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HomeMy WebLinkAbout040-1237-80-000 ry 0 N c a O I o I N C L � L 0 3 I � � 3 it i c a� r w 'V co O Z 0 Z C LL C O O U1 v rn I d' Z E O� Y C ct z v N CD m M 1- Z :!t a r n .� o Z Z � O Cl rn E N U �y_ N O C 1� N . 2 O O O "Nib d R fV N N C C O � 4U-_- O a O 2 Q Q Z F Z z Z 0 a N a 0 l Ill � L 0) E _ d r �y w y d I a cn �•i c c O O a 'o cu Oro N N N o 2 o o o Q 00 • N o. a IL IL U 7 O fn > a) rn w } I M Q, O rn = Q N I �1 f O O 7 q E M h m C a 0 N N a .-- O �p �V O O o6 N C cl r.+ O a O O E 0 0 0 0 N C N U a 0 0 0 4 £ O F E a N N N L rZ N ! - 0 10 N � Q M O Y _C N C V r 0 tU O •- M N H E M Uf O C C 0 0 O O M M O Z N Z Y E I 3 at a a t `Mri E 2 t A U n. a O v U Wisconsin Department of Commerce Shaft and'Buildings Division PRIVATE SEWAGE SYSTEM County: 7 '. INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST CRO x P information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338933 Permit Holder's Name: I ❑ City ❑ Village R) Town of: State Plan ID No.: THOEMKE, TODD & SHELLIE I TROY CST BM Elev.: Insp. BM Elev.: BM Description: f ^ _ Parcel Tax No.: ero , o I (0'a .J c eLH 040-1237-80- TANK INFORMATION ELEVATION DATA A9900185 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark IS3 10 4 3 Bp, Z Dosing 61q r4 v Aeration Bldg. Sewer Holding St/ Ht Inlet l• 30 Ot 2_9_�' TANK SETBACK INFORMATION St/ Ht Outlet 9. S 2, Z8 Veritto TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet q (oa 2 2 - 3 Septic 23 f NA Dt Bottom 13.20 Dosing 33 ` 33 ' NA Header / Man. 10,( Aeration A Dist. Pipe t o D ° /' %K3 Holding Bot. System 1 11 69 �o• �� PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demtnd Model Number D 9$ GPM �•` TDH Lift 3,0 Friction a s I System 1 .s I TDHA O Ft H ead Forcemain Length Dia. Z µ Dist. To Well SOIL ABSORPTION SYSTEM[ �� �Te.= f •145' BED / TRENCH Width, Lep r N o. T rich PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J (0• 's DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu pctur r: ` S` INFORMATION TypeOf CHAMBER Mode umb er: System: Calvw • > OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length_ W_ Dia. �_ Length > X2 0 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 o COMMENTS: (Include code discrepancies, persons present, etc.) � t S•� LOCATION• TROY 3.28.19. 204 NW SW 620 OAKLEY CIRCLE— COUNTRYWOO LO 4 , , 1 ,, �i Plan revision required? ❑ Yes ❑ No Use other side for additional information. on ISZb H-H-i SBD -6710 (R.3/97) Dat 1 (� Inspector's Signature Cert No. l � •ei�bts��{T +eGaiVetll I ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: E , i t eP _ — o # i 4 s c 4 " i e i r s t f "n a e i 3 g .fir .,m_. e x 3 wy t i .. ems. z ... _ " d, s e x i " t I .. _... m" P asp s I 9 3 i t E i i e i E I p f E »a " e ;, a ..... r" .. ,�........." �....,,. ,.. .. a a r .....�. e , �. .. .;. e .... _.. .... ,� s .,�.. a F s s g � i S e c � L e a e i 3 ST. CROIX COUNTY ZONING DEPARTME `' j_ 10/ AS BUILT SANITARY REPORT' Owner WA T6(z y Property Address Y City /State �UYa GF ( Legal Description: � l Lot �P Block Subdivision/CSM # Cdu k�R Wobb W 1 /4 '/4, Sec. 3 , T N -R 4 W, Town of PIN # T 3. ZK, 14, izo`/ SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer W2 Size ST/PC I a�� /Sfio Setback from: House ��' Well P/L So Pump manufacturer oe 1 eY< Model l Alarm location (HOLDING TANKS ONLY) Setbacks: Service road o esh air int e Water Line Meter location Alarm 1 on SOIL ABSORPTION SYSTEM Type of system: 'T�-j� i) �R p >nJ Width 3 Length Number of Trenches 3 Setback from: House I l$ Well a P/L 1 Vent to fresh air intake 004 ELEVATIONS Description of benchmark To Elevation 100 6 Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet 4 PC Bottom a Header/Manifold 9 13 Top of ST/PC Manhole Cover Distribution Lines( ) ! (- S S h1 A ot �. 7 Bottom of System Final Grade Date of installationo /! -/ 1�`I Permit number 33$833 State plan number Plumber's signature 4�..u�r' License number Date Inspector Y vj 6P Complete plot plan Q I 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 3 = r2R c1,D S 3x CV!3 6 J 45' t 38 as N INDICATE NORTH ARROW J 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 3 �2aN 3x r i 1 q5 t N INDICATE NORTH ARROW 82 PRIVATE SEWAGE SYSTEMS - II PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEWT CAP - T ti"C.I. VEUT PIPE WEATHER PROOF APPROVED LOCKING JUWCTIOW 80X MANHOLE COVER � ZR. FROM ODOR, r U . w AICCw OR FRCSH I ' AIR ;E;TAKE GRADE I Y" MI M. COWOUIT -- -_ -_ -_ -- IB•nIW. IWLET PROVIDE I - -- AIRTIGHT SEAL -- : r7 I I v I APPROVED .DINTS APPROVED JOINT A I II W /C.=, PIPE / / I I `' C'Z' PIPE I I I EXTENDING 3 EXTENDING 3 ALARM OIJTO SOLID SOIL I I ( ONTO SOLID SOIL B I I I I o C I I ELEV. FT. PUMP --� '"' OFF r 0 CONCRETE BLOCK RISER EXIT PEP,MITfED rWLJ IF TANK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFICATIOUS � DOSE 'TANKS MA NUFACTURER : �� NUMBER OF DOSES: PER DAy TAWK :.•IZE: �V GALLOWS DOSE VOLUME (, ALARM MANUFACTURER: S -J IcC�R S�3fiQr, IWCLUDING BACKFLOW: � ��-- GALLONS MODEL ►DUMBER: f I CAPACITIES: A= a ( MCNES OR 1 0 1 .i GALLONS SWITCH TYPE: fhR c GKy B INCHES OR � !• GALLONS PUMP MANUFACTURER: C n C =(e INCHES OR. L S O !PA6LOWS .MODEL NUMBER: M Oa J LL INCHES :R GALLONS SWITCH TYPE: t) P RLU lk NOTE: PUMP ANO ALARM ARE TO BE MIMIMUM DISCHARGE RATE " 0 b GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL. DIFFEREWCE 6ETWEEN PUMP OFF AN j D DISTRIBUTION PIPE.. J� FEET y — 111 AUM WETWORK SUPPL`J PRESSuKE . . . . . . . . . . . ' PPW FEET � FE OF FORCE J MAIM X LA�S— FY piT.FRICTIOW FACTOR G L FEET TOTAL OyWAMIC HLAp = FEET IIJTERWA:. DIMLUSIOWS OF TAWK: LENGTH ;WIDTH O 1' ;LIQUID DEPTH 51GA;E C: LICEAISE WUMB= R: `^��� 7 DATE: J ' 99 A - 1 Jim ok ELI Fes "-�_ - .`� m '.�a §® © •� .� ®. NOW ■■■■■■■■■■■■■■ • , 1010 ,■■■■■■■■■■■■■ . ■MM ■R■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ NEWRIA■■■■■■■■■■ ■■ \� \ll■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ 1010 \ \ ■ I1\■■■■■■■■■ ■ • ' Wi, �o \1010■■■■■■■■ ►0111V\\■■ ■1010■■■■ • 901 WOM\■ ■ ■ ■ ■ ■ ■■ \11 ■I■\ \ME ■ ■ ■ ■ ■■ \\ \I hl, N 1000 \\ Ill 0 Ill Ill ■0■ 45- 0100\ 1 IM !1010■ \\■■■■■■ ■010HO,11116 ■■\\,■■■■■■ ■�01► \I I■ \0® -�\■ ■1010■ • , ■ ■0 ■g 1;\' !1000■■ LINEN ■ ■11►� I\ ■ ■\ 0100■■ ��! \I 1■ \ 0101 ■1001■■■■ ■\ \al 1� i \\ \\0010\ 0100 ■► \� \I I■ I. ► ■� \�00■ 0100 ■■■ ■IR ■■■ ■1010■■■ . . . ... ... .:..... . . ... ... r Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. N viscohsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application state sanitary Permit Number 33 �3 The information you provide maybe used b other government a previous lication [Privacy Law, s. 15.04 (1) (m)]. y agency programs ❑ Check if revision to P State Plan I.D. Numb I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N P� O ner Name s Property Location rJ �1 /4 1 /4, S T ,� ?, N, R l 7 E (or) W Prop rty Owner's Maj Ong Address Lot Number Block Nt Cit 5 y, to Zip Code Phone Number Subdivision N e or CSM Numbe II. E OF BUILDING: (check one) g State Owned ❑ it� Near e Ro d ❑ Vi l age Public 1 or 2 Family Dwelling- No. of bedrooms own OF /`rte E�2 CIP-JR III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ?>, Zg • la. 1 24 1 [] Apartment / Condo J - - 41_77 �0 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. � S New 2. ❑ Replacement 3. E] Replacement of 4_ E] Reconnection of 5. ❑ Repair of an stem 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12XSeepage Trench 22 ❑ In- Ground Pressure \\ 42 E] Pit Privy 13 E] Seepage Pit C.3✓ ? r K 43 ❑ Vault Privy 14 ❑ System -ln -Fill ( ,X: j.( - r t ir' 3 >� 3 VI. ABSORPTION SYSTEM INFORMA ION: laVq 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5_ Perc. Rate 6. System Elev. 1 7. Final Grade G /\ Required (sq. ft.) Proposed ( ft.) (Gals/da /sq. ft.) (Min inch) / Elevatio o 100 O v 3 sc U'l Feet �. Feet at VII. TANK in Ca h g allo ns Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete st ucted steel glass Plastic App Tanks Tank eptic T e 00 ❑ 1:1 ❑ 11 ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. �Iu N riot) Plumber's Signature: (No Stam s) MP /MPRSW No.: Business Phone Number: Plum e5s Address (S re t, City, StaZ Zi Co e): -17A Z IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued IssuingAgeat Signature (No Stamps) Approved [] Owner Given Initial 00 Surcharge Fee) Adverse Determination /,OW X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD41M (p 11196) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber - I INSTRUCTIONS 1 . A s a nitary 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 -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 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. -------------------------- 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. i i t ��Y/� J A OE t oo � U � UIPp I v X09' 6' i fs' am= Tod �" 5�eel II pl �- akop IWO �)Ap AA�PtvtA Of $ W4 S p ry F.Pnl4t- Tl,O,� lub' 'f2 80' 3 - T►�N�I��s ¢y Se •<< �S� �d 3x 835 8uu jPl Not 11 11 e- W-Q - (6N S0 SeolQ 9p 50 . ) � BPDR�u M Wd nk b21ve ]. I i775 r 1, a� U OM N �S ►� 9v ,� �� oo�� c � �Ec� T- r x Ln ® - ��cc �O --n �� E r,- � (� 0 0.30 0 C oo CL CU N ►- ��r p i omo►?n N � °—'' �o. W v I c� cn OL -- - - -- cad rn > '� x CT% U �_:; -� o o �£ V x .. .. — . c ° (5) rn CA U L>+N L c _ 05 (A 3 CL • • • • i I Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 siabor and 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 8 1/2 x 11 inches in size. Plan must include; but St' C °qix not limited to vertical and horizontal reference point (BM), direction and % of slope, sc or: RCELI # dimensioned, north arrow, and location and distance to nearest road. pendigg APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION �r - y' fVIE`m: [)ATE PROPERTY OWNER: PROPER )AC Richard STout GOVT. LOT - 'N4 ;5W 1 ,$_ 3 N,R 19 for) W PROPERTY OWNERS MAILING ADDRESS LOT # BIL IFfA' S.UBD. NAME 1353 Awatukee Trl. 67 na' ood CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE N2 NEAREST ROAD Hudson, WI. 54016 (715) 549 -6731 Troy Tower Rd. New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft • trench, gpd/ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate • 5 bed, gpd /ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 90.14 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted outwash plain Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TAN fU K U= Unsuitable fors stem ES ❑U ES ❑U S ❑U ®S ❑U ®S ❑U 0 C? SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -22 10 r2 2 none 1 2msbk mfr qw if .5 .6 2 22 - 10 r4 4 none sicl 2msbk mfr qW if .4 .5 Ground 3 2- 4 none scl m na .2 3 42 10 r 6 � na np elev. 94. ft. 4 42 -89. 10yr4 /4 none fs osg mfr na na .5' .6 Depth to limiting factor +88" Remarks: Boring # 1 0 -20 10 r2/2 none 1 2msbk mfr gw 1f .5: .6 2 2 20 -42 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 42 -84 10 r4 4 none lfs osq mfr na na .5 .6 elev. 9 I Depth to limiting factor +84 Remarks: CST Name: — Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 554 200th Ave-, New Richmond, Wi. 54017 MO2298 Signature: Date: CST Number: 4 -19 -96 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # Pendina Lot #67 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 `w 1 0 -22 10yr2Z2 none 1 2msbk mfr qw if .5 .6 ' ".` "`' 2 22 -40 10 r4/4 none sici 2msbk mfr qw if .2 .3 Ground 3 40 -88 10 r4/4 none fs oscf mfr na na .5 .6 elev. 94 ft. Depth to limiting factor +88" Remarks: Boring # 1 0 -18 10 r2/2 none 1 2msbk mfr qw if .5 .6 4 2 18 -35 10 r4/4 none sici 2msbk mfr qw if .4€ .5 tiSii4~ 3 35 -84 10 r4 6 none fs osa mfr na na .5 .6 Ground elev. 93 ft. Depth to limiting factor +84" Remarks: Boring # , :: >:•.:. , : 1 0 -22 10yr2 /2 none 1 2msbk mfr 9w i f .5 5 .6 2 22 -37 10 r4/4 none sici 2msbk mfr if .4 .5 `? e : :. : 3 37 -82 10 r4/6 none fs osq mvfr na na .5 .6 Ground elev. 93 ft. Depth to limiting factor +82" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 NW4SW4 S3- T28N -R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 lot #67- Country Wood N 1 " =40' BM.= top of 1 "steel pipe C el. 100 30 1 llo� i Z� �o � 3 v � z07a Ga��L. el 4 -19 -96 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 0 14r,\ n �•( I .e / C i r �� III (Verification required from P Department for new construction)---A City/State t l K�So� W i Parcel Identification Number 040 — 1 2 3 1 000 LEGAL DESCRIPTION Property Location %4, SIA) %4, Sec. 3 , T , N -R lq W, Town of - F ? - o`? Subdivision 00UtdTP - y W00 D Certified Survey Map # Volume , Page # Warranty Deed # 111O Volume Page # Spec house ❑ yes no Lot lines identifiable yes ❑ no SYSTEM- MAINTRNANCE Improper use and maintenance of your septic system could result in its prcmaturafarTure to handle wastes. Proper maintenance consists of pumping out the septic tank every throe years or sooner, if needed by a licensed pumper. What you put into the system can affect &e function of the septic tank a treatment stage in me waste disposal - system. The Ply owner agrees to submit to St Croix Zoning Department a certification form, signed by the owner. smd by a m "' C1 P lourncymanPlmnbCr, restrictedplumber or a licensed pumpervuifying 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 must be completed and returned to the st Croix County Zoning Office within 30 days of the year a iration date. q SIGNATURE OF APPLICANT DATE OWNER. CERTIFICATTON 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 escn a ve, by virtue of a warranty deed recorded in Register of Deeds Office. � � d5 .l , SIGNknJAE OF APPLICANT DATE «s « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department « «•« «• ss 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 591106 LAND CONTRACT Form 11 Document Numbas __.___ _.. 57. CROIX CO., WI Roca c: �sre•d CONI RACY, by and between Richard O Stout ( "Vendor", whether NOV 0 b 199$ j0:50 �� one or more)_andTodd A Tboemke and Sheilee A Thoemke husband and offs : +s survivorship marital properly( Purchaser", whether one or Re rt+r of QMda more), Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance o' this' contract by Purchaser, the follow ing property, together with the rents, profits, fixtures and other appurtenant interests (all Recordin Area 7. to St. Croix County, State of Name and Retum Address called the "Property' Ricer Valley Abstract &Title, fret. Wisconsin: 040-1237-80 Sccoad Street Part Id fine ficalion Number Hudson W1 54016 Lot 6 Country Wood First Addition in the Town of Troy, St. Croix County, Wisconsin. TRANSFER Thts is not homestead property. 1353 Awatukee Trail, Hudson "sum Purchaser agrees to purchase the Property and to pay to Vendor at at the execution of this Contract: and of $ 331900 in the following manner: OP0.00 together with interest from date hereof on the balance outstanding from time o t the balance of S 27,100.00 % percent per annum until paid in full, as follows: time at the rate or 9.5 monthly payments of $230.00, principal and interest, commencing December 1, 1998 and the first of eac month thereafter Provided, however, the entire outstanding balance shall be paid in full on or before thelst d�Wmber tg 99 (the maturity date). Fallowing any default in payrnent, interest shall accrue at the rase or ^,G per annum on the entire ..nount in default 9,5 (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire Principal balance }, s sufficient to pay reasonably anticipated annual taxes, purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amount M due. To the extent received by Venda, Vendor agrees to apply payments to these when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow obligations hind O trustee account, but shalt not bear interest unless otherwise required by law, tied first to interest on the unpaid balance at the rate specified and :hen to principal. Any amount may be prey payments shad be app' without premium or fee upon principal at any time perrni»ierref ;leader" is less than principal, and interest {and in such case accruing interest from month to the amount that 1n the ever,: of any prepayment, this contract shag not be 'seated as in default with , -pact to payment so tong as the unpaid balance o Payments been made as first specified above; Provided that monthly payments shall be month shall be Treated as unpaid principal) said indettedness would have been had iris monthly continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being Pu the excluded here from. Purchaser states that a reS •lions of a s hown by t h e title evidence s ubmitted t any, as of the date of this contract asar for examir..tion except: easements, covenants a 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 � Pc147 Purchaser promises to pay when d.ae erg tares and assessments hevied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such paymerd. Other shall keep the improvements on fie Pr' party insured against loss or damage occasioned by tire, exlsnded coverage such h hazards as Vendor may require, wifhwut co-insurancs, through insurers approved by Vendor, in the span of f but Venda requre coverage in an amount more than the balance owed undo this Contract, Purchaser shag pay the insurance premiums when due - the Pr o shag contain the standard clause in lava of the Vendor's interest and, unless Vendor otherwise agrees in writing. the Original Of erg policies :0 ring sal g be deposited with Vendor. Purchaser shalt promptly give notice of loss 10 insurance comparies and Vendor. ie less P diems M Vendor O err raga& n wrong. insurance proceeds shag be applied to restoration or repair of the Property damaged, Pro vided economically feasible. the Propeorl Purchaser covenants not to comma waste nor allow waste to be committed on the Pt a a oroin and TeQUii,i a acting the Pr _and repair, to keep the Property free from lens superior to the lien of this Contract. and to com h Venda agrees that in case the purchase price with interoist and other moneys shag be fully pad and alt conditions shag be fully performed at the times li pens and neeer above s e V a liens or d xtic pea ad by the act or deteug an exeepteS simple, of the Property, free and clear Purchaser agrees that time is of the essence and (.:) in the event of a default in the payment of ant principal cr interes which continues for a period of 30 days following the specified ng writte notice thereof by Vendor ( personalty or malted by certified msh�, then ft anttas outstardkV period of. 30 days fallowing balance under this contract shag become immediately due and payaule in tug, at panda's option and without notice (which Purchaser her w olves), and Vendor shaft also have the following rights and remedies (subjec' to any 11 in s provided back through strictest loredoswe with may, a t his option, terminate this .;ontrad ti and Purchaser's rights, tle and i n t eres t in the property taw) in addition to those provided and recover this Property achy equity d nedemplion to be condltinrhed upon Purchaser's fun payment of the entire outstanding balance with interest thereon from Me date of default A !the rase in equity o on such date and other amounts due hereunder (in which event an amounts previously paid by Purchaser shag es property be forfeited as liquidated damag Purchaser (ads to redeem): Of (ii) for co mpel sntinediafte this nd tug payment of rental the entire ouutsta d ng balance, with into est therreon al the in effect on f the data of default and other amounts due hereunder, in which event the Pm shag !>e auctioned al judicial sale and Purchaser shag be liable for any deficiency: or (11i) Vendor may sue at law for the phone unpaid purchase price a any portion thereof or (iv) Vend a or may declare this Contract at n end and remove this Contract as a cloud anlitle have recover uitable interest of Purchaser is insignificant: action d the eq and (v) Venda may have Purchaser ejected from possession of the Properly a appointed it t e tolled any rents. issues or profits during the pendency of any action under 0I (l) a (iv) above, Notwithstanding any oral a vailleth statements a and when pursued in litigation and alt costs and expe actions of Vy an election of any of Me foregoing remedies Shan only be binding upon Vendor it nses iqudinq reasonable attorneys tees of Venda incur to enforce any remedy hereunder (whether abated or a t nt extent not prohlbiNd by law and expenses a We evidence shall be added to principal and paid by Purchaser, as incurred, and shag be included in a Upon the commencement or Ong the pend9nq of any action Of foreclosure of this Contrail, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to tolled the rents, issues. and pro% of the Property during the Pendency of Such adios, and such rents. issues. and profits when so collected shag be held and applied as the court shag direct. P;uchaser shag not transfer• sell or convey any legal or equitable interest in the Properly (by assignment Of any of Purchaser's rights under this written consent of Vendor unless either the outstanding balance payable under this Contract w tilt option, tong -hum tease a in any whip way) without III of Purchasers interest under this Contract solely as security for an indebtedness Contract is first paid in fug a the interest conveyed is a pledge igfm+ 4rq batincce payable under this Contract of Purchaser. in the event of any such transfer, sale or conveyance without Vendors written consent. the entire oulstarx shag become immediately due and payable in full, at Vendors option without notice. the Property On the date of this C (except for any mortgage Vendor shag make erg payments when due under any mortgage outstanding against r -aser makes timely payment of the o f Pu c amount^ then due under this Contract. Purchaser on may make any such payments directly to the Mortgage granted by Purchaser) a under any note secured thereby, pr ants made ire if Vendor twits to do so and all payments so made by Purchaser shag be tonaidered payments this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. Alt terms of this Contract shag be binding upon and inure to the benefits of the heirs, legal representatives, successors a in the °mod Property agrees 10 join ( 1 1 not a the e xe c ution of the deed to bs made in ftnifiltmment A eof.t� consideration joins herein to release homestead rig Dated this 4 1 day of �( / Venda Todd Th Oentke Purchaser A �y n y� Richard O. Stout y��< c t'��lY Purchaser Vendor Shetlee A. Thoenake ACKNOWLEDGMENT AUTHENTICATION STATE OF WISCONSIN Sigpature(s) COUNTY OF St. Croix r, day of c� Personally came before fns this above named Richard O. Stout, authenticated this _ _ day of - — �7 Jhl1�� Todd A. Thoetnkc and Shettee A. ,t Thoernks tie executed the foregoing signature a; Vri to me know n to be pf3rSon(S) instrument and ackn ge the e. type or print name y signature • (yL !!!/ �G TITLE' MEMBER STATE BAR OF WISCONSIN type or print name (If not, ---- -- Notary Public St. Croix County, Wt authorized by • 70ti.06, Wis. Siats.) -RA. -RA. r1.r%mmicsion is j Demt�lnent;(Jt not, state expiration date. _ N 423. la S83 °18'51 W o 193.3 16 - �� - _ - 211.9 11 0 4 9 . 33 T8 O 211. 423.3 57 E 19 N7 T 0 49� 69 2.00 AC. NY 87,201 SO. FT. -� 68 a 1.53 AC. EXC. ESMT. 6 � '�p 2.10 AC, 66,503 S0. FT. � 6, 91,263 SOFT. a � 66 N 2.57 AC. ,p 111,973 S0. FT. 0 2.79 AC. ao 121,711 SO. FT. a N in "P / ul °� / 2• ul a gg o N i S • 0+ • N � � 31 i / O - S90 ° 00'00 "W 664.27'- 0� n - - 259. 27' ` - - - 180.00' it D 1 N i - 3IREEI m - u ., o W i O � — _ 220.72' — — 214.52' — 1 LAS I Z a - N90 ° 00' 00 "E 654.73' - �� 1 � ` J O es9 51 57 In 5 6 M M 2.01 AC. 2.09 AC. I = ki FT. 87, 557 SO. FT. W 91,121 S0. FT. ti 8 8 8 ° ° 1.30 AC. EXC. ESMT� — W O z 56,545 S0. FT. I Q 0 y Z I w M J a in 0 °0 0 ' / 220.73' 225.46' ?4.14 SOUTH LINE OF THE NW,IOF-THE SWIM N „ n M m - _ANDS