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HomeMy WebLinkAbout014-1000-50-000 STC - 104 AS BUILT SANITARY SYSTEM RIMORT OWNER 1~A'iZi A nl(~~ R gbh; 1%, T ADDRESS Box, q5 CN DICE b14-- I e~Cx~ - C~caO LOT # 5U SECTION T-3 i N-R 15 W, Town of Fc>zc- 5-r- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i N ~ PC- z 10 w~. .it x.40' o m H out INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: (~At 'FL f\6, ItJ 17- f~GOD }~Kb" F3m2 Top p~ I~vmn ('~LAmB R. 111A0A0t-F ALTERNATE BM: ~Gp QV PLNnQ '(AgAny►mA►~1'IOLZ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 50y) Liquid Capacity: 1000, 1 b60 House ?J0 Other Setback from: Well 54-01 I Pump: Manufacturer GC)L)L.D5 Mode 1# WY-0 3M Size k7 VA09-5s, Float seperation { /r Gallons/cycle: 14Egc\~ /r Alarm Location 15 fiKvrn 6"Cim OF -TA#J1C SOIL ABSORPTION SYSTEM I / Width: ~Z Length 75 Nvili.ier of }~earahes bp-n Distance & Direction to nearest prop. line: t I'LO~ EA5T Setback from: well: House + 2 Other ELEVATIONS 4. ?"Z ST Inlet: 8.23 ST outlet: S~"9S, Building Sewer 134.7,Z-/ PC inlet 8`7.q S PC bottom &4-.41 / Pump Off 64,91 eader/Manifold 94.67 Bottom of system ~3 59 Header/Manifold-94.6'7/ I r Existing Grade 9 G.5 Final grade ~(Q . 5 DATE OF INSTALLATION: ql;3j 91 PLUMBER ON JOB: LICENSE NUMBER: Z"Z(y 5lo 4- INSPECTOR:~~Im 11-lav~ipr~l i 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299020 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: ANDERSON, DARIN FOREST CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 014-1000-50-000 TANK INFORMATION ELEVATION DATA A9700339 1 d3 - =,(/0 Aix- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C~,t~t ~~,"cam lido Benchmark C' Dosing Aer Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 7, q,9 TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet G% Septic C a NA Dt Bottom Dosing 11 NA Header n: (0 7 Aeration- _ NA Dist. Pipe Holding Bot. System I_J PUMP/ 1UPF®1d INFORMATION Final Grade Manufacturer Demand "2 " Model Number GPM 3 !i" oss TDH Lift~p pLength'p,5-0/ Friction System TDH Ft Forcemain Dia. mead " Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S DIMEN I SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA G acturer: SETBACK AMBER INFORMATION Type O ,-;iQ,s c+~,. a Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header Hd Distribution Pipe(s) Hole Size x Hole Spacin Vent To Air Intake Length Dia. 7 Length 7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade terns 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.) LOCATION: FOREST 1.31.15.4,SE,NE 2374 320TH AVENUE ~,E~'n^~SL~."C._ 1~•~-`(.~.. i'Y1'~/,»'i ~ ZL6JC7 L)I~? C. i7's"'''~:, . JJ V - - Plan revision required? [Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: b SANITARY PERMIT APPLICATION safety and uillngWater Sn Bureau o off Building Water Systems 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 than 8112 x 11 inches in size. :!5rt Gr0 IV, • See reverse side for instructions for completing this application State Sanitary Permit Number q~ o; The information you provide may be used by other government agency programs ❑ Check I revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Propert Location ~,1xiQ PiNi e ~1 ~E1/4 ~ 1/4, S T N, R 15 `D,00 W Property Owner's Mailing Address Box 95 Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number LGrAi~ ~.►aKt 54-op, c- i 3 II. TYPE F BUILDIN : (check one) ❑ State Owned ❑ ity Nearest Road ❑ Village 22~~uST Public 10 1 or 2 Family Dwelling No. of bedrooms- Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) - 1 ❑ Apartment/ Condo 0/`y - 1 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. g New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 NJ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill 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 Elevation Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) i .4" -7- 1 q00 9 Feet Feet VII. TANK Caaallaot in ns Total # of Prefab. Site Fiber- Exper. INFORMATION 9 Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existing strutted Tanks Tanks rf Septic Tank or Holding Tank to low J u3 Cie.ne>. ❑ CJ ❑ ❑ ❑ Lift. Pump Tank /Siphon Chamber &eo W~O ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT ~3 7 43 ~3~ - 3424 I, the undersigned, assume responsibil' for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) 7:)be'sSi n ure:,(No ps MP PRSW No.: Business Phone Number: 151-3C~Z,~ }o~J2`Z(:5t~4 I Plumber's Address (Street, City, State, Zip Code): 1 AJ 'b xvuZ0 ti 4_~G IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Indudes Groundwater ate Issue Issuing A nit Si t ) Surchargef ee) C Approved ❑ Owner Given Initial $~~j~j v g~ ~ Adverse Determination C/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. Ot,/94) DISTRIBUTION: Original to County, One copy To: Safety B, Buildings Divr ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3years. 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. 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, et(.), address and phone number. Plumber must sign applica't.ion 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; Q complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance -urve; 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 (lees) 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. P Togo of Fc % - S► • C-go tY. CS.) N I I I~ I ~ r 'SPSo 2.r~ Z" s►+c4ta Put, Ngin~ / / I i NP►~. ~t,Ac,, 10 p©pPLA--- -rvm-o 51pc ~~pt~'raN~.~ Pomp ctaamr3~~. ~1~Pv~ I doo 5A~- ~ tp ~o ~At.. G~mt3~~P.'~+®+~ V~ . 1 ► N%o 'Ft euo a: oS(~ W~trL Lac,u'[ t®~J c~tJ~Z.t lsl~..a-~1p51~4 P r 4 *C..I . V ff►.rt uI AppRO,J . C-Ap I°lnt P! Z YrAIA 4, -'F n•rf 010, c, t" es k • ~ ~ Q 93'-e 5~t~t . Ill... Z~z App les k6leA • C fzc)!-> I o n I IP • ! I •o~e 'L~4 peW 1c7d 3 2"Sc 40 pvc. N I ~ocr..c.~ gY1p+rJ No 5~~~ Page__3_Of 4- COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) 4" CI Vent Pipe with ,Approved Locking Manhole Cover Approved Cap, +25' With Warning Label Attached From Buildings ~ Weatherproof Approved _ Warning Label Junction Box Vent Cap 12" mum 6" Minimum 4" Minimum Final Grade 6 i ' 6" Maximum 4" C. 1. ' Quick 18" Minimum Insp. Pipe Disconnect 1/4" Weep ' Hole Baffles i ~ A 4 Alarm & ` On 61, B C i *APPROVED Off 6' JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Beddinq Under Tank-/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ o Doses: 2.5 Gallons Volume of Backflow:.... ...+_B6,'3Gallons Tank Manufacturer: Total Dose Volume: Gallons Tank Size-Septic/Pump: Q o Ga ons Alarm Manufacturer: Model Number:_ 1c,` Capacities: A 21 inches or~44~o Gal l ons Switch Type: + B 2 inches or Gallons Pump Manufacturer: n~_ 2,85 + C-winches orjkj~_Gallons Model Number + D_]_i nches or 115 Gallons Minimum Discharge ate: 3S GPM Total _ 9 inches or Gallons Vertical Difference Between Pump Off and Distribution Pipe:j,--_Feet Minimum Required Supply Pressure: . Feet 2.I5 Feet of Force Main x Z...4 FrictionFactor/100 Feet: +----,--Feet 2 Inch Diameter Force Main Total Dynamic Head:...= ( Feet Internal Tank Dimensions: Length Width 155 Liquid Depth 31 Signature License Number2lj~ Date Ig 7 ~ ,t~llllrl~, ■ Effillent EXMMn1 RM9 3885 CANADIAN STANDARD ASSOCIATION SP APPLICATIONS • Three phase: 1/2 HP - FEATURES Motor: Fully submerged in 1'/2 HP 200/230/460 V, high-grade turbine oil for Specifically designed for the Impeller: Cast Iron, semi- 60 Hz, 3500 RPM. Class B lubrication and efficient heat following uses: pump- • Homes insulation, overload open, outvanes non-forclog with mechanical umseal transfer. must be Designed for Continuous • Farms protection. Balanced for • Trailer courts provided in starter unit. smooth operation. Silicon Operation: Pump ratings are • Motels • Shaft: threaded, 400 series bronze impeller available as within the motor manufacturer's stainless steel. recommended working limits, • Schools an option. • Hospitals Bearings: ball bearings Casing: Cast Iron volute can be operated continuously upper and lower. without damage. • Industry a for maximum efficiency. Bearings: • Effluent systems Power cord: 20 foot ~p Upper and standard length (optional 2" NPT discharge adaptable lengths available). for slide rail systems. lower heavy duty ball bearing SPECIFICATIONS Single phase:'/3 and'/2 HP Mechanical Seal: Silicon construction. Pump: -16/3 SJTO with three carbide vs. silicon carbide Power Cable: Severe duty oil • Solids handling capabilities: prong plug. %-1'/2 HP sealing faces. Stainless steel rated, and water resistant. 3 -14/3 STO with bare leads. metal parts, BUNA-N Epoxy s seal motor end /4' maximum. , , provides secondary moisture • Discharge size: 2" NPT. Three phase: /2-1 /2 HP elastomers. 14/4 STO with bare barrier in case of outer jacket • Capacities: up to 128 GPM. - leads. On CSA listed Shaft: Corrosion-resistant damage and to prevent oil • Total heads: up to 123 feet stainless steel. Threaded wicking. TDH. models - 20 foot length design. Locknut on three • Mechanical seal: silicon SJTW and STW are phase models to guard 0-ring: Assures positive carbide-rotary seat/silicon standard. against component damage sealing against contaminants carbide-stationary seat, 300 on accidental reverse rotation. and oil leakage. series stainless steel metal parts, BUNA-N elastomers. • Temperature: METERS FEET 1040F (40°C) continuous 90 140°F Intermittent. - - - - 1--k] - _ SERIES: 3885 (600C) 25 - SIZE: SOLIDS • Fasteners: 300 series 80 E1 RPM: VARIOUS stainless steel. 5GPM • Capable of running dry 70 E, 5FT without damage to c 20 components. 60 _ Motor: s 15 50 • Single phase:'/3 HP, 115 Z - or 230 V 60 Hz, 1750 RPM; J 40 Eo H '/2 HP, 115 V, 60 Hz, -4 - - 3500 RPM; '/2 HP -1'/2 HP, ° 10 30 _ 230 V, 60 Hz, 3500 RPM. 2° Eo Built-in overload with 5 automatic reset. io Class B insulation. 0 00 10 20 30 40 50 60 70 80 90 100 110 120 130GPM I I 0 10 20 30 m3/h CAPACITY ©1994 Goulds Pumps, Inc. Effective May, 1994 11 B3885 Wisconsin Department of Commerce SOIL ITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in acco V- q ,,WAist" I 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 \ches4~~~)~ must County include, but not limited to: vertical and horizontal refe c point ,+tlki§ n and 5'f cpo i k percent slope, scale or dimensions, north arrow, and on and distance to nearest road. , Parcel I.D. # J . '.r \ Iw^' 'I 414- 1(b004-50 APPLICANT INFORMATION -Please pri inform, Reviewed by Date Personal information you provide may be used for secondary pu Priv K.Wkt )*f Property Owner Location aRi►~ A3oep.5C) Lot -5 e, 1/4 Ne 1/4,S T !5 1 N,R 15 Wor) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 50K q5 City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road C LoA-P. l,Av_e L01 g4c o5 (It6 Mo3-365q 'FORx3ST ~20-cw ST CK New Construction Use: ® Residential / Number of bedrooms_ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 45~ gpd Recommended design loading rate bed, gpd/f? trench, gpd/ft2 Absorption area required CK)O bed, ft2-7,5a trench, ft2' Maximum design loading rate • 5 bed, gpdfft2_ °(Q -trench, gpd/fl2 Recommended infiltration surface elevation(s) 7Fk I!f"AW%1 93,78 Alm. C -(o ft (as referred to site plan benchmark) Additional design/siteconsiderations JZ X"I5f Bat) Parent material V ,MDwo h f✓Gt~ f~nM~7-~ ~1~ Flood plain elevation, if applicable A, 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 ❑ U 91s ❑ u ❑ S C u ❑ S RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench -g '1,5,(P- z- 5 2m. r r e5 2. .5 •(eo -te 2mobk M. 1 S i A :.5 Ground 3 1v_ "1.5YR 51 l m^b ►K 1 .4 :.5 51t, 6 elw.,, 99 ft. 4 3 -41 ~.5 5~8 S 655 m 1 5 5 - 51 5Y?_5 Depth to 5 t trrab k i t a~ • 5'+ limiting Y" t . 5 <p factor in. Remarks: Boring # o- 15-JI -3 z 5► I 2m 121 i 135 1-1 WP ; .2 2 -15 10`( 513 S1 sM-0'bk 1 95 ,40 I5 2.5~f'(Z 3 51 2 v~.ab k 1 a S . 5~. rp Ground 4 $4o-84 - tv 5 os w,1 - 1 .5 ; el9v. rr Depth to limiting f ctor XM in. Remarks: CST Name (Please Print) Signatu Telephone No. 1700 Fp'~Soea'L' OU -I 5 E53-1-307-0 Address Date CST Number (4-11 1 T" A'4 zA O t~.l. 1 i 3181 PROPERTY OWNER ONE I f*J kM SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench I -10 _ 5 y v - 4 - s t 3C.P j IVA I S 2 N P:. 2- lo- ii to -Z2. 513 :51 1 2,M i V-S I 5 1 2_ Ground 3 x'41 2.5 2 3 51 Sn ab k~- Mj ) 0-5 .5 , elev. q 4- t-.S~fQ. 3 s os nr, l , 5 40 Depth to limiting factor Remarks: Boring # n' 1 o- 7.s~c~, z s ►1 Z m-; bt- 33 2 .5 •0 4 2 -1 :511 tmo b< I 95 I -5 -3h, 51 2i,, . ,b K mS I aS 1 .5 , • io Ground 51(o T5 m I elerv. !o q7-1 ft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # -7, 5%t24 Z 511 2+n ( 1 isP 01 - 5 2 -I to-N-5 j-3 :5i j 2rv, I n~ I 5 NP ; 3 2,5 Y2 3 s 1 -Z K 1 a5 ti . 5 Ground -19 l •5YQ 5~ S OS m 5 , 5 , So eleft. $5 7,5 Q S os 1 •5 ' • to Depth to limiting factor Remarks: Boring # 13 j Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) ~ DARI,s Ars►~.so~ PROpue--f-( Uoc mioo s 5~1 t y4, 5mc-I T31t1 !Z15tJ ZZ Ile- I I I I d I 65 15 t~ I I I t- I i o~► ~ac.+~ m~F.~c. ~o~-o "~~o ►s C~s~t 1~ OP,tu IFL.AO, 11J i~L" POPPL6 102-156 L•~ 1~110" r n Les fL 8z_ q I f- 2 0 4,~ r, k- 1j q~ EL $4 P.,,, jx~t.~ '5( (4-191 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER DA'R1 +J A NO 1QSo r~ MAILING ADDRESS 13ox q 5 At<o 63T 5 g PROPERTY ADDRESS 013 74 aD 5fr" (location of septic system) please obtain from the planning Dept. CITY/STATE C'lP- r L ke ~~DD S PROPERTY LOCATION 114, IV~ 1/4, Section T____5j_N-R 5 W o&a~s- - , ST, CROIX COUNTY, WI TOWN OF F SUBDIVISION , LOT NUMBER CERTIFIEDSURVEY MAP , VOLUMEI Z'~5, PAGE 2°c5, 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 requitement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix toning a certification form; signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in ptopet operating condition and (2) after Inspection and pumping (if 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 MR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning officer, within 30 days of the three year expiration date. SIGNED, DATE- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 o T C 10 0 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 portrait issuance. Should this development be intended for renslo by owner/contractor, (spec house), than a neccnd form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ---------------------------------A--6------------------------------- owner of property D F-I t 1\0fl ` Ot3 Location of property SF, 1/4 NE; 1/4, section I ,T_aLN-R_ l5_W Township FOR.-5T Mailing address Bn-k Q L- s:ae- LA r-a tii ~4-oe~ 5 Address of site J524 32041 SL. subdivision name Lot no. other homes on property? Yen- _No Previous owner of property ~"Nen~; tam 1J Gl_~ Total size of property ASS Total size of parcel 3s3 A R-a5 Date parcel was created 7129 19 7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes X No Volume 1'255 and Page Number 2q5 an recorded with the Register of Deeds. ---..r---------------- INCLUDE WITH THI9 APPLICATION THE F'OLLOWIN02 A WARRANTY DEED which includes d bOCUMENT NUMBER, VOLUME AND PACE NUMBER AND THE SEAL OF THE 9E9iST9R OF bEEDS& 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 the office of the county Register of Deeds as bocument No. 5(05506 and that i (we) presently own the proposed site for the newage disposal system or f (we) obtained an easement, to run the abcQ6 deocribed property, for the construction of said system, and the name has been duly recorded in the office of the County Regist6P of Deeds as Document No. ignature of Applicant Co-Applicant *-lg ~'-Aq'7 Date of Signature Date of Signature VOL 1.~~~PA~E~~J 563308 STATE BAR OF WISCONSIN FORM 1'1 - 1982 LAND CONTRACT Individual and Corporate (TO BE USED FOR ALL TRANSACTCONS WHERE OVER DOCUMENT NO. $25,000 IS FINANCED AND IN OTHFR NON-CONSUMER ACT TRANSACTIONS) Contract, by and between Thomas D. Nelson and Carol V- ; 7 A. Nelson, his wife, a101a ("Vendor", whether one or more) and Darin E. Anderson and Brenda L. AUG 4 1997 Anderson, husband and wife, as survivorship - marit a1 property _ ("Purchaser", whether one or more). 9:30 A. M Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance fiwvstvi it ~•ee.lY 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: THIS SPACE RESERVED FOR RECORDING DATA The Fast Half of Northeast Qriarter ( E 1/2 NAME AND RETURN ADDRESS ~I NE 1/4), Section 1 Township 31 North, Range Daniel M. Byrnes 15 West EXCEPT the North 1540 feet thereof. P. 0. Box 179 Amery, WI 54001 1 014-1000-10; 014-1000-50 PARCEL IDENTIFICATION NUMBER TRANSFER FEE i This its not homestead property. ! (is) (is not) t Purchaser agrees to purchase the Property and to pay to VendorX C/o Citizens State Bank Clayton, F[] the sum of $ 27 , 50Q._QO in the following manner: (a) $ 5 , 500.00 at the execution of this Contract; and (b) the balance of $ 22 , 000 . 00 , together with interest from date hereof on the balance outstanding from time to time at the rate of *See Below percen, zr annum until paid in full, as follows: Said principal and interest shall be payable in monthly installments of r less than $250.00 per month commencing on the /'fir day of :~F_p,. ,19c- and on the same date of each consecutive month until said principal and interest is fully paid. *The interest rate of this contract shall be adjusted on an annual basis t a rate one (1%) percent less than the rate being charged by the Bank of Turtle Lake, Turtle Lake, Wisconsin on farm real estate loans on the anniversary dates of this contract. THE INITIAL RATE ON THIS CONTRACT SHALL. BE 8-1/4% per annum. 1~?......(altui►totr~xitu,ciotw). xX' Following any default in payment, interest shall accrue at the rate of 12 % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). ~~kSG7l ~9@44txi~ 1~~Q~1~.~C4~3~7¢11t1~Q~~~4~t>IC34~b>k1%s}617~f51~>~#~-$$;;fi~4~bp fc~Qpl; ~I~Q~CCs~tx~i # > ~c x>s c k~xl > aclxamt~o~sXZaaoXbaZKAXAM KMXNXXJK 1 at a xgt ~ci~G~G I , e t Rye Y t ins b asx6lkxxocxxDcoebobby IbXVeXdOKf75>,cl M?AXXxWsX% NAXXXXWaMNI r X~ AC~ ~t~i3'itc~~►t~e Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after- July 1997 (prgr~p Qtitxpe>xr~~anaa~dox~c 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 tlfe Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and xcept: Sublect to municipal and zoning ordinances and recorded easements and restrictions of record, if any. 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 30 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 -_30- days following written notice thereof by 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 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 interest in the Property and recover the Property back 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 Purchaser shall be forfeited as liquidated damages 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 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 any deficiency; or (iii) Vendor may sue. at law for the entire unpaid 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 in a quiet- title action 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 enforce any 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 incurred, 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 to 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 [cuts, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without 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 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 granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amount then due under this Contract. Purchaser may make 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 tans of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and I'wrha:a r. (11 not an Owner Of the property the spouse of Vendor lot a valuable constdcrationjoins 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 July (SEAL) (SEAL) Thomas D. Nelson * Darin E. Anderson - - - - 6' li--_tr ~ s t~ yL~ (SEAL) ilen ~ ~ ~ % IY ItI (SEAL) Carol A. Nelson * Brenda L. Anderson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Of Thomas L. Nelson ar.-J Caro-L A. State of Wisconsin, Nelson, his wife, AND Darin E. An_derson ss. and--Brenda-L_-nd~r-s-on-.F-hiG ~ pM County. autht heated this lay of --JUI 1997 Personally came before me this day of 19 , the above named *Daniel M. B es _ TITLE: MEMBER STATE OF WISCONSIN (if not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Daniel M. Byrnes Law Office _ P_,_-O_.____Box 179, Amer , WI 54001