AOp PROPERTY OWNER: P ERTY LOCfIO%OkN �, Leroy Urhammer OT s g'90% �E, 1 T 30 N,R 20 *or) W PROPERTY OWNERS MAILING ADDRESS LO , 81_ SUBD R CSM # 1501 Scout Camp Rd. 21 re Ct . Es. First Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY G NEAREST ROAD Houlton, WI. 54082 (715) 549 -6497 Somerset l Hidde n [x] New Construction Use* ] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft trench, gpd /ft Absorption area required 375 bed, ft2 375 trench, ft Maximum design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Recommended infiltration surface elevation(s) 106.85 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANI U = Unsuitable fors stem I ❑ S KI U IN S ❑ U ❑ S au EIS K1 U ❑ S El ❑ S k7 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed jTw& .................. ................. .................. ................. .................. 1 0 - 13 10 r4/3 none sil 2msbk mfr cs 2f .5 .6 1 2 13 -30 10 r4/6 none sici 2msbk mfr gw if .4 .5 Ground 3 30 7 50 7.5 r4 4 none sci m na na na n .2 elev. 10 Depth to limiting factor 30" i Remarks: Boring # 1 0 -12 10 r4/3 none sil 2msbk mfr cs 2f .5 .6 2 2 12 -32 10yr4/4 none sicl 2msbk mfr gw if .4 .5 :::..::.:.:.:..... 3 32 -38 10yr4 /4 none scl lcsbk mfr gw na .2 .3 Ground elev. 4 38 -55 5 r4/4 none scl m na na na np .2 10 Depth to limiting f�c of Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 - 246 -6200 Address: 1554 200tW Ave., New Richmond, WI 54017 Signature: Date: 10 -25 -96 CST Number: m02298 PROPERTY OWNER Leroy Urhammer SOIL DESCRIPTION REPORT Page?` of 3 PARCEL I.D. # pending Lot #21 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 1 0 -12 10 r4/3 none sil 2msbk mfr cs 2f .5 .6 2 12 -30 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 30 7 43 10yr4 /4 2p7.5yr5/8 sicl lcsbk mfr gw na .2 .3 elev. 1 4 1 43-60 5 r4 4 none scl m na na na np .2 Depth to limiting factor 30" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ................. Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Leroy Urhammer 1554 200th Ave. CSTM2298 SE4SE4 S14 T30N -R20W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246 -6200 lot #21 -Green Acre Cty. Es. First Addn. ` =40' vBM.= top of NW lot stake C el. 100' �t r`% �2 25� � cldawh l o�u- rides -�� rb �l Gary L. Steel 10 -25 -96 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM t Owner/Buyer Mailing Address 1 P. Property Address �w l (Verification required from Planning Department for new construction) 1 (k�✓Y� City /State kU� i v "� Parcel Identification Number �32- 2� o4 LEGAL DESCRIPTION Property Location ' /a, ' /o, Sec. IL, T_�Q N -R,�_DW, Town of 'GOMEC-SCT Subdivision Cam 'fly -K� bk'T" 7 Lot # Certified Survey Map # Nf Pr , Volume , Page # Warranty Deed # ?212� 0 1 , Volume I q(,O , Page # Spec house ❑ yes �5 no Lot lines identifiable V ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. I- DA V__ kE 14 /zi;/ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property describe above, by virtue of a warranty deed recorded in Register of Deeds Office. T (� / ZG/ 2jr SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed LAND CONTRACT Document Number Form 11 CONTRACT, by and between GREEN ACRE ENTERPRISE, INC. a Wisconsin Corporation ( " Vendor ", whether one or more) andTODD R HOLT and LISA M HOLT i husband and wife, as survivorship marital property( "Purchaser" whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property "), in St. Croix County, State of Recording Area Name and Return Address Wisconsin: Robert F. Wall 032 -- 2104 -00 Parcel Identification Number 522 Second Street Hudson WI 54016 LOT 21, GREEN ACRE COUNTRY ESTATES FIRST ADDITION, TOWNSHIP OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. This IS NOT homestead property. Purchaser agrees to purchase the Property and to pay to Vendor at 1501 SCOUT CAMP TRAIL HOULTON WI 54082- the sum of $ 45,000.00 in the following manner: (a) $10,000 at the execution of this Contract; and (b) the balance of $ 35,000 , together with interest from date hereof on the balance outstanding from time to time at the rate of 7 % percent per annum until paid in full, as follows: $5,000.00 annual principal payments, plus accrued interest, beginning one year from the date of this contract and on the same day of each year thereafter. Provided, however, the entire outstanding balance shall be paid in full on or before the day of 1 19 (the maturity date). Following any default in payment, interest shall accrue at the rate of 12 % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated 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 principal. Any amount may be prepaid without premium or fee upon principal at any time after ' 19 (OR) 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, dnd interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount 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 on the date of this Und contract 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 fire, extended coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the sum of $ full insurable value , 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 free 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 all conditions shall be fully performed 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: 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 of the 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 of the 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 incurred, 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 of any 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 made in fulfillment hereof.) Dated this �"� "" day of Iv 0 f M & C 5 0 GREEN ACRE ENTERPRISE, INC. )�A I / k E J EROY A URHAN41VIER, Pre tdent Vendor * TOW R H LT Purchaser By: ADELE M •URHAMMER, �Ijreswcw Vendor I A M H( Purchaser AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) COUNTY OF ST. CROIX Personally came before me this Yt -4 day of ,W L Jff? the above named Leroy A. Urhammer and Adele M. Urhammer, authenticated this day of President and Secretary, respectively of'Green Acre Enterprise, Inc. and Todd R. Holt and Lisa M. Holt signature to me known to be the' person(s) who ex cuted the foregoing type or print name instrument and w get s m . TITLE: MEMBER STATE BAR OF WISCONSIN signature (If not, type or print name h authorized by' 706.06, Wis. Slats.) Notary Public St. Croix County, THIS INSTRUMENT WAS DRAFTED BY My commission is permanent. (If not, state expiration date: ,) Robert F. Wall "Names of persons signing in any capacity should be typed or printed below their signatures. W ISCONSIN REAL ESTATE 11111 U1 � TRANSFER RETURN STAPLE ATTACHMENTS HERE CONFIDENTIAL P E 5 9 9 1 t ` For completion, see the separate Instructions for Real Estate Transfer Return PE -500A. Submit this original form to the Register of Deeds with document(s) to be recorded. TYPE or PRINT clearly in black ink. Completely fill in all appropriate ovals. Q GRANTOR If more than ONE (1) grantor, fill in the oval at left. 1. Your Last Name or Company Name (Grantor 1) GREEN ACRE ENTERPRISE, INC. 2. Your First Name 3. MI 4. Social Security Number or FEIN 39 -1 827265 5. Last Name (Grantor 2) - Optional B. First Name 7. MI 8. Social Security Number 9 Address 1 501 SCOUT CAMP TRAIL 10. Clly 11. Slate 12. Zip Code ., HOULTON WI 54082- 13. Grantor is: Individual Partnership X Corporation Other (specify) GRANTEE X If more than ONE (1) grantee, fill in the oval at left. 14. Your Last Name or Company Name (Grantee 1) HOLT 15. Your First Name 16. MI 17. Social Security Number or FEIN TODD R 421 -88 =3818 16. Yew last Name (Grantee 2) - Optional HOLT 19. Your First Name 20. MI 21. Social Security Number LISA M 476 -56 -7578 22. Address 13375 91 ST PLACE NORTH 23. City 24. State 25. Zip Code MAPLE GROVE MN 55369- / 26. Grantor/Grantee X None Financial Partnership If Family or Other, Explain relationship Is: Family CorpJShareholder/ Other Subsidiary 27. Send tax bill to: X Grantee Grantor Other (provide name and address below) 26. Last Name 29. First Name 30. Address 31. City 32. Slate 33. Zip Code ® ENERGY 34. Is this prope subject to the Residential Rental Weatherizatlon Standards, COMM677 Yes X No (if No, provide exclusion code below) 35. Ettiurcllon Code 36. If W11. explain (see instructions) w- / 13 PROPERTY TRANSFERRED 37. Indicate: City Village X Town 36. Name of the Cllyrylllage/%wn 39. County Name SOMERSET ST. CROIX 40. Property Street or Road Address 1520 HIDDEN VALLEY CIRCLE 41. Tax Parcel Number(s) as appears on Property Tax bill a. 1st Parcel (see Instructions) 03 2 -- 2104 -00 11 additional parcels, attach addendum. IT. 2nd Parcel 42. Lot No. 43. Block No. 44. Plat Name 21 GREEN ACRE COUNTRY ESTATES FIRST ADDITION 45. Section (primary) 46. Township (primary) 47. Range (primary) 14 30N 20W 48. Legal Description Metes and Bounds most be typewritten below. If more space Is needed, staple an addendum to the front center of this return. LOT 21, GREEN ACRE COUNTRY ESTATES FIRST ADDITION, TOWNSHIP OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. L PE -500 (R. 7 -9B) r 'WISCONSIN REAL ESTATE f f f f T RANSFER RETURN � IIIIIIII IIII IIII VIII VIII VIII VIII III IIII P E 5 9 61 1 2 Q PHYSICAL DESCRIPTION AND GRANTEE'S PRIMARY USE OF PROPERTY 49. Type of Property x Land only Other (specify) -. Land and buildings) Business Use Business Use Single Manulactudrpl 50. Predominant X Condomm lamiy/ y/ Commercial Telephone Use Company Time Share Unit No. of Units Miscellaneous Use Mu9i -Iaml Agricu0ural, It so, did the N grantor own property for Yes No Utility Miscellaneous less than 5 years? 51. Estimated 51a. Lot Size 51b. Total Acres 51c. MFL/PFC/WTL Acres 51d. Feet of Water Frontage ea and type x O R 3 N/A N/A and typ FEET FEET ROUND TO NEXT WHOLE ACRE ® TRANSFER Dated Sale (Includes Deed in Other 52. Type of X original land Exchange satisfaction of Transfer contract) land contract -� (explain) Gift MONTH DAY YEAR 53. Ownership Interest transferred X Full e%rt ' Other l P ) (explain) 54, Does ranlor retain any of the X None Estate Easement O ther ng rights? (explain) followi 55. Value of personal ppropparty IN WHOLE 56. Value of property exempt r DOLLARS but EXCLUDEb 0 DOLLARS from local pro perty tax , 0 from line 57. INCLUDED on 4 1ne 57. ® COMPUTATION OF FEE OR STATEMENT OF EXEMPTION 57. Total value of REAL ESTATE 59. Transfer lee due IN transferred (round up to the $ 4500 DO (line 57 X .003) $ 135.00 AND nearest 5108) CENTS 59, Transfer Exemption a. 11 you enter "003" or "017," It Is Number, SEC 77.25 mandatory to provide your previous document number. ® GRANTEE'S FINANCING (fill in all that apply) Financial Institution- Financial Institution- Obtained from Assumed existing Other 3rd party No financing 60. X Conventional Government seller financing financing Involved ® CERTIFICATION -We declare under penalty of law, this return has been examined by us and to the best of our knowledge and belief it is true, corre t and complete. 61. Signaler. r .,s rant., or Gra ntors Agent (PL EASE KEEP GNATURE WI THIN BOX) 62. Dated /y' / /fir /mss 63. Telephone Numb eee r J/�/y 7 - !M NT A / J ! AR R EA ODE / . Gnt ast Name 65. First Name 66. MI URHAMMER LEROY A 67. Address 1501 SCOUT CAMP TRAIL 86. City 69. Slate 70. Zip Code HOULTON W1 54082- 71. Signature of Grantee or Grantees Agent (PLEASE KEEP SIGNATURE WITHIN BOX) 72. Dated 73. Telephone Number ,,_r. i I D q 1° q 9 (612) 494 -9692 Q tlu MONTH DAY YEAR AREA CODE 74. Grantees Agent Last Name �� ��' 75. First Name 76. MI 77. Address 78. City 79. State 60. Zip Code 81. Preparers last Name or Firm Name 92. First Name 83. MI WALL ROBERT F U. Telephone Number (715) 386 -5881 AREA CODE © TO BE COMPLETED BY AUTHORIZED COUNTY OFFICIAL 85. Document Number 86. Volumepacket 87, Page/Image 88. Dale Recorded 69. Date of Conveyance MONTH DAY YEAR MONTH DAY YEAR 90. Conveyance Warranty/ Land Quit Claim Other Code Condo Deed Contract Deed (explain) - 91. Are any of the parcels transferred part of an existing parcel? (see Instructions) Yes No 1 2 3 4 94. Assessment Year 92. Enter number of acres for each parssl classification 5 6 7 95. Land IN WHOLE $ DOLLARS 96. Improvements IN WHOLE 93. Fill In the oval corresponding to the 1 2 3 4 5 6 7 $ DOLLARS predominant classification 97. Total Assessment 98: County (1) 99. Municipality (1) 100. County (2) 101. Municipality ( $ �L�ARS Fill in the oval at left II more than two (2) municipalities J