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Pacel 038-1085-90-100 03/18/2005 01:14 PM
PAGE 1 OF 1
Alt. Parcel 20.31.18.356E 038 - TOWN OF STAR PRAIRIE
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* GILLAND, DOUGLAS G & SHERILYNN K
DOUGLAS G & SHERILYNN K GILLAND
2032 100TH ST
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2032 100TH ST
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 20 T31 N R1 8W PT NE SE & SE SE BEING Block/Condo Bldg:
LOT 4 CSM 1113119 5 AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
20-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/05/2002 370339 1830/559 WD
07/23/1997 1197/521 LC
07/18/1997 562566 1252/132 LC
07/18/1997 1252/131 WD
2004 SUMMARY Bill Fair Market Value: Assessed with:
30284 212,400
Valuations: Last Changed: 10/14/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 47,000 174,800 221,800 NO
Totals for 2004:
General Property 5.000 47,000 174,800 221,8000
Woodland 0.000 0
Totals for 2003:
General Property 5.000 23,500 123,900 147,4000
Woodland 0.000 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 138
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
00
Total 0.00 0.00
s
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSM# LOT #
SECTION,~~T~_N-RM__W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
lie J,~w
~~II
Ze
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: /
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 7-41 Number of trenches
Distance & Direction to nearest prop. line: T- /p
Setback from: well:- House, l Other
ELEVATIONS
Building Sewer
9Y. 9,f
ST Inlet: 9 ST outlet: 97
PC inlet PC bottom Pump Off
'Header/Manifold Bottom of system_
Existing Grade Final grade
t
i
BATE OF INSTALLATION: -
PLUMBER ON JOB:
#ICENSE NUMBER:
INSPECTOR:-
3/93 : jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Laborand Human Relations INSPECTION REPORT ST. CROIX
a Safety dnd Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 284230
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
RQBERT G. DAHL
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/&-60 le?j- ` Q 038-1085-96-100
TANK INFORMATION ELEVATION DATA A9600483 '~rO
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic C ZC~ Benchmark 3, 3a /dC)_
Dosing
i
Aeration Bldg. Sewer c`TIZ/
Holdin St/1A Inlet 7 3'
TANK SETBACK INFORMATION St/)t Outlet 5,717
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic ~ZSr NA Dt Bottom"
Dosin A Header F Y/~
Aeration NA Dist. Pipe
Holding Bot. Systems 7W S ✓ 0
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Li Friction S TDH Ft
Loss ead
^
For main Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width/ / Length / No. Of Trenches PIT No. Of Pits Inside Dia. uid Depth
V _M
DIMENSIONS ~ / DIM N
Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM
INFORMATION Type O y~Pvr C MBER Mode u 74 System: Cond-i.1 R UNIT
DISTRIBUTION SYSTEM
Header / Man fold Distribution Pipe(s)/ < x Hole size x Hole Spaci To Air Intake
Length Dia. T Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At- a Systems
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx
Bed /Trench Center Bed /Trench Edges Topsoil- E] Yes ❑ No E] Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.) V- X
LOCATION: NE1/4SE1/4, SEC. 20, TN. OF STAR. PRAIRIE
1 ^ ~arm
Plan revision required? ❑ Yes Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water System!
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size---s-j
• See reverse side for instructions for completing this application State Sanitary PVeerrm~iii Number -
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
Prop" Z 0 ner N e Property Location
T , N, R E (or)
1 /4 - 1/4,S
Property Owners ailing Adcjress Lot Number Block Num er-
Cit ate Zip Cod Phone Number _ Suk~divisio Na a or C ~ Number
`
II. TYPE F BUILDING: (check one) ❑ State Owned El El Nearest Road
V 11 f f~
Public 1 or 2 Family Dwelling - No. of bedrooms -~el EXTOw
III. BUILDING USE: (If building type is public, check all that apply) arcel Tax Number(s)
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing me 10 ❑ Outdoor Recre nal Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restau ar/ 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. JX New 2- ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an
-_____System________System- --Tank Only------ ExlstingSystem Exlstin System
-
B) ❑ A Sanitary Permit was previously issued. Permit Number ~p Date Issued ql,
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 JgSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min h ch) Elevation
ZZA, 1 -7-- Al Feet Feet
VII. TANK Ca y Total # of Prefab. Site Fiber- Exper.
INFORMATION in g Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin Gallons strutted
Tanks Tanks
Septic Tank or Holding Tank i ❑ ❑ El ❑
Lift Pump Tank /Siphon Chamber
VIII. RESPONSIBILITY STATEMENT
the ndersigned, assume responsibility for inst latior1o onsite sewage system shown on the attached plans.
Pluerm am . (P Plumber' Sign tam MP/MPRSW No.: Business Phone Number:
Plu er's dress Street, C , Stake Z' Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Age t Si
Approved F1 Owner Given Initial eQ/ Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any nevi 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.
If. 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-
V11. 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 8 112 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.
ys,
3 ~C
q
42
A
D~,J
f
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page _ of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
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. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location LL
Govt. Lot 1/4 1/4,S . T ,N,R E (ordN
Property Owner's Mailing Address Lot # Blo # Subd. Name or SM#
Z)".
City State Zip Code Phone Number ❑ City Villa [0 Town Nearest Road
New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow - gpd Recommended design loading rate 7 bed, gpd/fF ?L trench, gpd/f12
Absorption area requireds8 bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2~-g-trench, gpd/ft2
Recommended infiltration surface elevation(s) S ft (as referred to site plan benchmark)
Additional design/site//considerations
Parent material fxFlood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system CA S ❑ U ® S ❑ U ® S ❑ U 0S ❑ U ❑ S I ❑ S X U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Pont. Color Gr. Sz. Sh. Bed Trench
le Al,,
l
Ground 1_6 _A114
elleev`. /
7 .2
7~ 7 ft
Depth to ' ✓
limiting
factoy
Remarks:
Boring # /
r s
S` 8
Ground )VZ1 S'
A6~ &Z
ft.
Depth to
limiting
factor
,Z~2 in. Remarks:
CST Name (Please Print) / Signature Telephone No.
Address Date CST Number
s _ -
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page ~ of,~ ,
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
s
1_2 t-1, ~
A/
Ground ' ' yS T 'j '12
celleev..
/l~Cc-ft• ;
Depth to
limiting
factor
Iin. ;
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , 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)
~~•ff,~fY .~.~iC~ /Y~r"Y~ -_S,/l4-~~dd~f~'✓1~/J~OU✓ '~.rs~/L(J.D ~ .
ys
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations ST. CROIX
` Safety'andBuildingsDivision INSPECTION REPORT
(ATTACH TO PERMIT) SanitaryPerm'42
GENERAL INFORMATION 268642
Permit Holder's Name: Tty ❑ V~ilRlageR Town of: State Plan ID No.:
DAHL , BOB Aj~ 1
CST BM E►ev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9600337
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Loss Fie
Forcemain Length Did. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I N
LEACHING Manu acturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM
INFORMATION Type O CHAMBER Model Number:
OR UNIT
System:
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 Mffe Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ ❑ No
MENTS: (Include code discrepancies, persons present, etc.)
COM
LOCATION: STAR PRAIRIE.20.31.18W, NE, SE, 100TH ST
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Ce rt. No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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 J n
than 8 112 x 11 inches in size. 7(
• See reverse side for instructions for completing this application State Sanitary Permit Number
ZA& ~ q?:
The information you provide may be used by other government agency programs ❑ Check it revision to previouplication
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro y pwner a Property Location
~/7 ~ -1/4 1/4, S T , N, _R (or&
- Property Owner's Mailing Address Lot Number Block Number
zol
Ci , ate Zip Code Phone Number Subdivision Nam or CSM Number ,
( )
A) Z&
II. TYPE OF BUILDING: (check one) ❑ State Owned El tity Nearest Road
❑ Public 1 or 2 Family Dwelling - No. of bedrooms E] rowan of
III. BUILDING USE: (If building type is public, check all that apply) Parc x umbers
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home u oor 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. LZ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ]A Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Per . Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min inch) Elevation
15 IK Feet Feet
VII. TANK Ca
in g lloacits Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ E] ❑
VIII. RESPONSIBILITY STATEMENT
I, th undersigned, assume responsibility for in allation of onsite sewage system shown on the attached plans.
;P1 be s Na e: ( t) Plumb 's a e' S mp MP/MPRSW No.: Business Phone Number:
Plumbe sAddress (Street ity,State ipCode):
.t O
IX. COUNTY / DEPARTMENT USE ONLY
X ❑ Disapproved Sani ary Permit Fee (Includes Groundwater ate ssue Issui g Agent Signiitur (No Stamps)
Approved E] Owner Given Initial Surcharge Fee) '111k, &a Z 0 Adverse Determination
4~ ler
X. CONDITIONS OF APPROVAL / REASO S FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One cnpy 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, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, 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 8 112 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.
,C)ko Si,7 - 142 _ i
f ~ a
3
I
~ DAHL CONS CTION
►A:°(au T o t-bw+~ nl Lo-i ROBERT G. DAHL
60a- %P-S VAA wtl+t .-faw4 fif,-.JL6 Pq~;' stAj,~a5 7473 DICKMAN LEAST
612 HE - 10 MN 55076
TZOA-Pf, 47*46 R-4M 6" CA 6-L VAf, WIN & df-L- t 04n INVER GROVE
wt" bnoP dF ?Ptwm S'f Fzt - A'o M g- 3n-9(o
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aPT FLAA - '1.07 2
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DAHL CONSTRUC lI W
ROBERT G. DAMN.
7473 DICKMAN TRAIL EAST
INVER GROVE MGM MN 55076
612.451.1010
Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page of
abor and Human Relations
Divisior~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 kit-J. f
-
include, but not limited to: vertical and horizontal reference point (BM), direction and o r` C_, I
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel D:
7' ~._R t yti'~♦
~a.
APPLICANT INFORMATION - Please print all information. RevI by
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location `
~
i ❑ Govt. Lot /W1 /4 ;i(, ~ r E( ) W
Property Owner's Mailing Address ^ Lot # Block# Subd. N a r)e-
City State Zip Code Phone Number N rest Ro
( ) El City Vil 054- ~-Totyn
st) ,
New Construction Use: /Residential / Number of bedrooms Addition to existing building
Replacement I ❑ Public or commercial - Describe:
agpd vv~, Recommended design loading rate bed, gpd/fi2 trench, gpd/fit
Code derived daily flow 1-110 1
Absorption area required bed, ft2 V trench, ft 2 Maximum des' n loading rate,bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation s) O n ft (as referred to site plan benchmark)
1
Additional design/site considerations ft
Parent material Flood plain elevation, if applicable
S = Suitable for system Conventional Mo nd In-Ground Pressure AT-Grade System in Fill Holding TT k
U = Unsuitable for system ❑ U S❑ U S❑ U S❑ U ❑ S U ❑ S /U
SOIL DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Structure Consistence Boundary Roots GPD/ft2
Boring # in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Bed , Trench
Groupnd (y 04, 4
ov/ ft.
Depth to
limiting
,n.
-21 Remarks:
Boring #
0 f
Ground
17
Depth to
limiting
.Min. Remarks:
CST Name (Please Print) Signature Telephone No.
Year,. 1 ,715-.7 e?- /4,
Addres ~ r 1. Date ~ CS~T/.Number
L
Ale, C~ /
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page ot_
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
0 -1 r a -i.- m a t
~5 1 CS ~5..~
Ground ( qVW-/ 0
t.
Depth to
limiting
fac r
in.
R ring Boring #
13 Ground
Depth to
limiting
facto
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
41,114 V1, A)
Ground
Depth to
limiting
~f I.E
Remarks:
Boring #
Ground
elev.
ft. ;
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 03/95)
Soil Test Plot Plan
Project Name Charles Borgstrom ByrT Bird Jr.
Address 2033 Co. Rd. C
Somerest Wi 54025 M #3479
Lot 4 _ Subdivision Date 6/6/96
1/4 1/4S20 T 31 N/1319 W Township Star Prairie
Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of NE Property Line Marker
System Elevation 97.8/96.8 * H R P Same as Benchmark
County Road C
Property Line 75' J~OB.M.
0 3 or 4 75'
Bedroom
House Area o
-1 ~
Cn
0 30 Pri A 30
30' 30' -4
B-2 B-3
r
30' Rep A 4%
lope
B-5
Pr Lin
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER VQ9 PA t-I-L--
MAILING ADDRESS (~6L~• w► AN rPAG S ~07b
PROPERTY ADDRESS ~D
(location of septic system) Please obtain from the Planning Dept,
CITY/STATE k~(d Q t-
r sr- s
PROPERTY LOCATIOR Af-7 1/4, S r 1/4, Section (i T '2~ N-R W
TOWN OF KN r~ r~~~;P,~
ST. CROIaC COUNTY, WI
N tTl:, fV w,~- 2-o Ao S V f Df 0 t S 03 AJ
SUBDIVISION LOT NUMBER
54-91 (,,5-
CERTIFIED SURVEY MAP ,VOLUME/] PAGE'11 LOTNUMBER
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 (lie 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 iration date.
SIGNED:
DATE:
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 F'.
Location of pr perty sr F- 1/4 ;rz~ 1/4, Section Zy T 31 N-R IS W
Township Mailing address
741'; D 6&r m/N Z'. . t i _ 61A1
Address of site O ~h
Subdivision name otxE t~4- Lot no.
Other homes on property? Yes x No
Previous owner of property C S ~Qb& 1 OM
Total size of property 5 A( OP.3
Total size of parcel J 14t~S
Date parcel was created 1994
Are all corners and lot lines identifiable? - _Yesy'No
Is this property being developed for (spec house)? Yes No
Volume 111-7 and Page Number 5Z11 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 d~~ffice of the County Register of
Deeds as Document No. 44~~ , 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
tile off c~ of the County Register of Deeds as Document No.
Wex4r 4"",- -
Signature of Applicant Co-Applicant
Date f Signature Date of Signature
.
/o1va0~°2'
Jl FILED 3
JUN 2 6 1996
KATHLEEN H. WALSH
Register of Deeds
St. Croix Co., WI
545965 4~ s
r
v ~
CERTIFIED SURVEY MAP
Located in part of the NEJ of the SEJ and in part
of the SE} of the SEJ of Section 20, T31N, R18W,
Town of Star Prairie, St. Croix County, Wisconsin. Ek Corner
40 Section 20
LEGEND
N i
Aluminum County Section Corner Monument Found
w o
• 1" Iron Pipe Found ° W
O 1" x 24" Iron Pipe Set, weighing 1.13 lbs. r -P
per linear foot
- - 100' Roadway Setback Line
N I3 33
X X Existing Fenceline
"MM AREA
Cr -1 LOT 4 61~
° N 5.00 AC. INC. R/W
217,801 S0. FT. y20
~ 59~
y tit 59~ • I
0 0 -1 4.78 AC. EXC. R/ W
0 ° a 208,085 SO. FT. ly(o I W to
0 CA -1 (n M IC
I 0 LOT 5 I a_ w iO I-tj
o
o(Aa 6.00 AC. INC. R/W rG~ LOT 4 ; }0 Iy
S0, FT. 1 0 1-1
°w o (A Ct 0 261,352
o ,p 'v' 1-I
sr I w !sm 1('~ 1
400 5.82 AC. EXC. R/W
0
253,612 SO. FT.
~ I
,353 ( ~3
/V/ sr 50
o I
Q' • 19' 1 - ( Irk ID
N
s 0 ~3 I I o I0 1z
(0 %D
Ct 00
tie N611~~
0 1 LOT 5 ; im
~(0T I ~n
a
I
--h
C7-
n. I '
~ 736.521
1 10.84 r 6 6
a I N8605112011W
-9 r 747.36'
s. r~n. N 10
OWNER -
r
STATE BAR OF WISCONSIN FORM 11 -198
548865 LAND CONTRACT
Individual and Corporate
(TO BE USED FOR ALL TRANSACTIONS WHERE OVER
$25,000 IS FINANCED AND IN OTHER NON CONSUMER
DOCUMENT NO. ACT TRANSACTIONS)
REGISTER'S OFFICE
ST. CROIX CO., WI
Contract, by and between Charles H BorgG om Reed for RWA
and Dolores Borgstrom/, husband and wife t~ 1996
Teel nrPq Rnr-ctxpm ("Vendor", AUG 21 _
whether one or more) and Robert Q- Dahl at 10:40 A M
-R J&hk
("Purchaser", whether one or more). Register of Deeds
Vendor sells and agrees to convey to Purchaser, upon the prompt and full perfor-
mance of this contract by Purchaser, the following property, together with the rents,
profits, fixtures and other appurtenant interests (all called the "Property"), in THIS SPACE RESERVED FOR RECORDING DATA
St. Croix County, State of Wisconsin:
NAME AND RETURN ADDRESS
KRISTINA OGLAND
Zilz, Estreen & Ogland
P.O. Box 359
Hudson, WY 54016
$ Ry QSoFER
FEE- (Parcel Identification Number)
Part of NE1/4 of SE1/4 and part of SE1/4 of SE1/4 of Section
20, Township 31 North, Range 18 West, St. Croix County, Wisconsin,
described as follows: Lot 4 of Certified Survey Map filed June 26,
1996, in Vol. "11", Page 3119, Doc. No. 545965.
This is not homestead property.
XXX(XK (is not)
Purchaser. agrees to purchase the Property and to pay to Vendor at place Vendor directs
the sum of $ 18,000.00 in the following manner: (a) $ 3p600-00
at the execution of this Contract; and (b) the balance of $1~, 400 00 together with interest from date
hereof on the balance outstanding from time to time at the rate of 8 percent per annum until paid in full, as follows:
Commencing on the lst day of January, 1997, and on the lst day of each
and every month thereaster, equal monthly installments of principal
and interest in the amount of $174.71.
Provided, however, the entire outstanding balance shall be paid in full on or before the 8th day of
August, 2001 XKX (the maturity date).
Following any default in payment, interest shall accrue at the rate of 12 % per annum on the entire amount in default (which shall
include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes,
special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these
obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow 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 January 1
X*tX0PXNNSX10XX$0X0X-XX
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
-.-----'---''-----t________..:__:_.____.e_,.._._„_.u .,..,,,....I, A,..Itt,o..oornAncnnnai.inrinr,nallicleccthan the amountthat sa
VOL 1197 PACE 522
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor
on demand receipts showing such payment.
• Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils and
such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of $ N'4 A
but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums
when due. The policies shall contain the standard clause in favor of the Vendor's interest and, 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, insurance proceeds shall be applied to restoration or repair of the Property
damaged, provided the Vendor deems the restoration or repair to be economically feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable
condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and
regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed
at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of
the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and
except: Easements, restrictions and rights-of-way of record, if any.
Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a
period of - 'In 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 1- days following written notice thereof by Vendor (delivered personally or mailed by certified mail);
then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice
(which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in
addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the
Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment
of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder
(in which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for
the Property if Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment
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 portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title
action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a
receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or
written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in
litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or
not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be
included in any judgment.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a
receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendancy 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 makes 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 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 spouse of Vendor for a valuable consideration joins herein to release homestead rights in the
subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.)
12
day of August 19 96.
Dated this
(SEAL) ,rfi!' Lh4 ~r~ _ (SEAL)
• Charles Bor Strom Robert-G. Dahl
l (SEAL) (SEAL)
Dolores Borgstr m
a/k/a Delores Borgstrom
AUTHENTICATION ACKNOWLEDGMENT
Charles Bor Strom STATE OF WISCONSIN
Signature(s) ss.
Dolores Bor Strom, Robert G. Dahl County.