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HomeMy WebLinkAbout038-1019-50-110 r WCconsin.Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix . Safety arid Building Division INSPECTION REPORT sanitary Permit No: (ATTACH TO PERMIT) 514881 0 GENERAL INFORMATION 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: Modesette, Chad I Star Prairie, Town of 038- 1019 -50 -110 CST BM Elev: Insp. BM Elev: BM Description: - n Section/Town /Range /Map No: l c ac W e�Q� 03.31.18.76A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic V U 1z;50 Be Benchmar W&Q, 2-toy m z . (A vo Dosing L Alt. BM l� Co J �.• ` �� . 67 Go 75 0 �; Ao a4" wt, Z Bldg. Sewer q. 9 9Z. 7g ff7 St/Ht Inlet �t °1a 7 ` \ TANK SETBACK INFORMATION SUHt Outlet TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ! / / Dt Bottom Gee '92- 2-7 q i�,� scp.zs Dosing / yZ / Z7 / / Header /Man. I. z Ake Aeration Dist. Pipe Al. Z,Z, S.s1 Holding _ Bot. System . Ze 97• YZ- 6.t,1, 9tp.C7 d� PUMP /SIPHON INFORMATION Final Grade /6/-7.7 Manufacturer // Demand St Cover I�OJ�djS GPM �:\ u 1 - bi 93 ' 7 Model Number � � Ln TDH 1 1-i ft Z' `� Friction L ss System Htiad TDH yV l 3�J Forcemain Len f? / Dia. Z Dist. to Well SOIL ABSORP SYSTEM BED /TRENCH Width / Lengths No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 r- �c1 Z t •�� �— SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacture INFORMATION CHAMBER OR � ` dldf-Q�t Type Of System: , , 2-O / !� / UNIT Model Number: ^ J' � t , l / 0 ��, owe. Z'�! �6 7 (�? 7 DISTRIBUTION SYSTEM A, I{L ZI u Z7_ La�„)s•`, Header /Manifold / 0/ Distribution x Hole Size x Hole Spacing r1eAt o Ai r Intake _ Pipe(s) C /SIN / �Length Dia - 7 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 Topsoil Bed/Trench Edges 3 • $'S � \ "Yes [] No I "Yes EJ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2321 117th Street New Richmon WI 54017 (SW 1/4 SE 1/4 3 T31 N R1 8W) NA Lot 61 C Parcel No: 03.31.18.76A10 1.) Alt BM Description = �' �J ��- Ok ✓ S4r-w%, q_— ba.r. jpnq j 2.) Bldg sewer length - amount of cover Plan revision Required. ❑ Yes *No — - r,, �!� Use other side for additional information. �__ Z5 l i �� — SBD -6710 (R.3/97) Date Insepcto ignat _ Cart. No. `S a i alnsolou3 Of/ aojeljslulwpy apoo negejO ulnaN . 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Box 7162 �� Ci- C i COO s i n Madison, WI - Sanitary Permit Number (to be filled in by Co.) t 0ceParbrient of Commerce . s /yBSJ Sanitary Permit Application. S tate Transaction , N ( umber �" ' In accordance with a. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate tai unit is .required prior to obtaining a sanitary: permit. Note: , Application forms for state-owned P are Project Address (if different than mailing address) submitted to the Department of Commerce. . Personal information y es in accordasawith the Privacy .Law, a. 15.04 l m Stag. RECEI 2,3Z 1 1 f 7 51- k.- I. Application Information - Please.Print All Informatio Property Owner's Name Parcel # 0.c� / t ese e MAY 27 2008 03 / , o l '0 -%/ Property Owner's Mailing Address Property Location r X74 ST, CROIX COUNTY ZONING L)EEICE Govt. Lot City, State Zip Code Sw SC y,, Section trele are T N; REQ 11. Type of (checkali thatalsply}— >_ - - —Lot# _ -- _ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of ❑State Owned - Describe Use CSM Number ❑Village of J Town of N w 2-2 a--Z I '/ . Type of Permit: (Check only one box Dn line A. Complete line ll ii applicable) A, ❑ New System Replacement System d Treatnient/Hokling Tank Replacement Only ❑Other Modification to Existing System (explain) ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued B. 11 Permit Re ❑ Permit Revision _ Before Expiration' Owner" IV. Type of POWTS 3 stem/Com onent/Deviced Check all that a l v Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound a 24' n. of suitable soil El Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ' V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Ijate(gpdaf), Dispersal Area Required (at) Dispersal Area Proposed (sfJ A # a l m Elevation O f . CJ a c VI. Tank Info Capacity in Total # of Manuf er Gallons Gallons. Units New Tanks Existing Tanks t 1 V e y ti w 0 P. Septic or o mg Tank d 6 _ Dosing Chamber VII. Responsibility Statement -1, the undersigned, assume ra onsib. for installation.of the POWTS shown on the attached p lane. Plumber's liame (Pri m Pl ber' Signs hIP/MPRS Number Business Rhone Number ' t e t�s t3 is = 73 Plumber's A y fdress treet, City, State, Zip Code) VIII. Cozen /De artrit t Use Onl ErApproved ❑ D' Pemtit Fee Date sued Issuing t Signature • . S. . AiS D ❑ nee ` en Reason o $D S Z7 $ IX. ConditepsT� for Disapproval � �\ 1. Se Ic tank,' ent filter and J dispersal cell must all be services / maintained T rte_Q.-__ as per management plan provided by plumber: r t 4 �eC` 2. An setback tequirementa must be maintained n code / ordiltanlm. Attach to complete plant for the'system'and submit to the County only o paper not less than 8 1/2 x 11 In h size -C q .� SBD- 6398 R 01/07 Valid their 01/09. . a � Ot PM d� 3 m l 4 4 0 . ti y �rq Q � �I'N, a S � � Il I N a� s J� ti r� 1� ti 4 .� r t Vi #2084 SOIL EVALUATION REPORT Page 1 of 3 in accordance with Comm 85 9 i Department of Commerce , Wis. Adm. Code Division of Safety and Buildings Steel's Soil Service County Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference p oint BM direction and percent slope, scale or dimensions, north arrow, and location n i r� to nearest road. Parcel I.D. Plea print 11 i nformation. 3� / / � se t a P Reviewed B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /, Property Owner Property Location (� v Chad Modesette ovt. Lot na SW1 /4, SE1 /4, S3, T31N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# U 2321 117th St NOV 0 9 2007 1 na CSM City State ip Code Ph n NUm�� City Village Town Nearest R d ST. CROII n Mff 1 Y New Richmond WI 54017 715 - 248 -7525 Star Prairie 117Th St New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe na Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable na ft. General comments Conventional system, trenches spaced and depth to code. system depth to be determined at the time of and recommendations: instullation due to odd shape of terrain. / -L ��� �'' %,0) 7 6, rYv�7 Boring # Boring Pit Ground surface elev. 95.70 ft. Depth to limiting factor 110 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 T •Eff#2 1 0 -2 10yr3/4 none sl 2msbk mfr cs ivf .6 1.0 2 2 - 24 7.5yr4/4 none grcos osg mvfr cs na .7 1.6 3 24 -110 7.5yr4/6 none grcos osg ml na na .7 1.6 ti 2 Boring # Boring � pit Ground surface elev. 94.50 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 1 0 -12 10yr3 /1 none sil 2msbk mfr cs 1c .6 .8 2 12 -24 10yr5/4 none sicl 2msbk mfr gw 1c .4 .6 3 24 -36 7.5yr4/4 none scl 2msbk mfr gw if .4 .6 4 36 -70 7.5yr4/4 none grcos osg mvfrl cs na .7 1.6 i 5 i 70 -110 7.5yr4/6 none grcos osg ml na na .7 1.6 Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L CST Name (Please Print) i ature: - CST Number David J. Steel 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 1699 150th St New Richmond, WI 54017 11/7/2007 715- 760 -0347 SBD -8330 (R.07 /00) Property Owner Chad Modesette Parcel ID # Page 2 of 3 F # L- Boring L -- Pit Ground surface elev. 101.40 ft. Depth to limiting factor 110 in. ISoil 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 1 0 -6 10yr3/4 none sl 2msbk mfr cs 1vf .6 1.0 2 6 -20 7.5yr4/4 none grcos osg mvfr cs na .7 1.6 3 20 -110 7.5yr4/6 none grcos osg ml na na .7 1.6 b 3� F-1 Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 F-1 Boring # - 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 i * 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 need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Steel's Soil Service STEEL'S SOIL SERVICE 3 of 3 David J. Steel Chad Modesette 1699 150th St. CST - POWTSM SWI /4,SE1 /4,S3,T31N,R18W New Richmond, WI 54017 Lic. #248956 Town of Star Prairie, St. Croix Co. Direct 715- 760 -0347 CSM Lot 1 Fax 715- 246 -0318 Legend N 1 =40' ♦ = Benchmark Ele. 100.00 ft Top of L 6 4 S r n y- • = Alt Benchmark El 99.50 ft Top of. 5w �cr nYr� CP�'Nen� �fia El = Borings Boring Elevations B1= 95.70 ft B2 = 94.50 ft B3 = 101.40 ft B4 = 0.00 ft z 1- 4 ,33, 19, 19 r o IMP , Sw 7 `10/31/07 WED 09:13 FAX 715 386 4686 R002 FiLeo 1 JUN 3 H. 2000 625695 t GsfarOfdw 2 & cmir Co., Wl N CER ,, _ SURVEY MAP I LOCATED IN THE SW1 /4 OF THE SE OF SECTION 3, T31 N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN CURVE DATA OWNERS: NUMBER 1 4 Q APPROVED YOM & BETTY BOUMEESTER RADIUS 57.62' ST. CROIX COUNTY 887 170TH AVENUE 0 CENTRAL ANGLE 22 Planning Zoning and Parka Commiltee NEW RICHMOND. WI 54017 w ` CHORD BEARING N48 '45'10.5"E O w CHORD LENGTH 22.78' JUN 3 O 2000 c - ^ ` ARC LENGTH 22.93' N 7 TANGENT IN N60 °09'1 4 "E If not recordocs within 30 days of 11 ' TANGENT OUT N37"21'07 "E approval date approval shall be z 0 ¢ MC1vIE?[ La t�u'CED + aC�' and v41d ° m + - -- b - 117TH - ---- -- m o O-iIi GJI� DD --- `" 00t7Gf]Cs�G_3� 1 LOW S89°4T02 ' W 1279.9T o a I AREA _ is 839.84' 1 440.13' ®� f I 44' +/- �- NORTH LINE OF THE A 28.52' SW1 /40FTHESEI /4 ❑ HO E� w % EXISTING 1 z v� OUTBUILDINGS p 75 POND 66' WIDE ACCESS❑ ••A P % d EASEMENT z�" z LOT 1 / m C Lm 5.000 ACRES INC. I ,ti7 ESMT.{ o m 217,800 SO. FT. m L I w q 4.474 ACRES EXC. I 1 J m m ESMT. � I 66• I 75' i 194.875 SO. FT, o i� 7 ,' 66.02' ul A POND / N89°4T02 "E 440.13' cn z 1 C5 I c 7s z_; m lO r K o 75' BUILDING SETBACK LINE rn C.0 © FROM ORDINARY HIGH WATER MARK (TYPICAL) I� SOIL BORINGS m I nrnl LOT 2 NOTE: CLOV AREA C-3 EROSION CONTROL PLAN WILL 34.13S ACRES 86 PRIOR TO p n I O 1,486,913 SO. FT. CONSTRUCTION, I� I I� In^ I 'tDGE OF ! EXISTING WATT= 75 FENCELINE ++ T +/- WETLANO (TYPICAL) 663.40' 440 .12' - - ._�1_..... N89 °45'33 "E 1303.52' S1/4 CORNER SOUTH LINE OF THE SE1 /4 N89 °45'33 "L -- _ f SECTION 3 — N89 '4533 "E 2607.04' — 1:303.52' N � L1201 RE) © um�] )�J44 [ED aAHNl 1) 09 ALUMINUM COUNTY SECTION CORNER HEF.D my OO umigm!43 z z MONUMENTFOUNO --'-------------------- • 2" IRON PIPE FOUND ® EXtSTING SEPTIC VENTS c V X 24" IRON PIPE SET WEIGHING ® EXISTING WELL 1.13 LHS. PER LINEAR FOOT ............. 83' ROADWAY SETBACK LINE FROM CENTERLINE OF TOWN ROAD SCALE IN FEET V = 200' a EXISTING POWER POLE 200 0 200 400 Vo1.14 Page 3885 NO 'A il how; r us ,•` e, i IVY O t • ,�1.� S`f ne mr V 10 I �� h K ,� , �.a.. + , ,Q o �-.- :.•fin. �`' Cs7. .y a .c i .. ." �•, . gab ill bo ON tj co Ao co -Page .T Of y COMBINATION SEPTIC TANK /PUMP CHAMBER 4" Cl Vent Pipe w "'- Appro (No ved Scale) Locking Manhole Approved Cap, + �5' From c,0, r►1@ k .Co'.ve r With Warning Label Attached i I din g s 'll -dY� 7 Weatherproof Approved _ Warning Label Junction Box Vent Cap 1 12" Final Grade 6" Minimum 4" Minimum t I I Maximum - 4" C.I. � •Quick 18" Minimum 1 Insp. Pipe Disccnrec; I � 1 /4.. re=c Ho e - Baffles ,� +;roved Joint Pipe f LA i ,tending 3' Alarm cN79 Solid So 1 S Arprcvc� On d 7 - ` I Exte rc �� Gr,tc Sc' � ✓ �.,,1 Off D Cone. s, 3" of Bedding Under Tank --/ 4otc: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day /Doses: A<6 Ga''c -s Chlat� /C - Volume of Backflow: + f' lank Manufacturer: Total Dose Volume: = y f e ;ank Size - Septic /Pump Ga Tons /alarm Manufacturer: �1edel Number: (j�„ �/ C aci ti es: A �9J 4 ` nches or �69. y�l 1 cr Switch Type: /7 u,. + B inches or Gal C p,:ep 6lanufacturer:��� � + C riches or „i ba' ? o7; 1'odel Number: ey _ + D inches cr Ga 1 c alnim.um Discharge Rate. _ _ F Total .....= 4// inches or Vertical Difference Between Pump Off and Qistribution Pipe: Feet cFect 'num Required Supply Pr ssure :......................... + .�- - Feet of Force Main x �J9 Friction Factor /100 Feet: + ,kl Feet Inch Diameter Force Main Total Dynamic llead:... ,�`o�Feet � Internal Tank Dimensions: Length Width �;�Liquid Depth — O' — ? �N Signature _ ' L Nurnben 3 ���'� Date �� Do MAY -18 -2005 18:15 FERGUSON ENT HUDSON 715 386 6144 P.02 y M IGOULDS PUMPS Submersible dl V f Effluent Pump E PO4 & EP05 Series APPLICATIONS • Fully submerged in high ■ EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing foollowllow inng g designed for the lubrication and efficient improved performance. construction. uses: Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation, Auto- superior strength and corrosion canedim Sundards Amp • Heavy duty sump matic models include resistance, p� File # UM49 Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron GouWs p„nVs is 150 9001 Registered. Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS N Motor Cover: Thermoplastic FEATURES rover with integral handle and • Solids handling capability: float switch attachment points, a /a" maximum. ■ EPO4 Impeller: Thermoplas- x Power Cable: Severe duty • Capacities: up to 60 GPM, tic semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge Size: 1'h" NPT. seal protection, • Mechanical seal: carbon - rota ry/ce ra n1 i t:- Stationary, BUNA -N elastomers. • Temperature: 104 (40 continuous 140 (60 intermittent. MUM FEET ...... - - - - -- - - -- -.._. _ -M„ ,..� — - -.. _... ; ....... , • Fasteners: 300 series 10 " stainless steel. ^`•. -�— ••I I •. ..... — • Capable of running 9 s0, dry without damage to a ' i 25 rr components. q Motor: x • EPO4 Single phase: 0.4 HP, 115 or 230 V 60 Ha 1550 � ........... ..... RPM, built in overload with 5 _� v T ._.... J.. •....... �__ automatic reset. 4 • EP05 Single phase' 0.5 HP, 1 : ................... i ........., , Po5 .. .......E .. 115 V or 230V, 60 Hz, 1550 i . ................... _ RPM, built in overload with �.....................,. . . . EPO4 ....... I i ..... l automatic reset. 2 • Power cord: 10 foot i standaM length, 16/3 1 .. ........ S1TW with three prong � j grounding plug. Optional 20 0 0 0 10 zo # 3 0 40 5 0 GP foot length, 1613 SJTW with three prong grounding plug (standard on EP05 ). 0 2 4 6 B 10 12 W/ CAPACITY Goulds Pumps C 2003 Goulds Pumps EffeeCweJuly,2003 ITT Industries g4A91 MANAGEMENT PLAN FOR A SEPTIC TANK AND SOIL ABSORPTION COMPONENT Manhole risers, access risers and .covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. . i Tank abandonment shall be in accordance Zith Comm. 83.33, Wis, Adm. Code when the tank is no longer used as a POWTS component. SOIL ABSORPTION COMPONENT The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and. the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The -soil absorption component's operation must be assessed by inspection at least once every 3 years. This inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from -the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge or domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic :around or over the soil absorption' component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may'lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Pump Tank < The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If the effluent filter is installed within the tank it shall be inspected and serviced as necessary. D?v 0 lZ 0. TUE 12:10 FAX 715 386 4656 X001 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owneri ez j . 1j& 2 , - Ct — Mailing Address _�� TA Property Property Address /Va''y / /c kon D No/ (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Proj rtv Location W ', . TE Sec_ _ T 3/ N R 1 W, Town of - ,T_-7 car Subdivision Plat: , Lot # . Certified Survey Map # , Volume _— , Page # Warranty Deed # (before 2007)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 Department a certification form, signed by the owner and by a master plumber, journeyrnan 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 11 frill 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 tha: your septic system 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. Uwe 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 'SI GNATURE OF APPLICANT(S) DATE * * *Ar,y information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) it)` - STATE BAR OF WISCONSIN FORM 11 - 1982 64764U LAND CONTRACT KATHLEEN H. WALSH individual and Corporate REGISTER OF DEEDS (TO BE USED FOR ALL TRANSAC110NS WHERE OVER ST CROIX CO., WI 525,000 IS FINANCL'D AND IN OTHER NON - CONSUMER Document Number ACT TRANSACTIONS) RECEIVED FOR RECORD 06 -07 -2001 9:30 AM CONTRACT, by and between Thomas M. Boumeester and Elizabeth C. LAND CONTRACT Boumeester, husband and wife, ( "Vendor ", whether one or more) and Chad EXEMPT I Modesette and Linnae Modesette, ( "Purchaser ", whether one or more). Vendor CERT COPY FEE: sells and agrees to convey to Purchaser, upon the prompt and full performance of COPY FEE: TRANSFER FEE: 27.00 this contract by Purchaser, the following property, together with the rents, profits, RECORDING FEE: 12.00 fixtures and other appurtenant interests (all called the "Property "), in St. Croix RAGES: 2 County, State of Wisconsin: A parcel of land located in part of the SW 1/4 of the SE 1/4 of Section 3, T3 IN, Recordin Area RI 8W, Town of Star Prairie, St. Croix County, Wisconsin, also being a part of Lot Name and Return Address 2 of that Certified Survey Map recorded in Volume 14, Page 3885 in the office of Ronald L. Slier the St. Croix County Register of Deeds; described as follows: VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 1 18 Commencing t .= et at he Southeast comer of said New Richmond wt g Sec.:or. 3; thence along the south line 54017 of the SE 1/4 of said Section 3, S89 0 45'33 "W 1303.52 feet to the southeast corner of said SW 1/4 of the SE 1/4, also being the southeast corner of said Lot 2; thence along the east line of said SW 1/4 of the SE 1/4 and the east line of said Lot 2, NO I "35'05 "W 527.79 feet to the point of beginning; thence continuing along said east line of the SW 1/4 of the SE 1/4 and said east line of Lot 2, NO 1035'05"W 038 - 50 297.00 feet to the southeast corner of Lot 1 of said Certified Survey Map; thence (Parcel Identification Number) along the south line of said Lot 1, S89 0 47'02 "W 440.13 feet to the southwest corner of said Lot 1; thence SO 1 0 35'05 "E 297.00 feet; thence N89 "47'02 "E 440.13 feet to the point of beginning. The parcel shown on this document is being added to the parcel shown on the document, recorded in Vol. 1526 Page 551 g , Document No. 626426 St. Croix Court Register of ry g Deed's Office to create one parcel, and this transaction is thereby exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05(A)(3). This is not homestead property. Purchaser agrees to purchase the Property and to pay to Vendor at 887 170" Avenue, New Richmond, WI 54017, the sum of $9,000.00 in the following manner: (a) $0.00 at the execution of this Contract; and (b) the balance of $9,000.00, together with interest from date hereof on the balance outstanding from time to time at the rate of 7.00 % percent per annum until paid in full, as follows: $75.00 per month plus the Interest amortized over rive (5) years commencing July 5, 2001 and continuing on the Sth day each consecutive month until paid in full with a balloon payment due In five years. Provided, however, the entire outstanding balance shall be paid in full on or before the 5" day of July, 2006 (the maturity date). Following any default in payment, interest shall accrue at the rate of 7.00% 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 rinci al at an time. P p Y 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 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 tide as shov:a by the tide evidence sl�bmitted 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 closing. 'Cross out one. LAND CONTRACT - Individual and State Bar of Wisconsin Corporate Form No If - 1982 INFORMATION PROFESSIONALS COMPANY FOND OU LAC, WI 600- 655 -2021 v I,1 1655PAf'E322 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 the 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 Vendors interest and, unless Vendor otherwise agrees in writing, the original of al I policies covering the Property shall be deposited with Vendor. Purchascr 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 fusible. 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 licit of this Contract, and to comply with all laws, ordinances and regulations affecting the Properly. 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 oral[ liens and encumbrances, except any liens or encumbrances created by the actor 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 irnnrediately 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 tray, 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 ifpurchascr fails to redeem); or (ii) Vendor may sue for specific perfumrartce ofthis 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 Purchascr 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 reprove this Contract as a cloud on title in a quiet -title action if the equitable interest of Purchascr 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 ifand 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 ofthe 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 orthe interest conveyed is a pltxige or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchascr. 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 espouse of Vendor for a veluable 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 5" day of June, 2001 n ", / (SEAL) (SEAL) mas M. Bourn ester Vendor * d Modesette rn Purchaser � � q rci�.z7tJ (SEAL) •I 11 `� (SEAL) E!i abeth C. Boumeey�ter Vendor Linnae Modesette Purchaser // AUTHENTICATION ACKNOWLEDGMENT jKp Signature( -) "_ /I'{ 6611 �� iE /lIc6_A STATE OF WISCONSIN ) C. 1301,M ",4e , 0414 Acidesrti- '_J L,anr{e Aj "Jlf ) COUNTY) authentic red this S day oof J Personally came before me this day of _ Cam/ G�c7j, the above named A to me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN persons) who executed the foregoing instrument and acknowledge (If not, the same. authorized by § 706.06, Wis. Stalls.) THIS INSTRUMENT WAS DRAFTED BY Ronald L. Siler Notary Public County, Wisconsin VAN DYK, O'BOYLE & SILER, S.C. My Commission is permanent. (If not, state expiration date: Post Office Box ] l S, New Richmond, WI 54017 ) (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. LAND CONTRACT - Individual and Corporate - State Bar of Wisconsin Form No. I 1 - 1992 INFORMATION PROFESSIONALS COMPANY FOND W LAC, WI 800655 -2021 o v g p w. �� 5G O � L r. E 0 3 � N Qj O N p Z > N � N N U y 0 � a U S @ N C U t N @ L O C M O N N L > O N N � S O « @ C V) '0 O) C N .� E.S-p E o .S o C Z U @ @ @ 7 CO w � U p LL C O 0- N 'S - C c E @ 0 rn@a�a Q 0)0. 0 d a Z N 00 U) i O Z > r y y M > d m co {- U) C C7 O Z d ° c U O N m Z d V) c E . v N O N cn W • Ai � � a 0 z Z Z N LO M N E L ^ R �y d CL U) .. c � O N Zo 5 d � S O D a E c Z > ~ Fy- co c c L D •r 0 a a a N � o *� a E N Q 0 p o o (n vi .i U rn r-- z o Z mar N O O a D- < Z n @ E >> N N O l \ L U-)� w O N N (D U • L' 0 0 (n O --� N Z Z Cn O � r � E m a *t a m a w • a. 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