HomeMy WebLinkAbout004-1067-50-000
STc - 10 4
AS BUILT SANITARY SYSTEM REPORT
RECEIVI
r y N~ ss r~
OWNER '
197
ADDRESS flSQL ST CROIXvs
COUNTY
r ZONINOOFFICE
SUBDIVISION,--/-- -CSM LADT• .
SECTION.
-R fist, `Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEW-OF..SYSTEM
rte Ft
4 3~"~~°~
T>z~.tP~~sf-~ l
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
i t
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK PUMP CHAMBER ,.,KO.DIIG.,2~NR -IFDItMATiON =
Manufacturer: L.11.l~+SNQ~ .
Liquid',Capacit~,. ~ Q ~?fi.?r•., , ~ . Q
Setback ram-.1 e' 1 use.4
o 4 e ,
Pumps ManufactuModel
Float seperatlon
Gallons cycle:
Alarm Location Got
a
SOIL ABSORPTION SYSTEM
Width: Length O Number.of trenches
Distance & Direction to nearest prop. line:
Setback from: well. ous ther
42~~ ELEVATIONS
$991'9,.
Building Sewer ST ~I/n.llet ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold ~ a! Bottom of system A'1
5Z.
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
C/~j
LICENSE NUMBER: z
INSPECTOR: o
3/93:jt
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division County ST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryN5iliiisd
Personal information you provice may be used for secondary purposes [Privacy La S.15.04 (1)(m)].
y WS'LAND ❑6iby Village Town of: State Plan ID No..
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tt~$-1067-50-000
6 W 6tit. Sl-A ;j U
TANK INFORMATION ELEVATION DATA A9700497
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 100D Benchmark 3 ( ZGj /0
Dosing (.ovvt by (of~o f~{ f4q N"~ '714--Vf 9711
/
Aeration Bldg. Sewer CI`Lr~" /2,,68r~ 612,2
Holding 4t inlet 33 -'q.q(
TANK SETBACK INFORMATION St/ Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic z, loo", ' NA Dt Bottom 47&~"' ~(o `7
Dosing
00> NA H eader / Man. Aeration NA Dist. Pipe Holding Bot. System ~ 3 PUMP/ SIPHON INFORMATION /ee)ej . r,,, "ON_ Final Grade (07 0/
Manufacturer Demand J;~ .Z(p~ g (o•D
Model Number I? GPM k
TDH Lift q.Zot Friction ~Z System TD q/ Ft
Forcemain Length OC' Dia. Z Dist. To Well
SOIL AB PTION SYSTEM tiz I?,x G I C
BED RE Width 22 r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS J Z~' 2 DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN Manu r:
SETBACK
INFORMATION Type O ~f # CHAMBER \ M e Num er:
System tF-ysy~ `J I~O OR UNIT
DISTRIBUTION SYSTEM tcJuw nccfe ! 4 Zr)' _ 112.5
Header / Mani yid r~ Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake
Length to Dia. Length 112 Sr 8+o- Spacing ~ >25
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth f xx Seeded/ Sodded xx Mulched
Bed/ Trench Center Bed /Trench Edges ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: CADY 28.28.15.446A,NE SE 134 HIGHWAY 128
Ta w 6~ teas "-f 0410'lctc ~ ee,( 0,7.4(W , r . ► spc~ f
eG.c +k * V-C-vic ~ ,
Plan revision required? ❑ Yes No
Use other side for additional infor atlon. i-L
SBD-6710 (R.3/97) Date Inspector's Signa a Cr
'A i
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
t ` Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water System!
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County ~V
than 8 1/2 x 11 inches in size. :ff • See reverse side for instructions for completing this application State sanit ryiPer; it umber
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro y Iwner Na a Property Location
L4rsc _1/4S'e 1/4, S ~b T , N, R rS~
in C^0
Property Owner's Mailing Addresss0 Lot Number Block Number
City, St to . Zip Code Phone Number Subdivision Name or CSM Number
!eq -7 M31
II. TYPE F BUILDING: (check one) ❑ State Owned E] i.ty Nearest Road /
Public 1 or 2 Family Dwelling - No. of bedrooms Al rowan of w
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo 0014 J 14D(AO"3 - 5o
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. Q1 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting 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
12 91 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Ele ation
5U Feet Feet
VII. TANK Capacity' gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank ago 000
1L ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber Wj ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans-
Plu er's,Name: (Print) Plum r'sSiynature: (No amps) P PRS/~W No.: Business Phone Number:
ZPlu er's Address (Street, City, State, Zip Code):
Y'7/ s
IX. COUNTY / DEPARTMENT USE ONLY
(Includes Groundwater Date Issue Issuln A en Signature (No StamPS
Disapproved Sanitary Permit Fee 9 9 )
Approved ❑ Owner Given Initial C/( 0-t/11 M Surcharge Fee)
Adverse Determination 00 ~f
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
~ vYli!.F~' P.Dc ~ vti ~av~ k ~O~-Ir' fie..
SOD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit. Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The sE!ptic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7:
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this-system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
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.
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SEPTIC TANK & PUMP CHAt"BI7t CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 1211 MIN. ABOVE GRADE 6 WEATHERPROOF
25' FtZGM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH inIR INTAKE WITH CON nTt?T
c- _ MANF'OLE COv
FINISHED GRADE #41' ?ADLOCK
4" CI RISER "~-WARNING LAB
r-1_4" MIN,
18" 1IN. 6" MAX.
l i
INLET
WATER TIGHT SEALS GAS-1
+ _T_ TIGHT t
A SEAT, , APPROVED
APPROVED ALM JOINTS WITH
PIPE V B APPROVED PIPE
ONTO SOLID ON 3' ONTO
SOIL ! C ~ ~ SOLID SOIL
PUMP OFF ELE.V V. FT. OFF RISER EX
D PERMITTED 0
1 IF TANK
_ M %NUFACTURE:
3" APPROVED BEDDING UNDER TANK ~ HAS APPROVA
CO'NCRETE PAD
SPECIFICA'."IONS
SEPTIC / DOSE
TANK MANUFACTURER: LogA__ P/-ec*-f- NrUMSZR DOSES PER DAY:
~
TANK SIZES: SEPTIC i-000 GAL. DOSE VOLUME INCLUDING
DOSE GAL, FLOWBACK: GAL .
ALARM MANUFACTURER: ~ C- f`e~ CAPACITIES: A = - ?NCHES = ~GAI
MODEL. N~JMHER
SWITCH TYPE: t.e B - 2 INCHES W -3`GAI
PUMP MANUFAC`IuRER : d(rD'V1l}- C - goat/ INCP?ES = 151,x` GAI
MODEL NUMBER :
SWITCH TYPE: D -
- (D _ INCHES ~ ~-CAI i
REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER SLHR 16.23 W~
VERTICAL DIFFER NCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE t`75 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . .
2.5
FE
+ - FEET FORCEMAIN X 1(2a FT/100 F FRICTION FACTOR FEET
i
TOTAL DYNAMIC HEAD - j34.ILFEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH
WIDTH DT.AMETER
LIQUID -
SIGNED: n /1
LICENSE NUMBER: DAVE:
1/88
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ENGINEERING DETAILS - SW25/33
' R
1
.
Performance Data
Pump Characteristics 32
Pum /Motor Unit Submersible
7FT
Manual Models SW25M1 SW33M1 W za
Automatic Models SW25A1 SW33A1 °a
kj] 1/3 HP
Horsepower 1 /4 1 /3
Full Load Amps 8.0 10.0 Z 16 1/4 HP aTT- 7n Motor Type Shaded Pole (4 pole) °
a
R.P.M. 1550 o s
t-
Phase 0 1
Voltage 115
Hertz 60 0 o 10 zo 30
ao 5o so
Operation Intermittent CAPACITY-U.S. P.M.
Temperature 120°F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10
Discharge Size 1-1/2- NPT
Solids Handling 1/2 Dimensional Data
Unit Weight 30 lbs.
Power Cord 3-1/2 5-7/8 I. All dimensions in inches
18/3, S1TW, 10' Std. 4-1/2 2. Component dimensions may
(20' optional) vary 1 1/8 inch
3.1/2 1-1/2 NPT 3. Not for construction purpose
DISCHARGE unless certified
Materials of Construction 4. Dponzandweightsare
approxiroximote
Handle Steel 5. On/Off level adjustable
3-1/2 6. We reserve the right to
Lubricating Oil Dielectric Oil make
re wsr
visions to our
products and their
Motor Housing Cast Iron specifications without notice
Pum Casin Cast Iron
Shaft t Steel
Mechanical Seal Faces: Carbon/Ceramic
Shaft Seal Seal Body. Anodized Steel
Spring: Stainless Steel
Bellows: Buna-N 11
PUMP
Im eller Thermo lastic 10-1/8 ON
s-1/z
U or Bearin Bronze Sleeve Bearing
DISCHARGE
Lower Bearin Sin le Row Ball Bearin HEIGHT
Strainer/Base Plastic _ 3 3-1/2
PUMP
Fasteners Stainless Steel OFF
ran
z
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F
AURORA/HYDROMATIC Pumps, Inc.
1840 Baney Road, Ashland, Ohio 44805
(419) 289-3042 Y 47,
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wisconsir:bepartmentofCommerce OSITE EVALUATION Page 1 of 3
pivision of Safety and Buildings omm 83.05, Wis. Adm. Code
Attach con lete site Ian on r not less tha ,R Plan must
include, but not limited to: vertical and horizontal rey` (BM), direction and
St.
percent slope, scale or dimensions, north arr a iooi gnd tanceto nearest road. . CrO1X
Parcel I. D.#
APPLICANT INFORMATION - /e prir~aH informa\' n. 004-1067-50
R ie By Date
Personal information you provide may be u fob tern (Privacy s. 15.04 (1) (m)). 11 Property Owner Property Location
Larson Roland + = "'"7 ovL Lot NE 14 SE 1/4 S 28 T 28 N,R 15 W
Property Owner's Mailing Address n i Lot # Block # Subd. Name or CSM#
40 South WSHW 128 "
City State Zip`Oode phone m er ❑ City ❑ Village ®Town Nearest Road
Spring Valley WI 6 715777$ Cad I WSHW 128
New Construction Use: ® Resi r of bedrooms 3 []Addition to existing building
® Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .3 bed, gpd/ft' .4 trench, gpd/ft'
Absorption area required 1500 bed, ft' 1125 trench, fe Maximum design loading rate .3 bed, gpd/ft' .4 trench, gpd/ft'
Recommended infiltration surface elevation(s) 95.2 ft (as referred to site plan benchmark)
Additional design / site considerationsinstall 2 - Y x 108' Sidewinder Hi-Capacity "turtle-shell" trenches
Parent material till Flood plain elevation, if applicable NA ft
S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U=Unsuitable for system N S❑ U N S0 U N S❑ U E S❑ u ❑ S N U ❑ S❑ II
. SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDff
Boring# Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
,..,..1 1 0-5 10YR 3/3 - sil 2 m cr mvfr cs If/m .5 .6
2 5-12 IOYR 3/3 - sil 2 m sbk mvfr cw lm .5 .6
Ground 3 12-19 10YR 4/4 - sl 3 m sbk mvfr cs Im .5 .6
elev
97.7 It 4 19-27 7.5YR 5/6 - A 1 m sbk mvfr gs 1m .4 .5
Depth to 5 27-60 5YR 4/6 - sl 0 m mfr cs - 3 4
limiting 6 60-76 7.5YR 4/4 - mcosl 0 m mvfr - - .3 .4
factor
> 76"
Remarks: horizon 2 occasionally parts to platy; some gr 27-60• considerable IF gr below 60"
2 1 0-5 10YR 3/3 - sil 2 m cr ds cs 2f1m .5 .6
2 5-11 10YR 3/3 - sil 2 m sbk mvfr cs lm .5 .6
Ground 3 11-27 10YR 4%4 - A 0 m dsh gs lm .3 .4
elev
100.0 It 4 27-66 5YR 4/6 - sl 0 m mfr cs - .3 .4
Depth to 5 66-84 7.5YR 4/4 - mcosl 0 m mvfr - - .3 .4
limiting
factor
> 84'
Remarks: f gr 11-27• considerable gr w/ occasional cob below 27"
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 15-665-2681
Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref #
10/21/97 222774 207
PROPERTY OWNER: Larson, Roland SOIL DESCRIPTION REPORT Zo7 Page 2 6# 3
PARCEL I.D.# 004-1067-50
Depth Dominant Color Mottles Structure GPD/fts
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots
Bed Trench
3 1 0-3 10YR 3/3 - sil 2 m cr ds cs lf/m .5 .6
- 2 3-7 10YR 3/3 - sil 2 m sbk mvfr cs lm .5 .6
Ground
elev 3 7-11 10YR 4/4 - sl 0 m dsh cs lm .3 .4
99.5 ft 4 11-48 5YR 4/6 - sl 0 m mfr cs - .3 .4
Depth to 5 48-90 7.5YR 4/4 - mcosl 0 m mvfr - - 3 4
limiting
factor
> 90"
Remarks: ar & cob below 7.' w/ occasional st
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
. i
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
4- 106+
Ivy -Sti - 'LV -Z.St- s w
S 4
~-er„ 2t t~~t T3-~
CA
41, Ct-
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Saa.v:•-Q o_~Cso.~
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WisconSm bepartment of Commerce SOIL AND SITE EVALUATION Page 1 of 3__
division of Safety and Buildings omm 83.05, Wis. Adm. Code
Attach complete site plan on paper not 1 n(jB as Plan must County
include, but not limited to: vertical and horiz I Cence rection and S t. Croix
percent slope, scale or dimemslons, north arrow, and location and distance to nearest road.
Parcel I.D.#
APPLICANT INFORMATION - Please 1n on. 004-1067-50
w4oii "
laW, s. 15.04 (1) (m)). Re'e By Date
I I I , S
Personal information you provide may be used for a
Property Owner Property Location
r-r-. 1A
Larson Roland i\, L ~~0 G Lot NE 14 SE 1/4 S 28 T 28 N,R 15 W
Property Owner's Mailing Address i Lo # Block # Subd. Name or CSM#
40 South WSHW 128 49'7
City State 4ip Code Phog City ❑ Village ®Town Nearest Road
Spring Valley WI 54767 715'2 Cad WSHW 128
❑ New Construction Use: ® Residential/ Numbed bed s 3 []Addition to existing building
® Replacement ❑ Public or~iner-cif dos ine
Code Derived daily flow 450 gpd Recommended design loading rate .3 bed, gpolft' .4 trench, gpd/ft'
Absorption area required 1500 bed, IF 1125 trench, ft' Maximum design loading rate .3 bed, gpd/fe .4 trench, gpd/ft'
Recommended infiltration surface elevation(s) 95.2 ft (as referred to site plan benchmark)
Additional design / site considerationsinstall 2 - Y x 108' Sidewinder Hi-Capacity "turtle-shell" trenches
Parent material till Flood lain elevation, if applicable NA ft
S=Suitable for system Conventional Mound In-Ground Pressure AT Grade System in Fill Holding Tank
U=Unsuitable for system ® S ❑ U ® S ❑ U ®S O u ® S El U ❑ S ❑ U ❑ S ® U
. SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPDlftz
Boring# Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
.....1 1 0-5 10YR 3/3 - sil 2 m cr mvfr cs If/m .5 1 .6
2 5-12 10YR 3/3 - sil 2 m sbk mvfr cw Im .5 .6
Ground 3 12-19 10YR 4/4 - sl 3 m sbk mvfr cs Im .5 .6
elev
97.7 ft 4 19-27 7.5YR 5/6 - sl 1 m sbk mvfr gs Im .4 .5
Depth to 5 27-60 SYR 4/6 - sl 0 m mfr cs - .3 .4
limiting 6 60-76 7.5YR 4/4 - mcosl 0 m mvfr - - 3 4
factor
> 76"
Remarks: horizon 2 occasionally parts to platy, some gr 27-60• considerable f gr below 60"
2..,. 1 0-5 10YR 3/3 - sil 2 m cr ds cs 2flm .5 .6
2 5-11 10YR 3/3 - sil 2 m sbk mvfr cs lm .5 .6
Ground 3 11-27 10YR 4/4 - sl 0 m dsh gs lm .3 .4
elev
100.0 ft 4 27-66 SYR 4/6 - A 0 m mfr cs - .3 .4
Dept, to 5 66-84 7.5YR 4/4 - mcosl 0 m mvfr - - 3 4
limiting
factor
> 84"
Remarks: f gr 11-27; considerable gr w/ occasional cob below 27"
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715-665-2681
Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref#
10/21/97 222774 207
PROPERTY OWNER: Larson, Roland SOIL DESCRIPTION REPORT Zo7 Page 2 of
PARCEL I.D.# 004-1067-50 t
Depth Dominant Color Mottles Structure GPDIF
Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. nsistence Boundary Roots -
Bed :Trench
1 0-3 10YR 3/3 - sil 2 m cr ds cs If/m .5 .6
2 3-7 10YR 3/3 - sil 2 m sbk mvfr cs IM .5 .6
Ground
elev 3 7-11 10YR 4/4 - s1 0 m dsh cs lm .3 .4
99.5 ft 4 11-48 5YR 4/6 - sl 0 m mfr cs - 3 4
Depth to 5 48-90 7.5YR 4/4 - mcosl 0 m mvfr - - 3 4
limiting
factor
> 90"
Remarks: pr & cob below 7" w/ occasional st _
Ground
elev a
Depth to
limiting
factor
Remarks:
Ground
elCv
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
co 67~
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N ~ 3~ 1-1~•.~ ~,Zg
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STC - 105
SEPTIC TANK MAINTENANCF, AGREEMENT
St. Croix County >
OWNERJBUYEIZ e0ZjfAjd hhjd 13 t 4rV0Al -
MAILING ADDRESS GAD /yw l $ So.:'~ h Spy;NCi u A1//e y w47- SY?6'7.
PROPERTY ADDRESS 131 Hwy a g C•-) i♦Sr~nJ Cl-t :t- SL/ O.Z ~
(location of septic y tem) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION A)6- 1/4, 1/4, Section, T
TOWN OF 14 ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBEIZ
CERTIFIED SURVEY MAP , VOLUME/,;PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumpci verifying that (I)
the on-site wastewater disposal system is in proper operating condition and (2) after in 'pection arid
pumping (it' necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNK
Certification stating that your septic has been maintained must be completed and returned to the St Croix
County 7.oninp, Officer within 30 days of the three ye Icxp" ion &
SIGNED: !DATIlq-?-7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
I ludSO H, W1 54016 1 I,'"')3
• 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 should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Ownerofproperty & Ldt/'d h1a Alit ~ ff/ison
Location of property / F 1/4 1/4, Section ~e T,;Zn N-R ~5 _W
Township Mailing address 1 3~1 gus y /Z g W,/snw
uJ -IT I Nb21
Address of site #4-k" e-
Subdivision name Lot no.
Other homes on property? Yes 4101, No
Previous owner of property ~-C A,1 ()/crud
Total size of property $ b
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes )
_ <_No
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in -t be office of the County Register of
Deeds as Document No. ' and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature f Applicant Co- pplicant
1 1!1 -Cjj /y ~7
Date of Signature Date of Signature
• w1272rd447 /a °°Pac
567459 STATE BAR OF WISCONSIN FORM 11 - 1982
LAND CONTRACT ~I
Individual and Corporate
(TO BE USED FOR ALL TRANSACTIONS WHERE OVER
DOCUMENT NO. $25.000 IS FINANCED AND IN OTHER NON-CONSUMER it
ACT TRANSACTIONS)
_ - - - - REGISTER'SF'fllC:E
j Contract, by and between Shirley Holerud, a/ /a $T. CROIX CO., WI
Shirley M. Holerud, a single person 89ad f~- Rtlcw+
j! ("Vendor", j' OCT 2 7 1.7.77
whether one or more) and Rnl and fl_ T.a gran and Ri to
j M_ T.arcnn- htrahand and vifa ~ A i
("Purchaser", whether one or more). t Re at~r o/ Oc~dr
Vendor sells and agrees to convey to Purchaser, u in the prompt and full performance j
of this contract by Purchaser, the following property, together with the rents,
profits,
j; fixtures and other appurtenant interests (all called the "Property"), in
;i
R - C• o i x County, State of Wisconsin:
THIS SPACE RESERVED F RECORDING DATA
NAME AND RETURN ADDRESS
Northeast Quarter of Southeast Quarter
(NE'h of SEh) of Section Twenty-eight i rhdc' i=
(28), Township Twenty-eight North(T28N); 0FFI.CE
Range Fifteen West (R15W), excepting a 9g0 ai+Crest S?reet
i parcel of land commencing at a point at Baldwin. Wis. 59002
the southeast corner of Northeast Quarter
of Southeast Quarter (NEk of SEk) of ---1
Section Twenty-eight (28), Township Twenty- 004-1067-50
eight North (T28N), Range Fifteen West PARCEL IDENTIFICATION NUMBEA
(R15W), thence running west eight rods, thence north ten rods,
thence east eight rods, thence south ten rods to the place of
beginning, and EXCEPT beginning at a point eight rods west of
the southeast corner of the Northeast Quarter of Southeast Quarter
(NE'k of SEk) of Section Twenty-eight (28), Township Twenty-eight
North (T28N), Range Fifteen West (R15W), thence west 295 feet, j
thence north 295 feet, thence east 295 feet, thence south 295 feet
This 1 s homestead property.
Purchaser agrees to purchase the Property and to pay to Vendor at a place designated by Vendor
the sum o(E 82,000-00
in the following manner: (a) S 35,000.00
at the execution of this Contract; and (b) the balance of f 47,000.00
together with interest from date
hereof on the balance outstanding from time to time at the rate of six (6%) percent per annun until paid in full, as follows:
monthly payments of $288.00, commencing one month from date
hereof, and on the same date of each month thereafter
TRANSFER
I QV600
Provided, however, the entire outstanding balance shall b, paid in full on or before the f v (ri )dsWy - a s from date.
Wjr,- (the maturity date). hereof
Following any default in payment, interest shall accrue at the rate of 15 % 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 anticipated 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 i
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 anytime after January 1 19 98igy
V~DGIC~FIC~ISdtOtJCAQ~dCXX
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 h.tve been had the monthly payments been made as first specified above; provided that monthly payments shall be
continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Pur';laser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except:
none.
' VOL 1272 PACE 4 8
1997 real estate taxes have been propated between the parties
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendors interest in it and to deliver to Vendor
on demand receipts _,hewing such payment.
Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils
and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of f tr t t i n a tr r b 1 e
but Vendor shall not require coverage in an amount mote than the balance owed under this Contract. Purchaser shall pay the insurance premium
when due. The policies shall contain the standard clause in favor of the Vendors interest and, unless Vendor otherwise agrees in writing, the
original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly
and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property
damaged, provided the Vendor deems the restoration or repair to be economically feasible. give notice of lose to insurance companies
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable
condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances 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 Purchaser, a Warranty Deed, in fee simple, of
the Fioperty free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except:
t
a period of ~r 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 r
34.__ 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 days following written notice thereof by Vendor (delivered personally or mailed by cenified mail); then the entire
outstanding balance under this contract shall become immediately due and payable in full, at Vendors option and without notice (which Purchaser
hereby waives), and Venda 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 pro perty and
recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchasers full
event all amounts 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
previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill ;his Contract and as rental for the
Property if Purchaser fails to redeem); or (h) Vendor may sue for specific performance of this Contract to compel immediate and full payment on
the entire outstanding balance with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event
the Property shall be auctioned at judicial sale and Purchaser shall be liable for an deficiency;
purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title tin quKa
title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from
have a receiver appointed to collect any rents, issues or profits during the
perly and
pendency of any action under (i), (ii) P or (iv) above. onbove. of the ProNotwithstanding
any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding
upon
Vendor if when
pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any rein y hereunder and her
abated or nor) to the extent not prohibited by law and expenses of title evidence shall be added to principal and and shall be included in any judgment. paid by Purchaser,
as incurred,
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents a receiver of the Property, including homestead interest, to collect
the rents, issues, and profits of the Property durin the
ard such rents, issues, and profits when so collected shall be held and applied as the court shall direct to the appointment to
action
Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of pendency such
rights ch under
this Contract or by option, long-term lease or in any other way) without the prior written consent f Vendor unless either the ou
payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment 'Purchaser's interest tinder this Contract solely
i
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 due and payable in full, at Vendor's option without notice.
Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any ,
mortgage grantrd by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amount -hen due under this
Contract Purchaser may snake 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 other subsequent or prior default of Purchase.
All terns of this Contract shall be binding upon and inure to the benefits of the heirs, legal representames, 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 Q4at r
, 19 07
_ (SEAL)
(SEAL)
(SEAL)
R_ t
(SEAL)
AUTHENTICATION
ACKNOWLEDGMENT
Signature(s)
State of Wisconsin,
authe rticated this day of CF Cr - x
19 - County. ;
Personalty came before me this _.___Zr th-_ claw of
-October
Ro 1 ~ rid n 19--9-7-, the above named
a c
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, -Sh
authorized by 1706 o6, Nis. Sta ) to me known to be the person ho' 4d the. ~
instrument a td cknowted¢e the semiroeinb
THIS INSTRUMENT WAS ORAFTFn av