HomeMy WebLinkAbout020-1177-70-000 f
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER 'a /'411we TOWNSHIP SEC. T N -R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT % 7 LOT SIZE Z -kot.,�
PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
INDICATE NORTH ARROW
i
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: 106 Proposed slope at site:
SEPTIC TANK: Manufacturer: �1J „_ Liquid Capacity: e do d
Number of rings used: O Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side,Q Rear, O
�r feet
From nearest property line Front,0 Side,O Rear, O ) 4�, feet
Number of feet from: well r j(o7_ - ,U building: t l,�r ,
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER A,
Manufacturer: Liquid Capacity:
Pump Model: Pump /Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: A Trench:
Width: / ;7 - Length: J�2 Number of Lines: Area Built
Fill depth to top of pipe:
Number of feet from nearest property line: Front, 0 Side, Q Rear, 0it. G '�
Number of feet from well:
Number of feet from building: 7
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Y Plumber on job:
License Number: G
3 /84:mj
DEPARI OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS
`LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 , BUREAU OF PLUMBING
MAD;SON( ,5"07
N EB 4 ,NE %';S28,T29N —R19W CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number:
(if assigned)
Town of Hudson El Holding Tank 1:1 In-Ground Pressure ❑ Mound
Cedar Hills Est. Lot 17
NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
William Harwell Route 1, Box 1910, Hudson,WI 54016
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number:
illiam Schumaker 6382 St. Croix 92494
SEPTIC TANK /HOLDING T NK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUT ET ELEV.: ARNIN
WG LAB L LOCKING COVER
P OVI ED: PROVIDED:
ES ONO ❑YES NO
BEDDING: VENT IA.: VENT MATL.: HIGH WATER NUMBER O PROPERTY WELL J B UILDIN6: I VI:NT LE FRESH
ALARM: I I LINE: AIR INLET.
FEET FROM
DYES O t DYES &Kio NEAREST �"—
DOSING CAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL - . PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ONO DYES FIND I DYES ONO
GALLONS PER CYCLE: J PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. VENTTOFRESH /
(DIFFERENCE BETWEEN FEET FROM LINE J AIRINLET: .
PUMP ON AND OFF) ❑YES 0 N NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: I LE TH///��� NO. OF DISTR. PIPE SPACING. COVER INSIDE CIA. #PITS LIQUID
BED /TRENCH ) TRENCHES t M ARIAU P DEPTH
DIMENSIONS i "—
GRAVEL DEPTH FILL DEPTH IDISTR . PIPF DISTR, PIPE JOISTH. PIPE MATERIAL: NO. DI NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH
BE LOW PIPES ABOV C ELEV. INLET ELEV.E o. wPES: FEET FROM LINE AIR 1 ET
�� NEAREST SC 2 �
MOUNDS STEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES NO
SOIL COVER TEXTURE J PFRMANENT MARKERS J OBSIRVATION WELLS
1:1 YES NO ❑YES NO
DEPTH OVER TRENCH /BED DEPTH OVER 1RENCHIBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER. EDGES.
DYES 0 N ❑YES ONO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVEH
BED /TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV.: DIA. ELEV.. PIPES DIA..
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
DYES ❑NO DY ES ONO
COMMENTS: ERMA SENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM I LINE:
/ ,� ❑ YES El F-1 S ❑ NO NEAREST
a� g A'7�
1 2-gZ'
13.7ill"
Sketch System on etain in county file for audit.
Reverse Side.
SI RE: TITLE:
,l Zoning Administrator
DILHR SBD 6710 (R. 01/82)
--- SANITARY PERMIT APPLICATION COUNTY
� DILHR In accord with ILHR 83.05, Wis. Adm. Code 7
C
STATE SANITARY PERMIT #
, Atfach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8' /s x 1 inches in size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ® NO
PROPERTY OWNER PROPERTY LOCATION ,�'
' /a ,d.�' /4, S T 2t , N, R fQ E (ormi
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK MUMBER SUBDIVISION NAME
4 r-Ql s." .v l 7 l �e e - 2� • C 2
CITY, STATE ZIP CODE ❑VILLAG
PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK
A E :
I
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family Y OR ❑ Public (Specify):
111. PURPOSE OF APPLICATION: (Check only one in ##1. Check ## 2,3 or 4, if applicable)
1. a. ki New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in #2)
1. a. Conventional b. ❑ Alternative c. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In -Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. See a e Bed b. ❑ Seepage Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
old Feet Private ❑ Joint ❑ Public
VI CAPACITY . TANK Site
in alIons Total ## of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber I ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system show on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/ PRSW No.: Business Phone Number:
t '
Plumber's Address (Street, City, State, Zip Code): ame of Designer:
Q
VIII. SOIL TEST INFORMATION
Certified Soil Tester (CST) Name CST #
CST's ADDRESS (Stye , City, State, Zip Code) Phone Number:
sr r
IX. COUNTY /DEPA USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps)
Approved
El Given Initial > S rcharge Fee J7��
Adverse Determination /w' �v �. v� " ^J � - ��
X. COMMENTS /REASONS FOR DISAPPROVAL:
SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
1 / lls l G w.1/ oIr 1�a e� nd
ff4i s 93AL 69
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ilf' I'A1i IMF NT Of REPORT ON SOIL BORINGS AND S AFETY & BUILD
Ir �tDUSfkY, DIVISION
LABOR RY, P.O. BOX 7969
LABOR PERCOLATION TESTS (115) MADISON, WI 53707
RELATIONS
(1-163.090T& Chapter 145.045)
I LOCATIO�I SECTION: TOWNSH /MUNICIPALITY: OT NO.:BLK. NO,: SUBDIVISI NAME
N L 1�1� 2," 17`� N�R ) j�So / 7 — Cde� h►itLS E b T� T
COUNTY: OWNER U ER'S NAM AI N AD R S:
<<_ 14 ul'so N W, �4 6
US DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER AL DESCRIPTIO :: ;70 ,pS
Residence _ �L/ ' I+�New ❑Replace
7
�(l f � � /�M1 7 ! r ��
RATING: S= Site suitable for system U= Site unsuitable for system
� N ENTI N L: MOUND: IN -GR0UN : S -t •FILL OLDING TANK: RECOMMENDED SYSTEM: Io fohal)
$ ❑1 EIS ❑U S ❑U S ❑U ❑ S Cofy l/C-� - L it
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the //((
under s.1 indicat C L ass I Floodplain, indicate Floodp elevation: AI A
PROFILE DESCRIPTIONS
BORING TOTAL DEPT H R UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVE EST.HIGR TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
i0`&SLTS /0 ZS" M3 `7 S-t G'A
Y' gLSL� /8�'B4NSC. 17�lT�RttJ MS
B- Z 9.00 N „N} >
B -
9.4 9<6 .74 No > 9 q Z 38a� st c,P,
C > /O.O$ �S��LS�TS 13��►t $RrJ S 37 Rrl MS
Q- hIt}fv,
PERCOLATION TESTS
n c Fr
TEST QEPTH WATER IN HOLE TEST TIME DR OP IN WAT R L V L -IN HES RATE MINUTES
N UMBER AFTERSWELLING INTERVAL -MIN. PER pE�I PER INCH
P- I .e? N „4c 110 ? Z _ > - 4 < 2
P- z c, n I cia .7o 3 _> 7 >'Z
P- 3 S,00 0 9 0 �! 2 > Z
P - _._ L ,1A'SIO p<
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe whet are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. ' _ \ o peotsaskh / d- OT at.LX.y.
� �i? fin rZk 9 3 Z o N�t� o
SYSTEM / ELE PA ]ON Y ' E �� v t�� -, Foy lJ4 io2.6a
93.Zo
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures a of methods specified in the Wisconsin
Administrative Code, and that the date recorded and the location of the tests are correct to the best of my knowledge and beli f.
NAM (print): -' TESTS WERE COMPLETED ON:
ADO SS: CERTIFICATION NUMBER: PHONE NUM (optional):
A
- -- - CST SI \ ATURE:
S'rntrtl STION: Ot ininal and one ropy to I-of:al Atithorily. Property Owner and Soil Tester. J
i
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t)f.'PAH fM6NT OF REPORT ON SOIL BORINGS AND S AFETY &BUILDINGS
DIVISION
,
IiJDUS "tRY WDus RY P.O BOX 7969
LA U MA OR RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707
(H63.09(1/& Chapter 145.045)
LO ATI N:N SECTION: TOWNS /MUNICIPALITY: z OTNO.:BLK.NO.: SUBDIVISI NAME:
-�/ _ T72 Oil u>, /_7 — Cah4ft T)!!'
COUNTY: OWNER' R'S NAME: A
CJ?OIh !c AR iL4- '�IE oAa" KT pk s'Q�� /YU�SCiV �/b
1 �
US DATES OBSERVATIONS MADE
NO. 8 .: I COMMERAL D S RIPTIO ,�/
Residence l �Nt� 4alNew ❑Replace >AP (1 19V A{►R1� 7 M�
- SoILti 1*W PAh� 66 5 oI r,, Ida.,• ,�ic
RATING: S- Site sui table for s ystem U- Site unsuitable for system
N ENfiI AL: MOUND: - FILL OLDING TANK: RECOMMENDED SYSTEM: (o ional)
� S ❑U ❑S ❑U IN -GROUN , �S ❑U ,IBS ❑U El MV CcojV - rVrlay0, -L
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the �(
under s.H63.09(51(b indicat Li4S5 Floodplain, indicate Floodplain eleva AIA °
'b Ir PROFILE DESCRIPTIONS
BORING TOTAL T R UN WATER•lNCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH0 ELEVATION OBS VED TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.)
B / io " &s%.TS to btcEarqSL ZVt:r$trj WS 7' S4 Gx
SO 9�.� >�o�i� > 8 o Af &4 cst6A-
`j• QLc L TS J @''B+iNSC.. 17'LT$R#4 MS
B- Z 9 ,00 5.7 7_ N oNE: > 6 e.r S -46* S 9"C - r$RN ,MS
►3 "8 L S, I- TS J 3' a; L 34
,74 NON I_ > 9 4 s3 "gR �► St c-,Q
B 4 16. /UO13 IvoNL /O.ta� S 5 R ry ., S
B `> 77 9TS.1Z NO VVIC > 7. 9Z 7 " &L<_LTS Z►`DK &e/SL 67; 19414 IMJ
B
PERCOLATION TESTS
NE C
TEST Q5PTH WATER IN HOLE TEST TIME DROP IN WATER L V L- N H S RATE MINUTES
NUM BER AFTER SWELLING INTERVAL -MIN. PERIOD 1 PM1 PER INCH
P_ e J N e/ o.0 3 z z <1
P_ Z S. SO g .7G1 3 _ > 1 Z >'t
P- 3 s,00 9 o > *Z > Z
P_ _..__ _ .__ A C A
N-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. — -
SYSTEM E I�1' ON ` \ 6�. ARa m�llay - 43 �o Nate e paz� i e>� ac B�.K
t' 3 ELtVA riory fat ACUse %07.60
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LoT_ /f3 1R&NCA4MARK_ /'iteo'V
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1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures a d methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and beli f.
NAM(print� n TESTS WERE COM /PLETEpD yON`':�
N��1/C' �/ ONN� OA� �U`�C IJ SU'RtiI @i PIPi IL O / ! O /
J
ADD ESS:
I CERTIFICATIOW - N - 0 ` 14BER: PHONE NUMBER
(nptional►:
-- - - CST SI ATURE:
STRNMOTION: 0; i(Iinal and one ropy to Local Authority. Property Owner and Soil Tester.
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St. PT 1. C TANK MA I NT NANGI? ACRL :I,�ii: 'I o
St. Cruix County
a
r)
i' i re
NUM N Lill) bCr t
Kc)tt't't : /is OX l3L•!t� �
Z [T iG7 e 1`
C I 't' Y / t; T A't' E ._ — _`'.__
I'RI�I'L :k'1'Y L.UCA'l'll)N; a,
St. Cruix County,
Subdivision C"e -�._ �_`! __� Lot number Il - -,
1
) r use and wai.ntenultce of your ,cl >t i • systen+ could result in
[ Ill ) Ct)i c -
its prematurt� "iuilure to boodle wa�'t +.� :�.
I 1 1)pl:C Zil l llt4
s.ists ul pumping; out the septic. tank ever }' three years ur suuuer,
if (leeded, by a licensed Su Lie_ t_a_uk huulher. What you put into +
Che system can affect the funCtiull of thc_ septic tank as a treat-
ulent. Stage in the waste di:,l)osal System.
Cruix County residents ntaY be: clih.ible to receive a g f or
a Illaxi_wum of 60 of title cost of replacement of a Cailing system,
h
wtch watt in operation Iirior to .tuly 1, 1978 St. Croix Count Y
aL_ Ct.iJ LUd this program in ALQL16t. of 1y80, with ttto reyuireulcnt thaC
owners of all new stems agree to keep their s y s tems properly
maintained. - -- - --
The 'property owner agrees to submit to St. Croix County Zoning a
certification furl,,, signed by the owner and b a master plumber,
journeyman plumber, restricted plumber or a lic.enst-.d pumper veri-
fying that (1) the un -site wastew3Ler disposal SySteul is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic tank is less than 1/3 full of sludge and scum.
Certification form will be event approximately 30 days prior to �
three year expiration. °
Z
I /WE, ttre undersigned, have. react the above requirements and agree U
to maintain the private sewage disposal system in accordance with
the standards Set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources. Certificat_i.On form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED_
I
St. C -oix County "Zoning 'Off ice
1' . 0 . ,tox 9E
Hamillo'ild, WI 54615
715-7 or 715 -425 -8363
Sign, date and return to above address.
l
I _ _
APPLICATION FOR SANITARY PERMIT
S T C - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner /contractor,( "spec
house "), then a second form shuuld be retained and completed when the property is
sold <in'v siibmi_tted to t1its office with the appropriate deed recording.
Owner of Property
Location of Property �j '�, Section ate , , T ,2 N - R W
Townshi p ��ct.t1
Mailing Address �T / ,(�,�/ / - 4c1
Subdivision Name
Lot Number —17
Previous Owner of Property �,l
Total Size of Parcel
Date Parcel was Created C l r
Are all corners 'and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? _ Yes No
Volume 7y3 and Page Number l rZ, as recorded with the Register of Deeds
IN CLUDE WITH THIS APPLICATION ONE OF THE FO LLOWING :
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (We) eeAti.6y that aR Statements on this 6o4m ate true to the beb.t o6 my (our)
knowledge; that I (we) am (are) tle owneA(s) o6 the property deactibed in .thi.6
in6orma.ti-on 6o4m, by vi tue o6 a waA.anty deed recorded in the 066ice o6 the
County RegisteA o6 Deeds as Document No. 6i /7 , and that I (we)
pusentty own the proposed site bon the sewage pdis o loa I (we) have
obtained an easement, to run with the above descAibed property, 6or the
eons-tAuc ion o6 said system, and the same has been duty recorded in the 066.i,ce
o6 the County Register 66 Deeds, as Document No.
SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE)
y-- /C' - - / s�7
DATE SIGNED DATE SIGNED
F:
&VOL. :I gjPAf' E ?yam
• Zo,�uMENT No. STATE BAR OF WISCONSIN F(M 11 -1982 THIS SPACE RESERVED FOR RECORDING DATA
' LAND CONTRACT ?.�.
Individual and Corporate RE(� U RS OFFlr&
i (TO BE USED FOR ALI, TRANSACTIONS WHERE OVER
y 126,000 1S FINAN AND IN OTHER NON-CONSUMER
ACT TRANSACTIONS) ST. CROIX CO., Wis.
Rec'd, for Record this 11 th
Contract by and between _._ Harry_ J.__ as Personal day of
R Jun a A.D. Q 86
epresentative of the Estate of Aldro Larsen_a / - -- k /a John df 11:45 A M.
- -
Aldro _Larsen__af kja John_Aldro Myren Larsen 1_*.. ( "Vendor ",
James 0 Connell
whether one or-.more) and..-William C. Harwell _ _
�f�r d Dwd
*single man .............................. ("Purchaser ", whether one or more).
-��-
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- deputy
formance 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 RETURN TO
See legal Description on Addendum
Tax Parcel No.
38d
q.2 73 �.
: s
S X21
FEE
This ......? .......... homestead property.
304 (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at - such lace as he shall name
the suns of $.. 500, 00 ............. I ... ................... in the iollov manner: (a) $... o_,QQQ..QO ..................... - -..
at the execution of this Contract; and (b) the balance of $- AN— ,500_eQQ .................. together with interest from date
hereof on the balance outstanding from time to time at the rate of ...... ........ C.PA._CLQ7q )........... per cent per annum
until paid in full, as follows:
See Payment Terms on Addendum
Provided, however, the entire outstanding balance shall be paid in full on or before the....... 11th ....... day of
......... .11111p ........................ 19 --- 4.0_ ( the maturity date).
Following any default in payment, interest shall accrue at the rate of --- 1Q..._ % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees, to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time. lG9fik�1��XX�cxXXXX�cX�c ]��c7tg�C7cXX7���
tlset�e:x;, g,�A xi�mcx�xlnxe�txvQ' xiaacl�ie�iXRttl��s�aoi�ioxrufX�e�aRfC
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 1NRVt kkpayments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance• or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
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........thg..�7te -- hereof ............... g...
*Cross Out One.
LAND CONTRACT — Individual and STATR BAR OF WISCONSIN Wisconsin Legal Biank Co. Inc.
r
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's in,'.r.vvd
in it itnd 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-
irt d: overage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved
_f,y ' Vendor, in the sum of $. ...........n /.a .......................... but Vendor shall not require coverage in an amount more
thnn 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 covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of lass to
in:air:nn•e companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
it- npl:lied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
!:tulaicolly feasible.
Purchaser coven ants not to commit waste nor allow waste to he committed on the Property, to keep the Propc.t -
in rood 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 and 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 'urchoser a _ x= e d in Jee simple, of the Property, free and clear of all liens and encumbrances, except
ersonA R a s
any tens or encumbrances created gy the act or default of Purchaser, and except: . ... easements,..g>rotectxxQ..
..cov- enants..Qf ..recard ,...if ..any,.. and..zariing..a.rdi nance..rp-quirp -ments s ......... ...............................
....• .................................•--......._.....----•_•--...........-•---........................................................... ...............................
............. .....................•--•-•----................. _..................._.......... _ ............................---............. ......•---- ....................
........................................................... ........................_...... ------ • ... • ... ...--. ....... -.-- ...... . ............. .•• ..... ••--
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 AQ.... days following written notice
thereof. he 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
,taives), 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 hack 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
pail by Purchaser shall be forefeited as liquidated damatrvs for failure to fulfill this Contract and as rental for the
Property if purchaser fails to redeem) ; or (ii) Vendor cony sue for specific performance of this Contract to compel
iuemrdinte and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the state of
default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser
shall he linble for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion
thvrra,f: or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet -title
:erti m if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession
of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action
under (i), (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 Vendor incurred to enforceany 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 pendency of any action of foreclosure 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
npplied as the court shall direct.
Purchaser shail not transfer, sell or convey any legal or equitable interest in the Property (b assignment of any
of Purchaser's rights under tiis Contract or by option, long -term lease or in any other way) •rithout the prior written
consent of Vendor unless either the outstanding balance payable under this Contract is first patid 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 immediately dlle 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
thin Contrnct (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to
the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Contract.
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representat(ves,
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.)
Dated this ... .... day of June.......... , 19..86...
(SEAL) .. `_..... r.'!��!�1. ().�?�!1. i�s(:SEAL)
............................................................. ` .- Harr y.- J..... S. tewart ......................
... :
(SEAL) ! � 1._..( ... � ? ....�� ("A L)(
i
. .............
William C. Harwell
• --
AUTHENTICATION ACKNOWLEDGMENT'•,''1r :y t, }
Signature (s) STATE OF WISCONSIN "
ss.
......................... - ....._...... -... St.•- Croix ..._................Coultty.
authenticated this ........day of... ........................ 19 ...... Personally came before me this - 11th ..... day of
..........June ........................ 19-86-- the above named
Harry . J Stewart and Williatn C, Hartsell
--------•---••---------•---------------------- •-- •- •..................... .....-•--_---•.....----•......._......-•--.........--•-•-............_........--
TITLE: MEMBER STATE. BAR OF WISCONSIN
..... .......................................................... ................
(if not, ............................................................ - ••__... _-••_-•••----••....---••--••••-•-••------•-........-_--•---
authorized by § 706.06, Wis. Stats.)
to me known to be the person 5.......... who executed the
4 foregoin nstrument and acknowledge the. same.
THIS INSTRUMENT WAS DRAFTED BY
.... .......
..Lois...._ Murray, HEYWOOI), CARI, HURRAY
SHERBURNE, P.O. BOX 229, '••- k�,,D- •-- ..f ..... �2s.0, `;........._.
Huds - ow-W I �I ... 540IfT ---------- ------ - - • - ---------- •-- - - - - -•• Notary Public .... Ste Croix County. Nis.
(Signatures may be authenticated or acknowledged. Both My Commission is per anent. If noU state expiration
' nre not necessary.)
date:) .i ........... .. . -. -.. 19......�)
Humes of persons sinning in any capacity should be typed or printed bet - signatures.
3PAGE187
LAND CONTRACT ADDENDUM
Legal Description
The NJ of the NJ of the SEJ - of Section 28- 29 -19, except the South
100 feet of the East 565 feet thereof, and except a parcel of land
located in the NEI of the SEI of Section 28, T29N, R19W, Town of
Hudson, St. Croix County, Wisconsin, described as follows:
Commencing at the Ej Corner of said Section 28; thence S89 0 37 1 46 11 W
(assumed bearing referenced to the monumented East -West I Section
line of said Section 28, bearing assumed S89 0 31 1 46 11 W) 23.78' along
said East -West line to the point of beginning; thence continuing
S89 0 37 1 46 11 W 1301.48 along said line to the West line of said NEI
of the SEI; thence S 0 0 03 1 44 11 W 661.63' along said West line;
thence N89 0 34 1 48 11 E 761.97 thence N 0 0 05 1 12 11 W 100.00 thence
N89 0 34 1 48 11 E 535.40 thence N 0 0 30 1 38 11 E 560.56' along the Westerly
right -of -way line of U.S. Highway 11 to the point of beginning.
NEI of Section 28- 29 -19, except that parcel described as Lot 1 of
a C.S.M. recorded in Vol. 3 of C.S.-M.'s, page 862 as Doc. No.
359579 and except that parcel described in Vol. 583, page 527 as
conveyed to the State of Wisconsin.
Payment Terms
$35,000.00 on June 11, 1987 and $35,000.00 on each
anniversary date of this Contract thereafter; provided, however,
that if the unpaid principal balance on the Contract is greater
than $85,000.00 on July 1, 1988, Purchaser shall make monthly
payments of $3,500.00 commencing on July 1, 1988 and on the first
day of each month thereafter. Also provided that on the first day
of the fourth month following Purchasers death or permanent
disability, monthly payments of $3,500.00 shall commence hereunder
and shall be paid-on the first day of each month thereafter.
Vendor shall release Lots of not more than 31 acres in size at any
time during the Contract upon payment by Purchaser to Vendor of
$5,500.00 per Lot. Each $5,500.00 payment and each $3,500.00
monthly payment shall'be applied to reduce the next $35,000.00
required annual payment. Also provided that for each $5,500.00
paid by Purchaser in total monthly payments, Vendor shall release
one additional Lot of not more than 31 acres, upon request of
Purchaser. Purchaser shall pay the cost of drafting Partial
Releases.
Vendor shall convey to Purchaser one parcel of land around farm
buildings upon recording of C.S.M. without further payment.
Parcel not to exceed 6 acres.
t
}
x
ST. CROIX COUNTY ZONING DEPAR
AS BUILT SANITARY REPORT l� l` o
Owner OAA) uf (� M l CELE CYERM,4-GV
Property Address 7.k6 AlORC) CiQC(E .. 3T C a 14 98 J j
City /State H&I Os n E W i SC 5YU l� :. z �co u A X IIYG Iry
oFFI
Legal Description: )£ Z
Lot 17 Block Subdivision/CSM # CEOAde H Il5 0EVf1 U1)
At E t /4 NE t /4, Sec. a8, T -29 N -R /'/ Town of ftu05o A/ PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer UjEt5E& Size ST/PC 1(:00 / Setback from: House Well PAL
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road /VA Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: 5i0f Wi v.0ER Width 3� Length 6 0 Number of Trenches 2
Setback from: House Well P/L Vent to fresh air intake
ELEVATIONS
Description of benchmark / `0fn E06f. (JF 1 50),V& 0.V QEtAHC - D 6,4RA6E Elevation / 00, 0 "
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines () () ( )
Bottom of System O O ( )
Final Grade () () ( )
Date of installation I 1019 Permit number JA4 & ga' State plan number
Plumber's signature License number Z2l 8 _ Date
Inspector H
Complete plot plan �+
a, g
P
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 -j
J
1u
J ,M
T
„\ 3 O
L P
b � o
� x
r
�i a �D
� Q w
�Z�
w�
aaoiv�
�n v 3
INDICATE NORTH ARROW
6
1
4
(X H
7lJ y `
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7)
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Wisconsrh Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division
INSPECTION REPORT ST . CROI X
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3P�2r1njth:
Personal information you provice may be used for secondary purposes [Privacy L Y. s.15.04 (1)(m)]. 3 LL 44 b6 LL
8TR P 3� 1LJJPP�aiiVV o& J* s Ns�r & qftk*Ilage E] Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tdv _1177- 70-000
10d, oCY I fOc;'- 00 &.-)
TANK INFORMATION ELEVATION DATA A9800572
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic — ce�2, Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 3 o 9
TANK TO P / L WELL BLDG. Air i to ntake ROAD Dt Inlet
Air
Septic 5 ' 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 Fri on System TDH Ft
ss H ead
Forcemain Le th Dia. Dist. To Well
SOIL ABS O PTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3' 6 o' DIMEN I N
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manuf acturer: INFORMATION Type Of f Af CHAMBER Model Number:
System: fig,,, J.. /oo `moo OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCAT ION: HUDSON 2 9.19.1117 , NE , NE 786 ALDRO CIRCLE
Plan revision required? ❑ Yes E�No
Use other side for additional information. /i 1
SBD -6710 (R.3/97) Date ns a is Signature Cert. No.
Safety and Buildings Division
NALconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
In accord with ILHR 83.05, Wis. Adm. Code
Department of Commerce 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. 5 r°
• See reverse side for instructions for completing this application State Sanitary Permit Number
r 3a4g;�-
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous 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 LQcation F /
D a It 4: .^ of 7 N47 1 jV 1= 1/4, S ,2 iff T 1 . N, R 1 Jgor) W
Property 7 is Mailing �cj' ss G ! _ / Lot Number Block Number
!� q/ G 17
City, State Zi Code Phone Number Subdivision Name or CSM Numb r
y A-0 lit f p 1_ 6 1 ! (3g,�) Z 3 G C Q d I F
II. T YPE OF I IN : (check one) ❑ State Owned - Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms 3 m Town of la
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
_ - o�G
1 ❑ Apartment/ Condo 77 -70
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 E] New 2 replacement 3. [3 Replacement of 4_ C] Reconnection of 5_ [] Repair of an
------ -------- ________S�/ stem_ _____ _____ __Tank Only_____ _ - _ - - __ Existing System ________ Existing
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 03'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.) Pro osed sq. ft.) (Gals/d /sq. ft.) (Min /inch) Elevation ✓
Feet Feet
Capacit
VII. TANK in allo s Total # of r Prefab. Site
g Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer s Name Concrete con- Steel glass Plastic App
New Existing structed
Tanks Tanks
Septic Tank or Holding Tank S t` El gr El ❑ El El (
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plu ber's Signature: (No Stam s) MP/MPRSW No.: usiness Phone Number:
/J G k f04 S f V-V t , k I oD 22 7 2 -
Plumber's Address (Street, City, State, Zip Code): 1 7 _ to S g d / 7
IX. COUNTY / DEPARTMENT USE ONLY /
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
Approved []Owner Given Initial p
Adverse Determination o 0
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
4
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 b a licensed pumper whenever
9 Y P P Y P P P Y P P
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. j
r
Complete plans and/specifications not smaller than 81/2 x 11 inches n i6st be submitted to the county. The plans must
include the followi6g: 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
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the ,C/ o h G ° " en " /* residence located at:
5 E : , .t/ /, ; , Section _2- ty, T- N, R I f W, Town of
(f u 014t 11 . Upon inspection, I certify that I have found
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced:
Did flow back occur from absorption system?
L Yes No (If no, skip next line)
Approximate volume or length of time: gallons 3 minutes
Capacity: /000
Construction: Prefab Concrete y Steel Other
Manufacturer: (If known)
Age of Tank (If known) :
60 t =� o u y s s S
�r��6c
(Sig a un tt re) (Name) Please print
P(, 7 2Z I 6 0 G
(Title) (License Number)
Date
Form to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR 83, Wis. Adm. Code (except for
inspection opening over outlet baffle). _
Name 1� " k y 5 J. " 6 `c n Signature ���y MP /MPRS
Wisconsin•Department of Commerce SPJ�_AIUQ SITE EVALUATION
Division,uf'Safety and Buildings .�' ,��s� j Page of
Bureau of Integrated Services in a p� , ,f1 1iu th % WR 83.09, Wis. Adm. Code
Cou
Attach complete site plan on paper not less than 8,!1/2 x 11 inc * Ian must `,,
n
-. Cr��
� 1. ((
include, but not limited to: vertical and horizontal .teference poiht (�iWction and
percent slope, scale or dimensions, north arrow, And locat' .n and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please rrlh# all in i Reviewed by Date
Personal information you provide may be used for secondaky purposedfl q 005.9f (.J,�I ).
Property Owner �/� 17 'R,r erty Location
p n p� '�'liG�! /e �� , I ' `' ovt. Lot �1/4/4,S a T p� N,R �� W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number
Gr/l Wed (•71 5 - ")36 ) X36 ❑City El Village Town Nearest Road
o� S� /Z dsen I Adra C,i- /e
❑ New Construction Use: Residential / Number of bedrooms Addition to existing building
® Replacement ❑ Public or commercial - Describe:
Code derived daily flow l ! gpd Recommended design loading rate 2 bed, gpd /ft ` trench, gpd /ft
Absorption area required �y� bed, ft 51 2 trench, ft 2 Maximum design loading rate bed, gpd /ft - ig trench, gpd /ft
Recommended infiltration surface elevation(s) /�- U ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material 4!�j 7 �V.2s Flood plain elevation, if applicable IVA ft
S = Suitable for system Conventional Mound In-Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system Cgs El RS El � S❑ U I ER S ❑ U S❑ U EIS & U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground 4( 10 oO/ CC7 C JAJ
V10 91
Depth to
limiting
fac
Remarks:
Boring # /
V l y-12 lit .e ,3
Ground y ��� io ��d 5 � s s Ap .
e eYll ZS
Depth to
limiting
facto
in. Remarks: 0_ e o f r? �o� �o�^ o / cry,^ �h to 09
CST Name (Please Print) Signature Telephone No.
/ �'I 01 a _S 7 /f)
Address Date CST Number
S8 a l/4 13 98 2 ? 2 4 1.q 9
nn
PROPERTY OWNER lJc�v� Cky" ,G�e IL DESCRIPTION Page o-
PARCEL I.D.# 6� f) — // ` ,
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 9 /1 Bed ,Trench
oC t
Ground �1 -9 ICIVIe
elev.
7 /U ft.
Depth to
limiting
factor
t&Lin.
Remarks:
Boring #
D - O ,Q 34 �f- C 9
y a 6 --V ,d / Z lM r1r
3 3- / ---- 5 Q l �✓ -- _ 7 `d
Ground Os, m -
e
.3` ft.
Depth to
limiting
fact r
Xin.
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:
SBD -8330 (R. 07/96)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 0 4/t/ al M C1I ,E 1 E CERrnIq lA/
Mailing Address 7, ? �> A l 6RO C /if l C
Property Address 78V6 AZ DRO C I RCIC
(Verification required from Planning Department for new construction)
1
City /State � V,0SuAv r �(/ Parcel Identification Number
LEGAL DESCRIPTION
Property Location 5 E �/*, Af C 1 /4, Sec. 2 - , T -2 - t N -R 0- W. Town of NV4 50 �Ij
Subdivision CE014IQ H 1 // s Lot # 1 7
Certified Survey Map # /V u t 40e i i r'� 6 � E , Volume , Page #
Warranty Deed # Gf 3 (a d q? , Volume �f o�? , Page # /O
Spec house Pyes ❑ no 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 wastewater disposal 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 three year expiration date.
oa�v. G 11 / 1g,� 8
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.
oc� U. &'� >c / tie/ .70
SIGNATURE 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
t'`i'i- UmLril rvv WAIMAN(Y ULEU _ ..,....•..... �......•.......,._
s t A1'E B A it OF «'1st;U:ISIrf E Ult:,t 2
loo
REGISTER'S OFFICE '
1
George Miller A /K /A George O. Min ST. CROIX CO. Miller � w1
Ret r d for Record
.. ...... ...... ..... ".- . "..- ..- .....- ......... .... - ...I ... _ ------
_....
........................ ................. ........ - ... ... ........ APR 181988
:onve?s and - urralis
D "aniel V. Germain end M, ritCi �i ^ of 10:50 AM
uermaTn, I
us %and 'arid'wife as survivorship marital
pro -pert- ................. ........ ........................._ ............ C c.rJC
_"............." ......... ........- ......- .............. _. - ....... _........ ............
....... ................ -- ...._............. -.._.. -......._. ._....._- .......... .......
Rp►ssa� of D"&
1 i
_ ....... .......... •--- . "..- ........... -- •-- ....... ". .......... . -.. _......
........ ....... . .... ............. o
... .................... ".......... ...
... ...... ....._.--- ..... ...... ......... r _
..... .......... . . .. .. ......... "_ ".. ".. ........... ..... ............
Lhe following described real estate in .. ... ...... St... -.C"r- Dix...... ......... ".Cuunt), — " - - --
late of Wisconsin:
Txz I'arcel No: d°? @ 177- 70'C
Lot 17, Cedar Hills Estates in the Town of Hudson, -. Croix County,
Wi- consin.
'S' E
F
!
This .......1- 5- ..nQt... - -.... homestead property.
(is) (is nct)
Exception to warr,ntics: ease- ments, restrictions anJ _ of -way of record,
if any.
I)atea this ............ "....fifteenth April - 1: ..
....---• .............. .. day of ......._....... .
" .... .. ................................ . .... ...... (SEAL) ,.... � ,.
_(SEAL)
ueor ,e -__ _ _ -- a /k /a/ George O. Miller
..--• ....- .... • ...... .. ............ ....... .... ........
... " ............ ....... ...... ".... "......... ._._. .._- (SE:AL) .(SEAL)
• _ .."....." . ............... "- -.. ".. ".....-- .... - -_ ..... ,
i
AUTHENTICATION AC1 %. 0 W 1,F 1)GI\IENT
Signature(s) ... ....... ..--............ ---"...... . SI'A E OF -'I
� �
ss.
o 1_ Fcr.
authenticated this ........ day of .......... ......... ........ -_ ... c I - fc I r Inc t�Ils .'.. t h..._...day of
Ap. 11 11I ....... the above named I
.. . . ..............................
TITLE: bIErIBER STATE BAR OF WISCONSIN'
- . .. .. .... .. ........ ........
(If not . ............................. .......... "..........- ........
authorized by § 706.06, Wis. Stats.)
to me kr,, , ll t� n ^n _ .... echo executed the
furyK Ir.ctr :r�� 1 I.LIO.•(I 1�c the Sallie.
THIS INSin UMENT v.AS DnAC / --
iED ❑v � J
ri;,tina a j l er -
............. . " .- --= "...- --.. ..... ".. 1 1 n.if,►WCEJ.FLESCHAj-
-torney -a '-a.. _ _ ---.-.
................. ..... ............................... !7n1 I' I� ii ro i x State-
� tY, Nis.
(Signatures may be authenticate] or ac ,.no' �. I'. 'h !1` L. "'r S cn nnrnt. (If not STa?e C piration
are not necessary.)
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N60 059'32 "E
Form -STC- 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ��J�,'ctwt TOWNSHIP �,�y� SEC. T N -R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION C lk (f' LOT 1 LOT SIZE 4 - �
PLAN VIEW
Distances and dimensions to meet requirements of IIAR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
— b
`�
V'0 Q�g
INDICA E NORTH ARROW
BENCHMARK: Describe the vertical reference point used s e 0 .5
/!S
6 .
Elevation of vertical reference point: ldy t uv Proposed slope at site
SEPTIC TANK: Manufacturer: J w Liquid Capacity: e "'46 D
Number of rings used: D Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side,O Rear, O feet
From nearest property line Front,O Side ,O Rear, 0 ` feet
Number of feet from: well df/orf,W building: l,/" ,.<-
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MAD- SON..'LVI 5.1707
N1:k,NE;41'S28,T29N -R19W CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number
:
(11 assigned)
Town of Hudson ❑ Holding Tank El In-Ground Pressure El Mound
Cedar Hills Est. Lot 17
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
William Harwell Route 1, Box 1910, Hudson,WI 54016 b - O._ 9 17
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number:
illiam Schumaker 6382 St. Croix 92494
SEPTIC TANK /HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK O ET ELEV.: WARNING LA L LOCKING COVER
,t
UT P OVI ED: PROVIDED:
ES ONO ❑YES XNO
BEDDING: VENT IA.: VENT MATL.: HIGH WA NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: I LINE: AIR INLET.
FEET FROM
DYES O DYES O NEAREST
DOSING C AMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVI PROVIDED:
❑YES ONO I OY D E E S :
ONO I [DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING: V NT TO RESH
(DIFFERENCE BETWEEN FEET FROM LINE Al. INLET
PUMP ON AND OFF) OYES ONO NEAREST /
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LE TH NO. OF DISTR. PIPE SPACING: COV R INSIDE DIA. SPITS LIQUID
BED/TRENCH J TRENCHES 1 MATERIAL: PIT DEPTH
DIMENSIONS a J\
L DEPTH FILL DEPTH DISTR IPE DISTR. PIPE DISTR. PIPE MAT REAL: NO. DI NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELOW PIPES. it ABOV CQVER. ELEV. INLET . ELEV. E D. PIPES. FEET FROM LIN y ) ^� AIR I ET
112 'l` / a NEAREST -►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ONO
OIL COVER TEXTURE: PERMANENT MARKERS OBSERVATION WELLS
El YES 1:1 NO ❑YES ❑NO
DEPTH OVER TRENCH /BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER: EDGES.
El YES El NO DYES ONO OYES El NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED /TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL I NODISTR. fSTR. PIPE DISTRIBUTION PIPE MATERIAL B MARKING
ELEVATION AND
ELEV.. ELEV.: DIA.. ELEV.. PIPES A..
DISTRIBUTION
INFORMATION HOLE S1ZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
❑YES ONO 1 1:1 YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
Vf
OYES 1:1 NO I 1:14 ❑NO J NEARE
a�U QS G � (�, � 1 �
12
13.7�
Sketch System on � etain in county file for audit.
Reverse Side.
SI RE: TTLE
�l Zoning Administrator
DILHR SBD 6710 (R. 01/82)
-= -�-°^- SANITARY PERMIT APPLICATION COUNTY
( �J DILHR In accord with ILHR 83.05, Wis. Adm. Code - , 5 7— C f
STATE SANITARY PERMIT #
9a y
- Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
836 x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ® NO
PROPERTY OWNER PROPERTY LOCATION
, ,, & �`� � /4 / iW -14,S T2l ,N,R !Q E(orMJ
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
TY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK
13 VILLAGE:
a r ® LL
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family Y OR ❑ Public (Specify):
111. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. a. k New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in ##2)
1. a. Conventional b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tan k
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. _ Seepage Bed b. ❑ seepage Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
-9 f &— 1-- 3 02.6 Feet Private ❑ Joint ❑ Public
CAPACITY
VI. TANK in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION Manufacturer's Name Con- Steel Plastic
New Existing Gallons Tanks Concrete structed glass App,
Tanks Tanks
Septic Tank or Holding Tank I
Lift Pump Tank/Siphon Chamber L ❑
VII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the private sewage system show on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/ PRSW No.: Business Phone Number:
w- S'e u ,P— —
Plumber's Address (Street, City, State, Zip Code): 1qame of Designer:
Vlll. SOIL TEST INFORMATION
Certified Soil Tester (CST) Name CST #
r
CST's ADDR , S (Stye City, State, Zip Code) Phone Number:
IX. COUNTY /DEPARTMENT USE ONL
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial ,^,, `` S rc��haaC Fee
rge 7 y f
Adverse Determination /Co. vV 4� �. vo � /J -
X. COMMENTS /REASONS FOR DISAPPROVAL:
SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
�ll l� Jrt v /1/PI�I 17 �CS�e / l( (!/W.f! o/� LYb �S n✓
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IN1?PAHTIVIENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
IfJDUS'tRY, DIVISION..
LABOR AN.D PERCOLATION TESTS (115) MADISON WI 53
HUMAN RELATIONS
. (H63.09(11' &Chapter 145.045)
LOCATI N:N S ION: TOWNS /MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISI NAME:
N C '/4 - 1/ z hz N /V P (o I W u Dso q 1 Ce dt R HILLS EST'aT4*'
COUNTY: OWN R'S NAME A :
_ Ce C)Ih `E dR 1 CC" � Vitt.prdit'tC "� tCl / icek �7�0 /"IU��N � -4016
US DATES OBSERVATIONS MADE
NO. DR CO M AL S RIPTIO S S
l AfResidence b 4NK W New ❑ P IL t / J Replace �P gj_7 Mom 7 /9 7
Sob`s dK Phn4 66 so t.s - bae �I<osa
RATING: S= Site suitable for system U- Site unsuitable for system
C N EN�I AL: MOUND: IN -GROUN -F LL OLDING TANK: RECOMMENDED SYSTEM:( o Tonal)
s Du a �
s ou s ou s au o s �u PVC rjT1 w 0, I 9"
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.Hfi3.09(5)(b indicate: C LASS I I I Floodplain, indicate Floodplain elevation: AIA
PROFILE DESCRIPTIONS
BORING TOTAL DEPT UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEX URE, AND DEPTH
NUMBER DEPTHS ELEVATION B V D TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
/ �o "BLSl.T 10 " 'bKEaNsL ZVt rgacaW S - 7 0 Ita j S-t
B G�
�.Sv 9�.�3 nloN1E > 8:sa 4-1` Berl c t
�;• fi�sc. /8 fits , 17'l-rihieJ MS
B- 1 9,00 .'7 NONE > 9 O� 6' e.r S�tfare S9 "LT$RN MS
13 "$LSCT'S I3' RN' L 34 '$eaMS
B- 4.q 91:74 N o P4 > 9A 'Z S3'gR'j "I c>Q
B- 115A /00123 NoN L > / 0 ,0� ��.�� S'S S SI t $ 4' 'SL R 37n ea M S
B - 7.9 9ts.fZ No Ni: > 7.7Z 7 " & <,-TS z1`Dri$ *4S-L 6.'7* 80,4MS
B
p PERCOLATION TESTS
PTH WATER IN HOLE TEST TIME - DROP A LEVEL-INCHES RAT iNU ES
NUM BER I ft AFTERSWELLING INTERVAL -MIN. PFAIOO I PE 10D 3 PER INCH
P_
p_ 2 50 .70 > ? > Z
P- _ s.o0 Nowc Da , o 3 > Z > Z
P - &. t k
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. / - - O Sfr, d �P of Sum Y
SYSTEMA qA ON ` 6 � ` .� PRIM,iI,_y 4 3 Z Et_ty Tlotti To 140 / = /"07.60
Ac : - 9
4 1 �7
68 � / /� �\ °' � S tTt C 44M►Tlpr�i
..,� = 30
4
N
Ec t:\/A'rl6^) = /OCR 00 /
J
�tiLE�flOglt,
I, the undersigned, hereby certify that the soil tests reported on this form were made by me fn accord with the procedures a d methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and bell f.
NAM (print); p T STS WERE COM / PLETE p D ON:
kj4'PVL'/ ONn(�,o�( ICU�IJ �jUR>✓(t� ill O /
ADDRESS: CERTIFICATION NUMB ER: PHONE NUMBER (optional):
Say :�� taf vt~ t /. �uaS��! r4�,r� 4 3 -
CST SI ATURE:
n.... ,...,, r1... nr A emit Te <#nr
4•JwA!j ti
Dc,4uMENT No: STATE BAR OF WISCONSIN LF& 11 -1982 THIS SPACE RESERVED 7RECORDINIG DATA
' LAND CONTRACT
Individual and Corporate t�E�ggT s
, BE USED FOR ALI, TRANSACTIONS WHERE OVER
$26,000 IS FINANCED AND IN OTHER NON - CONSUMER p�
ACT TRANSACTIONS) ST. CROIX CO., wis.
Recd. for Record this 11th
Contract by and between ... Harry J._ Stewart, as Personal day of June q,p. 19_
--
Repres . . .......... ........._.
Aldr� .Lassen a /k/a ,�ohn_Aldro Myren Laren,_ - * ("Vendor ", James O'Connell
'
whether one or .more) and .... .. .. r_...._ ......_..._.. _.._..___._........__._.._.....
~Dlr N DNalr� /
*single man ( "Purchaser ", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- deputy
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures and other appurtenant interests (all called the "Property "),
in ............. St a -• Croix .. ........... ........__•____. County State of Wisconsin:
RETURN TO
See legal Description on Addendum
Tax Parcel No.
9�7- 3 y
�. g
FEE
This ...... 113..PQo .......... homestead property.
(is not)
Purchaser agrees to purchase the Property and to pay to Vendor at - SuCh place as he shall name
the sum of ;.- 192 500.00_, .... in the following manner: (a) $...SQ_,�QQ..Q4
at the execution of this Contract; and (b) the balance of $. U.5QQ-.QQ _.. together with interest from date
hereof on the balance outstanding from time to time at the rate of ........... teLlI _ M.)........... per cent per annum
until paid in full, as follows:
See Payment Terms on Addendum
Provided, however, the entire outstanding balance shall be paid in full on or before the....... 11th___ -- day of
........ ..Mine ........................ 19.3.0. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of ... % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time. iY4ti7iXX�SX?�?f.�SB?XXx�>��
tkoae: z:: �: �xmmc�u�wxerlt�xiaaiceoi�txveirtl��I�eooie�o�Imfx�endiasik
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 iR* kpayments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance• or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
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 ....... Kho ... s e..1?ereq - •_- „ ......... ... ..a... .
•cross Out One.
LAND CONTRACT —Individual and ATATF nAR Op wIRCnNBIN 1 —.I pl al. n.. r
64L, I I If r.) PPA ., tit)
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's in;';rest
in it_ Itnd 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-
►rr dvd coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved
by Vendor, in the sum of ; ........... .n1a .... ...................... 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
r•sntstin the standard clause in favor of the Vendor's Interest and, unle::; Vendor otherwise agrees in writing, the original
of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of lass to
in:�llras,f•e companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
it Applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
::wnlirally feasible.
Purchaser covenants not to commit waste nor allow waste to he committed on the Property, to keep the Property
in trovd 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 and 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 'urchoser a _W 3 D e d in ,tee simple, of the Property, free and clear of all liens and encumbrances, except
ersona7 Re resstnga € iv S
any yens or encum ances created gy the act or default of Purchaser, and except: easements,..protectxxe..
...covenaats..a£..recQrd,..if .. any,.. and.. zat ii. ng.. o.r dinanctK.. zp-qui> rsments. ......... ...............................
...............................................................................................................................•.......... ...............................
........ .......................................................................................---..........---•----•-•-....... ..•- •........_.................
..................................................................................................................... ............................... •-- .......
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 ...6LQ... days following the specified due date or (b) in the event of a default in
performance of nny other obligation of Purchaser which con tinues for a period of A0.... days following written notice
thereof. by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance tinder 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 inters -t in the Property and recover the Property hack 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 Purchnser shall be forcfeited as liquidated dama_es for failure to 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
defixiR and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser
shall he liable for any deficiency; or (iii) Vendor may site at law for the entire unpaid purchase price or any portion
therr4: or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet -title
nctit.n if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession
of the Property and have n receiver appointed to collect any rents, issues or profits during the pendency of any action
tinder (i). (ii) or (iv) nbove.Notwit list and ing 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 rensnn» ble attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the
extent not prohibited by Inw 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 pendency of any action of foreclosure 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.
Purchnser shail not transfer, sell or convey any legal or equitable interest in the Property (b;; assignment of any
rf Pltrchnser's rights under this Contract or by option, long -term lease or in any other way) - rithout 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 ns security for an indebtedness of
Purchnser. in the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding
balance payable under this Contract shall become immediately drse 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 Contrnct (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser
makes timely payment of the amounts then due tinder this Contract. Purchaser may make any such payments directly to
the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Contract.
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal re presentatives,
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 ....... 11 th .. ............................... day of ................. June............. .............................., 19..86...
t�
(SEAL) � .... ...................... `/.... �. ry, ,SEAL)
. ................................................................ • ..11arry..J....&tewart ........................
� G.. (P...D�?ti! ...7 ` f (�AL f-
(SEAL)
_
William C. Harwell
f ........................ ............................... . ......................................................
_.:.. ; Q
A.
AUTHRNTICATION ACKAiOWLEDGMENT"
.,
Signa ature r STATE OF WISCONSIN
ture(s) a () ................................ •--- ........................ •
as.
.... ......................................... •• •........................... St. - , C);oix . ................... County.
authenticated this ........day of.... ....................... 19...... Personally came before me this .11th ...... day of
- •__ -.. ...June........................ 19.86.. the above named
- "•• "• "...... "' " " " "• " "' Harr J Stewart and William C Ha
1'.....e ..................... ............................... _ . All
.
TITLE: MEMBER STATE BAR OF WISCONSIN
..-•--•• ...................•---............ ...............................
(If not................ ............................................................ ......................... ...............................
authorized by § 706.06, Wis. Stats.) to me known to be the person .- .......... who executed the
foregoin instrument and acknowledge the. same.
THIS INSTRUMENT AS DRAFTED BY
.... ..... ...............................
. -Lois. , A.. Murray, _ HEYlJ00D,, CART,, • MURRAY •„ ..!� .... s,
& SHERBURNE, P.O. BOX 229, •.. ....._�.... �..... O1✓
.. ................
•• ••• • y. Wis. Count
Hutisvn;' WI 44i� Notary Public ...._. t t Croix ................ t
(Signatures cony be authenticated or acknowledged. Both My Commission is per anent. If no state expiration
nre not necessary.) ''A
r date :) �� :. .............!b ........................ _. 19...... .)