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040-1233-70-000
Jisconsin Department of Commerca PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Builning Division INSPECTION REPORT Sanitary Permit No: 405179 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)]. +3 *-v- 3 -.. gyp- Permit Holder's Name: City Village X Township Parcel Tax No: Schwertel, Richard Troy Township 040 - 1233 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: W co .a CST Y60 *1 I cs„YQIw•� TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W C- ` Benchmark Dosing �� Alt. � �.�s �a� � �� 9a •3s Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic } 40 / , ,I,(l _ DtBottom �j� �2.(J 8 Dosing k « Header /Man. 2� t " S 5 ao • 3a Aeration Dist. Pipe ff p too • zo Holding Bot. System Final Gra tl PUMP /SIPHON INFORMATIO / �, -- 12+ Manufacturer CS .s GPM ndd��eo1 St over A Model Number w - A L ` " 1 _ cam» a � •19 {�,,<,,� !fit ��r� C��, �S , DH Lift Friction Loss System Head TDH Ft %ZVI O orcemain Length OL D D h Dist. to well 1 \ ZD ia. Z SOIL ABSORPTION SYSTEM -. S' BED/TRENCH Width / Length / No. Of Trendies PIT DIMENSIONS No. Of Pits Inside Dia. DIMENSIONS / 1 M I-kz-r'k4 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAC NG ufacturer: INFORMATION CHAMB Type Of System L / —^ UNIT Model Numbe J A DISTRIBUTION SYSTEM fi• •4a - �..e(L• Header /Manifold it Distribution i x Hol e�� x Hole Spacing Vent to Air Intake Pipe(s) Length �• Dia Length • W Oia Spacing 3• JfO SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Edges Bed/Trench Center Bed/Trench Ed Topsoil g p [! Yes [] No on Yes Ij No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #11 - 1 / I spection #2: u �I Location: 655 Tower Road Hudson, WI 54016 (NA 1/4 SE 1/4 3 T28N R19W) Countrywood Addn. I of 27 Parcel No: 03.28.19.1163 whu 1.) Alt BM Description = �"� 2.) Bldg sewer length - amount of cover G our ;1k = � care d? 1 � Yes No 4 1 7 I 8'IOZ - �JiL6o Use other side for additional information. I Insepctor's Signature Cert. No. � SBD -671 3/97 h n �}. I� n 5 t� -'oaf- Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Vi Madison, WI 53707 - 7162 Sine A ��� ass T �, Department of Commerce Z S =02— Sanitary Permit EJvED Sanitoy Permit Number In accord with Comm 89.21, Nra. Adm. Coe info n you provide ❑ Cheek if Revision / v may be used for secondary Privacy w s15. 1 m I. Appliation Informatioa - Please Print All Information JUN 1 Z State Plain I.D. Nun r 3 3 2 �' Property Owner's Name ST. CROIX COUNT Parcel Number YTe f ZONING OFFICE 4 Property / Owner's Mailing Address Property Location L l <l� 4 l r ,(� 'A A, S 3 T aZN. R /f City. State Zip Code Phone Number Lot Number a / Block Number 0 f/(p t Subdivision Name CSM Number 6 G-A/ � - 1t'dl6 Ca r V a U. Type of Building (check all that apply) 0City X or 2 Family Dwelling - Number of Bedrooms _ �� ` ❑village 0 Public/Commercial - Describe Use o 8t 0 State Owned / C ' & t x !co /o&.t�1� Newest Road ,6 .. Gnaw:✓ exe2 `f8 • o ! y� � ' � = d.� a /- Suf /Jtu - C v III. Type of Permit: (Check only one box on line A (numbering scbeme for internal use). Complete line B if applitab e) A. N For Counq Um 1❑ 2 Replacenseac Syste 3 ©Replacement of 6 ❑Addition m Tank out B. if Sanitary Permit Previously Issued Number issued IV. Type of Permit: (Check all that apply)(numbering for internal use) 44 0 Non -Pressurized 1a-Grouad 21 *Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 0 pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 310 Drip Line 45 ❑ At -Grade 46 0 Aerobic Treatment Unit 49 0 Recircula • 30 0 Other V. D ersaU't`rt: —tM- nt Area Information: Design Htow (gpd) Dispersal Aran Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed ✓ Rate(Gals./Days/s4st.) (Nn.nnch) Elevation Fiber — Prefab VI. Task Info Capacity in . Total Number �� ncrete Constructed step Glass Plastic Nmv Gallons Gallons of Tanks �L•�5� �� jor Tanks Tsnin Sep& or Holding T=k Dosing Clamber '.e A VII. b ' Statement 16 the unite , arsume reapondbillity for of the POWTS shown ore the attached lane. Plumber's Name (Prim) Plumber's Signature RS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) SC . 2 / VIII. Coup /De artment Use Onl Approved ❑Disapproved Surcharge �} Fee (includes Groundwater Date Iaauod I at Signature (NO Stamps) db 0 Owner Given Initial Adverse 3 LS • �l2 b 2 Deteraut>ahoa IX. Conditions of Approval/Reasons for Disapproval ib�i�►5-fvPvk, !o} icw q & mm 3 ,83. �U >Cr`ll will � q � f s' �� ��►�� sys , .� o rtof dama�2- j�-rn�at�"Sa� %!� /off q net than 8113 x 11 inches in Aaaeh nom � al(to � rapes SBD -6398 (R. 05101) Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE W1 54601 -1831 Too #: (608) 264 -8777 Visconsin www commerce i www.wiscon isconsin.gov n.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary May 09, 2002 CUST ID No.267341 ATTN. POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1 101 CARMICHAEL RD RIVER FALLS W1 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/09/2004 Ide ntification Number Transaction [D No. 732803 SITE: Site ID No. 644434 Jason Bast - 655 Tower Rd Please refer to both identification numbers, Town of Troy above, in all corresponklLce with the agency. St Croix County RE Part of NW 1/4, SEI /4, S3, T28N, R19W C E�VED FOR: Description Reallacement_F B� Mound System M AY 4 2o02 Object Type: POWT System Regulated Object ID No.: 850779 ST. N OIX CO Y The submittal described above has been reviewed for conformance with applicable Wisconsin A mi O @ 1 JAJ Z and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.0 1(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.0L'01). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54((). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. p.©.W.T.S. Co nditionallY APPROVED ARTHUR L WEGERER Page 2 5/9/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G lansky , Wastewater Specialist, (715) 726 -2544 TITLE SHEET Page 1 of MOUND SYSTEM FOR A L4 BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD- 10691 -P and the Pressure Distribution Manual SBD - 10706 -P (N.01101) (N.01 101) LOCATED IN THE I JLQ 1/4 OF THE Sk 1/4 OF SECTION 3 ,T Z.8 N,R 19 W, TOWN OF , ST• C.M VY, COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAPIBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE RECEIVED PREPARED FOR MAY - 8 2002 _ ss �-S Q tQ Q P� sT SAVEV & BLDGS DLV. 1+1 LLPrj PREPARED BY WaCSE SO S L TEST I NC AND . DES a: G;-1 SiERV I CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 �p Phone 715 - 425 -0165 Fax 715- 425 -6864 MEuEAEa Qeis w ELLS WpR7. • k DEPARTMENT Of COIVIMtFtCE ► S I G Nom,$ DIVISION CIF AFETY AND BUILDINGS Mae • S -�-OZ SEE CORRES NDENCE JOB NO. C) _� Mound System Management Plan p age Z of - 7 Pursuant to Comm 83.54, Wis. Adm. Code , Septic Tank �� The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition , the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall co leaned as necessary k to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shalt be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L 6005, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manua grid local or state rules pertaining to system maintenance and maintenance reporting. Ub No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank 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 a tank or component. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at -- LS - 3$6- y 680 Sr- QMVX The system installer at `1 LS - 3g b _ 3 t 2j S�tiv►�tt1 k�z The tank manufacturer at The effluent filter manufacturer at g0O- ZZ S - I q Z. ZrTeLr-, The pump manufacturer at - - PLOT PLAN ' Scale 1 - Page of — 1 Z6 �! s . ° �o Z . Z6 'vA�M _ V 1z 96 Dl3TXLG - MIS y a J 1 UVK)p Pryv ? 2S ' FtZ-u j-1 'i'`PCithzS NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be \ Z-0(3 /y00 gallon capacity manufactured by WIQ% 1Z_ co) c w / - 8 0(7 zr� - 13� ► L 4. Bench marks 5. Divert surface water around system to prevent ponding at the uphill side. Page L20r 7 Approved Synthetic Covering ASTM C33 Distribution Pipe Medium. Sand Topsoil - r H G Elev 12 1< S 3 E r) t ` I e % Slope - Distribution Cell of Force Main Plowed i" to 2- Aggregate From Pump Layer E o.S Ft. CROSS SECTION OF A MOUND SYSTEM F b- i3 Ft. o- S G 0,!5 Ft. o- S A Ft. H 1- k3 Ft. -o Linear Loading Rate= (,. 0 GPD /LN FT � l 00 t. Design Loading Rate =U- 3-3.GPD /SQ FT I Ft. J B Ft. K 9 Ft. �� i on _ L 116 Ft. W 2 6 Ft. I } - Observation Pipe K �• c�- f-- - - - - -- �c�� �.aq.s A (� �i� o _ W — F orce Main Distribution C ell of z to 2 z Pipe aggregate Observation' Pipe (Anchbr securely) PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout p2Qe of - 1 . o Place the holes at the bottom of the distribution pipes at spacing. Remove all burrs from the pipe and holes. Extend the end of each Iat e. , al uD with the use of long tun or 45° frLng to apoint within six- inches of the final grade, Te.=Lte the ends of the laterals with a valve,: threaded car or • threaded plug. Provide access from final Bade for the valve; threaded eap or thread ' ep1uQ• 7 I=m icr, L �_zLOss s; \j C_ F'Jal PVC Lateral Man*ld Lateral X x I z x12 1 X(2 x x z x Lateral Length — F Laterai Length — P Oistribat cn Line • � � � if C.C. ��S 5pX �t"J1F -FLU C i 1"O ?cZ- rn �rttJ P = Ft. Hole Diameter g Inch 5 3 Ft. Lateral I Inches} X 3 Inches Manifold 2 Inches Force Main " Z Inches I of holes /pipe \1 Invert Elevation of.L terals Nr� -O Ft. Combination Sept,c: and .' PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' PAGE OF 7. VE1JT CAP WEATHER PROOF JL!>JCTIOU 90X . -1 VENT PIPE s APPROVED LOCKIMG 1 10' FROM DOOR, AAWiOLE COVER 1 4 JIV -huoow OR FRE5H wARtJIIJG LABEL w 6 -� \ ALP IIJTAKE coracu�r tj 8r k { Ft iv ts*ED C1 5 Y� MIIJ. G RfiD E � I8' Mlu. L -- \ IMLET i' PROVIDE I -- . ••;� �AIRTiGHT SEAL I I Approved/ >'�8�� A J J Approved joint w/ R —Boo I II I joint w/ PVC piAe ALARM PVC pipe a l II I r J I ou - __ -- - C I 1 OFF D - COIJCKETE ie\j S S• (S0 BLOCK 5 . RISER EXIT PERMITTED OQLy IF TAWK MA;AJFACTURCR HAS SUCH APPROVAL 1 3"APPsZo,,et BFDD t>vr{ SEPTIC F SPECIFICATIOMS DOSE IA3LQnk- COry TAwKS MALI UFACTURI`R: / CZZM )DUMBER OF DOSES' S ' 3 PER DA"w TANK SIZC: �Z-00 L 8 0O GALLONS D05C VOLUME r ALARM MA)JUFACTURER: S`2ST15- S INCLUDI BACKFLOW: 1 3 3 .4 GALLONS MODEL QUMBER: CAPACITIES: A- I 00.3 • C' - IIJCHES DR � GALLOys SWITCH T:JPIL: E= I►JCHES OR L I Q• S GALLOWS PUMP MAMUFACTURCK: 60 VL-bS C= INCHES OR 2 3 " GALLOWS MODEL WUKBER: ZZ Z. D= 1 INCHES OR GALLOU SWITCH TUPE: tJOTE: PUMP AMC) ALAR Af TO 6C 6 MIMIMUM DISCHARGE RATE Z -1--is M INSTALLED 6Q EPARATC CIRCUITS VERTICAL DIFFERENCE CETWCEJJ PUMP D►STRI6UTIOU PIPE.. 1 4 0 FEET + MWItAUM LIETWORK SUPPLY PRESSURE 6 °SO FEET s •''0 X l• -I- �Z-� FEET OF FORCE MAIN X F j I J too FLFKICTIOU FACTOR.. Z' ()ST / TOTAL OyUAMIC HEAD = zZ• Z.F As per manufacturer II gal /in. Liquid depth 3 6.11 Goulds — 1 O - 7 Submersible Effluent Pump I 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: p 'and float switch attachment • EPO4 Single phase: 0.4 HP, manual operation. Automatic •Heavy duty sump g Points. • Water transfer 115 , 230 V, 60 Hz, 1550 models include Mechanical Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with automatic reset. preset at the factory. rated oil and water resistant. ■Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 , FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, g Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. , • Solids handling capability: automatic reset, plastic Semi -open design /4 maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING -� • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. - Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: 1 /z" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in 7" or "AC.) rota Ice i - _ ry ram c stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 j • Capable running d ry without damage to 9 30 !rte 3 5GPM components. Pump: EP05 - ~- - - -� y p' a j i f ?sFr • Solids handling capability: 0 7 25 -�— i i /4" maximum. a { Zz.� Z W ! L -- • Capacities: _ pac tees: up to 60 GPM. • Total heads: up to 31 feet. 6 20 z�, a . • Discharge size: 1 NPT. • Mechanical seal: carbon c 5 15 rotary/ceramic - stationary, a 4 BUNA -N elastomers. • Temperature: 1 04 F (40 continuous - 140 ( 60 0 C) ; _. intermittent. lttent. 2 � — _ 1 I 4 j 1 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m °111 CAPACITY m 1995 Goulds Pumps, Inc. Effective May. 1995 83871 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must (� include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. _ /Z 3 3 " -76 ' —O� Please print all information. PeVewed , by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). Property Owner Property Locatio SR -F Govt. Lot 1/45 1/4 S 3 T Z# N R E (or)_V Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# xry < t Qd ocrn &-.6a City State Zip Code Phone Number ❑ City ❑Village ® Town Nearest Road 14 dsv w l I S o (71S 3$( - S T Y 1 40 W d ❑ New Construction Use: D Residential / Number of bedrooms Code derived design flow rate GPD [j Replacement ❑ Public or commercial - Describe: Parent materia j "/ `` l ood til ML"Mli General comments SYS4t wt el•C V • �g. -5e) R and recommendations: t r e12V • as MAY 0 6 2002 ST, CROIX COUNTY a Boring # ❑Boring _ ® pit Ground surface elev. 9 i 30 ft. Depth to limiting factor ) n. 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#2 l C ID 3 2 — fi ( k rY4 - c s 1 q -P . r j Z D - 39 to 3 5 i G Z k r w IV . G 5b c Boring # ❑ Boring G pit Ground surface elev. ft Depth to limiting factor 2 in. il Applica Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. E 1 •Eff#2 2 Z3- it) I3 — Src.,l Zm bk Cv I ,/-f . w 32'0 5 C2F - 7•5 r �(� �c.L ZmSbk rr • `� Cc • 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) Signature CST Number A'QL a Y -- , Z-T 3 Address Date Evaluation Conducted Telephone Number t - . Owner / �- Parcel 1D # _ L.. _ Page Z of Property Ovm __.e'L�.L_!L F-31 Boring # ❑ Boring 2 (' pit Ground surface eiev. d ft. Depth to limiting factor 3q in. Soil Application Rate' Horizon Depth Dominant Color Redox Description Texture Struchue Consistence Boundary Roots GPD/W in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#2 U 312 — SO Zmabk rm-�r c..5 IV Z ( - 10 r4/3 I 5; s 2- rrs6k r• C-N j (v Lj . G Y 7.5 r '-t SCI Zrr•56k Lf 4 a Boring # ❑ Boring pit Ground surface eiev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. •EM •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struck" Consistence Boundary Roots GPD/ftz 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 need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. SBD -8330 (807/00) R PAGE 3 OF NAME 52 -L O14 7 LEGAL DESCRIPTION NW %Sw X ,S T Z8 ,N,R, orW r SCALE: I"= �lJ BM I ELEVATION U BM I DESCRIPTION - Aj2 BM 2 ELEVATION 'j ;L,!Y d BM 2 DESCRIPTIO (4 SYSTEM ELEVATION �• 6 ALTERNATE ELEVATION CONTOUR ELEVATION O O e �Ca( D C� 744vr - 98a ir 9�ra i 1 ol- L 1� a fZ Z3 I V SIGNATURE f� DATE ST CROW COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer RIL & t Mailing Address �7 t ,051 -{ 0 bS OA) Ltd Property Address / �� fit` , I (Verification tcquired from Planning Depamwa far now coastruotion) i s 4 City /State Q IJ I Parcel Identification Number oOYQ ,- Z 233 ?4D CoO GAL DESO& MON Property Location A %., „�a ls, Sec. . T22 AN -R_�Y— W, Town of Subdivision C-a7))a Q'iInel . Lot # �. Certified Survey Map # Volume Page # Warranty Deed # !E �8'0?.�f . Volume Page # _ 019'_ Spec house 13 yes t.( no Lot linos identifiable 0 yes Q no �S'TEM M�TII ANCE improper use alai maintensnee of your acptic system could result in Its premature failure to handle wastes Propw ruaintenanee consists of pumpwg oat the septic tank every three years or sooner, if needed by a licensed proper. What you put bft the syatom atages-ra-tlae.vaste mom__. The property owner RPM to submit to St. Croix Zoning Departmeat a cettfftcation form, signed by the owner and by a miworplumbar, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-ate e wastewat erdisposal system is in proper operating condition and/or (Z) after inspcotion and pumping (if nexsstay), the septic tank is Iess than 113 trill of Budge. Vwe. the uudmigned have real the above requirements and agree to maintain the private sewage disposal system with the aamdards ant fir try Lucia, as set by tho Dcparb=A of (:ommarcc and the mpartwcat of Nounal stesottrooe, state of vrwcomw- coedrwation stating that your acptic system has been maintained must be completed and resumed to the St. Croix County Zoning Office widna 30 thru year . ' data r,>ZL4 &j %tY GNATURE of APPLi6Amr DATE Q cE. RMUCATION I (we) ocr<ify that all statements on this form ate cue to the best of my (our) knowledge. I (we) am (are) the oa aer(O of tri desenm above, by irtul of a wananty deed recorded in Register of Deeds Office. KiNATURE OF APPLI PATS *a'"aw♦ Any in OnMtion that is mis- represented may result in the sanitary permit being revoked by the 7mi* Depaztmeat• f+ kdade with this application: a stamped warmuty deed from the Resister of Deeds office a copy of the eartilfled survey oup if referowe is made in the warranty deed U 1886P 019 STATE BAR OF WISCONSIN FORM 2 - 1998 r, - 7 49 a91 6 WARRANTY DEED 1{ATRLEEN H. NALSH • REGISTER OF DEEDS paw Mxlter ST. CROIX Co., kI RECEIVED FOR RECORD This Deed, made between JASON A. BAST and JANA S 05_97_2002 I0:30 AM BAST, husband and wife, -� Graraor. EX and RICHARD J. SCHWERTEL and _LINDA L. _. HWERTEL REC FEE: 11.00 us and and wif TRANS FEE: 539.70 �_._.._.�._ COPY FEE: _.._ CERT COPY FEE: ._.. _. Gtantee. PAGES: i Grantor. for at valuable consideration. conveys and warrants to Graaaee tiro following described real estate in St • Cr oix County, State or Wisconsin: n:irorca,p ass 6, t27 Plat of Country Wood, Town of Troy, ix County, Wisconsin. - - Title ,00 St., 0116 ,Hudsm-Wj 54016 . 040 - 1233- 70 -OOQ CZ {� parcat WwWlc tw" Manbw F" li This is riot homestead property. W (IS not) is I 1' ii Exceptions to w —mitts: Basements, restrictions and rights -of -Fray of record, if any. Dew titts 1st day or May 2002 1 i i (SEAL) (SEAL) � (sEAW (SEAL) AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, l ' St. Croix authenticated this day or Personally came berate me t; - day of I 4 the above named � L TITLE: MEMBER STATE BAR OF WISCONSIN of not. me known to be the person S �!r e� L In authorized by §706.06. Wts. Stats.) 4tnamment nowiedge the same. T143 as STriUAtEN r w AS DRA fTED BY �� Jason A. Bast of Wisconsin My commission h permapent. Of not, state expiration date: ` (Signatures may be authenticated or acknowledged. Both are not /(Q� necessary) N „s sW. y in , r-War"aaa.t,vp.d -p,I b la.nK.. .. , ._. N N a t e �j �: N �1 A "W 454.94 NOI ° 33' 31 C11 ca 1 44 S02 `59 "W U �' �I �l l 68 .00 ' pct • ss' — •OZ� �h eg i L ICXI _JI w o C-i 1 61 Lu s eN e � OD WI ¢ Q c,l 1 —I � W 1 I I S02 `59 "W 1 I 58.00' 1 354.00' NO2 °35'59 "E 412.00' s x �- W OD ro r NtP oa as m 1 �� �../� -�= S� � � � STC _ CREC*EIV � AS BUILT SANITARY SYSTEM REPORT ` OWNER �oc Sa.� G 5 T ' /' , ADDRESS �d w y �� SUBDIVISION / CSM# '�f LOT # �� SECTION T N —R W, Town of ST. CROIX COUNTY, WISCONSIN Goo ' ( 233 3. 2s.l�.11�3 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ' e c� � A/ /v _ �? Q •� rs1 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 BENCHMARK ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well 6 G House Other Pump: Manufacturer Model# Size Float seperation Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /,2 Length S Number of trenches Distance & Direction to nearest prop. line: s3' Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: T� PLUMBER ON JOB: Z � Oz — � LICENSE NUMBER: INSPECTOR• 3/93:jt r-- Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: - Labor an6 Human Relations INSPECTION REPORT ST. CROIX S'efety anAuildings Division {ATTACH TO PERMIT) sanitary Permit No,: GENERAL INFORMATION 289352 Permit Holder's Name: []City ❑ Village Town of: State Plan ID No.: BAST, JASON TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 040 - 1233 -70 -000 TANK INFORMATION ELEVATION DATA A9700167 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T e O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 3.28.19,SE,SW 655 TOWER ROAD LOT 27 Plan revision required? ❑ Yes ❑ No Use other side for additional information. ITI I- I SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: F I SANITARY PERMIT APPLICATION Safety of at e r i y Bureau of Buildin Water S 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. :5 d "'K • See reverse side for instructions for completing this application State Sanitary Permit The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 30 5VA -1 da, s ' Sg 114 ScJ 1/4, S 3 Tar , N, R /Q E (or) Property Owner's Mailing Address Lot Number Block Number a 5':r ok1 L T City, State Zip Code Phone Number Subdivision Name or CSM Number l ` ( II. TYPE OF BUILDING: (check one) ❑ State Owned 1 t� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF va p III, BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © l a g F 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 F1 Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel/ Motel e / Factory 13 ❑ Other: specify IV. TYPE OF PERMI (Check only one bo n line A. Check box on line B, if applicable) A) 1 ❑ New 2 (&Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of 5, ❑ Repair of an - _____System _ _'_____System ____Tank Only______________ Existing system ________ ExistrngSystem B) ❑ A Sanita Permit was previousl ' sued. Permit Number Date Issued V. TYPE OF SYSTEM: ne) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 F(Seepage Bed 21 []Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq- ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 14 Elevation �1 7 "eG�— Feet 9, le" Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fi ber- astc x Plastic INFORMATION New Existin Gallons Tanks Manufacturer s Name Concrete st noted Steel ass Tanks Tanks Septic Tank or Holding Tank ❑ Lift Pump Tank /Siphon Chamber I I I I ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) I VP MPRSW No.: Business Phone Number`. Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY []Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issue Issuing Agent Signature (No Stamps) E] Approved [:]Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL _ L SOD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 code administrator or the State of Wisconsin Safety nd Buildings 608-266-3815. d n s , y g To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. 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. Complete for all septic, pump /siphon and holding anks for this system. Check experimental approval only i tanks g Y f to s received experimental rod r P Pp Y p product approval from DILHR. VIII. Responsibility statement. Installing plumber isto 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 submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------- - - - - -- 'I GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r I b la �; Q R' o N 7 fi 4 0 � 00 '1 n 4 n ° C � 4 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 fAC�5r and Human Relations Pivision of Gafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code fl S t Crd i . Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or (t rl e dimensioned, north arrow, and location and distance to nearest road. X3 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION 2 3 D PROPERTY OWNER: PROPERTY LOCATION IWA 717 ' Richard Stout GOVT. LOT 114 �Ik tvTY R (or)W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NA M # 1353 A T 27 na Count CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE GOWN D Hudson, WI. 54016 (715 549 -6731 Troy Tower Road [x] New Construction Use [ 31 Residential / Number of bedrooms 3 [ ) Addition to existing building I I Replacement [ I Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft Absorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft - 8 trench, gpd/ft Recommended infiltration surface elevation(s) 93.10 ft (as referred to site plan benchmark) Addirionai design i ske considerations backf ill to be to code l" p r p {S Parent material pitted outwash plain Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem RIS ❑U ®S ❑U B6 ❑U ®S ❑U ®S Out EIS 7U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botx>dary Roots Bed Tmr& 1 0 -22 10 r2 2 none 1 2msbk mfr Cs 2f .5 .6 _ .4 5 ••• •- mfr if •• 2 r 2 none scl m 24 10 36 2 3 r Y Ground 3 43-93 10 r4 6 none s 0sq mvfr na na .7 .8 elev. 97.8 ft. Depth to limiting factor , +93" q3 j q2-. L l U 2" Remarks: t 9 g 4 uvrii t,. tr 1 0 -32 10 r2 2 none 1 2msbk mfr cs 2m .5 .6 .'.:2 2 1 32-51 10 r5/4 none sil m na cfw if np ` n ::... ................. ...:........ Ground 3 1 51-96 1 r4 6 none S 0sa mvfr na na .7 91!v ft. Depth to limiting factor +96" Remarks: CST Name: — Please Print Phone: Gary L. Steel 715 - 246 -2600 A ddress: 1554 200 Ave., New Richmond, WI. 5401 m02298 Signature: Date: CST Number: C 2�9 �2f2�±� 7 -23 -96 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of —_ PARCEL I.D. # 04Q42-Q -70 Lot #27 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 7Bed Tre nch 1 0 -30 10 m cs 2 30 -52 10yr4 /4 none scl 2mgr mfr gw if .5 Ground 3 52 -11 10yr4 /6 none s 0SCf mvfr na na .7 .8 elev. 9 8.9 ft. Depth to limiting factor +110" Remarks: Boring # C3 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(R.05/92) t STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 NW SE S3- T28N -R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 lot #27- Country Wood N 1 " =40' BM.= top of SE lot angle point survey stake C el. 100 �y •_ Sys�E� r � �,2c� � � W - 5c��P�t• Gary L. Steel 7 -23 -96 T HIS INSTRUMENT DAACTEO ET EO ELANUM \ 11EnRiNGS ARE AUERECEO TO THE T � Z WVTH Ln+E Do HE SFIiA of 9ECT�oN i, na ^.VM•n TD nrAn w t t�� Mp�C� SIS•O9 Z? 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Fr a YLYr111 w - mar , •I.P .AI MM+n �,,,,; p pr[aw w ewtt -� ' Lao daxa ..w w 4 law I m it m mw ar• anetn rIu'ati daa••a a. ■L•e•r11Y•a aa• 2 1�Ltle//e■YM. 1i w L" ce w• t4s ■-■ a M.w tlwl•Y• nowim, rL1r Yww Illr r l'rl'ItY •�• S p 1. .w. w N 1M ft -MAa lr..wl+ tttrpwrta•■w1 ■e. 1614. an ■.na ■t tt4rw awrwa 1n.■• ■.w r4nuw r1ArnN L AY It. a aLr NNL•w aMpra11,M ar• u.w ■rlrxw t11r1'117 - -L` TN It 1 r Nf.w pM•M 111N'Y,M IN.w M.JV aa/I41l1•llw N/lrllw•• ". +L f•. a TN ■ M.w MY•a• nMiM U1tw 7x.11• W'{rN7 Rr1ln7 j t. A C71�1w1w a•■LL1al _ .J • wL - u IN,Ir mewl. tt Nralw M.lr ul w OWN flrwaw �+ ' �-• u Ylw N4rIr ■P■•Ww Zw a•w rlwrrw ea•rtw ■ STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County K OWNER/BUYER `r4 S�c) X MAILING ADDRESS 7 _<50. &55 Gs$' 7'0 -, le IV44 g X PROPERTY ADDRESS i Z? / — VIP C z �J (location of septic system) Please obtain from the Planning Dept. x CITY /STATE Xf c).D So), x PROPERTY LOCATION SF 1/4, S7 &) 1/4, Section , T o;? S' N -R _ W x TOWN OF 76f*1 ST. CROIX COUNTY, WI SUBDIVISION _ v LOT NUMBER o C�S CERTIFIED SURVEY MAP � VOLUME �W/_, PAGE 4�9 , LOT NUMBER ,;?7_ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, set by the Wisconsin DNR. Certification stating that your septic has been maintained must to the St. Croix County Zoning Officer within 30 days of the three ye piration da X SIGNE . DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. -------------------------------------------------------------------- Owner of property X1,45 � d - J . U Location of property 26 114 1/4, Section _,T Z N -R W Township Mailing address At `z 54 ' A A- C5 �t 157 4409 ;'- Address of site O o i( ot' ax;I 46 Taj 3 rP� Subdivision name 'emu M f r L, Won cr Lot no. 217 Other homes on property? YesNo Previous owner of property _ JQ Total size of property _ ��?,� AdK9 Total size of parcel o 00 ' Date parcel was created 4 -0 -9�P Are ali corners and lot lines identifiable? _ Yes No Is this pr b being developed for (spec house) ? Yes �_ No Volume e and Page Number A �/rr as recorded with the Register f Deeds. /a-I? ------------------------------------------------------------------- �\ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the 2re of the County Register of Deeds as Document No. k X G,'�Q L S' g--X�f-icant- C o- Applicant Date of Signature Date of Signature ' " � Pd , o g fi` ► low 19L.Alew � �ov Ala• DOCUMENT qO. STATE BAR OF WISGUN''ISfNFORM 11 - 1982 THIS SPACE RESERVED FOR RECORDING DATA LAND CONTRACT Individual and Corporate C �8106 25,000 IS FINANCED AND IN OTHER NON - CONSUMER a j TO BE USED FOR ALL TRANSACTIONS WHERE OVER REGIER OFFICE • 7Ft S) AIJ ST. CROIX CO., WI Contract, by and between ("Vendor , AUG 13-1996 whether one or more) and Jn-,nn R si- and .Tana 4 Bast at .:.3:30 P . M ( "Purchaser ", whether one or more). � * J.4k Register of Deeds. Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant Interests (all called the "Property"), in �q_ i:_- rani x County, State of Wisconsin: RETURN TO Lot 27, Plat of Country Wood 3 3 S o(b k k� Town of Troy, St. Croix County, Wisconsin.. 'Tax Parcel No. Subject to all easements, restrictions, rights -of -way and covenants of record, if any. (This land contract is being re- recorded to correct the legal.description of that certain land contract recorded August 13, 1996, in Vol 1195, page 100, as Doc. No. 548146 in ,�Qf the 0 for St. Croix County, Wisconsin ) "�A�!ti u($fEFt'S OrFr-;C ST. CROIX CO., VYI HZE Vol Ils P."4 FEL , ..- :W N 2 .. 1997 # / 10 :10 A. M This is no homestead property. —Md"�� OAS, (is) (is not) Aeglsterof Dews Purchaser agrees to purchase the Property and to pay to Vendor at . , 5 016 the sum of $ 7 5 , 0 0 0 - 0 0 in the following manner: (a) $ 1.00 at the execution of this Contract; and (b) the balance of $ 74,999.00 ,together with interest from date hereof on the balance outstanding from time to time at the rate of__ n i n ( 9 % ) per cent per annum until paid in full as follows: payments of $562.50 interest. plus $50.00 principal and $120.00 tax escrow monthly beginning September 1,1996, and on the first day of each and every month thereafter. Provided, however, the entire outstanding balance shall be paid in full on or before the 1st day of August 19 97 _(the maturity date). Following any default in payment, Interest shall accrue at the rate of d_% 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 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 principal. Any amount may be prepaid without premium or fee upon principal at any time after August 1 , 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, 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 title as shown by the title evidence submitted to Purchaser for examination except: Seller shall proveide title insurance policy at time permanent financing is obtained. Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall i be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on date o F classi ,1 g Cross Out One. •t,a. , ry18Z0� SB11 NTF Doss LAND CONTRACT - Individual and STATE BAR OF WISCON ` N s -t Corporate FORM No. 11 - ,1982Jv Nelco Forms P.O. Box 10208 Green Bay, WI 54307 -0208 , Y, Purchaser promises to pay when due all taxe%Lds1Ftes levied on" the Property �r upon Von 'or 's 'Interest -t-' in it and to deliver to Vendor on demand receipts showing such p"6 Purchaser shall keep the Improvements on the Property Insured against loss or damage occasioned by fire, ex- tended,Qovesrage .perU T azards as Vendor may require, without co- insurance, through insyrgrs�ap,proved by Vendor, in the sum .tif ' Q but Vendor shall not require coverage in an'am`odrit4nol?e than the balance owed r t ct. Purchaser shag ayy thQQ ipa a�rrtt 'p( sums when due. The policies shall Contain the stapc#ar�;cj�lu in e Vendor's Interest` � d, 'unlasts,�erld qt rwise agrees in writing, the original j f all policies cgvering the Proll be deposited with Vendor. Purc?iaaaa�§§§er ____sffhhttall promptly give notice of loss to nsurance companles and Vendss Purchaser and Vendor otherwise agree in writing, Insurance proceeds shall e applied to restoration or re Property damaged, provided the Vendor deems the restoration or repair to be pconom ically'teasible. ti Purchaser covenants not to co mit waste nor allow waste to be committed on the Property, to keep the Property to goVd tenantable condition dnd r air, to keep the Property free from (lens superior to the lien of this Contract, and to comply with all laws, ordinances an 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 tim@@ss and in the manner above specified, Vendor will on demand, ,execute and deliver to the - Purchaser,° -Warranty Deed;' ih fee simple, of the Property, free and 'clear of all liens and encumbrances, except any liens or encumbrances created by the actor default of Purchaser, and except: Paaempnts_ , r G ` r i i on rights-of-way and covenants- of recarcl 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 f;n_ 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 60 days following written notice thereof by Vendor (delivered personally or mailed by certified mall, then the entire outstanding balance under this contract shall become Immediately due and payable In full, at Vendors option and without notice (which Purchaser hereby waives), and Vendor shall also have the following ights and remedies (subject to any limitations provided by law) In addition to those provided by law or In equity: (i1) 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 falls to redeem); or (II) Vendor may sue for specific performance of this Contract to compel Immediate and full payment of the entire outstandng 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 thla 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 durin the pendency of any action under (I), (Ii) or (iv) above. Notwithstanding any oral or written statements or actions o Vendor, an election of any of the foregoing,'remed(es "I )Only be binding upon Vendor If and when pursued in litigation and all costs and expenses Including reasonable attorney '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,: in- curred, and shall be included in any juogment. 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 �pproperty, Including homestead interest, to collect the rents, Issues, and profits of the Property during the pendency of suph 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 ,securlty_for_on 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 joiry in the execution of the deed to be made in fulfillment / hereof„ Dated this L '4K day of , 19 6 dl dl/� (SEAL) (SEAL) Richard 0. Stout on A. Bast (SEAL) �. (SEAL) Jana RA st AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croi , County. , authenticated this day of , 19 Personally camebefore me this day of .111 3Z 19-9-6—the above named IP S it -hgrri 0 tniit JAgc)r1 A_ Rast an Jarna —S Rant TITLE: MEMBER STATE BAR OF WISCONSIN (if not, to me known to be the person G who executed the authorized by § 706.06, Wis. Stats.) foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Janet Stout . Notary Public County, Wis. My Commission Is permanent. (If not, state oJrplration (Signatures may be authenticated or ac�i a��lgd�gged. Both date: �" `1,7 , 19 are not necessary.) ry "'tbliQ ) 'Names of persons signing in any capacity sh� y p y ed"or printed.bef �s SB11 NTF 0040 Vgrp4 , dr Statw4 r"fa onsln LAND CONTRACT — Individual and Corporate Fes�LJ�S�Q� -1932 Nelco Forms, P.O. Box 10208, Green Bay, WI 54307 -0208 VOL ooCumr=N NO. 1� STATE BAR OF WISCONSIN FORM 11 -19" If r.•..a O- ACC a._smkv+op ram wacawwma Ostia I� LAND_ CONTRACT i i � y 7 ! �� ��, oo__ r.eu• 7adSVWgs1 wnd Cocpara[� � I! '.'+ , - ^ r ^ ^ cY•4 L.LT. ^ '�Zv? wsaTR -� n�'ER� !�'�..°�� ... _ . {e ,! 026.000 fs FJNANGED AND IN O AT '1'SAiY6tA.CYTM C 7 y,Li W '• Coaitraot, by and between -- Y-ELBER'f L. SINGEi2riQC]SE and Rued - -- - ---- 8%,:RtvTE _ H..__SINGEF MUSE, _ husband _ails_ - mite - - -- - - - -- -- -- I f JUN 5 1995 33 -------- -------------------------------------------------- ------ ----- ---------- ------------ - --- ( "Wender". fit 00 A. whether one or more) and -- -RICtHAR�?_ O_ --- TOUr- 1 ____ _______ __ ____ ________ _..�___ � ---------------------------- --- ---- -- ----- --- ------------ -- ("Purchaser ", ovhelher ons or morn). Vendor sells and agrees to convey to Purchaser, upon the prompt and full Her- �1 iormance of idlis uonirr L b i ui - i:i :aoo. e`. aG.'.Gv'.- ' -,^.: �.:�w• `1 11 rents, profits, fixtures and other appurtenant interests (all called! the "Property "), in_ St Croix_ -- - - --- County, State of Wisconsin: N- of SWk of Sec. 3, T28N, R19W, EXCEPT tbat part thereof lying northerly of town road (Touter- Road). SEk of SK- of Sec_ 3, T28N, R19W. T - a a Tax P No.. _ _ All of SE4 of Sec. 3 T28N, R19W, EXCEPT that part t),Aereof 7 y:. ng northerly v Own T� road (Tower Road), and EXCEPT Certified Survey Map in V01. 8, Page 2130. /L Subject t:o right --of way of town road (Torwer 'Road) along th9b northerly side of 1-be E el1Lire tract described abavf_ -. %"oc� ether Wit=h and o j<s: v to 0_-% r ; and restrictions of record, if any. ` Thic contract includes the provisions of the attached Addendum. f This _ 1S _ homestead property, (is) (is not) Vendor's. residence or as Vendor Purchaser agreaa to urcnase the Property and to pay to 'Vendor at othOYwi3,e di,r4Cts ice' i ; 3.tin9' �p ,.._. __. ... the sum of $ -- 490 G(Q . Ov -_-- ---_ : in the following manner: (a) $� • • . - -- f { at the execution of this Contract; and (b) the balance of $'340,,00& _00 __ -_ _ -__ togothof with in "orest from date . hereof on the balance outstanding from time to time at the rate of .: k5Z.4C1�._ ��°__� per crust per IInsvm until paid in full, as follows : �! The entire unpaid . balance ( $340', 000.x0) • plus: accrued interest shah bpi } a3t� on or I before June 2, 1996 '(a total of $362 100:00)on t21at. elate, wi per diem " interest being $6:3.55). The parties mav/ subsequently agree in writing 'bo ext6Tid:and,/or f modify this contract, but neither party is obligated to do so. � II 3ru tided, however, the entl1rg outstanding balance shad--be paid in full An or b tote.._ ._.._' day of 1 --- -- ---- -- -- ------- ---- -- (the maturity date)- unless e�wnded by writ8en. agreelm�ni . 1 Following any default in payment, interest shall accrue. at the rate of 0 / 6 ___.. per annum on '%o entire +ufugougt ! in default (which shall include, without limits an, delinquent interest and, upon acceleration or maturity, the entire +� principal balance) . 1 Purchaser, agrees to pay Ig@uet annual taxes, special assessments, fire and required insuranoovremiuma;whell du J - Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any + amount xnay be prepaid without premium or fee upon principal at any time In the eve of any prepayment, this contract shall not be treated as in default with respect to paymeut so long as the unpaid balance of prineipal, and interest (and in such entice accruing iDto - car from month to mouth shall be treated as unpaid principal) is less than the amount that sttiid indebtedness would have been had the monthly pa�-ments been 4 {{ made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds �i of insurance or condemnation, the condemned premises being- thereaftar excluded herefrom. l i Purchaser states that Purchaser is satisfied .with the title as shown by the title evidence submitted to Purcbaser for examination except: i ! 1 ii Purchaser agrees to. pay tho cost of future title evidence. If title evidence Is in the form of an abstract, it shall be retained by Vendor i^ntil the full purchase price paid_ Purchaser shalt beentit,,ed to take possession of the Property 2,._.-----__-- _•-- --_--_ -cross o..t ooe. �I C ND 7.AON - TRACT' — lndiole5xn .n l aB 3TA - � 1Q19Cffi11�s R Iacarufn Lr¢al Hlaak ems. tnc. � T o C F A 1•- tIOa� � 4 tKllPa�kra. Wfe_ - 1 i ADDEbMUM The tollowing provisions are part of the attached t an d ConWact dated June 2, 1995, betvie'.I4 Delbert L. Singerhouse and Bernie H. Singelibouse, as Vendor. an Richard 0: Stout, as Purchaser: 1 - Purchaser may subdivide part(s) or all of the prope—rty, and Con;strztf: AAA roes arid other imp: ovements required for subdivision. All expenses shall be paid by Purchaser. who shall provide Vendor with lien waivers as work progresses on size project 2. Vendor agrees to release portions of the property, with all deeds anal otfi- rolea documents to be- furnished at Purchaser's expepse, on the following baskq: aa. 'M e as and three acrss o f surrounding land shall be released upon Purchaser's payment of $40.00OI30; b. Other lands, without existing buitdings, sb al.l be released upon Purebasel `st paymem of $1,800.00 per acre. Release payments s1 be applied first to accrued interest snd the balance to Principal. 3. Real estate taxers for '1995, payable In 1996, have been prorat4d al c1o.5I X&' W Purchaser receiving credit for Venuor's share thereof. Purchaser shall therefore pay the entire real estate taxes for 1995 (and subsequent years) when due and furztigls to VendOr receipts sbovv,;ng timely payment thereof. 4. Vendor Sn a.0 bei� the expense Of 1r.1.: PcCi aaud 4'Gli.akil3MWAL& trac via„ mL%ALWc LL%L " Q6 % under irhe DH-1-1R Rental Weatherization Prograzrt_ Purchaser Shan be respr►ztsi..ble for the cost of any repairs or improvements necessary W bring said house into compliance with the Rental Weatherization Standards,. w)•r�R� This instrument Was Drafted By: hoc. No. ^ �33slr�ss S Rental Unit Energy Wisconsin Department of industry DILHR USE Efficient Standards Labor and Human Relations Efficiency Safety & Buildings Division Stipulation P, B Weatherization . WI P.Q. ox 7969, Madisonn, WI 53707 TYPE OR PRIN USING BLACK INK (608) 2660671 o...,•..• _ crre!, edrfrnoe• -, Pornrninn Infnrmatinn /Leave Blank) C _..� . . , . � . a .� .._... 4 , I' StreetAAd Count ` Redo for t ra Y ity Ste & Zip Code: Number of Rental Number of Rental Units 1 A h y Buildings on Property: on Property: f�Ub 99 Seller's T ephone N bar (In d e): r i 2:30 A 3 . Legal lscription of R Unil Property (may attach separate sheet): yq Return To: P URPOSE: Section 101,122 (4) and (6), Wis. Slats. requires that a properly authorized Certificate of Compliance. Stipulation or Waiver accompany the transfer documents at the time r:ertifirate ,,,,; �_, ,,,,.;,, aece,rofa of Cornp!lanrta arr irrantiv licensed inspector oirecordaiion. Thisprpcessi3iuriirssinxj, talieu "iirohaNteriLiIR ..,a ,, a ,,, ... , ... „ �. , •.•..•. - -_. _--- - --- _.._ is proof of conformance with energy conservation standards of ILHR 67.05. In lieu of the Certificate of Compliance, the purchaser may accept responsibility for future conformance with either Stipulation or Waiver. SE. The purchaser of a residential rental building shall present this property validated Stipulation to the Register of Deeds at the time the transfer is to be recorded. This Indicates the building is subject to the Rental Weatherization Rules, and that the new owner will bring it into compliance with energy standards within ONE (1) YEAR following the transfer. INSTRUCTIONS: The purchaser(s) should complete all entries down through the Stipulation Agreement to include purchaser's signature /address block. The Stipulation must then be submitted to DILHR in Madison orto DILHR agent for validation (contact DILHR for location of nearest DiLHR agent). Wnensubmitting for validation to DILHR, send all copies of completed form plus $50.00 nonrefundable filing fee. Do not send cash; make check payable to DILHR, and mall to: DILHR, Rental Weatherization Program, P.O. Box 7969, Madison, WI 53707. After validation, copies will ba returned to purchaser sinless another party is designated in writing. BUIL12I WITH 05TING L ASE• The purchaser of a building with 4 units or less who intends to owner- occupy, bill is unable to do eo •,within 60 days of the transfer due to an existing lease, is requiredto take out a Stipulation. DILHR will cancel the Stipulation after confirming thatthe owner has occupied one of the units. Written notification to DILHR of owner - occupancy is required. DILHR will confirm cancellation in writing. (WS) This document is valid only it no 011P`PULATION A.G.REEM "NT previous Stipulation or Waiver is currently on file for this property. (in accordance with ILHR 67.08(3), ILHR 67.13(4) and Wisconsin Statutes 101.122) 1(we) accept all responsibility to bring the above described residential rental building into compliance with energy conservation standards of ILHR Chapter 67 no later then ONCE (1) year from the date of validation. Date Signed: i%r Purcha Name* s is ignatur q s Putch ear's Stre dres /� �'' Pu aser' City, State NZlp 4(ooe / (urchasee ! eiephurie 1-11 ofir tiro crva ,v o; Date Validated Expiretiun Dat@ Volidated By; {add one (1) year to DILHR ❑ date validated) DILHR [xI DILHR Agent ❑Authorized Municipality my 25, 1995 tuly 25 , 1996 YRAHi 1 FER Auth. or Tax Rev. N: �S9_000 Print Official's Name: Official's Signature Enter DILHR Transfer Authorization Aug tMIR TIGN Number From Stamp Here: OUMBER, Kathleen H. Walsh Municipality /County Name: Office of: S s 4 9 2 7 3 4 St. Croix County Register of Deeds — _ _ — TRANSFER OF STt IPUL,A►' i��iaN It the above described residential rental Building(s) is transferred within one year of the validation date of this Stipulation and before the residential rental building has been certified as being in compliance with ILHR 67, the new purchaser must sign below and forward a copy of this document to DILHR. By signing below, the new purchaser accepts the compliance responsibility t¢ this Stipulation, THUS REOUIRING CODE COMPLIANCE BEFORE THE EXPIRATION DATE GIVEN ABOVE. Transfer of the property after expiration date is not valid without conformance to energy standards. _r Print New Purchaser's Nam e(s): New Purchaser's Signature {s):Sig New Purchasers Street Address: City, State & Zip Code: Telephone Number (include area code): SBO -7115 (R. 12192) Copy Distribution: White -For Recordation; Yellow-DILHR; Green -DILHR Agent; Pink - Seller(s) a 0 6q 1 0 ° o I � o 0 CIO v N ,? a O d �� I O @ . .•. C U 10 C n C- L a' n y t .0 N@ C 0 O ? 7 N O N O p•�p• "d 0 -0-0 m n N @ C p O L N C N °• L N- C C N _ m y O a E 3 o c" c y w ' C'r N N N O Z— °@ p N p N U@ U C� V N O C o °- N @ a? o Z (n O y y n@ E " ° o L xo a) Q) o ., C)° o Eon a� ° io v z c . p ° z O o >ya cL N O M N aa)i O` C c d LL o E o LL o �Yoi m o 2 v m �j . E N C N C "6 C 7 N 'D C T N N '6 X .� @ O =@ o@ O E Q dN c E Q WILL L) 3 U N E O V p O Z y y m 4) a m a m m F i o z d c a> Z c al I N C E _v -0 h p N ca WJ N ] @ N CY N C C O N N C3 O O aD • C .0 .0 N I d (n t �zz o z °o z o o .a 24. O. w .I.+ - a Q t4 o Z p N d ID N @ N y i @ c v 0 L L c Q d L LO p F H H v ° H H H p • ►�'v o a o a a b o a a iL - N d a ° Ic I r N J V O O N m 0) 0) Z @ N N Lo _ a�� N W z `E N O @ LO LO t...! E p tD t0 .- ` Ln m a m c � . , I d Q n is o v a Q r; to to v _— — O c co m e `n C) y 00 U ° E C3 � p U p C O O Q U N c " O { N @ 0 CL O O C N C t \ N N t ' d 7 N LO N T 3 ..@.. 7 E > . t `� o y Cl) z •T om , O O H UJ O Z N d Y fn CO C O N Z ' w v� M a ) (L > >, L: a T • ce a m .� `) y a+ c u 0 m o 3 :z 0 3 :°. o — A c�a ou)L) ov�c� � o -0 °o °o, o 0 °( O °� 0. I � � c O � c C y I E O_ O f6 N O m y 22 a e o Z Q) Q) O O O U c Z c o c Z a 7 f0 C O LL C N LL p E a O t 'a CU — E ¢ CL N N ¢ N U ; , N � M a N y y Z N O v O V Z r I I 00 a m a m Cl) IN LLJ c 0 c (9 5 o z c w IX r _ a�i 2 c O c N ~ E c Cl) '0 N N m N C N of N fl N • N c O o Q M Z Z Z m Z N _ .. Z _ c Au N � O .. l0 E W V! N CL Ac co CL r w w c ° D G a E E a N C D a Op r- N U) 3 U N 1 O U) U N I-- 3 a Z o 3 •ry @ oaaa `r'aaa ►� a *� o N!= o C) aWi N rn rn z to J U o o _ O N N O } pp O 7 lfi Lo 3 O O O m CL � 'p y � s`3) . - U) w I C Ln 2 C _ L o E t `o v - o O C CO O ! N ca N U IL o C5, C C C M a C N r O _ 'E V C M� � m m e6 C: ~ N N M 5tb N 'O 'O Li 3: CU (D C C G O N M N O • ? ° c v o o N w 0 > +� U m� � N o 0 y 0 0 N U) V O a — Y `1 :F U) Co N 0 Z Z O CC :.7 .. a m a x* ° L� a r L a U E �1 A C) a '', O 'n v O in 0 I Page 1 of 1 Daniel Sitz From: Sharen Kortas [skortas @sbcglobal.net] Sent: Wednesday, October 15, 2008 8:15 AM To: Daniel Sitz Subject: 655 Tower Road - Duplex Hi Dan, Went through the MLS last night to how many times this property has sold and what it was sold as. In the MLS records it sold" April of 2006 and was marketed as a duplex. May of 2002 it was in multi - family and marketed as a duplex. Text: Rare rural duplex in a beautiful subdivision w /over 3 A. beautiful willow trees, lawn. Many updates: New windows 95 - new insulation /siding upper /lower level almost completely remodeled (96) - New garage (96) - current rents under Market Agent Interest - listed by Kernon Bast expect it was owned by him or close relative.,_J Hope this helps - maybe the time line will help with looking. Thanks, Sharen Sharen Kortas - ABR,GRI Keller Williams Realty Integrity WI /MN 2424 Monetary Blvd., #201 1 °� /VC, /�l J Hudson, WI 54016 " Sharen@HudsonRealEstate.com www.HudsonRealEstate.com Direct: 715- 386 -8192 Cell: 651 - 402 -3753 -4 15 S;' 4" �ur � �1-4 ^1 So i t 15 ✓rA t I_ b ,G�� /Y 10/15/2008