HomeMy WebLinkAbout038-1096-80-115 (3)
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8 T c ST. CROIX COUNTY
b g o SURVEYOR'S RECORD
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CERTf~FI D RVE MAP
V
Located in part of the Southeast Quarter of the Southeast Quarter of Section 23, Township 31 North,
Range 18 West, Town of. ,tar Prairie, St. Croix County, Wisconsin.
Prepared for and at the t1quest of: EAST 114 CORNER ---q}
OWNER: SEC. 23-31-18
Ronald Wohlers (ALUM. CO. MON.)
1282 200th Avenue I
New Richmond, WI 54017 s 1L~ i I
Drafted by. Kristl A. E&ndt 1991 yr,
~~01i
~ ~~~co,w► \ I ,
UNPLATTE _ S OF OWN W
I
ti
W I
N 89'56'07" E 361.00'
W
1 pl W I ~p
LOT 5 it \ 9 <iwi ~ j a
j 0ML AREA: 01 1
W i 3
I 130, 682 SO. FT. / 3.00 ACRES I
~ 10I
w I RRe Fxr^1 UD. R.O.W.: I -nll of
~l t t
O i 8 1 118, 769 SO. FT. / 2.73 ACRES A z0-1
l p
U I m t
WELL
N I I \ O fn
J W M 3 \r
I I BUILDING SETBACK UNPLATTED LANDS
t P
O j SEP77C s I
...I. o
G
z l 'I ME o GEED
TER
SEP77C i POLE N DOC._N0.-348388
VOL. 573 P437
o 00
o ORI VEWA Y - f2-- - -
--S 89'56'07" W
--1422.31'--"~,~ 200th St. ~R. 0. W. 200t St. 870.00' 1
S 89'56'07 W
_--_--S 89*56*07" W 2653.31'------ -
200T1t AVENUE
SOU7H 114 CORNER SOU 7H LINE OF THE SE 1/4 SOU7HEAST CORNER
SEC. 23-31-18 OF THE SE 114 OF SEC. 23 SEC. 23-31-18
(ALUM. CO. MON.) UNPLATTED LANDS (ALUM. CO. MON.)
NNtN
co0
/[/9-I
RONALD F.
JOHNSON
NOTE: The parcel(s) shown on this map is/are subject to State, County and 9-1.186
Township laws, rules and regulations ( i.e. wetlands, minimum lot size, access AWEsY.
nnrnpl. etc.). Before ourchosing or developing any parcel, contact the St. ^
AS BUILT SANITARY SYSTEM REPORT Form S T C
OWNER /'5 TOWNSHIP
_j O'4, e SEC. o-;2 T T N-R~~W
ADDRESS ST. CROIX COUNTY, WISCONSIN
ice rh f stir 'S~
SUBDIVISION LOT
LOT SIZE -'-`PLAN VIEW
Distances and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
a .
34
7e '
17 INDICATE NORTH ARROW
62 /
BENCHMARK; Describe the vertical reference point used /p ?G C~or ter- ~1.~ L
Elevatinn nF
PUMP CHAMBER 1 r
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size _
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
I ~
Width: Length: Number of Lines: Area Built:
c/
Fill depth to top of pipe:
Number of feet from nearest property line: Front, (RrSide, O Rear,0 It.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: _ Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
SW4, SE4, S23,T31N-R18W CONVENTIONAL ❑ALTERNATIVE State Pfan I.D. Number:
of assigned)
Town of Star Prairie El Holding Tank ❑ In-Ground Pressure El Mound
200th Avenue 11-10
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE
Ronald Wohler Route 2, Box 32 Wall Street Village, 11-~~$-97
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. New is mon , WI 5 01 7 REF. PT. ELEV.: 7T . ELEV..
Name of Plumber-_ MP/MPRSW No.: County: Sanitary Permit Number:
Byron Bird Jr. 3318 St. Croix 102820
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
/'Q/r i/ q P OVIDED: PROVIDED.
1/7 362, do I
/VAFi/ /Wfr/A dl 7
YES ❑NO ❑YES NO
BEDDING. VENT DIA.. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. JVENT TO FRESH
ALARM FEET FROM LIN16, AIR INLET
❑YES O ❑YES NO NEAREST a
DOSING CHAMBER:
MANUFACTURER JBEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED. PROVID ED.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN PUMP FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑No NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING,
or excavation. Of soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH: LENGTH. NO. OF DISTR. PIPE SPACING COVER JINSIDE CIA nPITS LIQUID
BED/TRENCH TRENCHES MA$RIAL: PIT DEPTH 514 DIMENSIONS ! & /
GI- I ~
RAVEL DEPTH FILL DEPTH UISTR PIPE
DISTR. PIPE DISTR. PIPE MATER IAL. NO. DIS NUMBER OF PROPERTY WELL BUILDING VENT TO F HESH
J`R
BELOW PIPES l 1 ABOVE COVER ELEV INL T ELEV. END'. PIPES FEET FROM
LINE q I
/ tl n~ 2
lQ + ~ f. NEAREST-i .7 1v `T
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE PERMANENT MARKERS NO 1.111E.VATIIIN ❑ YES WELLS
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED ❑YES SEEDED ❑ MULCHED ❑NO
CENTER. EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH ID ISTR PIPE DISTRIBUTION PIPE MATEHIA1. & MAHKIN(,
ELEV.. ELEV.. CIA.. ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS-. NUMBER OF PBUILDING
FEET FROM LINE
~Ip ❑YES ❑NO ❑YES ❑NO NEAREST
0
Sketch System on
(y t31P.fn county file for audit.
Reverse Side.
SIG TITLE
c/ Zoning Administrator
DILHR SBD 6710 IR. 01/82)
DILHR SANITARY PERMIT APPLICATION COUnIT~
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8'/z x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES IR No
PROPERTY OW %R PROPERTY LOCATION
!a ~~r^ ttf'/a - '/a, S T , N, R E (or
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOC UMBER SUBDIVISION NAME
CIT , STA 6 ZIP CODE PHONE NU ER CITY s \ REST RO LAKE OR LANDMARK
ILLAGE ~zO C)
G rG//ll~/ V
TOWN OF-
II. TYPE OF BUILDING OR USE SERVED: d- 6082"
Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify):
III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable)
1. a. XNew b. E1 Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a. Conventional b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. [See a e Bed b. ❑ seepage Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): qq'
rivate ❑Joint El Public
i.4P
7Feet
VI. TANK CAPACITY Site
in gallons_ Total # of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank
❑
Lift Pump Tank/Si hon Chamber ❑ ❑ 1 Li
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name (Print):: Plumber' Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
An - Plumb s Address (Street, City, Sta e, Zip Code): Name o esigner:
VIII. SOIL TEST INFORMATION
Certifie Soil Tester (CST) Name / CST #
CST' DDRESS (Street, City, State, Zip Code) Phone Number: cc~~
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issu' g Agent Signature (No Stamps)
Approved ❑ owner Given Initial a T S chargeFeee11
Adverse Determination sj& ~W I v f
X. C MMENTS/REASONS FOR DISAPPROVAL: r_
SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
TO THE APPLICANT:
1. This sanitary permit is valid for two (2) years;
2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needgd
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system; _
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. Private sewage systems must be properly maintained.,The septic tank(s) should be pun°fped by a licensed
pumper whenever necessary, usuallyevery 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local codE: administrator or the
State of Wisconsin, Bureau of Plumbing, 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 where the system is to be
installed;
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, ;and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following:, A) plot plan, drawn to scale or'~ith complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building SwIrers; wells; water mains/water service;
streams and lakes; dosing or pumping chambers; 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; close 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 fora.
-----------------------------------------------------------------7---------------------------------------------------7---------------------------------
s
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill Ground~later
included the creation of surcharges (fees) for a number of regulated practices which "Iiscor~inIs a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that biried reasure
is used in your building is returned to the groundwater through your soil absorption o
system or the disposal site used by your holding tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- f
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398 (R.03/86)
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HIJI'dIAN FYE'LATIONS \ / MADISON, WI 53707
3707
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSHI MUNICIPALITY: LOT NO.: BLK. NO.: SUBDI VISION NAME:
54J14'/a Z3 /T.31 N/R/ (o
000y~TY: OWNER'S/BUYER'S NAME: MAILING ADDRESS:
/ Lro, ~r 1`.2 v X C f~'cef (J+ /Y k c e~ ~rC f/Jisse
USE V, r DATES OBSERVATI MADE _ d/
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPT DNS: ER OLATION TEST:
WResidence New ❑Replace
/-/6 -1
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYST :(optional)
rU, S ❑U S ❑U 9S ❑U [IS ,®U ❑S Z1 Cdr.
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in t e
under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevati n:
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TE TURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- ! 7 a--~ ~i r5.
B- -7- 41044
13
ool
B-
PERCOLATION TESTS
TEST WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER lEPTH AFTER-SWELLING INTERVAL-MIN. PERIOD 1 PE IOD 2 PERIOD PER INCH
P-
P_ 1220
P-
P_ 101
P_ .
_P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. Jn/3~~f`Ta~
SYSTEM ELEVATION
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INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 5395 • , .
To be a c and accurate sail test, your report must f#aclude:
1. Cornplete legal descriPtion;
2. The use section must clearly indicate whether this is -a residence or cornmercial project;
1 MAXIM number of bedrooms or commercial use planned;
4, Is thiG a n or • 'placement system;
5. Co€npk - City rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER . 'ST_;iS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. E LEASE use the abbreviations shown here for writing profile, descriptions and competing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
ate sheet may be used if desired;
are your benchmark and vertical elevation reference Point are clearly shown, and are permanent;
9, L_# e all appropriate: boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, elevation) does not apply, place N.A. in the app#o' riate box;
11. Sign the form and place your current address and your certification number;
12. Make legible caries and distribute as required, ALL SOIL TESTS MUST BE FILET) WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIES SOIL TESTER:
Sail Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cob Cobble (3 - 10") SS Sandstone
gr - Gravel (gander 3") LS Limestone
*s Sand HGW High Groundwater
cs - Coarse Sand Perc Percolation; Rate
rued s Medium Sand W Well
fs Fine Sand Bldg - Building
Is Loamy Sand > - Greater Than
X-sl - Sandy Loam < Less "T"han
*I Loam (fin - Brown
siI Silt Loam BI - Black
ai - Silt Gy Gray
*cl Clay Loam Y - Yellow
scl Sandy Clay Loam R - Red
sicl - Silty Clay Loam root - Mottles
sc Sandy Clay w1 with
sic - Silty Clay fff - few, fine, faint
*c Clay cc - common, coarse
Pt Peat ,m111 Many, rnedium
rn - Muck d - distinct
p prominent
HWL - High water level,
Six fTJ'3t;€"<`a] 5{3!l textures surface ;Hater .
Ic waste disposal SM - Bench Mark
VRP Vertical Reference Point
H
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• STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
OWNER/BUYER c2
~vC-O v~~~~5 y
}
ROUTE/BOX NUMBER ig Fire Number
~ ~ •
CITY/STATE 7.IP /
PROPERTY LOCATION: ~L, Section, T N, R1~W,
Town of St. Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into I`
the system can affect the function of the septic tank as a treat-
ment 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 systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
E
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- ~v
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
APPLICATION FOR SANITARY PERMIT
STC-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 ~w/TG~ 6t,,-" ®hC
Location of Property ~k k, Section .92 , T -N-RW
Township 1AA ~q r
Hailing Address
off6 , Z ,9 J ~V ~ C /-//A
7
Address of Site
A, F
C 12
Subdivision Base
Lot Number `
Previous Owner of Property / L~ f L S` > s
Total Size of Parcel
Date Parcel was Created b
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes x 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-1982 THIS SPAGf. RESERVED FOR RECORDING DATA
LAND CONTRACT
j Individual and Corporate
(TO BE USED 'FOR ALL WHERE OVER .,o 04
$26,000 IS FINANCED ANDRIN OTHER NON-CONSUMER 1!0190\ 1•M'~
ACT TRANSACTIONS) br{j~lp
r
. v'rij t Nvc:ntEAX
Contract by and between -Y-17X Q-_ OR.I DA.U._Md......_... RCG15fERS OFFICE
--Einar 0, dstness_, husband and wife ST. CROIX CO., WISII
("Vendor", Wd. for Record 17th
whether one or more) and----------.. Al G ._I9IQh.L~X Y of_lnP
uaL A.D. .&7
8:30
("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser, the following property, together with the
~ - NIIIer tee ~
rents, profits, fixtures and other aRpurtenant interests (all called the "Property"),
in SF__. Croix
County, State of Wisconsin:
RETURN T ~
RZXXXatx$tXatXgkt*xgaaxtexxkl*xlmmzklp #a 91b e
11xK5zXk*xRXRgsxi$xWffz * ~/rZ w IV,
Sk of SEk of Section 23, Township 31, Range Tax Parcel No
18, EXCEPT part to Joseph L. and Karen A. Langer
in vol. "496", Page 467 (No. 31) and EXCEPT Certified
Survey Map in Vol. "2", Page 333 (No. 32) and EXCEPT
part to Franklin DeJerome and Leona B.B erget in
Vol. "464", Page 376 (No. 33) and EXCEPT part to
Virgil D. and Sylvia A. Estes in Vol. "464", Page
592 (No. 34) and EXCEPT part to Glenn Goldsmith
in Fol. "477", Page 129 (No. 35) and EXCEPT part to
Robert E. Casey in No. "625", Page 223 (No. 47) and
EXCEPT Certified Survey Map in Vol. "5", Page 1331
(N(?. 49).
This homestead property. '
(is) (is not)
their
Purchaser agrees to purchase the Property and to pay to Vendor at ._P.lace Of *ZS request
the sum of in the following manner: (a)
at the execution of this Contract; and (b) the balance of 1 together with interest from date
hereof on the balance outstanding from time to time at the rate of...... mine ...49.)-- - per cent per annum
until paid in full, as follows: Four Hundred Seventy-seven and no/100ths ($477.00)
Dollars on the 15th day of July , 1987, and a like amount on the 15th
day of each and every month thereafter until the 15th day of June,
1990, at which time the remaining balance, if any, shall be due
and payable to the principal thereon. The Purchaser herein shall
have the right to prepay in any amount at any time, without penalty.
Further, Purchaser agrees to allow the Vendor to keep all rents paid
for the year 1987, as well as allow the party rentin said operty*
Proyyided, however, the enti a outstanding balance shall be paid in full on or before th day of
J_une________________ 19..0. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
r
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor.
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after-__-_.I1.11; a _15_._____._, 19.8.7-- (OR)
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 mnnthly nwvmonrc I.-
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Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of 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 8 112 x 11 inches in size. S7' 6bA
• See reverse side for instructions for completing this application State SSSaaniittaryy Permit 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
Property ner Name Property Location
j111/4, S T N, Rl E (ord
Property 07w- Mailing Adddr L1l Lot Number Block Number
City, tae Zip Code Phone Number Subdivision Name or CSM Number -
IV-(-w 12,d im n O (71 -Ii/co -(1<; r
Nearest Road
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ityage
- Town OF 'ZOd AVc,
Public 1 or 2 Family Dwelling - No. of bedrooms E] VIl
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
$.31. 18. ~o~A 1D ~ - 96f~--1
1 ❑ Apartment /Condo - I nq. 8 Z27
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. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ Repair of an
_____System ___System_____________TankOnly______________ Existing System ---Exist---ing System
❑ 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 WSeepage 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
Re u'red (sq. ft.) Pro osed (s . ft.) (Gals/day/sq. ft.) (Min./inch) [Elevation
ys~ Z y~ qL,1 /mss, Feet 7 7 6 Feet
VII. TANK Ca acit
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastit App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ E] ❑ 11
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ I El 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for i stallation of the onsite sewage system shown on the attached plans.
P b is Name: (Print) Plum 's to : (No Stamps) MP/MPRSW No.: Business Phone Number:
If ~ "`74e j-,,9
umber's Address (Stye t, City, State, Zip Code): ,n J
7 5~'e?- / 6 ti~ f~ !C i
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt nature ( Stamp )
Surcharge fee)
' g 5
Approved ❑ Owner Given Initial/ G~~ a13
Adverse Determination O
X. CONDITIONS QF APPR VAL /REASONS FOR DISAPP OVAL: _
SBD-6396 (B. 0' 5/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Divi 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 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.
ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling-
111. 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.
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Gabor and Human Relations
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Page of
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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. v ' r O t
Parcel I.D. 6C2 it
APPLICANT INFORMATION - Please ri ~ 8 / 3 - q b
ormatlReviewed by
Personal information you provide may be used for secondary ses Date
~ .15.O~j~(~.~•
Property Owner
~ 9 Pr Location
1
Property Owners Mailing Address r Govo 5 W 1/4 $ 1/4,S a 3 T N,R !q E (orf
sr. Ct3C3►x Lot Block#
i~~ . f Subd. Name or CSM#
City State Zip Code u
1V ~gA
ity ❑ Villagg ~ Tom Nearest Road
Y' ~~`ve L ~a Q11L
❑ New Construction Use: Q~ Residential / Number of bedrooms
❑ Replacement Addition to existing building
❑ Public or commercial -Describe:
Code derived daily flow y 5 D gpd
Recommended design loading rate bed, /ft2
Absorption area required bed, ft2 2 9Pd trench, gpdfft2
n trench, ft Maximum design loading rate bed, d/ft2
Recommended infiltration surface elevation(s) 3 9P trench, gpd/ft2
ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material A ~ AC. ~ y
Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In -Ground Pressure System in Holding
AT-Grade
U = Unsuitable for system as S Fill Tank
❑u ®s ❑u ®s ❑u ®s ❑u ❑s ®u ❑s ®u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles
in. Munsell Texture Structure Consistence Boundary Roots GPD/ft2
Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Trench
O -5 J j k i L -
't
Ground I D
~ele'vO. S L
5 • c. L '
Depth to 3.33 7. (Z y 4
limiting
factor -
$ sL-70 Remarks: -
Boring # H~ ~ • ,
Ground
• • • • •
elev.
ft.
Depth to
limiting
factor
in. Remarks:
CST Name (Please Print) Signature
4_ tp
l Telephone No.
Ad7D p YN Y) 14 dress J 'Sta'r k, 71S-;L9 S -,:35 $9 OTC 1 P Date CST Number
~6g0ab
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of`
.
PARCEL I.D.#
2
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed
Trench
Ground
elev.
ft.
Depth to
limiting ;
factor
in.
Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in.
Remarks:
GPD/ft2
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Trench
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ,
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
'n. 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 certify that I have inspected the septic tank presently serving
the S7_y £ lit,~,ar/n residence located at: L,/
Sec. T 3I N, RA < 4z' W, Town of 2rZQ 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 i!2!4-7
Did flow back occur from absorption system? Yes No (if no, skip next
line.
Approximate volume or length of time: gallons minutes
Capacity:
Construction: Prefab Concrete Steel Other
Manufacturer (if known):
Age of Tan (if known) :
(S ature) (Name) Please rint
G i~~cl ~Q ate/ C ~ Z ~
(Title) (License Number)
r4
(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 4 ' &,s Signature
MP/MPRS
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER tr MAIL
ING ADDRESS /Z 2c2 dw,
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE/pr
PROPERTY LOCATION 5jx) 1/4,,S e-_ 1/4, Section 7-2 , T_Z-3~N-R_ZZ' W
TOWN OF ~5~/ ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP VOLUME Y PAGE 7,Z- LOT NUMBER J
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 ust be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three y xpirati n te.
SIGNED:
DATE: G
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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.
Owner of property S-;EL'4f- in Icy n
Location of propertyL.~.2_1/4 S V 1/4, Section, TAN-R~_W
Township ST6 , Mailing address 12_>c) zap,67&-j-
Address of site
Subdivision name Lot no.
Other homes on property? Yes__--I"_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 _)r 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. ~43 '-;7 , and that I (we) presently
own the proposed site for the se7wage 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.
Signatur o Applicant Co-Applicant
~I&
Date of Signature Date of signature
OOGUMENT NO. WARRANTY DEED ( ♦N,• sr~cc Rcscwvw low R[GOR94146 ow►A
z ! h STATE BAR OF WISCONSIN FORT[ 2 -1962 I~
a
VOL
%J
4G2437 iI 1AGE
REGISTER'S OFFICE
Ronald -Wohlers ST. CROIX CO., VA
Recd for Record
at P
c.,nceys and warrants to . S. ev.en..L,._.WQjan.-and_Marj.orie.A•
Nojan-, -husband .and-.wife, as.-marital--property-,
with..righta. of-.survivorship., b¢grd099~
f
it
_ .
the following described real estate in ..St•..-C 9:O * . .....................County,
State of Wisconsin:
Tax Parcel No:
7 Part of the Southwest Quarter of the Southeast Quarter (SWh of SE%),
r Section Twenty-three (23), Township Thirty-one (31) North, Range
Eighteen (18) West, described as follows: Lot One (1) of Certified
Survey Map filed September 11, 1990, in Volume 08", page 2270,
_ TOGETHER WITH and SUBJECT to 66 foot private road easement as shown
on said Certified Survey Map.
MANSM
s 370
FEE
'i
This is-.not.. homestead property.
(is) (is not)
Exception to warranties:
19.90
Dated this ! T . day of - -------September--- - -
.(SEAL)
4 Ronald -WOhlere-•......... . -
(SEAL) __(SEAL)
AUT IBNTICATION ACKNOWLEDGMENT
L
- r
STATE OF
Signature(s) '.VISCONSIN
r
St. Croix --------County. \F,
r
authenticated this ........day Of 19...__. Personally came before me this bf
September. , 19.90. the above named
Ronald--Wohlers----------
TITLE: MEMBER STATE BAR OF WISCONSIN
-
-
(----ieoin,~inwument - - -
authorized by § 706.06, Wis. State.) to nown be the person who executed the
for and acknowledge the game.