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HomeMy WebLinkAbout016-1069-30-000 0 Cl) O g T C7 Cj O °' f r W O n 3 (D 1 d N CA A C7 0 O m O O A CD < A O CD c x l CD OD O. 7 O. CCD N V * O _ j (D C PI (D N O O 0 CD :J N fD CA ? p_ CD O O O O OD W N Ci C p O O W W A7 N N N O O O D A a ° O rn m CD N P. m CD N C O C CD -4 7 m to o n r N CD n II r a_ �I Z oZ 000', Me _ _ N fp fA O N� ? Q T O O a 0 D G) O pl N CD O i O1 N 3 d �, CL N A z o z z w O D D G v O c Q• CD a �� I � i l�l i C a 3 Z CD -1 y cn O A Z n A z O N C) 7 G G U) M Ill W N O O O o zt A. z c 3 O N Z w CD D CL CL 7 T z 'c, p .. CD Z N O II I � ti O I Iv O O V I A � N O O '-h CD Olt v cfl O I o t ti i ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner e! f) A /,S, d ez e R Property Address I> e- 1Z— City /State C L (s t/ oo C f► j k Legal Description: Lot — Block — Subdivision/CSM # l S21-, ' /a , ' /., Sec.,L,2 TAN -R /, W, Town of PIN # /6 - /e SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: N p u> N �N , Tank manufacturer /o��� �S "fG� / l A/ Size ST/PC / ,,?e o / 22eo Setback from: House � Well P/L ; Pump manufacturer C o W L d Model J--� !� Alarm location 4�-A s &- M to & 1 ' (HOLDING TANKS ONLY) Setbacks: Service road en sh air-intake "" - - Water I;ine Meter location ___ -- Alarm locati on- ----- SOIL ABSORPTION SYSTEM Type of system: Ma U N d Width Length Number of Trenches Setback from: House ' Well PI ' Vent to fresh air intake -f f ELEVATIONS Description of benchmark re� p o yell 6v /f a/ // _ Elevation Description of alternate benchmark _7` CP t, l Elevation 16L �U Building Sewer a 3 ST/HT Inlet 3 ST Outlet PC Inlet PC Bottom Header/Manifold �., t7 Top of ST/PC Manhole Cover e) Distribution Lines q /, t? l ( ) ( ) Bottom of System y (? , ,� ? () ( ) Final Grade (/) / 1 7.x- O ( ) Date of installation �/ / //� Permit number State plan number Plumber's signature License number Date Inspector Complete plot plan � x NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW N l ,SRN(H © fo P o 0 s y I I� I INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST . CROEX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344572 Hold 1 M, NCHeRISTOPHER ❑ Cit aN ( Town of: State Plan ID No.: U �(J� CCii 3 8 CST BM Elev. - - Insp. BM Elev.: BM Description: Parcel Tax No.: C am - s ; ► Z t F 016- 1069 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV. Septic Z�0 StrD Benchmark -42 $,a3 �(�• A0 �6�i Dosing # Z_ % �3 �• 6 Aeration Bldg. Sewer - 7 q, 2 .3 8 3 Holding St/ Ht Inlet �$ �- �'}. - 4-3 TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Air I to ntake ROAD Air Septic 110 a I I NA Dt Bottom 2. 1 Dosing u f( .2 NA Header / Man f 0 f , Aeration NA Dist. Pipe Holding Bot. System ' 9 p, 2,+ PUMP/ SIPHON INFORMATION Final Grade 5 Manufacturer a ft Dema Model Number r9 o21 g P gs, 93 TDH Lift ,'S Lriction -,0 Syste�`,; TDHC(A Ft ea d oss Forcemain Length ` Dia. 2n Dist. To Well SOIL ABSORPTION SYSTEM 4E'D T ENC Width , Length f No. f T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN N S DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Typeof Model Number: System: (N -3 O 5 �fe�' OR UNIT DISTRIBUTION SYSTEM 5 Header/Manifold u Distribution Pipe(s) u x Hole Size x Hole Spacing Vent To Air Intake Length Dia - Length Dia. 2 Spacing ( rr �� 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.) $1 S �sv LOCATION: G 32.30.15.483 2836 QTY_ RD��D . LJ Plan revision required? ❑ Yes ❑ No _ Use other side for additional information. t� E x SBD- 6710(R.3/97) Date Inspector's Signature 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: . . e � F , x � e E e , x s b S F e } E c � e i l 3 { E g p F I b � P a � f 1 F f I e 3 S r R S _ � '.^ ......E 3 ... a.. ............. ''m,e. ,. .. _. e. , .... .. ..... $ e s i , p .. ..... w,n .e.a .... ......: .. ® mm r , e .. m � i °j x f i 3 i e.....__...... ,ad..W .._, a_, an W �,�,...�.... N ...-. ..... �., ,.._.� .me €. ... .... ._ ,. i ......... k.. ......,..E._... 3..., 4 [ f y f x _ { y pp x 3 � � i � e mm ,m m� e..m.� .. ..— �.. t a r t 3 d t eem, a:.. P F ._ . x r r , e e e .. ®® .... � 3 , Safety and Buildings Division Ai scons i n SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 3 4/yr'?'Z Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 9 Property Ow r Name / Property Location f0 e 4 D /� 1/4 Y W 1/4, 5 J ?a T �p , N, R (3' IM W Property Owner's M il�g A dress Lot Number Block Number C , St to Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned E] ity Nearest Road t� Public 1 or 2 Family Dwelling - No. of bedrooms O Town OF o1 40 RO/ T/ 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 2- 3 o • is . $3 1 [] Apartment/Condo O /v ` /10 v '? 10 a D 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_ E] Replacement 3. ❑ Replacement of 4. E] Reconnection of 5. ❑ Repair of an - _____System ________System _____________ Tank Only______________ Existing System ________ 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 JyMound 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 6o 0 � D a l • Z- D� .2.3Feet Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I j X I Do / P4 e, 4.S ❑ ❑ ❑ ❑ ❑ 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 tamps) MP/ o.: Business Phone Number: Zu �_M t� I Plumber's Address (Street, City, Sate, Zip Code): � W v lu oo a 6 i 3 0 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundw Adverse Determination Issui Age t Signature (No Stamps) Surcharge Fee) A roved Owner Given Initial �PP ❑ V `�'w X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 IRA 1/97) 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 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 count x riortoinstallation 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 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. 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 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. ---------------------------------------------------------------------------------------------- - - - - -- "'VROUNDWATER 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. Safety and Buildings 1 15837 USH 63 HAYWARD WI 54843 -8107 TDD #: (608) 264 -8777 Viscons www.commercestate.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary July 01, 1999 CUST ID No.222234 ATTN' POWTS INSPECTOR ZONING OFFICE �, r GALE W SMITH ST CROIX COUNTY SPIA'.� 3228 HWY 170 1101 CARMICHAEL RD C0 11 w? GLENWOOD CITY WI 54013 HUDSON WI 54016 1 RE: CONDITIONAL APPROVAL o, APPROVAL EXPIRES: 07/01/2001 Identific ` rs BAR ?Ms Transaction ID N .233339 Site ID No. 175383! Please refer to both identification numbe SITE: C th U Site ID: 175383 above, in all correspondence with enc . y ST CROIX County, Town of GLENWOOD; CO HWY DD, GLENWOOD CITY 54013 SE1 /4, SWIA, S32, T30N, R15W Facility: CHRISTOPHER ULLOM CO HWY DD, GLENWOOD CITY 54013 FOR: MOUND SYSTEM, 600 GPD Object Type: POWT System Regulated Object ID No.: 476673 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. 4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). 5. On page 2 of 5, the cross section is showing a bed type mound, which is incorrect as the designer proposes to install a trench type system. A copy PP 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincere , DATE RECEIVED 06/18/1999 FEE REQUIRED $ 180.00 �i..�. FEE RECEIVED $ 180.00 ATRICIA L SHANDORF , POW PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WSMART code: 7633 1 Lv 40t I r4 -�- T -- - - - - - - - - - � l e Pae TF- i 1 1 3 , i } I �",nP o <Low fee P s /6 , -L ! I WESTSURNE SUPPLY INC. /�e- 12 DUSTRIAL RD. Goulds ON, W1 54016 Submersible Effluent Pump 38 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. tic cover with integral handle Motor: Available for automatic and • Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical RP points. • Water transfer 230 V, Hz, 1550 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. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload w ith construction. ■ EPO4 Impeller: Thermo- • 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. SP Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: 1'/2" 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 "F" or "AC ".) rotary/ceramic - 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 • Capable of running I dry without damage to s ao' t � components. Pump: EP05 $ 2.5 FT j • Solids handling capability: 0 251 -- - -�-- 1 /4 " maximum. w • Capacities: up to 60 GPM. s 20 i- - - -- - -- — - • Total heads: up to 31 feet. g � • Discharge size: l '/2 " NPT. Z s j • Mechanical seal: carbon- 0 15 rotary/ceramic- stationary, _j 4 ~ 4 �_ - - - -- - --- - -� - -- .� - - - -� - I - EPOS'_. _. • Temperature: a 10 104 °F (40 °C) continuous _ 140 °F (60 °C) intermittent. 2 EPO – 0 00 10 20 0 40 50 GPM 0 2 4 6 8 10 12 m -/h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 83871 - Wisconshl Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page / of Division of Safety and Buildings in ac ance iWth­s,. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 .1 es i sizeffllan must County include, but not limited to: vertical and horizontal refer faoe point (B and percent slope, scale or dimensions, north arrow, and a on and d arest road:\, Parcel I.D. # 0 f� Q /off -30 APPLICANT INFORMATION - Please pr' tall infora�ai�igg /x i R vi e b Date Personal information you provide may be used for secondary p�rpos@s ( b�15.04 (1) (ryE 6 l C Property Owner e, Prr ocation 1145W 1 /4,S T gO ,N,R 06r) W Property Owner's Mbiling Address � : _..E_ of # f til ck# Subd. Name or CSM# o S City State Zip Code Phone Number Nearest Road / �. 0-23 (J1-r) V 9� �` city Village Town ® New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 o gpd Recommended design loading rate Y bed, gpd/ft *.?" trench, gpd/ft Absorption area required _ _ bed, ft O D trench, ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 9e" a_r ft (as referred to site plan benchmark) Additional design /site considerations y– Parent material C /f C / iR �. / / Flood plain elevation, if applicable N ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ®U I ® S ❑ U ❑ S Emu I ❑ S ® U ❑ S ® U [ W U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench DE .7 o S11. 9 j Af RVER .4 S 1.7,cl ,d �L 1712Y — sa 1a,4,6&m M F GS vdc - Ground / /r M M E -r Nk , N A �e ev. Depth to limiting factor . -7-in. Remarks: Boring # 1 1 0-1 M s s4khj Al v r A 3 a5' ; .d og_ �L A_?j - 911flYRIVAI 5 2 hlr GY lv'r 16/ ` s 2A14KAi MF-r NA Ground elev. rul 1 ft. Depth to limiting factor j in. Remarks: CST Name (Please Print) Si nature Telephone No. Address Date CST Number .mow / �d�e��.vo o a/ e !, ��.s' 01 /�* 98 / '>� r L PROPERTY OWNER 1 a 11 ® OIL DESCRIPTION REPORT Page of � / ,+ / PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 u` D S 0 Sj A M Al VER A S S .5� d 9 �6 I Sore 7 Ground L & I lev. Depth to limiting factor Remarks: Boring # k ' Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; Ground elev. ft. Depth to limiting factor in. Remarks: Boring # ; Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) _o s r - �_ - A A, -ter -- -- -- - — ! -- - - -- -- -- �_ -- o -- e- - -- — -- —� - - —� -- I- -� - - - — — —� - -- - 1 w - -- I i % _Q - - -- -- 1 - -, -- - -- - - - -- - o L- - -1 - - °- 'e' - -- -- - - - -- - - -- - -- - -- -�--- rDp i 9 P i I , i 1 i I , ' i r i i , I _ _ I , I I i I I } , , I ' �- i it t t I r _ pp— ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bwfer- Mailing Address Property Address Cf (Verification required f Planning Department for new construction) / City /State arcel Identification Number .l4 O ` .�O •- � 4 0 LEGAL DESCRIPTION Property Location � V,, s'kl ' / <, Sec. ,�, T�N -R W, Town of �� e/C� AJ D .Oo� Subdivision , Lot # Certified Survey Map # ----- . Volume , Page # Warranty Deed # J O. �� , Volume 1; Page # � Spec house ❑ yes g no Lot lines identifiable ❑ yes X 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 mas r lumber, journeyma lumber, restricted lumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system to � P P P P �J YAP 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 must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. �L Pil U&-- A /197/99 GNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed CUMENT NO. LAND CONTRACT tJ a: VO T243 PACE 1TI ST CK:X C D ., w l IwCd fw Ra a4 JUN 2 1997 Contract, by and between William C. Ullom and Louise Ullom, as 1C9 9: 30 A.M survivorship marital property ( "Vendor ", whether one or more) and Christopher M. Ullom and Melissa A. Ullom, husband and wife, as survivorship marital property ( "Purchaser ", whether one or more). Vendor - sells and agrees to convey to Purchaser, upon the prompt and full performance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property ") in St. Croix County, State of Wisconsin: RECORDING INFORMATION ............................... The South 1/2 of the NE 1/4 of the SW 1/4 and the SE 1/4 of the SW 1/4, NAME AND RETURN ADDRESS both in Section 32- 30 -15. Bakke Norman, S.C. See additional provisions on Attachment. 900 Main Street Baldwin, WI 54002 RA ht, � Oct 016- 1069 - 20.016- 1069 -30 This is not homestead property. (Parcel Identification Number) Purchaser agrees to purchase the Property and to pay to Vendor at 2955 County Road DD, Glenwood City, Wisconsin, 54013, the sum of $36,000.00 in the following manner: (a) $ -0- at the execution of this Contract; and (b) the balance of $36,000.00, together with interest from date hereof on the balance outstanding from time to time at the rate of 6.31 per cent per annum until paid in full, as follows: The sum of $250.00 per month commencing 30 days from the date hereof, plus all sums received or to be received by Purchasers from the Conservation Reserve Program (CRP). Provided, however, the entire outstanding balance shall be paid in full on or before the 31st day of May, 2002 (the maturity date). Following any default in payment, interest shall accrue at the rate of 8.5% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). 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 date hereof. 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 h *m. Purchaser states that Purchaser is satisfied with 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. Wiscrosin D epartment of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings Ce with s. ILHR 83.09, Wis. Attach complete site plan on paper not less th I/ 11 inc s in sie; @I must County r include, but not limited to: vertical and horizo eren dir nd percent slope, scale or dimensions, north ar vvi nd loca nce t aeq est road. Parcel I.D. # G 0/ APPLICANT INFORMATION - Pie se`o int all n tlbn. Re awed by Date Personal information you provide may be used for sgcon' ry purposst@ +pW Law, s. ) (m)). �/ • •g� Property Owner roperty Location '> ! 1b Govt. Lot S e 1/4s' 1/4,S3 ? Tao ,N,R �� 0"r) W /!E td 4Meq Property O wneesMaUfhg Address ti's Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number Nearest Road o6 02 (,7� j )' j rl� El cit Gi � Village � Town D X New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate ! 2 bed, gpd/ft o -3 trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate _ bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) �.� o It (as referred to site plan benchmark) Additional design /site considerations 'Pe tteM 0 0 1 t - S �/n M e " Parent material 64 /l Q /A L Z_ Flood plain elevation, if applicable ,I�� ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S (,X U ® S ❑ U ❑ S 0 U ❑ S [o U [:IS LV U ❑ S & U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench � t o - 3 -- S' �Z 6 .� .6 1 4 e M Fes' v Ground I- f F C t elev. � ; y � Depth to limiting factor 3_in. Remarks: Boring # I or! to YR 2Z1 — /4 j_s MFR d S A-1 •.s';,L d 2 2- 11 Sa / - '*1 /<M M r GS ! � -1 s6 d_, ME LT 2 •3 Ground elev Depth to limiting factor 2-?--in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number 3a� f //4/ / G eNki c ^ 7'' �i oi.� - PROPERTY OWNER CA Res' U1,401.4 Page DESCRIPTION REPORT � "� Page 2 u PARCEL I.D.# 0/ O /10 6 9" 20 I Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench dL �o•• �' L e t I �F , '� Ivev Ground ��JT' A 6 /rC . e l ev. , ft. Depth to limiting factor Remarks: Boring # 5 a C ti Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; F .. Ground elev. ft. Depth to limiting factor in. Remarks: Boring # I Ground elev. ft. Depth to limiting factor ' Remarks: SBDW -8330 (R. 08/95) de Ad Tf 13 r � t C� -i � � i q A4 It v j I S IP 0 hA S-s I i , i G ' I I I t- I I i -- - - - - -- - -_ - ! - I - - - - - - -I -- -- - - - 4 - -- - - - -- 1 � I i i . I I _ -- , I' �_. -- -- - -- - -- - -- - - -- i -- r