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HomeMy WebLinkAbout020-1300-50-000 y o 70 0 o ~ ~I a~ 4:1 a O O N ti LO O y x ~ I O N U ~ L O ~ I ~ I Cl) s C (D U p a N C z y 3 ~ LL ~ L ~ Q eN.. I U) C v £ O Z `m d Z a m C a o z d d Z d' ' ~ ~ o I F I' (D z - a~ N m N C v I m ~ U) ~ a I • N g c O U O z z z N > N d. ~ ~ N w >O i N > C w w c O (D ` a 0 a n a N N hr U O O V,N d M •j I- I-F- N N N N S ~i N 0 O O lip N 0 0 0 •N is a a a M o m g tp J U u M rn } N V) M N L O N 0 0 0 ~ ~ ~ N (n a) Y a N Fi 00 m d m O O N C i O a O O N E C14 LO 00 O r R O r- E a :2 :2 -0 C U) C> 0 0 N N N V O aj ~ l c C 0 tll 4 ~ 0 ~O O C N - N N Cl) o i Co r- N ~ N • 7a rl: 'Z a 0 y M N (6 e.U y O S N O z N to O ~ D M a • a w S 0 y s rr~ E L c c `~1 A c0 as j oin0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER j,gn~IF~ ~pC.c L ~,ei u ADDRESS ~o?g ~bC 45T ~T SUBDIVISION / CSM#~A,PKt/jEC ~Sr.4TE5 ~xrN Ied~T~o.U LOT SECTION I rl T ?7 N-R W, Town of-./-/%4,6SOny ST. CROIX COUNTY, WISCONSIN PLAN VIE SHOW EVERYTHING WITHIN 1 0 FEET OF SYSTEM /O/O OF ,?O~ OR GPEA7F~ SLoOE p ~o,hf~cF '1 ~i0E.~1ee5~ r Slo PUc /,j<(JF 5~,,,E,~ 1415-0 6~t SEOTiL TrplJ K 'q 6 e, NT CiwE \ , T,QoPosfl~ _ ~ X15 c.,eu `/6 - - - - q_ A- Vc 'SriKKS EAsr jolt o& 3(P ~ /'ROPE PTY A4E CO V/E P ovFk, Ocr i (E7 s//~c' ~M ' T P fl~ ~<FOi/o.V E IND ATE NORTH ARROW 5e cE Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~D n~ /Et~~~c/E ~E~C' ?IfL ~1~ /DO oo' ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (JI-g-s Liquid Capacity: Faso 6,ft Setback from: Well ~a• House ?s' Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM Width: Sr Length :5:?' Number of trenches 3 Distance & Direction to nearest prop. line: GJEST Setback from: well: 9S'' House 6-8' Other - ELEVATIONS Building Sewer ~5• ST Inlet. ST outlet-T91- PC inlet PC bottom Pump Off Header/Manifold 4''67' Bottom of system S$-ofl" Existing Grade 7 5~a" Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: /'t~f ~~s ab js INSPECTOR: 3/93:jt . s Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: _ Labor and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name_ _ ❑ City ❑ Village ❑ Town of: State PI RvU ,O , JAMES X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /0© /'~q 0 , Y4 !e_ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark iv r . i io o. Dosing Aeration Bldg. Sewer 9 ~a Holding St/Ht Inlet q~ 9q .a3 TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet Air l Septic ''SO a5, 7a S'' NA Dt Bottom Dosing NA Header/Man. %a s s>:~~' /a.46' 88.4'9' Aeration NA Dist. Pipe '4s1 ire, q'7 a, Holding Bot. System 13, s; ; f°.Gv 3 9.G.2 ' PUMP/ SIPHON INFORMATION Final Grade 875 Aa,yd. Manufacturer Demand Model Number GPM TDH Lift Lriction Syestem TDH Ft Forcemain I I Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5' „Sa' -3 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mode Number: System: 3t. ' ,sg ` 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 K Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench ~U Edges 3~) Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCAlf LON : HUDSON. 17 .291.19W , LOS' 134, BROOtfWOOD DRIVE Plan revision required? ❑ Yes L'1 No Use other side for additional information. SBD-6710 (R 05/91) Date nspectorrs Signature Cert. No. z , ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: h =Zmh SANITARY PERMIT APPLICATION LA In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ - ///j w,v~ ~ 1. STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ~,rrt 1Z~7 ;z-. 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S T N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER S o/6 II. TYPE OF BUILDING: (Check one) ❑ State Owned VAITY ILLAGE NEAREST ROAD ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms PAR EL =N OF: TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 01 0 -/30 0 - o 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION o0dP 00 Feet d _ 3 Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) -hfP/MPRSW No.: Business Phone Number: 001 1 41711", _77,1_ - 02~~~ . Plumber's Address (Street, City, State, Zip Code): _r T. n IX. COUNTY/DEPARTMENT USE ONLY X I ❑ Disapproved Sanytary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) si , Approved El Owner Given Initial Surcharge Fee) 3l~~ ~4 Adverse Determin tion I - 14~d,6~41 J~~ / X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 thin time of renl:.-val any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authori.y. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer'R,--, wal Fo -n; 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) r^.ist be pumpr::d by a licensed pumper whenever necessary, usually every 2 to years. 6. If you have questions concerning your onsite sewage system, contact your ;oval code adr,inistrator or the State of Wisconsin, Safety & 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. It. Type of building being served. Check only one and complete of bedrooms f 1 or 2 =amity Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replaceniert, ,econnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total (:aiions, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank materia . Cc: iplete for, all septic, pump/siphon and holding tanks for this system. Check experimental Gpproval only :i 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 81/2 x 11 inches must be submitted to '.Iqe county. The plans must include the following: A) plot plan, drawn to scale or with complete diner - >r , location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells,; water n,airr= water c:;ervice; streams and lakes; pump or siphon tanks; distribution boxes, sail absorption systerro: -o t .ement system areas; and -:see location of the building served; B) horizontal and ve,tical elevation rc, ei point.; C) complete specifications for pumps and controls; dose volurmt; elevation d fterenc~-s fr :t on loss; pump performance curve; pump model and pump manufacturer; D) cross section (.I the sc+ ?s r.)tion system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin ,pct 410 included the creation of surcharges (fees) for a ;;umt:r:r regulated practi;;es which can effect groundwater. The, rnorrres - !'acted through there surcharges are used Mt rt~:.t. t ing c)rarrrFci~aat:r, ~r, d rrc water contarninafion investigations and establishment cif st< ida-ds. SBD-6398 (R.11/88) /Ya 7c AIOATH AA01OZATY Zi,✓E Toro or .YU/o ass G~tLCATE~Z ~~°AoJfO /~+«°RtEo •PLB 87 Iy°,og /ZEJ~LOBn/C6 PLOT & CROSS SECTION PLANS ~i ZAPPA. BROS. EXCAVATING INC \ PLUMBING UNIT Rs ~✓ELC r PROJECT ' y /°vc rcNrL, 510 QL o6 SeWER S~/$SD ~AL SMac 7A-,jx 41 "-'oYG J'DR _2S~ EiI L!/ENT LsNC• O s' ST- regame - - xzo Di¢zvEwAY 3Y0 /9QrOA7ZOn. T En/CH6J ~3 s► ~s' ALT'. ,l'17E E>orT /i~Y GcNE 6,/~ /~orEa7Y L=,,e 89 • /3a2 BY N All = dTao oP TrLegvONE /-l.LtEJTAL .ELEV.rZION =/vo.oo r SCALE CAaTEa CSr1CLF A7 =y0. FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 120 ABOVE FINAL-GRADE -t MAXIMUM OF 42' ABOVE 4' CAST IRON VENT PIPE PIPE TO FINAL GRADE SIGNED: MARSH MAY OR 8YNTHETIC COVERING Irv LICENSE:~ MINIMUM AGGREGATE OVER PIPE DATE:/ ,;//x/96 DISTRIBUTION PIPE TEE SOIL TESTING BY: ELEVATION BED 8' AGGREGATE • BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TESTIS COUPLING TERMINATING Obi FT. AT BOTTOM OF SYSTEM Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of Labor and Human Relations DVsioh of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but '`F-l coo Ix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LO ATION &Ni_EAu GOVT. LOT NW 1/41'3CJ 1/4,S !7 T _Z ! q N,R J ? E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK # BD. NAME OR CSM # k A~ I R ES r4 i es IV CITY, STATE ZIP CODE PHONE NUMBER OCITY VILLAGE OWN N~EAREST ROAD j A New Construction Use [ Residential / Number of bedrooms //4.ju [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate Cam: bed, gpd/ft2ZTtrench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 62' trench, gpd/ft2 Recommended infiltration surface elevation(s) il V,4A,*92. Q ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T K U= Unsuitable fors stem KS E3 U S❑ U S❑ U j 14 S❑ U S❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bour>dy Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Twich r pp~C b~► i/ 3 2 - L Z r►, ~ K J/ ~ s J S o~6 L~ z4 i 3 4- 5. Z&' cc /hrT ' r'S 6.S 6, 6 Ground 64-44 L 4 t` l't't elev. 9ii.Aoft. Depth to limiting factor >iZ.33 Remarks: Boring # 1. ~ rr► s~ K r* J OMO- o. r1 c5 Z~ 6.7 } $ z-ISQ /bY12 i t s r~.1 - .7 .F~ Ground elev 9f ft. Depth to limiting factor > Remarks: CST Name:-Please Print Phone: Address: Ov t\x c h! ,,,j -Ao 16, Signatur Date: CST Number: --.It PROPERTYOWNEROU4AU SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 35 a c r A Tr Zn, s 0.6 Ground $ ~3 7. go 4 Li~ - M r M ( f_5 fin, ] 0~ elev. %3-1 ft. 16 /ny s t 4 /71 ' ~ . Depth to limiting factor Remarks: Boring # Q /lay 1 L, m C r 11'1 r :S/ O.S 0 ,6 Z M C r n,-Fr C- Z 8 -37 7.s X,0 A3 - 5 3Mqr n~ 1 r s 0,7 Ground V Depth to limiting ~ fa/ tort Z Remarks: Boring # S. 9-Z1 r- ^7r CS Z O.S 0.6 L(- 71~ A All S O r- ml cs Ground 14 9ft. ~-i~ /O S awl r 0, 7 0. Depth to limiting factor f3f 1 F Remarks: Boring # •~ynhti :Sh Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) SO ` Amp L? loll i / ~JCuMa~2>,. I DP nCl ?'~,E PN~►.J~ ~ lk~tSTdL - ELLS ICI M O N ' /W40' 4 ~ ~aL~ 3oR 3 'ScAL~ ~'~0 •~°eO3rIRON'FIFE FOUN 23o 12 (6). %'is Stals 0 2"< 30' IRON 'IPE SET, WEIGHING 3.65 LOS 1~ f PER LINEAR FOOT Cenified this day of NOTE ALL OTHER LOT CORNERS MONU MENTED DtILITi EASFjIF'1if 1 WITH 1'r 24" IRON PIPE, WEIGHING 16e LOS. Ne pule Ot hutaeJ cables s+• to ha Dlu. eJ s anatsl lot, en uou1J Jt st e,h •nY su+vY !ts'•<1 PER LINEAR FOOT, •1nn9 !nr lea lint et !t.<a I,n<. eten t st 111 !nr DepanmentofAgriculture,Trad. 1 1 RECCi1DED BEARING AND CR DISTANCE Th< dastu['~<nce • tutu: "T' S11-1 236.31 Of YI, 'I, l.+ StUttlune s:) I— t_s r' CRAINAGE EASEMENT hereon !et t-h ate l0[ th° use of Duhll- b.- a e serve the 12' WIDE UTILITY EASEMENT puhl to utalttse! h•rtn4 IT. +Ilhl I. L EAST WEST 1/4 LINE Of SECTION 17 Et/4 CORNER A(SISTFR S SEC CORNER NBB°59'34"E \ N88°54'54"E SECTION 17 ~i. cnix SECTION n yI`~. N _ I p1~1~.' IV LY R+' ~ -v ~..~p(y'j'yt 943.02 4339.28 I dw a CERTIFIED SURVEY M_AP VOLUME I, PAGE 182 I Vdw g g~ ()QC. N0. 329659) ISB9°21'40~WI I 11 588. 6'55°w 735.48' zoez~ - --I 125.00' 402.24' m ep LOT 134 LOT 133 o0 105 q 1.60 ACRES C 1.91 ACI15 69,694 SO. FT, O S! 83,092 SO.FT N Z IN139°IS'10'E 13000'1 n LOT 135 sari 46'3o'w _ n 2 it . ACRES 149.79' 1 F- 92,088 so. F T - - ~ I I - - " TI W 91 y9 4 WI 0 .81 n. al ~i 2 9~' 21 I 616 N- I ZI IN! `7~ „ y .yryT' a+ Ina tMi Mi o e0 LOT 132 LOT 130 I 0. 00j 1.06 ACRES M1 ! 1.07 ACRES QI WI N)7 Q8.zS, 46,086 SO FT. g 46,56550.FT 106 pl c'1 01 N ~1 342.32• n 0 I I at \ Y ( I QI OI Z! \1 3 0- >I m LOT 136 o- I c to 8 1,35 ,7 ACRES NBB°56'SS'E 231OY Z 9l89°13•M"E tlD aU 33 ' 33' 71 o I 38,740 SO. FT JI 01 - - ✓ g S88°46'46•N1 WI 49 o I LOT 131 0 1 .98' 9~j! 1 '6'TJJ° Ci 1.00 ACRES pLl I 1,188°56'53°E 366.40' 9~ f 43,747 SO. FT \ BROOI / - a IceoRs _-rte LOT 137 s °36'35"w 217.47' \ v~ ~s~1- 4 154.00- ~ a\\ RECCc is eaa sa vr. N C~ LOT 146 g LOT 138 ° ,i ✓ to / 1.16 ACRES t \ V. 50,566 SQ 4130013A4 cNES ~i ~~S,t tp~t J. \ YI , SOFT. to see°s6.53 w zlo.od j \ i0 f3 a 4r :yH~; 1 a ' / P .phi 6 ~F Nz.<67~ y, O •C 2 DRAINAGE EASEMENT- • 6 `)xif ?p p • X0 's" rot LOT Dp45 ~6gea dy ss w u.n sa tN 0 L s _ 50.5" so. FT ~ ti' e. • ~ to y LOT 139 •~~1•,tc/ 1.39 ACRES I- 60.04 $0. Fr. ~t o° J'~~ - ' ~t1` uti•g LOT 147 O n 9 dj'r © 66' d 1.32 ACRES 57,576 SO. FT. 1AI to r ge' LO TE142 _ \ ea 47 71p ,y `P 91.007 SQ 'ST. 01 w15 M1~• `t0• 11 - 11 LOT A141 CRES °ty i dy / / S of 1.01 AERES / 164, / LOT E144 /01 - _ 4,J< 43.930 SO.rT. //~•.p ?t !~i .s 10 2w s0 fT ^l~i Ol . ~II LOT 143 ~a N / V.19? So FT of ~g $ LOT 140 <!m ai 102 ACRES J~ W m1 3 I$ 44,469 SO. FT. 'JJ °s• • O - ~ly DRAINAGE Y 0 DETEMION .o X00° eW a, POIO 217.37' 2>Z yy t o - R I Ssseowze N a<I v! a87°50'00`E 285,00' f0 FI F-I Y ? OI J1 ~ OUTLOT 2 p-, T 8.21 ACRES rV! a• 357,636 S'.ri - I I I NI e47*04•E 1996.40° 1 I--- IN89°09'27'E) ~ 7g I 79 I 80 I 81 182 83 1 84 I 85 I WILLOW I RIDGE EAST. 1 I I ~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix Coun OWNER/BUYER ©GG~ MAILING ADDRESS 0& A AX X D T ffl-ovw -fl X W /17vtJ PROPERTY ADDRESSq- (1 castionlI of septic system) Please obtain from the Planning Dept. CITY/STATE '5y a& PROPERTY LOCATION 1/4, 1/4, Section T N-R /2 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION ®h4t U! LOT NUMBER 3 CERTIFIEDSURVEY MAP VOLUME J PAGE l , 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 re urned to the St. Croix County Zoning Officer within 30 days of the three y pir tion date. SIGNED: DATE: J/7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11193 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 _ VAS dLGG Location of property 1/4_1/4, SectionT_.Z2 N-R__Z2_W Township- /J lt7J Mailing address _r7-. Address of site Subdivision name -gym///&L,) "71-y77-z>7 Lot no. 43 Other homes on property? Yes No Previous owner of property_, ~C, 14"1 ~ Total size of property ~5 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 4,-No Volume I and Page Number Z 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 ( e certify that all statements on this form are true to the best of my (ou knowledge that I (we-) am (ate the owner(-s) of the property described in this information form, by virtue of a /JrJD warranty --d L ead recorded in the office of the County Register of C G Deeds as Document No. S-?)-7W7 , and that I (m16) 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. S g ature of Applicant Co-Applicant c:~3/7 Date o Sig ature Date of Signature r r, r- FASr DOCUMENT NO, STATF. OAR OF WISCONSIN FORM It - 19132 TN:S S✓ACE RESERVED FOR RECORDING DATA LAND CONTRACT Individual and C-purate - - - ALL l.F' o10• IS SHNAUIR!J) ANT) IN 6Tt[F~ILNNON lOhJU>tEa r,'T rR \NSACrIONSI ~I .i Contract, by and between __Darrel E. Wert and Beverly A. T DEC 2 a 1 3: rVert, husband and wife, individually and each i------------ eir own ri t---•---•-----------• .................••---•-----•--°------•-•---•--•---g I ~ ("Vend r % 9:30 A. 1 whether one or more) and..JdlileS V.-- Fioulesu and Kerry A. Rou eaur hu$b-and-_and_ _wife as survivorship marital Property Purchaser", whether one or more). ii - 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 rents, profits, fixtures and other appurtenant interests (all called the "Property"), - - - m.......... St-_.C'"Q1X.---------_-•--_--•-••------------------ County, State of Wisconsin: i ~ln Law Firr,~il',rb1.Q•J , RETIRN TO p.0. Box 106 _ Hudson;- W>FW1`sLl _ Tax Parcel No. 020-12.0050 Lot 134, park View Estates Sixth Addition to the Town of Hudson ~ ~ AN~SFER This .-_1S nOt homestead property. (is) (is not) Purchaser a ees to purchase the Property and to pay to Vendor at764 South Shore Dr. , Amery, WI the sum of $_38100.00.................................... in the followitl manner: (a) $ 3;800.Oi1___ at the execution of this Contract; and (b) the balance of $-.34,20.00 ,together with interest from date hereof on the balance outstanding from time to time at the rate of..... 7...._ per cent per annum until paid in full, as follows: In ten installments of not less that $3,420.00 per year of Principal Plus all accrued interest, beginning on July 31, 1996 and continuing on July 31st of each year thereafter, until fully paid by July 31, 2005. Interest shall be calculated on the unpaid balance on a daily rate basis of 1/365 of the annual rate. Provided however, the entire outstandin balance shall be Jul 200 g paid in full on or before the__.3lSt dap of ye-•------------------------•-- ( the maturity date). Following any default in payment, interest shall accrue at the rate of % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). 'i Purchaser.Mesa-axoooe&b ,*oa4or, agrees to pay men#~e~y- ettdersneatrrtsaeffirient{opsi reeserrablT-al icy pare annual taxes, special assessments, fire and required insurance premiums when due.-'Prl-thr extrntreceived-b,, irrm}or, Vendor -egreee-te-appty-geyents-te-4heEaeeb!igeriowswhen -mower-& 4-aolowfrtsreaeius~~ ike-leadeaP-tet$ayzaesat-0t taxes-ame"ments-slid himra»ee-w a 1-3e depesitee! into -efr- ~a+>~ ep-tpvrst~ xcauatT but~halLaot_k>~ r ;^r~•~ r .+u+lasa..atlao- ^ s~}uiaed~,y_.lam, 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 (T------ R) fl36tG-iGZj~O.^~ p_~;mont of n~inninRl avithn~i~nrj~yygg~a~ ~~~+''1l ~ /~I, E In the event of any prepayment, this contract shall not be treated as in ~efaui pee q~paym~O long res 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 with the title as shc.vn by the title evidence submitted to Purchaser for examination except: Vendor shall provide Purchaser with an abstract for the property on or before August 31, 1995. Purchaser may have abstract examined by an attorney and if there is any objection to title, it shall be raised in writing prior to Sept 30, 1995 or be waived. } • QL 1155PArs:1`9 Purchaser promises to pay when due all taxes and a:;,c:-sn.encs levied on the Po-perty or upon Vendor's interest . in it and to deliver to Vendor on demand receipts showing Such payment, Purchaser shall keep a-~ improvements on the Property insured against !ons or d:unag:a occasioned by fire, ex- tended coverage perils and such other hazards as Vendor may require, without co-insurance, ti,rough insurers approved t )y Vendor, in the sum of $._3. 00 , but Vendor shall not require coverage in un amount more Lhan the balance ,wed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall ccntain the standard clause in favor of the Vendor's interest arid, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, irsurat.-e pro.-eeds shall bue applied to restoration or repair of the Property damaged, provided the Vendor deems the rest6r-^•.;en or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property. to keep the Property =n brood tenantable condition and repair, to keep the Property tree from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid arid all conditions aball be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to th-e Purchaser, a Warranty- Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: .!pne - - . - . 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 ..3Q--._ 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 'ollowing 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 -vaives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided bylaw 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 r+demption 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 whichevent all tunounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to r !eem); 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 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 port,on 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; arid (v) Vendor may h-ve 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 in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. 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 f* r any mortgage granted by Purchaser) or under any note s, - fired thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any st.eh payments directly to the Mortgagee if Vendor fails to do so and all r.ayments so made by Purchaser shall be consider,d payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spo,,.se of Vendor for a valuable consideration joins herein to release homestead rights In the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this day of AL1quSt-._. - sr 19.95. . 6_ ~Jn ' (SEAL) L.t'~~-cc%- Lr !L ....(SEAL) Darrel E. Wert J V. Roule - - - - -.---(SEAL) _ ;_£:lf/J-`'✓c_/ G:G ~:('L-C-:~ - (SEAL, Beverly A. Rouleau . _ . - - IM J"~ AUTHENTICATION ACKNOWLED-411k]AT '.1s Signature(s) Darrel E. Wert and Beverly A.- STATE OF WISCONSIN 2 7N, fl m a - Wert, arrd wife Al St Croix Coad¢Y ~7 ? authen ted s of____ Au .__.9}?St 1~5... Mgr onal came be Oro m6, qf,. r a Hu H. Gain husband arxi wife «'irt . . TITLE: MEMBER STATE BAR OF WISCONSIN ; _ } (If not, authorized b S 4.1 by § 706.06, Wis. Stats.) to ?W,kno~ to be the son who ^scented the 'X' foregoi str a nd knowlet g;e the, same( . 11 7~/ z State of Wisconsin County of St. Croix 1 hereby CwWY n tlat UM and aoraedt Dopy of *A dooxmt on file and of MW b EV 4#10 ad best bean compered by ma. A t.Aarch 8 "ff Kathleen H Waish MUM K Walsh Register of Deeds