HomeMy WebLinkAbout018-1075-10-100
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER A L,
ADDRESS P
SUBDIVISION / CSMJ LOT
SECTION 3 _T! ~N-R_ / 7 W, Town of
ST. CROIX COUNTY, WISCONSIN 3y Z`~, SZG/Ff
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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tom > INDICATE NORTH RProvide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
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L"VE
ST CROix
BENCHMARK: X" 5 0 _ I' COUNTY !
o O XI (7FFICE.
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
R.s.
Manufacturer: anaw. / L-) L.-j - Liquid Capacity:_ /000~ 8d0
Setback from: Well 6 8 House / Other
Pump: Manufacturer 3.o-p~ Model# q 8 Size E a H10
Float seperation 6 Gallons/cycle: J40
Alarm Location-
SOIL ABSORPTION SYSTEM
Width: a e Length q4~ Number of }'mss
Distance & Direction to nearest prop, line: 738
a~-
Setback from: well:/ House S~ Other
ELEVATIONS
Building Sewer ,gS
ST Inlet: ST outlet: q ~.o $
, I ~~L
PC inlet 9'3.e 1 PC bottom-__2_!!I, 5' Pump Off _9 J,7S~
Header 97.1 Bottom of system q p , y 0
Existing Grade- 9-7,3 Final grade i o o. $
DATE OF INSTALLATION: /v - - 9 7
PLUMBER ON JOB: W oQ~
LICENSE NUMBER: ;-;L7 -7 r o
INSPECTOR:
3/93:jt
Wiscof1sin 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 299084
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
WENDT, BRUCE & BONNIE HAMMOND
CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.:
/GU• Cd 1 ' , CC;; , SAP 0 5 018-1075-10-100
TANK INFORMATION ELEVATION DATA /o o X97
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic a -6d Benchmark .r .3,W1
Dosing S ccw C - ~W - //4-
Aeration Bldg. Sewer
Holding St/)t Inlet -
TANK SETBACK INFORMATION St/y( Outlet
AirIto ntake ROAD Dt Inlet G
TANKTO P/L WELL BLDGVerit
Air Ito
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe y fS t1
Holding Bot. System "2S <22
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
mead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I
SYSTEM TO P/L BLDG WELL LAKE/STREAM [_E G Manufa
SETBACK CHAMBER
INFORMATION Type O Moe u .
System: 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.)
"o 4,1
,j,6&TI&N: HAMMOND 34.29.17.526A,SW~SW 1826 60TH AVENUE
C1.1 . ~~4 _11Z7_
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. F_ FT I I I
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Visconsin Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. S+ Cra i
• See reverse side for instructions for completing this application State Sanitary Permit Number
299Q8~
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 INF RMATION (7-
Property Owner Name Property Location
t-"Ce 490m LJa- SWI14 SW 1/4,S S T,Z N,R /7 E(or )o
Property Owner's Mailing Address Lot Number Block Number
~ 4 6 a tom. Av r- r l~o~►- f- o ~ ~l v /r~ o e. S Tv 7'0~ ~
City, State I Zip Code Phone Number Subdivision Name or CSM N mber
>M d. L~?~ yo/S (7~s>79~ ss~o N,,
14&m
IL PE F BUILDING: (check one) ❑ State Owned Ity Nearest Road
Vile
Public 1 or 2 Family Dwelling - No. of bedrooms O To
wn OF NaW !>7vhd wd ~j ry e
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo q 01 _)7- a~
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. ]s 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 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
V1. 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) Elevation
116'a %i ; sr , Al NA, 48r Feet /oo, 7 Feet
VII. TANK Cap gallons cctTotal # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App
New Exist in strutted
Tanks Tanks
Septic Tank or Holding Tank / ❑ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 6100 0A._P a- ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.,
Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
0o_1+,e- 1- A/eC.r V/` JJe pis- 7Y 3~~z
Plumber's Ac dress (Street, City, State, Zip Code):
94,-7 U w lO i2v bC.►- 11-5 L.c o o
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps)
NApproved E] Owner Given Initial surcnargeree)
47 A
Adverse Determination 0
0
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R.11/96) 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 septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
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, 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.
ULBRICHT & ASSOCIATES CO.
655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX `
DILHR Plan I.D. # S97-03219 Date Sept. 20, `1997
Owner Bruce Wendt Phone 715-796-5590
Address 1826 60th Ave. Hammond, Wis. 54015
Legal Description Part of a total 40 acre property. Tax parcel No. -
34-29-17-526A. SW, SW, Sect. 34, T29N, R17W.
Town of _ Hammond County St. Croix
C.S.T. Robert Ulbrichtr CSTM2482 Installer
Local Authority/ Supervision
St. Croix County Zoning DEpt.
PROJECT DESCRIPTION
An existing older 2 bedroom home has a failing inground.
conventional trench/drywell system. The failing system is
sited in seasonally saturated soils and shall be abandoned
per code.
All non-conforming treatment tanks shall be properly
abandoned. If the existing septic tank after internal
inspection is not code conforming for size aNd condition,
a new 1000 gal. septic tank shall be installed (Weeks Concrete
Co. New Richmond, Wis.).
The new system shall be oversized for 3 bedrooms-
for an estimated daily wasteflov of 450 gals. Soils in the
replacvement area are permiable (.4/.5 GPD/Ft2) but seasonally
saturated at 2711. A long narrow mound system using 12" of
sand fill is proposed.
10f33m .W. ;
I VLPRI{/(1 j -
P9.1 PLOT PLAN VIEWS y~ D71~ IN1 : - !
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS G`3~'``~\~~~, r
- hryrril/Uln~p~pp~1~~"`
Pg.3 PIPE LATERAL LAYOUT
Pg.4 DOSING CHAMBER CROSS SECTION,
P9.5 PUMP PERFORMANCE SPECS
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Di ST Ri(3uTinN
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of raP sorb
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OOi FORK TOE u
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PLAN VIEW OF MouAJp Wit" 13E :D
~aec~-tir,~'~v A 5 F T.
I • I (3 7& Fr
K /a F r
w I` ---j! 1 FT
6~• o r_ Z g
N f T-
EEn OF !/2"
o. w n.. To 1
00 T 10 AJ PIPE UErwoR k
TOTAL- V oL V M t= d F L .4 TG-2 AL
9197RI t3uT 10
LATERAI-
isNo CAP r
2___,_
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x x
Y X Z PUG ~oRGE
M A i u
LAST VAoIE s HA 11 f3 pa
NEt7' Td ENp SAP
Vo t D Vv t uM E Fo R D Fr.
g.2- IA IS.
Y-uvERr IEVArio~ dF FoRcE MAW
_ 9. `
PEI?FoRAT-ED PIPE DET-Ai L
G. H01E9 lee-AreV OX-N
`I GOTr-Om SHAtl BE
I Y VARiA(3LE y b`(RONIIN/ SPACeD.
DtST~NCE
P -7 2 r- r HOI 61N K #a Te R
L ATERA L ' -2'
R ~aMANi FOLD
FuRct=_ MA k)
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,41C of
VEMT CAP
4"C.I. VEfJT PIPE APPROVED LOCKIMa
WEATHER PROOF
JU0.ICTION BOX MA0.IHOLE COVER
25' FROM DOOR, ImWAi~NINC A13EI
WIUDOW OR FRESH 12IU.
AIR IUTAKE
11"A>Dr-_~it1, " T/ON GRADE I 40 m1w.
~$~0 COMMIT
~l~-v~+n ow . 111
PROVIDE I
T 'pE I
IMLET _ AIRTIGHT SEAL I I
I ~ APPROVED JOINTS
APPROVED JOINT A ~NS~(pclJ .A I I W/C.I. PIPE
w/C.I. PIPE ~q 1 EXTEtJDIM& 3'
ZXTEIJDIAIG 3' ~0, 111 ALARM ONTO SOLID SOIL
OMTO SOLID SOIL B I I I
V • 3 ,3 > I I oIJ
S c
ELEV. FT. 1 PUMP vsF ✓
OFF
I
.y5 ~1oe'c eF
k ~~~v/~ D 1 BLOCK 51fvfl
~cc, lj- VA
~-zr--
RISL'R EXIT PERMITTED OUL9 IF TAUX MAIJUFACTURER HAS SUCH APPROVAL
SEPTIC E SPCCIFI*CATIOUS
DOSE
TANKS MAAIUFACTURER: ~U5riWS CDuG~ WMBER OF DOSES: PER DAM
ISO
TAWK SIZE: goo GALLOAIS DOSE VOLUME /O
IMCLUDIMG, BACKFLOW: 16GALLONS
ALARM MAAIUFACTURER O
:
MODEL HUMBER: - - `L' CAPACITIES: A= IAICHES OR GALLONS
SWITCH TSPE: why B= py IMCHES OR GALLOWS
PUMP MAMUFACTURER: p2ow`~ CIIJCHES OR 1_-GALlO1J5
MODEL MUMBER. I 2- ~ D= ~J ING14ES OR GALLONS
SWtTCN TYPE: LlssyAMC IqB& ' ~10~41 IJOTE: PUMP AND ALARM ARE TO BE
MI"IMUM DISCHARGE RATE-:RZ5 -GPM, INSTALLED 00.1 SEPARATE CIRCUITS
VERTICAL DIFFERE0.ICE BETWEEN PUMP OFF AUD DISTRIBUTIOM PIPE..~-(o" FEET fiANk Specs
+ MIUIMUM METWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET ~AG(n, I , J-t oltt '
-F J0 FEET OF FORCE MAIM X 1016 FJooiTFRICTION FACTOR.., SJ FEET
~ ~~~r I s 2 0
LFEET ld
TOTAL 013MAMIC. HEAD l;
~pbuv0 $ cf " D
1UTERMAL DIME."S100.1S OF TAUK: LENGTH ;WIDTH ;LIQUID DEPTH
1
L HEAD CAPACITY CURVE y '
MODEL 119l3" 7/6 t 1/4
4 5/8
r 25 9
6 ( 3 5/a
• +
+
O
t5 ~
4. 4 el / J/16
to
.
2
1 1/2-11 1/2 NPT
5
0
U.S. GALLONS 1p 2 30 10
5
LITERS 0 80 70 b0
an 160 240
0 FLOW PER MINUTE
TOTAL OTNAWO NEA&ILOW ►EII LUgU1E
EFFLUENT AND OtWATIPANG
HEAD CAPACITY 12
UNITSIMIN
FEET METERS GALS ITRS v
e .1.52 T2 213
to 0.05 e1 231
Is 4.51 44 170
20 a1o 2e es
3 5/16
lock VeM ~y .
L4
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and
supplied with an alarm. • Mercury float se switches are available for controlling single and
three alternators, Itir duplex systems, are available with or • Double h tae aback mercury float switches are available for
without, alarm switches. P 99Y
variable level long cycle controls.
modals - WIght 39 Ibo - I/, H.p. 1 •sirM last operated 2 SELECTION oU1DE
Sand - 2. Single ~ onochanical switch, no external control required.
Standard alt Control Selection t piggyback
le Ooal switch tl Of or double P,20Yback b•ck mercury. Goat
Mode Am • elm lox switch. Reler to FM0177.
Model V he-Ph 9 Mechanical albrruuor 10-0072 or 10-001i
Mgt 115 1 ua p p _ Du bIt
1 or i 4. S•• FM0712, for correct model of E
DSO 290 S. Mercury somm a" switch 1 us.w Allsin alor, control a ti
y • oonrol acwaror .pecOy
1 ° 1•'1 t or 1 6 7 _ duplex (9) or NI soar system
Ef10 230 1 .Non 1.5 z e. b a - - - - O Fwrr.111 hole °J P.k" 6..., d c
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page of 3
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and T G/eO!
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. If
-
3 y- z y • Y2_Co
APPLICANT INFORMATION -Please print all information. Reviewed by Date;
Personal information you provide may be used for secondary purposes (Privacy Law, x. 15.04 (1) (m)).
Property Owner Q Property Location
,~it~UGF /_3Dvx11e- GV~•N~J" Govt. Lot ,Zj 11451 1/4,S 3 T Zy N,R 17 E (or
0
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
162& 6 6 - ~U~ • Af4 of d lffkes 7'07'&X
city State Zip Code Phone Number 2- Town
Road
r! ~/~/~~~V~ ~f! sf{O(S (Z fs ) 7 `j~o'SS J~O ❑ City ❑ Village ,,Town
❑ New Construction Use: g3lfe-sidential / Number of bedrooms Z- Addition to existing building
R-11apiacement ❑ Public or commercial - Describe:
Code derived daily flow
~ gpd Recommended design loading rate bed, gpd/ft2 • s trench, gpd1ft2
Absorption area required 313 _bed, ft2 30 trench, it 2 Maximum design loading rate !bed, gpd/ftz ' • 3' trench, gpd/ft2
Recommended infiltration surface elevation(s) s e-45- ,•c 3 It (as referred to site plan benchmark) Q
Additional design/site considerations ~ES~ ~'VSfI
Parent material 10,e S-9 CAP O 011L_ 4914 ~12_ Flood plain elevation, if applicable ft
S = Suitable for system Conventional MMoun In-Ground Presssuu a AT-Graded System in Fill Holding Tank
U = unsuitable for system ❑ S U as ❑ u ❑ s WU ❑ s t~ U ❑ s Emu--
I ❑ s
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/1`12
t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench
l .15 16 31,_ L 1441S d5 e .s ' .
W• y7 /a wQf
Ground e
elev.
CZ__ 414
Depth to
limiting
factor
5. SS • Remarks: L~XiSTiyG- SYS T /S 5'~'T~D /.y ff CT'/U ~flr~j
Boring #
6 12- /0 Z- 4`5 5
/O Yoe 3 L 2 CS if S'.6.1
4ow 7:-9
Ground d C 2 ~JL ~T /yy . ~o
elev. -7 S 1/4 s/~v
rj 3-0--ft. ATO /6Y 44A Af 4e
Depth to
limiting
fac or
sS 3rin. Remarks:
S CST Name (Please Print) ~bQ ~,,Signature Telephone No.
7IS • 3 86 lc~S
Address Date CST Number
r c Associates
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page Z of -3 •
PARCEL I.D.# 3 `7 1 ! S Zc.P 4-
Boring # Horizon Depth Dominant Color Mottles Structure 2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
0 -/jj 16e'213 L 2- 4, '5:
16;llf 313 Xh47~e 'e5
Ground /d 3 5-1 Z- / ~Jr he 40 7/e e s Z , . 3
elev. -
4h ,,Izl .51z- 1,5 IM 7~e
Depth to y
limiting S 0 • 0 ~O J ~i L s M~►`~/~ . 2- . j
factor
~in. '
$5 Remarks:
Boring #
4 2- -FShe S: C',
c ; . s
G C 2 S/GL / s - 2- 3
Ground 7 • So
~el~ft.
Depth to
limiting
factor
In. Remarks:
s.s Horizon Depth Dominant Color Mottles Structure
Texture Gr. Sz. Sh. Consistence Boundary Roots Bed GP Trrenen
in. Munsell Qu. Si. Cont. Color Trench
Boring # ;
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to cer/~tify that I have inspected the septic tank presently serving
the ,[g -cam jo a-w~ C )-JL~ residence located at: S (C
Sec. , T Pj N, R 17 W, Town of St. Croix
County, Wisconsin. 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 Q±:- l / 1 4"7
Did flow back occur from absorption system? Yes K No (if no, skip next
line.
Approximate volume or length of time: gallons minutes
capacity: " o o 0
Construction: P fab Concrete Steel Other
Manufacturer (if known):
Age of Tank (if known):
1 L1.3 (1,I~ )v 9- c~U
(Signature) (Name) Please Print
p -r4PR5 C,:) 03.2 a.a
(Title) (License Number)
C/ 3,f q 7
(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 L,)2 G c At*- olk (f i' / Signature
MP/MPRS 0
oz
8 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.
Owner of property 17n,~ 6
a7l.' r G')
Location of property _.S W 1/4_1/4 , Section, T_Aa_N-R 1 7 W
Township 14 Mailing address 18
to 0 t- 19 11'.& • -v- of . o~ IV 0
Address of site /8;! 4p b v it' R Q , l~ a,yn,r C.<.9 sY o S
Subdivision name IVA. Lot no. /u IQ,
other homes on property? Yes ✓ No
Previous owner of property
Total size of property-
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 C,-" 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 the 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 of Applicant Co-Applicant
Date of Signature
Dat of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERMMR ~?1u=~CSZ ~C7 a~ 03
MAILING ADDRESS-/ O/ S
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
a
CITY/STATE ~ c
PROPERTY LOCATION 6L3 1/4, SO 1/4, Section T_F q _N-R_L3---W
TOWN OF 1-4 , ST. CROIX COUNTY, WI
SUBDIVISION 144, P0. ►-f o 'Y y LOT NUMBER
CERTIFIED SURVEY MAP /V A , , 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 pumper verifying that (1)
the on-site wastewater disposal system is in proper 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 DNR.
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: zo" #V7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
rT 11
• • `DOCUMENT NO. STATE BAR OP' ~ TURM 11 -1 ~wis sewcs Rcuw.w row weco,m,wo DATA
LAND CONTRACT
I.41,iHM wi CWP-ratb
,TO HE USED FOR ALL TRANSACTIONS WHERE OVEN
4~j1~+A,) s2.~,oou 18 FINANCED AND '!I OTHER NON-CONSUMER
ACT TR,AN"I TIONSI REGISTERS UFICE
John D Ron------ en _ and....-_ ST. C"X Me 1M!
CConeract, by and between _ - Recd for R
Record
Jo Ann _R_onningen,,-_ husband and wife,
(-Vendor., S _D 2 11990
t
whether oye~or more) and.---.Brues-_ 8:30 A. M
Al].a • V
("Purchaser', whether one or more). M~dD9ed~'
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser, the following property, together with the
recta, profits, fixtures and other appurtenant interests (all called the "Property"),
in sex---tiro ix........--_..._....._.----_-. couaty. State of Wisconsin: waTURN GQHARLES E. WHITE
Atta<„cy M uW
River Falls, Wisconsin 94022
North Half (Nl/2) of Southwest Quarter
(SW1/4) of Southwest Quarter (SW1/4) of
Section Thirty-four (34) Township Tax Parcel No.
Twenty-nine (29) North, Range Seventeen
(17) West.
This ---------l.S-_I4o_t homestead property.
XXXXXX)MX such place as Vendor may
Purchaser atop urchase the Property and to pay to Vendor at I.-.reas-onab~.X_..direr-t------------- a
the sum of $ 4...61613.0 is the following manner: (a) $-.f?.,-0-0.4.199---------------------------
at the execution of this Contract; and (b) the balance of 1.$0-00_.-00 .......!....q..... together with interest from January
19919n the balance outstanding from time to time at the rate of----- ning---M)--------------- per cent per annum
until paid in full, as follows: Said principal and interest shall be payable in
monthly installments of not less than $204.85 per month, beginning on
the first day of February, 1991, with interest to begin to accrue on the
unpaid balance on January 1, 1991, provided the entire purchase money
and interest shall be fully paid within twelve years from the date
hereof.
Provi ed, how v r he entire outstanding balance shall be paid in fall on or before the 1....4....th day o
Segtemer,-_$b..,xxxxx( the maturity date).
Following any default in payment, interest shall accrue at the rate of .......9.. % 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
VOW
amount may be prepaid without premium or fee upon principal at any time after ._.January ._.1.--_, 1991.-X.
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 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.
Purchaser states that Purchaser is satisfied -;~.th the titl as shown by the title evidence submitted to Purchaser
for examination except: The Vendor shall furnish the Purchaser 30 days prior
to the date of ultimate closing and the Purchaser shall accept as a
sufficient showing of title an abstract showing merchantable title in
Vendor, Vendor's heirs and assigns.
N
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's 5„ re
is it and to deliver to Vendor on demand receipts showing such payment. {
Purchaser shall keep the improvements on the Property insured against loss or deniags oceasioned by Ass, es`
tended coverage perils and such other hasards as Vendor may require, without co-insurance through insurers apprav4
by Vendor, in the snap of 4~~ ...in tars? ~..Y l})4ut Vendor shall not rewire eoverage In sa amoast awe
than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall
contain the standard clause in ravor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the or(giaal
of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to
insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
be applied to restoration ar repair of the Property damaocd, provided the Vendor deems restoration or repair to be
eeaeoasically feasible.
Purchaser covenants not to commit was+e 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 Contrast, and
to cot-Ay with all laws, ordinarew anW regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be full paid and all conditions
shall ~t~perfat the timer and in the manner above specified, Vendor will on demanz execute and deliver to
Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrance,, except
any liens or encumbrances created by the act or default of Purchaser, and except:._. 4: mkcitfl s
•_re&erY_4t1 7n_a_and..
__Y lsistx_.. g*>Y€ o.__peX... he__192.9-.real•_ez3tate. taxes on__..h.. prgl $e-$•.1>p--_,--
_
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 cwstinues for a period of ....6.Q. 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 ...64.._ days following written notice
thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this wmt.act
shalt 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 bac;s 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 dateand otheramountadue hereunder (in whicheventsli amounts previously
paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the
PPrmu rty 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
default and other amounts due hereunder, in which event the Prcperty 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 nn end and remove tnis Contract as a cloud on title in a quiet-title
action if the equitable interest of Purchaser is insignif'-ant; 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 enformany remedy hereunder (whether abated or not) :o 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 prof" 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.
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
mattes 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 male 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 -e resentatives,
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 e.e execution of the
deed to be made in fulfillment hereof.)
. 19-90
Dated this 14th--- - day of ---------.Septgm r...............................
L
- ----(SEAL) ---..(SEAL)
.B ace" Wendt John D. Ronningen
- - - - -
y~ -
11~-~-- -
- - ._CICL-` ----------(SEAL) 4 - - - (SEAL)
. Bonnie-.L,--.Han$en-------------------------- ` ---Jo -Ann--Ronningen
AUTRUNTICATION A%9 WXG
John D. Ronningen, Jo Ann
Signature(s) ROTIR3.?,>~a---XC~---•---el?~t !1TE OF WISCONSIN
and Bonnie L. Hansen °B-
County.
an aticated this 14x4- ay Se tember 1990. Pers Ily came before me this day of
- 19- the above named
1 -
Charles E. White
TITLE: MEMBER STATE BAR OF WISCONSIN n
j
o me known to be ny t
to--me--known-
who executed the
theerson
p
~ w