HomeMy WebLinkAbout020-1067-90-000 r
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353170
Permit Holder's Name: ❑ City ❑ Village ❑xTown of: State Plan ID No.:
Diversified Invest ents of Hudson I Town of Hudson
CST BM Elev.> Insp. BM Elev.: BM Description: Parcel Tax No.:
1 m • a P uL = C �3 •+� 1- 020 - 1067 -90 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic O Benchmark S S Z oS: aU . 0
Dosing Alt. BM , Q O �o Z• fit`
Aeration Bldg. Sewer
Holding St /Ht inlet
TANK SETBACK INFORMATION St/ Ht Outlet S • O Z
TANK TO P / L WELL BLDG. Air t to ntake ROAD Dt Inlet —�
Air I
Septic 7 3 O ` �' NA Dt Bottom —
Dosing NA Header /Man. IZ.:H
2.8 �
E 13.31
Aeration NA Dist. Pipe c 1 • 3(, L.!
Hold i Bot. System E I }
LJ
PUMP / SIPHON INFORMATION Final Grade "eAA ' 2 - 9T.'4 -0
SA 6•f(
Manufact Demand St cover �,, L o r OO.
Model Number GPM
r TDH Li Friction Sys TDH Ft
oss 4 orcemain Length Dia. H Dist.Towe
SOIL ABSORPTION SYSTEM
B/ EN Width , Leng , N Of enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 7S DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING M
urer:
SETBACK CHAMBER h�iYO
INFORMATION Type Of , Mo a Number:
System: C 01VIV . $ f S p I OR UNIT
DISTRIBUTION SYSTEM
Header/ Manifold 4 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length �� Dia. "t /
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/Tr nch Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: /mob Inspection #2: - -
Location: 847 Polen Drive, udson, WI (NE1 /4 Z
j SE1 /4, Section 24 T29N -R19W) - 24.29.19.258B i
Plan revision required? ❑ Yes No
Use other side for additional information_ C
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
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F Safety and Buildings Division
,-'` `SANITARY PERMIT APPLICATION �1 201 W. WashingtonAvenue
JI O Box 7302
Department of Cor 4 ,, -i In accord with Comm 83.05, Wis. Adm. Code
ns
"` O Madison, WI 53707 -7302
• Attach comple P (to ty copy only) for the systerxl, ora paper not less, co my ST, ��� If
than 8 tie x 11 i in `M9RINGOFFICE,
• See reverse side fo i S�trWLtions for completing this applilc +on t, _ I ! S to Sanitary Permit Number
Personal information you provide be used for secondary purposes
[Privacy Law, s. 15.04 (1) (m)). ; ,r eck if revision to previous application
k.
,-. , Sta_tte Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT A E F R �
N =
Prope Owner Name � s. r� rt Location p
rl T ere ;Fd .�t c. ( roC ,, .."'i�a'::�` '. v4, S "` T �`r r Nr R f ( E (or
Property Owner's Mailing Address Lot Number Block Number
E
C ity, S tate Zip Code Phone Number u ame or CSM Number
-0r C S'� . 1A,, (13
3 32
II. TYPE OF BUILDING: (check one) ❑ State Owned it Neare Ro
❑ e srG dlC°
Public 1 or 2 Family Dwelling - No. of bedrooms � T OF 1 1
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) a �. I ' %
1 ❑ Apartment/ Condo 0,;2- — /OG 7 , Vt7
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 _ ______ ______Tank Only Existing System
-------------- Existing System ___ -____
B) E] 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 i
VI. ABSORPTI 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
� 1 7 U 75� _ Feet i - Feet
Cap acit y
VII. I NFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- steel Fiber- Plastic Exper.
New Existin Gallons Tanks Concrete glass App.
strutted
Tanks Tanks
Septic Tank or Holding Tank �� ( /et ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' Name: Print Plumber'sSign ture: No Stamp) MP /MPRSW No.: Business Phone Number:
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Plumber's Address (Street, City, State, Zip Cod _-
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IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved S itary Permit Fee (includes Groundwater ate ssue Issuin Agent Signature No Stamps)
Ap ❑ Owner Given Initial
A roved Surcharge Fee) .�
Adverse Determination a5� 11 0-0-
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
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SBD -8398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings 15i.ision, Owner, Plumber
INSTRUCTIONS '
1. A sanitary permit isvalid 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 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.
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;
8) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction4oss; 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.
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Wisconsin Department of Commerce SOIL AND SITE EVA �"'� Page 1 of 3
Division of Safety and Buildings /�
in accord with Comm 83.0 Ai#m C e A
A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must County
include, but riot limited to. vertical and horizontal reference point (BM), direction afxr Y
t- l St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to r road. Parcel LDW
APPLICANT INFORMATION - Please print all in Ye P Y secondary purposes (Privacy � f wmatron. 020- 1067 - 90-000
Personal information u provide may be used for seconds Priva Law, s.'15.04 (1) (m)) n Y Da� t q
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Property Owner Property LC% n
Diversified Investments Of Hudson GoJ&,Lot '6 4 S 24 T 29 N,R 19 W
Property Owner's Mailing Address Lot # \ � Bloch# S' N Oa or CSM#
11950 12th Ave. 4 ° ` CSM Vol. 13, P . 3632
City State Zip Code PhoneNumber ❑ City ❑Village ❑Town Nearest Road
Burnsville MN 55337 612- 882 -0574 Hudson Polen Drive
❑ New Construction Use: ❑ Residential I Number of bedrooms 4 [-]Addition to existing building
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpoff -8 kendl, gl
Absorption area required 857 bed, ftz 750 trench, ftz Maximum design loading rate .7 bed, gpdff .8 trench, gpdff
Recommended infiltration surface elevation(s) 91.00' ft (as referred to site plan benchmark)
Additional design I site Considerations Install trenches using high capacity infiltrators. Previous soil evaluation report completed 421/99 for this site.
Parent material Outwash s & gr. Flood plain elevation, ff 'cable NA ft
S for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ® S ❑ U ❑ S ® U ® S ❑ U ® S ❑ U ® S ❑ U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring# Horizon
Depth Dominant Color Mottles Structure GPD/ft'
in Munsell Chu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1 1 0 -6 10YR3/2 Non gr. sl 1 f cr mvfr gs 2f &m 0.4 0.5
2 6 -22 10YR4 /3 None gr. sl 2msbk dsh cs ?f,m &c 0.5 0.6
Ground 5 0.
Ground 22 -38 10YR4 /4 None gr. A 2msbk dsh cw 2f &m -0.7 0.8
elev
95.71' ft 4 38 -109 10YR6/4 None strat. s 0 sg dl - if 0.7 0.8
Depth to
limiting ' Y ot
factor
>109' - -
Remarks: Horizons #4 consists of approx. 10 -15% cobbles and stones.
Z 1 0 -6 10YR3 /2 None gr. sl 1 f cr mvfr gs 2 € &m 0.4 0.5
2 6 -20 10YR4/3 None gr. sl 2msbk dsh cs ?-fm &c 0.5 0.6
Ground 3 20 -46 10YR5 /4 None sl 2msbk dsh cw If &m 0.5 0.6
elev
96.03' ft 4 46 -113 l 0YR6 /4 None strat. s 0 Sg dl - if 0.7 0.8
Depth to
limiting 2
factor' �S
>113"
Remarks:
CST Name (Please Print) Sign re: Telephone No.
James K. Thompson / (7)S 20 7767
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
10/5/99 3&OL 1115
t
'PROPERTY OWNER: Diversified Imestments SOIL DESCRIPTION REPORT i Page 2 of 3
PARCEL LDJ 020- 1067 - 90-000 AC.E. Soil & Site Evaluations
Depth Dominant Color Mottles Structure GPDHI
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz, Sh. �o nsistence � Boundary Roots
Bed I Trench
3 1 0 -7 10YR3/2 None gr. sl 1 f cr mvfr gs 2Mm. 0.4 0.5
2 7 -25 10YR4/3 None gr. sl 2msbk dsh cs 2fm &c 0.5 0.6
Ground
elev 3 25 -56 10YR5 /4 None sl 2msbk dsh cw I f &m 0.5 0.6
96.51' ft 4 56 -119 10YR6 /4 None strat. s 0 sg dl - if 0.7 0.8
Depth to
limiting
factor
>119'
Remarks: Horizons #4 contains approx. 10% cobbles and gravel.
4 1 0 -7 10YR3 /2 None gr. sl - _ mvfr - - - -
2 7 -25 10YR4/3 None g. sl - dsh - - - -
Ground
elev 3 25 -74 10YR5/4 None A - dsh - - - -
98.95' ft 4 74 -115 10YR6 /4 None strat. s - dl - - - -
Depth to
limiting
factor Soil evaluation for replacement area conducted with hand auger. Loading rates not calculated due to inability to determine structure of soil. Horizons # 4
>115' & 5 would have 0.7 / 0.8 loading rates if a morphilocal evaluation were completed.
Remarks:
5 1 0 -8 10YR3 /2 None gr. sl - mvfr - - - -
2 8 -30 10YR4 /3 None gr. A - dsh - - -
Ground
elev 3 30 -77 10YR5 /4 None sl - dsh - - - -
100.16 ft 4 77 -118 10YR6/4 None strat. s - dl - - - -
Depth to
limiting
factor Sal evaluation for replacement area conducted with hand auger. Loading rates not calculated due to inability to determine structure of soil. Horizons # 4
>118" 1 1 would have 0.7 / 0.8 loath rate if a morphil evaluation were completed.
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
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/jc%s" see -.2 i .29iI� 950
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5�. er^oik L�o.� cJ�. 55337
SYSTEM ELEVATION AND SIZING CALCULATIONS
Below Grade Chamber Soil Absorption Systems
Permit Number 10/18/99 Date
x °x. Gravity Distribution
only 1 Pressure Distribution
3 ft Suitable Soil , Note 1: Bury depth as per manufacturer
18 in Chamber Height 2
8 ft Maximum Bury Depth 3
600 gpd Estimated Daily Peak Flow
0.80 gpd /ft Wastewater Infiltration Rate 750.0 ft Code SAS Size
40 % Down Sizing Credit 300.0 ft Reduction ( -)
450.0 ft Min. SAS Size
91.09 ft Proposed SAS Elevation
Soil Surface Acceptable Finished Grade EL 4 (ft)
Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum
Number Elevation (ft) Depth (in) Lowest Highest Elevation? 94.09 100.59
1 95.71 109 89.63 93.54 Yes
2 1 96.03 113 89.61 93.86 1 Yes
3 96.51 119 89.59 94.34 Yes
1. Depth of suitable soil required below the infiltrative surface for treatment.
2. Total height of chamber in inches.
I Maximum bury depth as per manufacturer's recommendations.
4. Based on chosen system elevation, and chamber height. Top of chamber is
equivalent to top of aggregate. The addition of fill for cover or the reduction of
finished grade may be required to meet minimum or maximum code standards.
SBD- 10553 -E (R.05/98)
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
A.C.E. Soil &Site Evaluations
Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal referee nt (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, ocat�ron a i stance to nearest road. Parcel I.D.#
ty \._. 020- 1067 -10 -000
APPLICANT INFORMATION - p s` tint all informiion.
nda Re ' w d Dale
Personal information you provide may be us ry rpell�s (Privacy Lava, s. 15.04 (1) (m)). -
.n
Property Owner _ - Property Location
Scott Dornseif 1u ,r` ovt. Lot NE 1/ 4 SE 1/4 S 24 T 29 N,R 19 W
Property Owner's Mailing Address -,. -I - of # Block # Subd. Name or CSM#
843 Polen Drive rX f'....' ` 4 NA Proposed CSM
City State p 04RNR r r e ,, [� City [] Village ETown
membe Nearest Road
Hudson WI Hudson Polen Drive
New Construction Use: Res ti I / rooms 3 ❑Addition to existing building
❑ Replacement Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpolft .8 trench, gpolft
Absorption area required 643 bed, ft 563 trench, ft' Maximum design loading rate .7 bed, gpd/ft .8 trench, gpolft
Recommended infiltration surface elevation(s) 97.4 uppper trench,95.4 lower ft (as referred to site plan benchmark)
Additional design 1 site Considerations stall trenches using high capacity infiltrators. Site must be cut to reduce slope to < 20 %. Ste oofe4c r
Parent material Out wash s & gr. Flood plain elevation, if a licab WA ft
S for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ❑ S ❑ U ❑ S ❑ U ® S ❑ U ❑ S ❑ U ®S ❑ U ❑ S ❑ U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPDIft
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed Trench
1 1 0 -7 10YR3 /2 None gr. sl 1 f cr mvfr gs 2f &m 0.4 0.5
2 7 - 10YR4/3 None gr. is o sg ml cs ?f,m &( 0.7 .08
Ground 3 21 -40 10YR4 /4 None gr. s o sg ml cw 2f &m 0.7 0.8
elev
102.40 ft 4 40 -113 10YR6/4 None strat. s o sg ml - if 0.7 0.8
Depth to
limiting
factor 0
>113
Remarks: Horizon #2 &3 consists of approx. 10 -15% cobbles and stones
2 1 0 -6 10YR3/2 None gr. sl 1 f cr mvfr gs 2f &m 0.4 0.5
2 6 -22 10YR4/3 None gr. is o sg ml cs Zf,m &( 0.7 .08
Ground 3 22 -38 10YR4/4 None gr. s o sg ml cw 2f &m 0.7 0.8
elev
97.84' ft 4 38 -109 10YR6 /4 None strat. s o sg ml - if 0.7 0.8
Depth to
limiting p`
factor
>109 loS ti
Remarks: Horizons #2 & 3 consist o 10 -15% cobbles and stones.
CST Name (Please Print) Signa re: Telephone No.
James K. Tho mpson 715- 248 -7767
Address A.C.E. Soil & Site Evaluations Date CST Number Ref#
340 Paulson Lake Lane, Osceola, WI 54020 4/21/99 3602 1004
PROPERtYOWNER: Scott Donmif SOIL DESCRIPTION REPORT Page 2 of
`PARCEL I.D.# 020-1067-10-000 A.C.E. Soil & Site Evaluati ns
Depth Dominant Color Mottles Structure Consistence Boundary oots GPD/ftz
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ry Bed Trench
3 1 0 -8 1 OYR3 /2 None gr. sl 1 f cr mvfr gs 2f &m 0.4 0.5
2 8 -13 10YR4 /3 None gr. Is o sg ml cs 2fm &c 0.7 .08
Ground
elev 3 13 -38 10YR4 /4 None gr. s 0 sg ml cw 2f &m 0.7 0.8
102.37 ft 4 38 -116 10YR6 /4 None strat. s o sg ml - if 0.7 0.8
Depth to
limiting
factor
>116
Remarks: Horizons #2 & 3 consist of approx. 10 -15% cobbles and stones.
4 1 0 -6 10YR3 /2 None gr. sl 1 f cr mvfr gs 2f &m 0.4 0.5
2 6 -16 10YR4 /3 None gr. Is o sg ml cs 2fm &c 0.7 .08
Ground
elev 3 16 -34 10YR4 /4 None gr. s o sg ml cw 2f &m 0.7 0.8
94.93 ft 4 34 -93 10YR6 /4 None strat. s o sg ml - if 0.7 0.8
Depth to
limiting
factor
>93
Remarks: Horizons #2 & 3 cosist of approx. 10 - 15% cobbles and stones.
5 1 0 -8 I OYR3 /2 None gr. sl 1 f cr mvfr gs 2f &m 0.4 0.5
2 8 -13 10YR4/3 None gr. Is o sg ml cs 2fm &c 0.7 .08
Ground
elev 3 17 -31 IOYR4 /4 None gr. s 0 sg ml cw 2f &m 0.7 0.8
93.98 ft 4 31 -96 I OYR6 /4 None strat. s o sg ml - if 0.7 0.8
Depth to
limiting
factor
>96
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
SOIL AND SITE EVALUATION 1004 Page � of $
PROPERTY OWNER: Scott Dornseif
PARCEL I.D.# 020 - 1067 - 10-000 A.C.E. Soil & Site Evaluations
REPORT MEMO
Due to e)asting woody vegitation and severity of slope, borings #4 & 5 were completed by hand auger. Slope in the
area of B - 1 to B - 5 ranges from 20 - 25 %. Plumbing contractor will need to alter slope prior to constructing system
and must finish grade site to be in compliance with Comm. 83.09(3) and 83.10(7).
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ST CRO)X COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 1 ve /'Si ��'e o/' �� 'fin �� �, f / U 0 C',
Mailing Address l�✓ �� j`' Svc (, S33 7
Property Address 1 -- fir
(Verification required from Planning Department for new construction)
city/State Parcel Identification Number
LEGAL DESCRIPTION
Property Location N %,, �Gf %,, Sec. �' T - �' W, Town of gd3 o -�
Subdivision L5 111 Z p 3 6 Lot it
Certified Survey Map # �o � a� � �a _ vohuae , ��_ 2 Page # 3 � 32
Warranty Deed # _ 601?a4l volume /W _ page # 6 3(
Spec house 0 yes 0 no Lot Imes identifiable 0 0. no
SYSTEM 1ViARC=ANCE
mousemdnm eofyonrsqftsygemconldresait in. its; &am to handleRnstes.Ptopecmamftanoe
consists of pumping oat the septic tank every three years oc soomr if needed by a Iieensed pugw. What yon pmt into the system
can sffact the fm�n of the septic t�mlcas a tnrataxmt stage is the rvssoe dupoaai sy:bem. .
The pt+oQecty oWna agrees to submit to St. Crok Z=iog D a oertifiabion fom>, signed by the ownac and by s
?
PIUMAC4 7oowcy=nP edpbm dworaheewedpm* cvr. dfyingdnt( I) ffieon- site :ste�vatadisposalrystem
is in pmPU operating condition and/or (2) after inspection and pamping.(if necessary), the septic-tm* is less than 113 full of sludge.
Uwe. the Undersgaod Lame read the above requirements sad agree to msiatsin fie private sewage disposal system with Hue s
wt forth, hrrein,'as set by fire Dgmt=m t of Comm= sod fie Department of Nadu:t Ra m=es, State of Wisconsin. Minn
stating Wtd Your septic system has been maintained aunt be Completed and retumed to the St. Croix County Z,onh% Offix within 30
d: three year lion date.
/0 I i 9y
SI TURE O APPLICANT DATE
CER CA ON
I (we) certify that all statements on this form are tme to the best of my (our) knowledge. I (we) am (are) eho owner(:) of
q descxibod . by virtue of a warranty dead recorded in Register of Deeds Office.
li d
TURF 9t APPLICANT DATE
« « «« Any information that is mizvapresentedmaymult in the sanitary permit being revolted by the Zoning Department. « «ssss
ss Include with this application: a stamped warranty deed firm the Ragistet of Deeds office
a Copy of the certified survey map if referent is trade in the warranty deed
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STATI M
1=2NMCT
e ars
KATI He VAL
USED FOS. AU TUANUCTOM WMU OVIR
REGISTER W
DOCUMEW t4m
ACT TRANSAMONS)
ST. CRUX V1
FIR
C04tf&d by antl betweett Scott A. D=Mif ard Erin S.
Do�if hZ;;SWr;d and wife
iu Ln CMMKT
Whether I am M -gifiAti Tryveghnents of
Huds6A. CM CRT FEEs
CM Fffs
Mrchaseer", whether one or more). IMM FEEs 114.01
N�rfi# V j&rM tf) Co�kyq to Puirbaser, upon the prompt and full performance EMUS FUt V-0
Of two contract the Wowft propem together with the r d * M a ts ,
flaur" and other appurtenant Interests (all called the Troperty). in
St. Croix CounrA Sum of Wisconsin:
THIS SPACE AESERVED FOR PACOOW04G DATA
NAME AND RETURN ADDREU
Dsvid J. Estreen
304 Locust Street
Hudson WI 54016
PAWAL OEN'nFICATION NUMM
Vat part of W-kSEk Sec. 24-T29N-R19W being part of lot 1 of Certified Survey Map
rec 3 page 784 described as follows; Lot 4 of Certified Survey Map
=ded in Vol
recorded in Vol 13 of Certified Survey Maps, page 3632 as Doe. No. 602260.
This is not homestead property
xft (b
ftMJMer agrees to the Property and to pay to vendor at their residence
*&Sumofs38.W0* in the following (a) 18 a 5M. 00
at I% tion of this ract; and (b) the balance of s 19 a 5W - 00 together with intefest from date
bered an the balance ouutand�g from :ime to time at the rue of - eight (8) - percent per annum until paid in 6A&s1blkwm
Payable in one installment of $19,500.00, plus interest, six months from the date
of execution of this Contract.
provided, however, the enthe outstandutsbaiance shall be paid in hiU or before the
on day of EQ==
ULMthe maturity due).
FoPowing 2q default in payment. intetest shall accrue at the rate of -9 per annum on the entire amount in default (which shall
hiclude, without limitation, definquem interest aid, upon ac-celeration or matuft the entire principal balance).
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PqMeM shall be applied Am to interest on the unpaid balance at the rue specified and then to principal. Any amount may be prepaid
without premium or fee upon principal In any time al6r dal-A nf r-Iry-minlZ lvv%-� phoput
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
peocipal. and wetest (and b, Such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that
add IndikItedness would bave been had the monthly payments bee, sde as fist specified above; provided that monthly !mym,-nts sliall be
continued in the evatt of cmdk of my proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaserstates:hstPurchowls set dwitht fitleassh by the ser
ishe he town title r-idence submitted to P,;.-cha for examination except:
None
hr to Pay
_,��aaer, aftes Cost Of future title evidence. If titk cvidence is in the form or an abstract, it shall be retained by %kndor antil
tbe, 6A purdi pe, i, paid.
Purchaser k*11 be entk6d to -�r possession of tlx PropLtcy on -date-aL,,closivg--.- ft--
--AM Logo,
STATE IRA.Z OF WISCOF%N
W r W; - Wtvidwt tmd Cori�r, IFOM Me, 11 - 1%2 U"WA�l Vft.
suites dtt tulles as'da PMopasgy aR w °
an descend ntoaipRS such M ARaet
Nachos altal! beep tit ice+ amen an the teopmy bow Ioll or ooti ied by � " " �` y
era! snob other harnda u NoAa miq reputes, a�id�oat waenaaoor. dlaMaeea �porrairtim�a� is ebe ass a€ T _ �. ��
but Vmdor shalt not sequin sevara>D in an smoemt mane *m rise bahrsrte owed rands dde Cor�act; tttidaW sba)(
stien doe. The Polides -h- testate► the auto" eirm tie ftwot d the vadotti interest and, woes Vendor otherwise die
ae1gph�al of on pofides covering this f hrp ly shy bt dgodwd wid►Nitedoc K-Asm pooaapdjr notice of too 11F
and Vkudor tWess h xbmr and Mddor WWwW ago is wtideti, iorttsaetoe proceeds shalt be applied to tatotatiaa as u "
daenged, provided the Vbmdoi deems the restoration a tap* to be e00nOmiCally iraaible. •` `�, ° � _ �
hmdmw ovenants not to comma cosec am affosrwssse to be commitmd on the ttvperm to latep dm tropett� W pe¢ tlit/titir�4
eomdidan and repair. to beep the Property Get Gam beer ssperlw a she hen of dos Caruract, and to complq with ai hYNS, atioArtoie end
.. the Floret
Vendor apes 64 in Case the purchase price wMh Ineetat sad corer moneys a6aQ be Inge paid attd ad ooadtdoassW Ifs plt�0eased
at du titles and trt for warmer abac apedBed,Vinxt wil on demand. eacse and deliver to the ftduw a MOhnaayr ke it li0ipit: of
t�f e�e and clear of ell liens and awtunbtsnoes, except arty hems or enftx�oes treated by ft act or defattk d and
Parelwer agrees that ninon Is of the easerr[x and W ®the event of a default to the paymau of airy � a kMaseet.
s period of _ days foUovrhtg the specified due date or (b) in the event of a debuk in perkemance odler a�
continues for a period of days bRowring wtittm mike thereof by Vendor (delivered personalty or rrtaded by
outstandintgbal auce under thIs contract shot become immediately due and in 64 at Verrdorb option and
wawa), ithout
hereby a), and vlmdor Ad ciao have the fonoatmg riglus and If (wbjea to sty limitations provided by W it tae
provided by law or in equity: N Vendor =*A at his option, terminate this Cantrsa and Pundmert ni0tts tide and' and wertfiAl
acover' outstanding g' mx. vrhh tr�a the�rtan date of dw e5t a � date
ad orlmt a tot
event an amounts previously pad by Pumbster shalt be htrfeised >n liquidated damages for hihtre to fid81t Aw 69
Property if Pundmw oils to redeem); or (ii) Vendor may ante far specific perfonmantco of this cataract to Compel tom usse a4
die entire oatstandee�g balatoe, with interest dwrem a the rare in rare on the date of defauk and other amounts dery
d w Property slap be soaiortcd n judidd sale and Purchaser &A be habit for army deficiency; or (iii) Vendor may sae at ban
purchase peke or any portion thereof; or ((v) Vendor may declare this Cannes at on end and remove this Contract as a
title action d the equitable interest of Purdatser is insignificatir and (r) Vendor may have Purchaser ejected from
rove a receiver appointed to wileu any tents, Issues of pndis daring the pendency of any action under (Q, (ii) or (ir)
sty oral or written wamma or actions of Vendor; an decdan of sty of the kngoatg eemedia ,liar! only be binding t
pursued in litigltion and all earn snd eapmsa hbdudtrtg nemomabie attorneys fee of wrntdor incurred to enforce any areas MA
abated or not) to the nun not prohibited by law and eapeuses of title evidcna sW be added to prindpd and paid by
and »bail be inebrded in any Judgment. r
Upon the commatoetnettt or doing the pendency of any action of forecUmne of this Conuau. Purchaser coruaeaas
a receiver of the Propeny; indudintg homestead interest, to copra the tents. Issues, a profits of the Property during ilia a
and such rents, issues, and profits when so colitcted shag be held and applied u the court shall dune.
Pwchow shad not aanafer, sell or convey any kgd or equitable interest in the Property (by aarigmn►ent of any of
this Contract or by option, long-w.= ieac or in any other way) without the prior written consent of Vendor unless either the
payable under" Cartract is $rat paid in full or the iruaest conveyed Is a pledge or assignment of Purchaser# intmest under —1 — ill efjr
sa security for an indebtedness of Punebaser. In the event of cry welt transfer, sate or conveyance without Vendor% wtipar Willow sitssist
outstanding balance payable under this Comma shaU become immediately due and payable in 16H, at Verdorb option without nolfplC,
Vtndor shall make all pay918mn when due under soy mortgrge outstanding against the Property on the dam of thfs Ccetteaet ...... a - -
mortgap granted by ciP6r lumen) or under any note stowed dwmb% provided Putdma nudes timely payment of the amount then dnt tinier dos
Contract. Purchaser may make such payments directly to the WWrgppe if Vendor fails to do so and aU payments so made by P - * be
considered payments made on this Contract. i
Vendor may waive any defauk widwa waiving other sAwequent or prior default of Purchase. " �
AU trams of this Contract shall be binding upon and inia a to the benefits of the heirs, legal representatives, stcceseors and aanf ta attiisor
d
and Pusrhaw. (if not an owner of the property the spouse d Vendor for a vahwbte cortsideration joins herein to reksse bontnealf ri�— i- dtr
� any and � to � m the avecution d the cited
su w be made in fulfiUment hereof.)
, :.
Dated this S dayof _Atiomt
n Diversified stments of HubM Ise.
(SEAL) -d lit ---' MAL)
• Qg< V_ Rouleeau pi• g4 jAg nt '
_ ($EAU OFAL)
• Erin S. Dornseif
AUTHENTICATION ACKNOWLEDGME'`�.Y= ,
m ott A. Doi'nsei Erin S. State of Wisconsin,
t?'
Do and James V. Rouleau
su this of At>gLat , Ign— Pervanany cane before me dtia oL
ITILE: � 1�ISCONSiN
•
w ) t
to me known to lac the person
� TT • • ttu"Ument end scimowkdre the
THIS @tSTq�J1�6 VVM UFL*kTED BY
Attorney David J. Estre en '
`304 Locust St. s Hudsonj W1 _ - Notuy Public,
(Stpt6ures may be authe -iticsted or acknowWrd. firth rte not My eamnossim is parz�nent
nemmaryt)
• Names of pawns +tWa to any wxp %MuW be typed or pit a d.bt6w dwir o4wrovs
1ssE
LAND CONTRACT - IndhQua cod [mporate - Sam bar of . own i1 w
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