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010-1027-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CRC IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338849 Permit Holder's Name: ❑ City ❑ Village CK Town of: State Plan ID No.: PETERSON, DENNIS E14FX -ALD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 010- 1027 -40 -000 TANK INFORMATION ELEVATION DATA 13 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. Air intake ROAD Dt Inlet Air 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 Friction System TDH Ft ad oss Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) 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 E] Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCA'T'ION: EMERALD 12. s0 16.1S9,NW,NE 2659 170TH AVENJE Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: 9 t ®.em. .. ,� n..... � i m, � «..� ... �mm .. ee . m ....,. k z t .e »a e... .�.. t � 3 f ti i z F 6 f 3 i .. .te ».. ... ....... ., .... �aa» .n...... a ..� m ,tee: a ..�.�....,. .,.. ...:. ... ... .. m .,., ,e ... .�. e € mme ^r d z .. ' i # f s a € ` i t m mg f 3 t € mom � e » e .e 1 " s„ a i £ � k y e F �z E ®e. . -w _ »� .., . 88 r # t € {{ »-., w ... ..0 .«.......:. ... f 3 c p � p 3 c b y �e a p 6 ; Safety and Buildings Division Vi sconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in si ze. • See reverse side for instructions for completing this application State Sanitary Permit N mber Personal information you provide may be used for secondary purposes ❑ Check if revision to pr vious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name , Property Location De - S pal r e rs o l,/ 1/4 N t 1/4, S 1 Z T N, R! ,E<or) W Property Owner's Mailing Address /r'U� Lot Number Block Number `' City, State / Zip Code Phone Number Subdivision Name or CSM Number k,% ra W• 1 "Z)/ ( ?h—)AGs= 41,f.0 II. TYPE OF B IL ING: (check one) ❑ State Owned ❑ It Nearest Road VV Public or 2 Family Dwelling - No. of bedrooms Town OF � �r, q III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 �) .2b . 16. I V 1 1 ❑ Apartment/ Condo �( U- l v Z 1 - 0 066 7 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. `Check box on line B, if applicable) A) 1. ❑ New 2 ❑ Replacement 3. ❑ Replacement of 4. & Reconnection of 5 ❑ Repair of an ______System -------- - ----------- - _TankOnly______________ Existing S -- - ----- --------- ------------- stem Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ 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) Elevation Feet Feet Capacit VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con - Stee► glaze Plastic App New Existin structed Tank Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 111 ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility r install ion of the onsite sewage system shown on the attached plans. Plumber's Name: (P int) Plum is Signat o Stamps) /MPRSW No.: Business Phone Number: Plumber's Address (Stf� G tate, Zip Code) 4 z - , ` rG 4' 12, 9 IX. CO NTY / DEPARTMENT USE ONLY ❑ Disapproved Sanjtpry Permit Fee (Includes Groundwater ate Issue Issuing Ag nt Si ture (No m pproved E] Owner Given Initial' Surcharge fee) Adverse Determination - 1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3_ All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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 tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 81/2 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, Iocatidn of holding tank(s), septic - tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------- - - - - -- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. PLOT PLAN - - _ Page Z. of _ e Sca l - . S -40484 jai, Kvi rJ�c�gsr UWE of EL• kw ON OvAtr IV 3 ,44"b)Y), PvC AI P6 D PRIVATE SAGE SYSTEM �l. loo Condit1Onlly B.3 Z Q ULAN MUS N t;l:� w , r OEPT. OF INOII LABOR r p BUILI)10s 1 r plVl OF ° � lo o r �1.9.9Y CO _ I,ONDENCE r r N r tite ve- �I' I A -C S ` Ts � 3 8�Rt') x'1081 Ltr h4tl�t E � a•� 2S. zs- Ei i • ,� j� G � f O O tJOT W1h1�ItT �-t � k s C', otL O�sZvvz3 r o � a f NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be l bM/bSO gallon capacity manufactured by F - Z �UwL SC�.I�..rl ���t✓�.r� s1 ;,�,� 5. Bench Mark g } Ou p - 6. Divert surface water around mound to prevent ponding at the uphill side. I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0 , 1 '2 � Mailing Address 2 6/ Z ? d �` l U L( '� Property Address � � � s�`l � V � ? � � � �/ q (Verification required from Planning Department for new construction) City /State Parcel Identification Number . 0/0 - /Q J- - 7 " `�0 - /6 6 LEGAL DESCRIPTION / Property Location N `J '/4, N f ' /a, Sec. 12 - , T 3 0 N -R 1 G W, Town of r Subdivision , Lot # Certified Survey Map # 0 Z 7 3 _ , Volume Page # 36 3 Warranty Deed # q 3 5 7 , Volume �U , Page # `/ 2 �— Spec house ❑ yes D--fio Lot lines identifiable [-yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained xgust be completed and returned to the St. Croix County Zoning Office within 30 days . of the three ye p' 'on date. SIGNATURE 6F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the �srty, ibe a o e, by virtue of a warranty deed recorded in Register of Deeds Office. SI NATURE O APPLICANT DATE * * * * * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * * * ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed --A i ' Parcel #: 010 - 1027 -40 -100 02/21/2006 10:26 AM PAGE 1 OF 1 Alt. Parcel #: 12.30.16.1696 010 - TOWN OF EMERALD Current X j ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - PETERSEN, TODD D & TRACEY M TODD D & TRACEY M PETERSEN 2659 170TH AVE EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 2658 170TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 2.918 Plat: 3638 -CSM 13/3638 SEC 12 T30N R16W PT NW NE BEING LOT 1 Block/Condo Bldg: LOT 1 CSM 13/3638 2.918AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 30N -16W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 05/26/1999 603823 1429/233 QC 07/23/1997 723/547 04/01/1988 435766 806/422 LC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 80107 260,200 Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.918 22,500 216,700 239,200 NO Totals for 2005: General Property 2.918 22,500 216,700 239,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.918 22,500 216,700 239,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 12/04/1998 Batch #: 516 Specials: User Special Code Category Amount 010 - GARBAGE SPECIAL ASSESSMENT 30.00 Special Assessments Special Charges Delinquent Charges Total 30.00 0.00 0.00 Parcel #: 010 - 1027 -40 -000 02121/2006 10:23 AM PAGE 1 OF 1 Alt. Parcel #: 12.30.16.169A 010 - TOWN OF EMERALD Current �X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - PETERSEN, DENNIS K & JOYCE B DENNIS K & JOYCE B PETERSEN 2612 170TH AVE EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 35.460 Plat: N/A -NOT AVAILABLE SEC 12 T30N R16W NW NE EXC PT CSM VOL Block/Condo Bldg: 1/245 & EXC AS DESC VOL 8061421 & EXC CSM 13/3638 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 12- 30N -16W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 723/547 04/01/1988 435766 806/422 LC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 80106 Use Value Assessment Valuations Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 34.460 5,600 0 5,600 NO UNDEVELOPED G5 1.000 100 0 100 NO Totals for 2005: General Property 35.460 5,700 0 5,700 Woodland 0.000 0 0 Totals for 2004: General Property 35.460 5,700 0 5,700 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 4 1 S Pee _ S, f`1 ADDRESS L ,2 f 21) C ve SUBDIVISI / CSMj LOT � 5/goy,Q� X101 SECTION ! T 2U / N -R W, Town of `ij e�A1 ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r1l a i lax I INDICATE' NOPTH hPI2" I - � Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic Lank m,)nhole cove, i rr BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: /�/e 0 csc c , -•'P\ Liquid Capacity: J V G e Setback from: Well House Other Pump: Manufacturer Z, Model # ^� Size ' Float seperation �2 Gallons /cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 5 Length S Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS �7 Building Sewer I y, 7 "I ST Inlet. ST outlet PC inlet PC bottom — �. Pump Off q 4'0 Header /Manifold �UQQ� Bottom of system /UU Existinq Grade .Q7. Final grade— 6.2 DATE OF INSTALLATIO PLUMBER ON JOB: LICENSE NUMBER: �� 6� INSPECTOR: 5/93: )t I 4199 ' x M Q 2 5 n L tug doeeos` � ` S ('r;` ` G CERTIFIED SURVEYMAP Located in the 1 1 NW /4 of the NE /4 of Section 12, T30N, R16W, Town of Emerald, St. Croix County, Wisconsin. OWNER / SUBDIVIDER 01 W , DENNIS A JOYCE 0. Bearings referenced to the North PETERSEN Z line of the NE V4 of Section 12, 2612 170 Avenue �I ai assumed S88 14 ' E. Emerald, WI. 54012 0 ' Q ; � UNPL.A TTEp N Q _ _ _ LANDS g� w' N1/4 Comer Section 12, Scale 1" = 100' IT30N, R16W, Emerald Q, ( County nail found ) North line of the NE 1/4 _ 170TH AVENUE W —S 88 14" E 328.00 w S 88° 27' 14" E 2,324.89 S 88° 2 14" E 328.00 C6 w NE Comer, Section 12, s 100' road y setback line 10 ( County nail found) Q1 - - - - Stf8d - - - - - - - - -_ v ' = 2 COD 'O , LEA w �� ,m -�- - Indicates Section dwelling m i itJ Corner Monument ( as noted ) g' In T Indicates 1" X 24» -�G� 00 (�. Z 127,122 square feet c �� ,� iron pipe weighing " Z r o 1.13 lbs. / lin. ft. set. ( 2.918 acres ) T ' � Indicates fence. including R. -O. -W. i 116,298 square feet ( 2.670 acres) excluding R. -O. -W. 0 N N 88° 27' 14" W 328.00 SCALE IN FEET I" = 100' s UNPLA TTEp LANDS , 9 OWNED BY P '' 0 25 5 loo' �� 2 00' 300' c - - -- -- -L.ATTERS z s Z ' PREPARED BY: GRANBERG SURVEYING 1239 C.T.H. "E» S1/4 Comer, Section 12, New Richmoncl, WI. 54017 ( Alum. monument found) Phone ( 715 ) 246 -7529 Job No. 99 -0 10 dM=n THIS INSTRUMENT DRAFTED By JOSEPH W. GRANBERG SHEET 1 OF 2 CIO Vol. 13 Page,,, 638 ,.,, 0 0 0 0 r co r r N (D O • Cl) m r • � I � • L89 t O m 0 0 m N `- . 1892 �. g9z s 8992 • 899Z N Fil • 6£9Z a 19Z ZL9Z Q Is u109Z LV m V Z99Z . 999Z l,Q 099Z • • £89Z L89Z bL9z /1.� ) ' Z �V 999Z N • • 6bSZ N 9KZ �bsz ��' � •Eby b£5z O tU r O lzsz M m Tell MIRM", - -- N EMERALD PLAT W E L T 30 -N • R 16 -W .S 0 Farm & Home Publishers, I.W. See Pages 115-116 For Additional Names. FOREST PAGE 72 CYLON PAGE 70 W .. S a a s 77 a Eaten lobe Pahl so 4e P eters Rey wid 3 Eaton & & Ranae cConvNe N 57 S&L H 121 s— 'is Henderson 129 & nee' Peter & I1a Chan & 5 6 s 6& Sam n re•� s oseph�c a Roukema ill � e 5 391 7 e to R 2325 D s ucd 5 8 310 7 " Gillen 119 S� B 2 I ti� Kevin William �yaymes & Wittmer ' Darlene & Willett 80 02 Walter 80 Dale ffi Dennis Adolph ama & Smu I s: Demar 16 Dods 9 Kehler 72 &Ruth Janet & Joyce Waroer & ` • 67 s`.•'. s owI 1 K Ottt tiu wn T 160 amore Petersen r s 39 H ` °MOk `'` z 78 °0 ' ° z s 40 IM 80 77 3 3 Mss . _ Larde 170t Gloria • I o P,M,°m' Lonny & Da, M is Quam er 35 1 5 ,o ISnda t=*=e o d Ut a & s .. Doreen Kiekhoftt 3 M_ &Beth Ranee tD DJoseland r Family Bradl n prvold �'q Hmdttson g 161 L Trust & B er.Mra 142 �Ff 120 230 3 $ i Bonnie 200 Kohler 79 s�•o 77 Sbeinert j Mark & 1S8 O M.an Dennis T. 1 James, Don 160 r ode & lr , 5 El Mary ■ aaRe d &Dods & )can & Ellason Mar 79 a, al 40 ° Pheasants •o ffi y Berends Lister 80 8g lohak .&oea:lOe Forever P 149 f 4 P ; g 1& anet David & Muk so 156 15 AB 2 P•'° 6 M)cNamaza Anderson to P B 80 aad8e 0 80 e wx �v 7 2 80 2 M 160th AVE 4 t - el h& &° 2 & R Arnold K & R R � 4 h Norman sr Marie Klatt Wmk 46 peer Speer & Ls. & Mary Ary ax Family Trust ` A - Berg Trust smsm' Lo rman Fronds 160 231 10 160 158 80 25� & Susan & C 26 s 3 119 80 Matt 1 C, 238 1 Claudia & Maurice Virginia David w Edward L ye ) & N N ' Ma 120 MazzazeBa Dnth ulle, J Jul s Joseph Tmbravt 59 200 SR a xo� 225 Mak MM12 ThnOlhy (7 H &K zo Wa4 G &D E y O Wroff �& __ —. ---- O W s _�_. ____ M & O 3 ° M B Raba I'M & Richard EMa'5y � bg John ? + L ' 66 7 Burleigh a a Robert Trust 77 JJ was o Bradley Vrteze & ^o & an, • i 2 Derrick ta,rrence TP C S Cz &wile s`I Dorwin Brad)ey Waldean Moral 66 Larson V j z DRY 156 12 �'b` °n 110 is nn ldngers 237 a 243 & M.0 Dun zo 12 ! 19 omem Djmd ary Alta Bernice elsooe 7s Kay & Harvey & lern ryw „a & Suzann WBUm a° Michael v Rogtt & M & I N Mack ensen 78 Omann Hebuch Mapxe Hielkema &Vicky & Kay Deborah rm,��n 1O adeau rust ar 120 Dean Daniel & °`°very 102 Spaeth Dorwin Schug w „ H & lulte� c eieey Diane ea s 80 276 a 240 _ 5 Harz s 4 K 3 M 3 3 a Raebel 80 0 0 a 40 1 & 140th AVE 4 jt 16 G Richard gg 100 Dennis vita & w7a 9 37 caEEK 80 $ Vg Frhi F •o ovrud Om Treutel & _ can & K' m B N & ; h 6 $$5 7 160 • ss Wink " m x $x & 60 Nadeau 120 1�am��en�� E&a DI DJ14 t c� °� .5 17 dt Bruce & Ge&n• H , y a a Helrn•� fi la a David Henry Davis 177 5p 00 �,& & Dori ulu 66 Trust 170 EO $ David z &Julie 1lurtgen Rwn pub Waidroff Gam, w-a. � 51 M& aa.aohn& Daniel N Waldroff 232 135 �& jeeeefie Borst s I°i° we ..+w S co Waeace Miller so ' y d 218 40 73 s w z2 t° 40 1 77 130th AVE °i m 4 A & r O „ D&C 20 Panay a 1 g & amMe H<ebads 1 eresst & Lorelei ^ & Doru Q Wink 7 Rm & Roy Jr F Thomas S & Whd� sl D Thom9son &R g ao x Geo a ao y & Rita N g u d Y ac- Kevin & tl 20 Aaron s2 n �5 & 1 0 E & s AF eo S0� W lac Grant G & 1 rP PhYWstt •. E Hotk a< Co o C heryl & 0. a 198 156 Bradley 59 Na 110 61 140 Smith 60 3 ° Dorv7lss &o U iov& uu ) 7 "e M° Edward rvs D Anna Soon so as zo Ste 0 7uMdrva & Donna I 42 old ven H O1 �' ' Bradley Arlssa Lundeen Wolla Rausahaot kttm g Janet ck ehl too 133 • •• Rolle o" 4Erlta •: ra 200 s &v a.0 188 & V ■ 11 1 D Dorwill WINeu � Wldied DIe1W D8 CLL 30 K7ueaer A DD 's BALDWIN PAGE 40 i Solid Log Construction, L.L.C. ORII (Axe Original Old -Timer Lag Home Dealer) Kiln Dried Logs • 100 Year Warranty • Custom Built Homes Licensed General Contractor w3i r r i! CUSTOM HOMES i , Come visit our model home 2 miles South of New Richmond on Hwy. 65 1443 300th Street - Glenwood City, WI 54013 s 54 www•newhorizonhomes.us i, 0 ■'a c ` � 0 ��� ( k2 ID @■ w 5 E z o\ 2 m§ e _ C') k � \ ƒ § / \ ' $ / CD § m 7 :Z ° 7 : 7 $ Q ) ) } ) \ ] CD k { ( 2 » E E E: a o f o k( \: © Cl) « > E � CO a $ R @ 2 \ o o / / 3 o ® @ ? >' \� § \� CD $ = o E § 0 � ° ° [� { m T m ■, 2( 0 0 0 L - § s / ƒ § j § � § \ / $ � o v Ul CD ( - ; w, ( / { } z .. > > 0 \ \ \ CD �- i = � O @ . _ \ � k k � = � ■ � z $ z 2 ■ -0 2 � k � k = 0 z z q � GmIA $ /± 22 8§§77& 2 R ] CD CD \ 0. ZY CD Z E :3 - 0 — o E . $) /}Iq 8 = m E \ =r ) Co CO =r =n .1, 2 & /Q)W CD k C Cwl q } } //§ ® a =Ea £o \E % 2 =2 §q CD A \ . m / 7 } o � % Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Lai6or and Human Relations I NSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermitNo.: P 't'r;K C� '� e DENNIS El City El an Village IR Town of: State Pl D No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: DO TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer qb Holding St /Ht Inlet �k 97, Fe_/` TANK SETBACK INFORMATION St/ Ht Outlet '7,i7/ 97, 53 ' TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic yat ' 4 y�5 NA Dt Bottom �6,�3' 9 �/ U Dosing r �� " 9 � NA Header / Man. 3.1 /o/. 41.� Aeration NA Dist. Pipe p ,r' /o / " 3s'" Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number � 'GPM TDH Lift 6,y , Lriction� � Systems TDH /0,37 Ft Forcemain Length Sd Dia. - Dist. To well Q SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 ' 5 DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O f CHAMBER Model Number: System: r� �� �S� ru�� ' 4) 1` OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake Length Dia Length3 5 ' Dia. P ! I ' Spacing 3 '/4' 3G ' d 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 �u F Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Emer ald - .12.30.16W, / 2 .30.16W, NW, NE, 170th Avenue { Plan revision required? ❑ Yes [E�No Use other side for additional information. 45 1 :', �, G SBD -6710 (R 05/91) Date ns ectbr's Signature Cert. No. Safety and Buildings Division Elm SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. •, In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (tS the county copy only) for the system, on paper not less County than 8 112 x 11 in es in size., • See reverse side for instructions for completing this application State Sanitary Permit Number a 3 3 4W The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Dennis Peterson NW 1/4 NE 1/4, 5 12 T 30 , N, R 16 E (or) W Property Owner's Mailing Address Lot Number Block Number 2612 170 th. Ave. City, State Zip Code Phone Number Subdivision Name or CSM Number Emerald WI. 1 54012 1 ( 715 ) 265 -4807 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road ❑ VIl age ❑ Public 1 or 2 Famil Dwellin - No. of bedrooms Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 /v-102? 9 6,000 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5, ❑ Repair of an System System Only System Existing System B) ❑ A Sanitary Perm itwa?previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check onl ne) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 [!3 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) Elevation 450 375 375 1.2 100.7 Feet 102.7 Feet VII. TANK in Ca gaclt allo 5 Total # of r Name con Prefab. Site Fiber Exper. INFORMATION Gallons Tanks Manufacturer Concrete Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank X 1000 1 Midwestern ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber x 650 1 Midwestern ELI 1 ❑ 1 1:11 ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Joe Stang MP 6646 715- 698 -2266 Plumber's Address (Street, City, State, Zip Code): 506 Willow DRive Woodville, WI. 54028 IX. C LINTY / DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Fee (includes Groundwater j D a;:t e lssuelssuingA ent Signature ( to s) Approved E] Owner Given Initial �2QQ Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Ruildin% Divr ion, 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 and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ -Department Use Only. Compete 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, loc,:,tion of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; s [reams a ,d lakes; pump or siphon tanks; distribution boxes, soil absorption systems; replacement system areas; and the location of the building served; B) ho, izontal and vertical elevation reference points; Ci complete spec fi(ations for F,urnps and controls; dose volume; elevation dif ferences; friction loss; pump performance curve; pump model and pump rnanufacturer, D) cross section of the soi absorption system if required by the county; E) soil test data on a 115 form, and F) Ull sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r I I I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 7, 1995 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S95 -40484 FEE RECEIVED: 180.00 PETERSON, DENNIS NW,NE,12,30,16W TOWN OF EMERALD COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above- referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely rard M. Swi Plan Reviewer Section of Private Sewage (608) 785 -9348 1056R/ 1 SUDA- 7997(8. 10/84) . . Page of 6 MOUN : .FOR STEM 8 9 5 -404 84 A 3 BEDROOM RESIDENCE LOCATED IN THE NW 1/4 OF THE N 1/4 OF SECTION T 30 N, R 1 6 W, TOWN OF eV-A �-VWD( COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER ' PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR RECEIVED aEtJt.�`S \��T2 SON JUN - 6 quE _ �_t, w l Sq_o�Z iN,06S• ' PREPARED BY WEGEtREFZ !E3 C3 I L TEST i NG AND te ° t F.O. BOX 74 421 N. KAIN ST. c f RIVQ? FALLS. IiI 54022 715- 42`,r0165 a `'`" Al I 0A JOB NO. S L Z r � PLOT PLAN - . - Page of . 111 s. ��• �� 0 4 _ �. lo ~nt '+�� • _ - ' /zi +��'acR -t�sT' �.iuE of 3�Ac +Pt� -, � a�'1 - �1- •�bo•o p►v 6�Ht6 }I, ly 3 /y `O1H• Pv C �1PG �J' W /wcoU Lt%TH D PSIVATE SEWXGE SYSTEM l00 � nagy ConditiO t IA Eo's G tr taau u�„t. art. a�i a� � u a1 � 1 Q,Z 1 N � � 1 C I -- f �Rrl hD8►L� tjtit� a.� is 1 LL O O ►.10T @.Ot�M�kCT otL ��s�vvz3 n ' Ttt l S RiL�A r iV OTE = V p 1^3 e—LU ) -14 @t P(T (-L 56 F=114 mpWuL� h �T Ul,"T t) 4 NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to bel MtAS0 gallon capacity manufactured by I� 1LpwLS'[�1Zjy \?1�Ncr� r Iijz, 5. Bench Mark UP 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of 6 Approved Synthetic Covering S 9 5 - 4 0484 r�sTM c 33 Distribution Pipe Medium Sand _ H_ — Topsoil Eled. ob_1 _ 3 E D b � % Slope ( Force Main Plowed Trench of k" -2k" From Pump Layer Aggregate Undisturbed D 1.O Ft. Soil E 1. Ft. Cross Section Of A Mound System Using F o•B Ft. I Trench For The Absorption Area G N o Ft. A S Ft. H ) S Ft. B - IS Ft. I Z Ft. Linear Loading Rate= 6•o GPD /LN FT j 8 Ft. Design Loading Rate= 4.35 GPD /SQ FT K 10 Ft. L ck S Ft. A+b@~C-e Position of Force Main W 2-S Ft. L J i FqWae B K _ A �°t- - - -- — � — W Distribution Trench Of 2 2 Pipe Aggregate J Observation Permanent Markers M (AnchorsSecurely) S���E Y.. 'L ' ty ��SlOw S Mound Using Trench For A } o t Ar g0A p B p��`g�fiS 4 s r �ir►tR� t't OR \V S Page Of 6 Perforated Pipe Detoll 8 9 5 — t1 0 4 8 4 0 End View ) Perforated End Cap PVG Pipe � as Install permanent at end of each lateral Holes Located On Bottom, Are Equally Spaced it Q End Cop Q �'t * PVC Force Main Distrioution Pipe Lost Hole Should Be Next To End Cop , y �.L�i> ution Pipe Layout P 3` {.S Ft. e X 31, Inches il Y 36 Inches Hole Diameter Inch Lateral l y Inches) �F ����S�r. aF Manifold — Inches 00 ' Force Main Z Inches of holes /pipe \Z S � Invert Elevation of Laterals Ft. � y ri Place lst hole from tee with succeeding holes at 3L intervals. Last hole to be next to the end cap. 4% 6'/4 HEAD CAPACITY CURVE 45,° LLJ w "57"r - "59" SERIES - � W 4 /° 25 l r _1Yz- 11thNPT 43 /t6 20 6 S9 � I W W U � 15 Q Z p 4 975 /16 J o ro.29: 10 33 /32 2 Z8.0$ 5 TOTAL DYNAMIC HEAD/ FLOW PER MINUTE EFFLUENT AND DEWATERING HEAD CAPACITY UNITS /MIN 0 FEET METERS GAL LTRS Us 10 20 30 40 50 5 1.52 43 163 GALLONS 10 3.05 34 129 LITERS 0 80 160 15 4.57 19 72 FLOW PER MINUTE 19.25 5.87 0 1 0 CONSULT FACTORY FOR SPECIAL APPLICATIONS . Piggyback Mercury Float Switches -Available with special cord lengths of 15', available. 25', 35' and 50'. • Variable level long cycle systems • Alarm systems available. available. a Duplex systems available. Standard cord length - automatic 9 ft. SELECTION GUIDE Standard cord length - non - automatic 15 ft. 1. Integral float operated mechanical switch, no external control required. 2. Single piggyback wFde angle mercury float switch or double piggyback mercury 57/59 SERIES Control Seledlon float switch. Refer to FMO477. Model - VoMs -Ph I Mode Amps Slmpk Duple 3. Mechanical alternator 10 -0072 or 10 -0075. M57/59 115 1 Auto 8.0 1 or 1 &7 — 4. See FM0712 for correct model of Electrical Alternator, "E- Pak ". N57/59 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10-M used as a control activator, with "E -Pak" 7 1 Au o 4.0 1 or 1 &7 duplex (3) or (4) float system. E57/59 230 1 Non 4.0 2or2 &6 3or4 &5 6. Four (4) hole "J- Pak ".junction box, for watertight connection orwired-in simplex or 2 pump operation, 10 -0002. 7. Two (2) hole "J- Pak ", for watertight connection or splice, 10.0003. 57 Series - Wt. 27 -.3 H.P. 59 Series - Wt. 29 -.3 H.P. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, An Installation of controls. protecticin devices and v should be done by a qM111led FMO514: Piggyback Mercury Float Switches. FM0477; Elcectrical Alternator, FMO486; Mechani- ocumed electrician. All electrical and safety coda should be followed b ckiti p the cal Alternator, FMO495: Alarm Package, FMO513; Sump /Sewage Basins, FMO487; and Simplex mm scenI National Electric Code (NEC) and ft Occupational So" and Health Act Control Box, FM0732. (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. 80X 16347 Louis'vHe, KY 40256 -0347 Manufacturers of... OZZ Z LIW C27. SHIP To: 3280 Old Millers Lane LouisviNe, KY 40216 .. N (502) 778 - 2731.1(800) 928 -PUMP l U&&IrY PllAIP9 F1A 1YXF FAX (502) 774 -3624 WisconsirF Department of Industry SOIL AND SITE EVALUATION REPORT Page X of 3 Labor , Human Relations Division, of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST C 1 x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GQVi NW 1 /4 V11: 1 /4,S N T 30 N,R I6 E(dCW) PROPERTY OWNER' :S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Z 6 \Z ll� TT 1`W Me • — — CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [GOWN NEAREST ROAD 0 INE" i LJI S \-I ul i (`11S)Z6S 4 80 -1 E�1 �1� RvE [,tQ, New Construction Use [Jc] Residential / Number of bedrooms - S [ ] Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow �A SO gpd Recommended design loading rate bed, gpd/ft ° • 35 trench, gpd/ft Absorption area required n S bed, ft2 'n S trench, ft Ma*num design loading rate a _'S bed, gpd/ft %. trench, gpd* Recommended infiltration surface elevation(s) l�0 •'t ft (as referred to site plan benchmark) Additional design / site considerations VI WKJN�, w/ S `K1 S" '1 Stt__11;ctl . In t Ki . I t o�= SANt 1=1 0— Parent material 1_ o S ova `�-��� Flood plain elevation, if applicable N A ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem El [R U ® S El U ❑ S ®U El RJ U [IS C0 U ❑ S M if SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench . >, o - �o K� 3 t — s i t z ►� S b � a, S _ o, S o- 6 — _ e, Z -7 -VS Vzo 31L sit Zw, sbk 1rn`f C>a o S b Ground 3 1 S Z9 31 S) Z vn s b k yv i Gw - o, s CI ° t � -] ft 1 19_� l S 4w 31 c e z.g�R jay SC.� o - — Depth to smiting factor Remarks: Boring # > 0 -1Z V, It 3/3 ST, Zwt0bIT Yh` 0..S Z Z l2 -Zl to�rR 3/t. — S i 1 Z�t sl�h wt �� C& 31y g Zw, Ground GZ z.SyR 3l� elev. Z6 - S ti Q 3 1y a t y G t 3 S c vrr. w►�' 133. ft. Depth to limiting ' factor 2 b'r R emarks: CST Name: — Please Print Arthur L. We erer Phone: 715-425-0165 egierer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: Date: - CST Number: 0 1 b I' -vt'N? gJ9 M00576 PROPERTYOWNER 11 -tMSOw SOIL DESCRIPTION REPORT Page ? 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounckvy Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench' Z Yq WT wx'*f a.S — o. s 0.6 Ground 3 2l - �•S `1R 31 — S Z r►1 S �k f'1 `f �S 0- S ele v. ft. y Z6 -39 S `itz 31 Gz z.s�R 3ry — — Depth to limiting facto Remarks: Boring # x �cq Ground elev. ft. Depth to limiting factor Remarks: Boring # £a Ground elev. ft. Depth to limiting factor Remarks: Boring # z Ground elev. ft. Depth to limiting factor Remarks: PLOT PLAN Pa 3 of 3 SCALE 1 "= L4O ' 1J3V "uesl Llwt` OF 30 Ac+ P V C�i.. iv 3/y ��OITI• Pv C S'lP6 °i .g .3 2S' I N I I J a.� 2s- -� I.J. O O ►.�oT ��"►M�kcT oR O�slvvz3 Tlt 13 111ttVP� � r O `tho►'l6 1 8� Pfr LetrsT 1s�>7 hT Lu"T So' V- J" o c� S 'LlpfLi II lq cis ( 715 1400576 CST Signature Date Signed Telephone No. CST # STC - 10S SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Dennis Peterson MAILING ADDRESS 2612 170 th. Ave. Emerald WI. 5 4 0 12 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY /STATE E M Cg A'V PROPERTY LOCATION NW 1/4, NE 1 /4, Section 12 T 30 N -R 16 _ TOWN OF Emerarld ST. CROIX COUNTY, WI SUBDIVISION LOT NUMER CERTIFIED SURVEY MAP , VOLUME t PAGE 4- 2 �Z , LOT NUMBER 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 (t) 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. 1-Mle, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR Certification stating that your septic has been maintained must be completed a r turned to the St. Croix County Zoning Officer within 30 days of the three yeayexpiration ^ ate i SiGNE DA I1 r St- Croix County 4onmg Office Governnicni Ccntcr 1101 Carmichael Load Hudson- W1 510 . S T C - 100 This appl. cation 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 Dennis peterson Location of property 1/4 NE 1/4, Section 12 , T 30 N -R 1 6 W Township Emerald Mailing address 2612 170 th. Ave. Emerald WI. 54012 Address of site 2 L 5 t t 70 r s Subdivision name Lot no. Other homes on property? -� --Yes X No Previous owner of property d�a Vi d- Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes X No Is this property being developed for (spec house)? Yes X No Volume and Page Number y 2 2 as recorded with the Register of Deeds. ------------------------------------------------------------------- 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 w b-n6r _ e ffice 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 t e office of the County Register of Deeds as Document No. T gna ur o pp cant Co- Applicant 4 , - - - (� - D e of Date of Signature i� _ AWN 4 ucx u MIN I NO. yTATE BA13F "9 11 -1M ii SPACE RESERVED FOR RECORDING OATS ' LAND CONTRACT '( ���� ^� ' tad and Corporate (TO HE USED FOR ALL TRANSACTIONS WHERE OV b ER�I 3Y5 000 I9 ALL FINANCED AND IN OTHER NON - CONSUMER i ACT TRANSACTIONS) REGISTER'S OFFICE 4 ST. CROIX CO., WI j ; Contract, by and between ....................... ! Ree'd for Record n -------- ---- ----------•-------•----•---------•---••----------•-•- ---__- -•--------------- • ----- --- -- -- -- VB II -----------------------------------------------------------=---------- ...--- ,-------- - - - - :- .._ ("Vendor" � � AP 11986 whether one or more) and_.__)Slt�._ ��t�X .SBYI.15�__�4y�4.__. :.._.... '� I Eetersarj- ,._hLisbancL. and.. wJfe,.. aa. survivarst >jR..mar -ital_____ - -_- � al 8:30 A M pra p erty ----------------------------------------- ("Purchaser', whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- hgidN of i Doedt formance of this cc -tract by Purchaser, the following property, together with the rents, grofita, dxtllrea snd other appurtenant interests (all called the "Property"), �_ f in St. roiX - --- --- - - - - -- County, Mate of Wisconsin: 1 ��r „ qr� To ;I o Financial Services � O Os sceo W _54020 Part of the N} of NEJ of Section 12- 30 -16, more parts ula ly descrribed as follows:.` Beginning at the NW cprtler of the W *= ter sec. 12; thence N89 47' 11 "E, 1266.07 feet; thericl S02 24"E to the South line of the NJ of wa, Sec, 12; thence West on said South line to the West line of hEj , Sec. 12; thence North along the West line of said quarter' to I the point of beginning. Part of the N} of NE4 of Section 12- 30 -16, mere particularly described as follows: Commencing at the NW oor!er- of N8 Q1rartw, Section 12; thence N89 11 1758.84 feet to the point of beginning; thence S02 11 E to the South line of the NJ of IQwu Quarter, Section 12 , thence East to the East line of said Section; ther_ce North along the East line to the NE corner of said Section; thence West to the point of beginning, EXCEPT the S 20 Rods of the E 16 Rods thereof. This ....... ig..Wt......... homestead property. OW (is not) Purchaser agrees to purchase the Property and to pay to Vendor at ___Vendor's desig nation --- _ ... ......................... the sum of ;.24.QQQ_.QQ. ....... ............................... . in the following manner: (a) ;.. ..I....... ................................. at the execution of this Contract; and (b) the balance of ;...?.$> 40 .. ................ together with interest from date hereof on the balance outstanding from time to time at the rate of .... en_.?) ...... ............. per cent per annum until paid in full, as follows: I i $1482.96 commencing September 30, 1988 and every March 30th and September 30th thereafter until paid in full. r Provided, however, the entire outstanding balance shall be paid in full on or before the ..... 3Oth-- ----------- day of ---- Marich ......... 2002 ........ 7476X------ ( the maturity date). Following any default in payment, interest shall accrue at the rate of ___19 ___- % 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 it the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after..... Q1Qning. ........... Wx xxxK HQ �6x7dtL�CYr3�2G ]tX�f'3G1lm1fifd5Xb�X�6i31d61FX 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 i of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: NONE Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it Shall be retained by Vendor until the full purchase price is paid. ' Purchaser shall be entitled to take possession of the Property on.... closing x$)m 'Crow Out one. I l LAND CONTRACT — Individual sad "STATE BAR OF WISCONSIN Wisconsin Legal Blank Ca Inc. Corporate FORM No. 11 -4812 Milwaukee, Wu. ; vC. 1L ` Pu O06PA rchaser promises se to pay when due all taxes and asssments levied on the Property or upon Vandoes 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, ex- tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approW by Vendor, in the sum of ;_tLll..insurable_. al m but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covtring the Property shall be deposited with Vendor. Purchaser shall promptly give notice of lose to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances anW regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except :................. ............................... ..--°---------------------------°---------••-•--•-•.....--------------•°-°-»-_.-...---...--•-•---•--...--•-- -................- -•-- -......» » »_. ».... »..._..» .... ta*ieQlenta .._r.>tatr_ip. tknq..md_. of.. remr- d ............................................. _.... »... - -- - . .............................. _._ .............. _ .... _ ....................................................................................... _-........_......._.... 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 --- 6Q... 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 _6Q... days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure w fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for tae entire unpaid purchase price or any portion thereof- or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a qufettitie action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from poasesaion of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under 2, (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of incurred to enforce.any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendencyy of any action of foreclot ure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or ayeitable interest in the Property (by assignment of any Of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediatelydue 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 p ayments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Datedthis ...... _ ............................. day of ------------------ ........................................ •- -• --• 19 ......... (SEAL) _ ..... .............. • -•- •--.......... (SEAL) O I David W. Steinert Vendor is Pete, Purcha r ---- •- ---------------- - - - - -- ..... r ................................ ........... ...... .. .............. (SEAL) .C?.'(SEAL) l oyce B. Peter: 1 P 51 ° r cYla A : --- ......- •- •-- • -• - -- i AUTHENTICATION AC8210WLSI i�[1g111L�0'_�Z Signature( s) ------- ------- --------- ---- •------ --- ------- -- --- ---- S?•ATE OF WISCONSIN J� ••........ ��.. Ay w -• .............•---------.....------•------•----. ....._-- ••---- ...-------- ••• - -• POLK ' •...... w�••`'' ............. . °......- -- -•- - -- ••----County. authenticated this ........ day of. ........... ___ ___ 19 ------ Personally came before me this ...: ..... day of ........... 4,4. X41 ................ 1 19.M.. the above named - ------------- -•---•-•------ -- •-----•-----... _ _.. __...-•- --••-----•- -----•-•-- -- . . .. .. ........ ........ .... .... .. .. __W. Stnet, Dennis • __Pgg$, - _ TITLE: MEMBER STATE BAR OF WISCONSIN oyce . Peters�q .... ....... .................... (If not- ------- ------- -•----_- ----- -- --------- -- ---- ---- -•-- - ----- --°--°--------------.-•••°-----•--•-------•-•--°-_..................---- authorized by $ 706.06, Wis. State.) to me known to be the person s...._...__. who executed tftm. foregoing instrument and 4anowledge the same. s THIS INSTRUMENT WAS ORAFTEO BY • .. LAUX LAW CFI:ICE, 215 - _Cascade St., Helen M. Lund ren : � .............................. �_._._ - T- -' P.O. Box 456 Osceola WI 54020 _ " _ ...................... ......•-------•----•----'- -- ---......-• °•- ----......•.... Notary Public - --•-•..... 9lk _.__ ................... County, Wis (Signatures mlly be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) 4 ............................. *games of persons sirnina in any capacity should be typed or printed below their signatures. LAND CON" krT — Individual and Corporate — State Be, nt wl.reneie Po -+• *to. 11 — 198`