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038-1120-20-100
Q' O O O O O O d GS O 6 O 0. CO p c E 0 fn N L E -C N E (L) CL zz -0.5 Q ~ E LO N O U M p O O X V h E N N ~ I C r L_ ~ L Q 3 N o y C o > m c E - O L T co ~c N I N N O o Y 3 O L O 00 O 2 NZ0 a) cr) C z L C Z 7 3 m C> N m C LL O O LL CO -p_ N CO H e . 75 O N O E O N _0 0 ,1 w Q O a M N O ` N z y z y) ~ O _ O t P OL Z d N d d a co a m N F- U) O O Z d 2 d Z d c C O m m O Z E c E -p p v o 2 Cl) O N p O N = - m I m N N N N •AJ a U) L U) M p 1 p O N Q O a-°) Q z m z z co z O o z N N N J pC c ~1 O U) d d V y d C rl a a«« LO Q«« p C o O - o G a (L a CO G G a a M N N CO 0) D m m E 0 0 0 E O O O z o o •rv is a a a a a a IL a 0 0 N m ano ano a3i 0) a) fA J V Z 0') O) Z z CF) 0) Z O N (n O O O C N N C C E 0 0 > ` O O) O N a0 Q =3 Q C N N '6 V C .C CD N ~i.♦ N V1 C N N ~ -G d Q } ~ p N Q } tD ~O d d w D C 3 a y N N r,~ 0 3 (o e (o w e Mri ° L o o> o o c c E c c :3 04 LO 0) U © ~ N ` p Q 'D N N N L d~ co N O N i m` N E E E o v cv ao C Nco N N C O O 7 N izz - rn a Z "p0 d0' H FL- Q~j • A (fin of o rn N m o o(D E E U O ca IL IL CL w d a • c~ Q m ~ a~ m e y c `Frl ~ E s c c 3 c 3 ~ A cpi a l l 0 U) L) 0 U) L) j 70 C) 0 0., o c I 0 0 N M U I d C Z o 3 Q0 ~ I ~ I 0 ~ y I z H co w E r U) C z a m , N FM-- U) o o z:!t 0 in H o z E ~ M N ~ N I N OC O z z z U z 4.; N 4 N _0 I LO CL M Z NN 0 0 E o r r r~ co o N ` j v O a z ~ if 1 ~ I 3 o N o Z ~o 0 ~ N N J V UZ-H.' a~ N d V a z ca = H c O ° 3 1, co a E p! .0 ~ coo 0 (n v o= ° ° 0 o ' N ai E 0 0 a r_ v p N N co 40. N N O N m n l 0-4 C6 ~ d c 0 CD U) -4 C N * d • , r°Di aMi f6 O co o E ca v O o N U) N CD Z - -7 rL co 3 ik a a a • 0 a y ;u m -1 A v a 2 j O v~ v s Parcel 038-1120-20-100 03/31/2005 10:23 AM PAGE 1 OF 1 Alt. Parcel 29.31.18.497B 038 - TOWN OF STAR PRAIRIE Current I X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * MONDOR, BETH A BETH A MONDOR 961 192ND AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 961 192ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 9.730 Plat: N/A-NOT AVAILABLE SEC 29 T31N R1 8W SW SE 5AC LOT 1 CSM Block/Condo Bldg: 7/1866 ALSO BEGINNING NW COR LOT 1 CSM 7/1866; TH S 544.5'; TH N 89 DEG W TO W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) LN SW SE; TH N TO NW COR SW SE; TH E TO 29-31N-18W POB ALSO COM S 1/4 COR SEC 29; TH N 00 DEG E 666.67'POB; TH S 89 DEG E 657.34'; more... Notes: Parcel History: Date Doc # Vol/Page Type 12/01/2003 747851 2465/073 QC 12/01/2003 747850 2465/072 WD 07/23/1997 1128/477 LC 07/23/1997 788/241 2004 SUMMARY Bill Fair Market Value: Assessed with: 30638 301,400 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.730 70,700 244,000 314,700 NO Totals for 2004: General Property 9.730 70,700 244,000 314,700 Woodland 0.000 0 0 Totals for 2003: General Property 9.730 37,500 206,300 243,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 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 I 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 r) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # q~ t APPLICANT INFORMATION - Please print all information. Revie ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). I \s/ a~..?=_E~~IE~„ Property Owner Property Location i , Govt. Lot 14- _ 1/S~ T/ E Property weer ailing Address Lot # Block# Su a or C3NIlt C. State Zip Code Phone Number c ❑ City Villages ~~bw - ew Construction Use: XResidential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow _'!~,60gpd Recommended design loading rate bed, gpd/ft2-- 1-trench, gpd/ft2 Absorption area required =1i bed, ft2 (trench, ft2n Maximum design loading rate bed, gpd/ft2_trench, gpd/ft2 Recommended infiltration surface elevation(s) T r :2 IL 9 i~ ft (as referred to site plan benchmark) Additional design/site considerations > t /J Parent material i. l ~/G=~:OL.~ Flood plain elevation, if applicable ft 1 Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank S = Suitable for system U Unsuitable for system S El U XS ❑ U S E:1 U N~S ❑ U El S U ❑ S J,+~~J~/U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench V Ground 3 D 5 ele ' Depth to limiting facto n. 3, Remarks: Boring # C>_ Ground ley e-.2 ~ limiting factor ~afr. Remarks: CST Name (Please Print) Signature Telephone No. 2-5 Address D e CST Number /SOIL DESCRIPTION REPORT PROPERTY OWNER ' Page of ► PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~Djft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o Ground 3 ,1 ~✓)J~} O _57 ZISQ l p I ft. Depth to limiting Remarks: Boring # Ground Depth to limiting in. 3 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 # 2 ~ girv a ~3 rj,~ - ~ / K - a. Y S s s4 Ground Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) 1 Project Name Brian Mondor Soil Test Plot Plan Byron Bird Jr. Address 1854 100th Ave New Richmond Wi 54017 CSTM #3479 Lot Subdivision Date 9/25/96 SW 1/4SE 1/4S29 T 31 N/R18 W Township Star Prairie E] Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Property Line Post System Elevation 91.7 *H R p Same as Benchmark • M • Property Line 15' B-4 5' 5, B-1 Slope 30' 0' 0' B-3 0 Fio3 Rep A Ph A m o B-5 30 B-2 c~ Property Line (00 04 n."=- 4i999 01 CERTIFIED SURVEY MAP 5X . LOCATED IN THE SW1/4 OF THE SE1/4 OF SECTION 29, T31N, R18W, " TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN S $ N OWNER SURVEYED FOR ~ n r: ,r RALPH MONDOR BRIAN MONDOR A , ~ I4 R.R. #4 R.R. #1, BOX 210 El/4 CORNER NEW RICHMOND, DEER PARK, SECTION 29 WI 54017 WI. 54007 A"=` T31N, R18W ~Q'rl~r: L.'1 i:1>Ei'✓': i':t::.`.J ....I~M1H~ AND LoNfil('; COMM2{TC-* W _ N. LINE SW1/4 OF THE SE1/4 o r~ N r1 M U N P L A T T E D LAND S POINT OF a'~ BEGINNING z M 192ND AVENUE M ~O M - m S8 1 E -4T' -CY) 1970.67' m N89°42'19"W w S89°24'0 "E 400.01' M o N. LINE OF THE w SE1/4 OF THE H SE1/4 w w o W H a cnI LOT 1 _ ^ `O 5.00 ACRESt, Being 217,800 S.F.± al Including Town Road Right-of-Way o W 4.831 ACRES±, Being 210,425 S.F.± N z Excluding Town Road Right-of-Way QI ml rn 3 ~ o ~I AI o z P41 `r'• N - zl o 0z x z <4I UCH-iz I M _ oLn aI ww-1 H Ln r-I Cn w H W -i v1 Cn I~ ~ N N Ln P4 O H W 3 QI U O 44 O -t W W a w ^ ^ HI cn H H I a H z z ° ~I W ~4 H a pq a P41 0 00 z zC 1 t9 W U H M 01 H z Q-1) ON H z rI H x H r-1 w z FF-4 O z A w 91.52' 308.48' Opp 0ch0 3~n Cy dl o l 03 A 3 0 d 3 y p °rno o ai o °Coo y WW 0• N c ° m (D a CL 3 z m H v a j o 0-4 A \ a S S N N 0 Z` O N M 1 CD CD 5 `A\ CID A CD w 3 3 y W N S N W ° a N 10 :3. 7 7 N O N N N t~ir y N O N (D N v O -0 (D a 0 co cri K) C: 3 0 to 1 H N N N ° _ C D Aa N U) D eo Cn°i fl o CD fD CD N O. 7 CO U) N a a p ~p > N W a N CM c CL 00 0 < lot CD 0 CD CD CD CD ~VV -4 -4 X ~i 003 I 0 0 0 3 0 o z 0 0 0 0 3 p o o pp JE o D o n a 3 vi CO) CO) a o f vi CO) CA ° o D 1, ca cr o c vi CD !mot (D 411- CC :3 o N ` d-4 7 3 m ! CV oz D (DD o D a O 0 0 CL O , S fA N• CID IN N w ~ o a ~ a a 3 N ' N Z CID Cb p 2 eD ° c c n o. A z 0 (A N 13 m 0 CD m j CID CL z a 3 ' 9 °o ' °o X cn co m N Z y z CID CD o :E Ca I I _ o C4 m~ n S a d.3 ~N o- N a CID `~CD07m n o m c agD?~ v c CD -0 a, z a o Z a 0 c o CID 0 0 N 3 CD CD m N ~y CID 41 a e °o °o " g 'c a CD C, Y- Co°~ < f° Q o b 19 =0 CD N O O x 0 > > 1 N 0 S CD OOo N 0 O O~ NN CID 14 0 0 0 W b CD N O ° O I ~ f o b D a °o Form-STC- 104 t AS BUILT SANITARY SYSTEM REPORT OWNER ~bI- TOWNSHIP SEC. kT N-R_2Y__W ADDRESS j6X A/0 ST. CROIX COUNTY, WISCONSIN &.e r 10gr I L l Se qO0 SUBDIVISION LOT ,_.----.--LOT SIZE -----PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 8 ! 9r toy ;7 ' - - ' G a a- INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used r,p p Go0 < P" 0 r► A PUMP CHAMBER 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, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenjth: ~ Number of Lines: , Area Built Fill depth to top of pipe: 02 Z/ Number of feet from nearest property line: Front, O We, @ Rear,0 Ft.~ Number of feet from well:D Number of feet from building: (Include distances on plot plan). / SEEPAGE PIT 73~ 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, O Ft. 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. BA)X 7969 BUREAU OF PLUMBING MAIJISON, Wr 53707 SW41 4,S29,T31N-R18W CONVENTIONAL ❑ALTERNATIVE Sltate Plan I.D. Number: Town 6T Star Prairie ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 192nd Avenue 00 0 11a NAME OF PERMIT HOLDER: DDRESS OF PERMIT HOLDER: INSPECTI DATE: Brian Mondor A Route 1, Box 210, Deer Park, WI 54007 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number: Byron Bird Jr. 3378 St. Croix 99097 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. . WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: IVENTIATL. HIGH WATER DARE MBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM' ET FROM LINE AIR INLET. ❑YES ❑NO ❑YES ❑NO ST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L. NUMBER OF PROPERTY WELL: BUILDING. AIR NL07 RESH (DIFFERENCE BETWEEN FEET FROM LINE PUMP ON AND OFF) ❑YES ❑NO NEAREST MATERIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH: 11111 TER or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH TR EONCHES =IPE SPACING MATERIAL' NSI DE DIA *PITS LIQUID PIT DEPTH: DIMENSIONS DISTR. PIPE MATERIAL: O. DISTR. NUMBER OF PROPERTY WELL, BUILDING: VENT TO FRESH GRAVEL DEFTH FILL DEPTH DISTR. PIPF DISTR. PIPE N BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END: PIPES. FEET FROM LINE: AIR INLET: NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED :1H OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL A MAR ELEV.: ELEV.. DIA.. ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL. PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LRNE:ERTV WELL: BUILDING: FEET FROM YES ❑ O YES ❑ NO NEAREST tAa V0 S,~O -A, 3`~ >M rnyc 2 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) Zoning Administrator ILHR SANITARY PERMIT APPLICATION COUNTY L( { In accord with ILHR 83.05, Wis. Adm. Code - STA SANITARYPERMIT# 9D -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% 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 R NO PROPERTY OWNER PROPERTY LOCATION A), I Qh O ,(V% , S .iZ T,3 , N, R E (or PROPE WNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME CI AT ZIP CODE PHONE NUMBER CITY Ate, E A LAKE OR LANDMARK V TOWN ILLAGE , 11. TYPE OF BUILDING OR USE SERVED: - 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. ~ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 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. %Seepage 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): a- *-Feet Private ❑Joint ❑ Public 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 strutted Septic Tank or Holding Tank Z- Lift Pump Tank/Si hon Chamber 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's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ~5 ~d~761 PI b s Address (Street, City, State, Zip Code : Name of D igner: / VIII. SOIL TEST INFORMATION 10001 ool Certified Soil Tester (CCSZ}yame CST # of" ee 3Z/ CST's ADDRESS (Street y, St e, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit -Fee Groundwater Date Issu' g Agent Signature (No Stamps) rA Approved ❑ Owner Given Initial ~ charge Fee Adverse Determination /ao.V'a 'v 7 X. C, MMENTS/REASONS FOR DISAPPROVAL: 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 needed 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 pumped by a licensed pumper whenever necessary, usually every 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; ll. 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 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; 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; 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. 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 grourWwatbrbill Groundwater included the creation of surcharges (fees) for a number of regulated Oyactices which Wiscork it's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried 'reasure is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- G tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, t it's worth protecting. SBD-6398 (R.03/86) f APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in.full and signed by the owner(s) of the roperty 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 Location of Property/.tom ~t S fit, Section 9 , T_N-R_Le W Township Nailing Address x Gv~sL, ~4'v~7 Address of Site 13% Subdivision Name Lot Number p Previous Amer of Property R,g R Total Size of Parcel A /2 &-s Date Parcel was Created U y g Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes Flo _ No Volume 8N> 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 1-1932 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED A' cyc N 42 t - - and Ma Deed, made between ------.------Ralph-S. Mondor ,;-c,,~yw ~ - _ y K. Mondor, husband an -d - -_w- -i--- -fe, - - "sl4th Grantor. ~,y Of Aug• and -Brian J Mondor " -------------------and -_Beth __A._Mondorl-------------- 11: 30 A~ t►s. husband and wife, as survivorship__ma-rital-_.-__--_ - - property - Grantee, Witnesseth, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in S_.___ RETURN TO County, State of Wisconsin: Tax Parcel No: Lot One (1) of the Certified Survey Map filed in Volume 7 of Certified Survey Maps on Page 1866 as Document No. 428999, being a part of the Southwest quarter of the Southeast quarter (SW 1/4 of SE 1/4) of section Twenty-nine (29), Township Thirty-one (31) North, Range Eighteen (18) West. This is a transfer from parent to child for no consideration. I This _..---i=~--not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-..--.grantor _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances~g~X and will warrant and defend the same. Dated this - /C>( 7 11 day of August - .1987- .--..(SEAL) '4 ......(SEAL) Ra ph S. Mondor :arY K. Mondor --------------------------------------------------------------.(SEAL) - --(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) -Of__Ral-ph ___S-.___T!I riftZ__-_-__._..---_- STATE OF WISCONSIN and Mary K. Mondor ss. ' H z En H a STC - 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z d OWNER/BUYER G (,jq/~~ /uz,91) H ROUTE/BOX NUMBER ~ T Fire Number 16)96 CITY/STATE D, ~~lk /,r CS G, ZIP .~yoo7 PROPERTY LOCATION;a~_k, SC k, Section a9 Tom/ N, R/(~' 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 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 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ro 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 Z DATE_ /d- 2 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HUMAN RELATIONS N WI 53707 (H63.090) & Chapter 145.045) LOCATION: SE TION; WNSHI UNICIPALITY: OT NO.: BLK, NO.: SUBDIVISION NAME: '1W1 o? /T31 or) W r ' COU TY: _ OW ER'S BUYER'S NA E: MAILIN ADDR SS: c"S~Groin n o r, / usE ~/O ~r ~r~l G~ir~ 6-Y OO DATES OBSERVATIONS MADE [EAResidence NO, BEDRMS.: COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: New ❑Replace ~j - 2 -SS RATING: S= Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ®s❑u I (9S au as❑u os 21 ❑s u ~~5 s If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the under s,H63.09(511b1, indicate: A Floodplain, indicate Floodplain elevation: ~p PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES HIGH ES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) V.2 OIL O/t C .04 B. S ( oar o- S 3oT.o -f'G,,5~ B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. ---PERIOD t PERIOD P R PER INCH P- 1 , 5 D,,L •e P- - < 6 G < P- P_ P_ PLOTP- 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, SYSTEM ELEVATION 4 , r_ r i t r ,r, 4 lQ~ A . r . el Ile iA a' o tN 1 r t ~~2 1 t z ~ ~ 3 l i PLOT PLAN PROJECT r, c; dr,wr_ADDRESS lkJ' 1 /4~ r iy y' .c ~r ~ 41,E 1/41,Vlev Tom/ N/R W TOWN .7'- ~ ~W 1`- G r y y~p~~ MPRS Byron Bird Jr. 3318 DATE COUNTY/ BEDROOM CLASS PERC CONVENTIONALAf CONVENTIONAL LIFT MOUND_ HO ING TANK IN-GROUN ESSURE SEPTIC TANK SIZE o~ LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE b, Benchmark V.R.P. Assume, Elevation 10Q' BED SIZE Location of Benchmark 'il 'a * H.R.P. M Borehole Q Well Scale Feet O Perc Hole usw -System Elevation TYPAR COVERING 2" 12" 3' 4 6' 4© 3' 1 Sewer Rock 12' C%~ z S fi 1 a~,.-,7 ~V 14 All 1 ~pr~ . - u f'•3Ey ~ o i~ ;fro 0 3 A 0 d O1 I o m c ° ~ T :i A T CD d ` N o ,ccoo °w 3 N = j 90 CD CD m O N d. O N ^ N? C O O N N o- 3 W t \ 1 O O Cf CO " o O O V fD O C W 0.1 Vt N 3 = O K 7 a, 0)j F °O O. Co - w c C) N (D 3 O CO d = _(D c C D o a N o y co CL (D N O- C O O < 3 CD N O O C) CD N ` O O fD 0 W~ n r CO) C) co co) Q z 0 00 3 ao gg = l a~ (A CO) y a o~ D ~QQ o. pp IQ O _o O K M N v d fo w N I Z M N o 0 D D 0 m O CO) • N CD 7. C N W CD a a 3 Z CD ip -I N O N O A Z Cam'! - c i 90 a A G) 0 C40 --I K) CD CL Z c cn o y z F a 0 I MC"' rnR cos a CY 0) 3 CL 0 0 CD 7 or S C Co M N CCD y oz 20. ~ y fD 3 C'no• tOn a Cc fi O C y A CD ~ O a<) O =4 C (D CA 0 x o = = Q 1 tN 7 ~ ~ O O S O N O H N A x 7 w i N = b CD oa o o O CD CD °a ~ Parcel 038-1120-20-100 10/06/2005 12:11 PM PAGE 1 OF 1 Alt. Parcel 29.31.18.497B 038 - TOWN OF STAR PRAIRIE Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner BETH A MONDOR O - MONDOR, BETH A 961 192ND AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 961 192ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 9.730 Plat: N/A-NOT AVAILABLE SEC 29 T31 N R1 8W SW SE 5AC LOT 1 CSM Block/Condo Bldg: 7/1866 ALSO BEGINNING NW COR LOT 1 CSM 7/1866; TH S 544.5'; TH N 89 DEG W TO W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) LN SW SE; TH N TO NW COR SW SE; TH E TO 29-31N-18W POB ALSO COM S 1/4 COR SEC 29; TH N 00 DEG E 666.67'POB; TH S 89 DEG E 657.34'; more Notes: Parcel History: Date Doc # Vol/Page Type 12/01/2003 747851 2465/073 QC 12/01/2003 747850 2465/072 WD 07/23/1997 1128/477 LC 07/23/1997 788/241 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.730 70,700 244,000 314,700 NO Totals for 2005: General Property 9.730 70,700 244,000 314,700 Woodland 0.000 0 0 Totals for 2004: General Property 9.730 70,700 244,000 314,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 roo y 2 ~ sr 1 ~ FI~E~g7 p 0 4626999. CERTIFIED SURVEY MAP daoiri LOCATED IN THE SW1/4 OF THE SE1/4 OF SECTION 29, T31N, R18W, & 6~ TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN 8 N OWNER SURVEYED FOR RALPH MONDOR BRIAN MONDOR ' ✓ R.R. #4 R.R. #1, BOX 210 El/4 CORNER NEW RICHMOND, DEER PARK, SECTION 29 WI. 54017 WI. 54007;:} E=x tJ / T31N, R18W AND w- ~O N. LINE SW1/4 OF THE SE1/4 fo r~ N o M-i U N P L A T T E D LAND S POINT OF o BEGINNING z M 192ND AVENUE - M - - - M r, S8 E -'4 -7~ 1970.67' M ~ N890 11911W w S89°24'0 "E 400.01' - - - - o N. LINE OF THE w ^4 SE1/4 OF THE H SEl/4 w o w z W H a ~I LOT 1 N ~t H I 5.00 ACRES±, Being 217,800 S.F.± i, o ~ al Including Town Road Right-of-Way ri N w CD 1-4 4.831 ACRESt, Being 210,425 S.F.± N z Excluding Town Road Right-of-Way wi m HI ° - cn I ~ O G]I W Na0 i ON as i `n Ln Z I 1:4 o O ~ MHz CD irk w - a i w w M v~ ^ N v1 v] H N u'1 00 ~ O H W 3 Q 1 U o o WI w oIT rW ~a w ~ ^ H I -I HI zn' H w° o c I zz rwA ~ a a I 0 aal 00 z zl ° o i M °I z H z O1 F-q F-4 QD ° 3 A w 91.52' 308.48' N89 42 19 'W 400.00' , STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS 4/ . 1'7 SUBDIVISION / CSM## LOT ~ SECTION -~c T--y~LN-R W, Town of Y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM h v0o a i INDICATE NORTH ARROW 4zlsw Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tangy; manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TAN PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer.14A Laid Capacity: i cl/ Setback from: Well House < Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM c ~ Width: Length Number of trenches Z~i Distance & Direction to nearest prop. line ~/`'~~.rl~ Setback from: wellHouse4e~ Other ELEVATIONS / Building Sewer ST Inlet:_,*L_ ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade /✓y DATE OF INSTALLATION: ~ r PLUMBER ON JOB: ~S^! LICENSE NUMBER: INSPECTOR: 3/93:jt {onsin Department of industry, /gr and Human Relations PRIVATE SEWAGE SYSTEM County: fety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: 0y,( dcY El City Village E-] Town of: State Plan ID No.: 11 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA 960 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 5 /Cl~Oc Benchmark Dosing-_ y~ f t Qt, ~~q Aeration Bldg. Sewer i Holdi St/ Inlet 95 TANK SETBACK INFORMATION St/ Outlet 7/~~ 9s G9' TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet IL A_ Air Intake Septic n NA Dt Bottom Dosi NA Headern. i Aeration A Dist. Pipe Hol. Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM DIMENRENN H gTypeof Length No. Of Trenches PIT No. O f Pits Inside Dia. Liquid Depth DIMEN 1 N O P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION CHAMBER ModelNum er: x,25 OR UNIT DISTRIBUTION SYSTEM Header / Mani old 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 JDe pt h Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center d /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. Ll I SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I r Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262402 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: MONDOR, BRIAN STAR PRAIRIE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irIto ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Air 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 oss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK INFORMATION Type Of CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TOWN STAR PRAIRIE.29.31.18W, SW, SE, 192ND AVE Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Perm itlVO.: 'GENERAL INFORMATION Permit Holder's Name: Mi" ❑ FFF State Pla NDOR, BRIAN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA s~~/~Y6 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark er Dosing I L, l Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air In take 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 Fi Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches IT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIM N I N SYSTEM TO P / L BLDG WELL LAKE LA/ STREAM LEACHIN SETBACK CH ER model Number: INFORMATION Typeo 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 Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TOWN STAR PRAIRIE.29.31.18W, SW, SE, 192ND AVE Plan revision required? ❑ Yes ❑ No IT I Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bo; E was Building AveerSystem! In accord with ILHR 83.05, Wis. Adm- Code P-O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Saannit`!a/ryy P~errmit Number The information you provide may be used by other government agency programs El 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 O r Name Propert Location ,Orf at /4 '-1 /4, S o2 T , N, R J0,7 a~;_ Property Owner's Mailing A dr s Lot Number Block Number i ate Zip Code Phone Numb r Subdivision Name or CSM Number t . (7 ❑ it Nearest Road II. TYPE OF BU DING: (check one) ❑ State Owned r ❑ Vil age J!~, ~Ar`~~e Public or 2 Family Dwellin - No. of bedrooms own OF III. BUILDIN USE: (If building type is public, check all that apply) 44 Tax Number(s) 1 ❑ Apartment/ Condo 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. ew 2. El Replacement 3. E] Replacement of 4, E] Reconnection of 5_ E] Repair of an ~ ystem 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 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation .oC Feet Feet VII. TANK Capacity in gallonTotal # of Manufacturer's Name Prefab- Con Steel Fiber- Plastic Exper- INFORMATION New Existing Gallons Tanks Concrete glass App. strutted Tanks Tanks Septic Tank or Holding Tank 0 El Lift Pump Tank /Siphon Chamber, ~ ~ EEl 1:1 1:1 l ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' ame: (Print) Plumber's ature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plum s Addr s (Street, City, State Zip Code): IX. COUNTY / DEPARTMENT USE ONLY UMQ Agent Sign re ( o Stamps) ❑ Disapproved Sani ry Permit Fee (includes Groundwater ate Issued Iss / Surcharge Fee)/ *Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: r SBD-6398 (R. 0b/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 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 systerri, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. .1 1 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 ^'Dw Iling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one or- line A. Complete line B if permit is for tank repiacernent, reco inection, or repair. V. Type of system. Check appropri~. E. box depending on system type. VI- Absorption systern information- Pi oyicle all information requested for numhers 11 hrough 7- Vi1. Tank information Fil! i ul:e capacity of every new/or exiting tank, list. Vie iota! g illons, ~f tanks and manufa_turer's n Y c, inal,-atc p efa!_, or site constructed and tank material Cemt 'ete fo pump/siphon and holding tanks f% nis ~.s±ern. Ch,-,, k experimental approval only if tanks e ea _,xperim~- > oduct approval from DiLHR VI!'I. Responsibility statement. Install r ,3 plumber is to fill in name, license number with appropr,. e :l G fix (e.g. MP, etc.), address and phone number. Plur-4 er must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. 'ti? _ S'I)e catJ ,fir _a )o str.j ?'7 R 1/2 x Mt_ r> i) silt r~ :e'.1 ilE; Mani r!-..1st L:: ✓Ir _ of i' - +~1`: .~IE Or Nii -f ;;ete Ili cnslr a t~ „Kt=~~~, $ept!~ A TIP Or S pho.r, h!;~1,1,ng served, „ oI -0 r; Ma !0-l GROUNDWATER SURCHARGE 9li_ c:; surcharges (fees) fora nuf-nt:,2-of rr~r pled pc(( czn eff~r~ -o indti~at r 1fe' mui"leo _J'.lec =d ~.~'JUQ`l tc.e -~lrge5arE' nd for monitoring groundv,, r c ~lrr.n:: 1'St.C,;3i1;1 5 and establ:sll r;c -~t r)f Land r - SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations August 22. 1995 1}40 Fast. Green Bay Street RUTTF 300 Shawano WI 54165 BIRD. BYRON J.R. 896 68 AVE AMERY WI 54001 RE: PLAN S95-31005 FFF RECEIVED: 110.00 MONDOR.BRIAN NW,SW233,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROiX NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal, Conditional approval is herebv a_ranted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145; Wisconsin. statutes, and chanters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with anv stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chanter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary per°iiiit ;Zz:, Y), _ The licensed plumber responsible for this ra_cj installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city; village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely. Keith Wilkinson Plan Reviewer Section of Private Sewaae (715) 524-3627 SNDA-8828 (R.18/84) SAFETYic BUILDINGS DIVISION -201,E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations August 22, 1995 1340 East Green Bav Street SUITE 300 Shawano WI 54166 BIRD, BYRON JR 896 68 AVE AMERY WI 54001 RE: PLAN S95-31005 FEE RECEIVED: 110.00 MONDOR BRIAN NW,SW,33,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan `submittal approval will expire two years from the approval dame, or if a sanitary permit is obtained, plan approval will expire on the day initial sanitary permit expires. The licensed plumber responsible."for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the-appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior'to instal'laiion.' " Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, T Keith Wilkinson Plan Reviewer Section of Private Sewage ' (715) 524-3627 SUDA•69181R. I(M) i Tk S ivle~~ 41 m 00 'I JCT G,~i^~~ h o~ G ADDRESS E GrJ 1 /4 1141SR /T/ N/R/ r + W TOWN COUNTY MPRS Byron Bird r. 3318 DATE' B CLASS PERC.•,Z_ CONVENTIONAI.~ON-G UND PRESSURE CONVENTIONAL LIFT MOUND_ HOLDINQJANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA ~1-~ PERC RATE SIZE /a jc 3 . Benchmark V.R.P. Assume Elevation 100' BED Location of Benchmark ❑ Borehole Q Well Scale = Feet O Perc Hole System Elevation Vent 12" Grndp TYPAR COVERING 2- 12' 3' 4 6' 4O 3'r 1 Sewer Rock I ' 1 6"1 1.2' -~05,e,-/P-0-S r~ S ~ u-ct,~ ~tf C2-1 -2 36 Sys _ h 2 OJ Ir. ~p a• a - P,1 5. = 60 • i/78 . 1. PR3OJECT. DETAIL DATA SHEET i f, i'U 1 .f y NAME OF BUSINESS 61 01 LEGAL DESCRI .OWNER.MAILING ADDRESS ARCHITECT, ENGIN o ADDRESS PLUMBER OR DESI ER otc . , ZIP TELEPHONE NUMBER' 761z Check appropriate building usages) and fill in'fhe information requested opposite' each usage :%l.isted. Please con su-l-t-*-Section,H 62.20. :Existing -building; New building Addition ( ) Apartments°and. condominiums : -Number-,of bedrooms Y .Assembly hal 1.... Seating capacity Seating cap4city'L. of meals served, .i., A -;Bowling, a112y•~;`fT Number. of lanes With bar Campground -and camping resorts Number of sewere s.ite$,;.• Number -of' unsewered 's rtes Total number. of s.ites:. . Camps._..". , `,1 • ) bay use only Number of persons ).Day and night Number of persons ( ) Catchbasin Number ( ) Church No kitchen ;.,Number. of ..persons With kitchen Number of persons O Dance hall Number of persons ( ) Dining hall Number of meals -serve daily ( ) Doq kennels .-On. Number of enclosures Drive-in restaurant. Insi-de seating capacity- Car-service --.Number of car spaces Dump station 6`~StM. Number of dump stati Empl o {~IYEt o al sshi fts) Number of employees Hotel ote.l g:. Number of units with persons per unit Number of units with 4 persons per unit ( ) Medical. Number of doctors,"-nurses;. medical staff - F 11bober of office personnel i~JRAat~iU.JI Number of patients MohR1h pW© 8 1~'."s Number of sites 014 (O1E`!itll~ng►rt3i~ NulOr of beds ( ) Pa.ks . . Umber of persons ( ) Toilets ( ) Showers,. ( au ~0~oElfflCE. Seating capacity SEA G~1~~ - ( ) Dishwasher and/or disposal? ( ) 24=Hour service tail store . . . . Total number of customers Schools: . . . .Number of classrooms "eals ( )Showers ( .),,Self service laundry Total number of machines O Service: station ' Number of cars served daily Swimming pool bathhouse Number of persons. ( ) OTHER .'.(Specify) "Wks- COMPLETE OTHER SIDE - Indicate whether the following facilities are present. Floor drain yes..' no. Number'of drains i -Food waste grinder------yes;_.._-._..no_.. Dishwasher' yes no Automatic-clothes washer, es.- - -no.--,4 .Number of clothes washers.:, . _y ~=J`i~ Sr' 1 Ir tqq 3. • Septic tank.,capacct ' ' 4Gt~~14 Holding' tank 2capacity_.._ Septic or holding tank manufacturer i✓ • ti , I. SEEPAGE TRENCHES:...- total--square feet : width of trenches trenches. OM3JT depth number-of trenches SEEPAGE BEDS total_square. feet width 1 ength.. of bed. depth CC 11 , ti, c f ! r9; SEEPAGE PITS = d "t6tal)99 syquare feet outside diameter depth~ below Anlet r totdV'depth `from top -.tobottom of pit 10 Signature of person ±comp prig"'form::,', FOR DEPARTMENTAL USE ONLY ~b b9, a _ Address 6/ ~.c ZIP zjT2 Telephone Number 5 r r i ' ' Date 'T ._...._...:~u'f ~~t M~~~~ .J ro' .duj«rI . • 1 •,f .I ...s,. r r ,~~i p~: •c:,rllyi~' • i I • Zg i r ....0 r' Tv ~ r y r f'" L. H 1 I , PRQJECT ~"i~h y~o/~Lld~^ ADDRESS Gvc`i9~y~ ] 1 /4 1 /4/S4~y/T N/R/W TOWN COUNTY MPRS Byron Bird r. 33 8 DATE' 'a -CLASS PERC-.,.2--- _ CONVENTIONAJXIN-G UND PRESPURE CONVENTIONAL LIFT MOUND_ HOLDING TANK SEPTIC TANK SIZE _ i oOoLIFT TANK SIZE DOSE TANK SIZE _ HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE /a x 3~ 11116 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P. 1:1 Borehole Q Well Scale Feet O Perc Hole System Elevation Uent-4-{?er 17L(+9, S3 13(1) 12" TYPAR CO ERING(4 a>qrljCdL 2" 12" 3O 6' O 31 1 6 Sewer j Roc w / AGE SYS-M S Y ~ e 1✓~ -fie, s',Ce.~ pap, 0- 'Pit ENO kig g1~11.DINGS OEPAR ~(~EtypluY~~"" Uc 5~ _ DANCE D E CrC;~R~3pON 02j 73 1 S1Ys _ co j-v r 1~~srrt~~uF; Q,rc. 6, 6 IY ! ti 895-31005 Labor &nd Human Relations "s`~' SOIL AND SITE EVALUATION REPORT Page _ of 1 Division of Safety 8< 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 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 LOCAT N O/t- GOVT. LOTS 1/45 1/4, 9T31 N,R l E (or) PROPF,(a~ OWNE~a MA ING ADDUS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ''ZIP CODE PHONE NUMBER ❑CITY ILLAGE OWN, !NEAREST ROAD Ne_~Jf6C"k/no"j sYo)-? ( 1,5)a ? -36Y6 M New Construction UseResidential / Number of bedrooms [ ]Addition to exi tingluuildi j ] Replacement [ Public or commercial describe.G~~~S 7_344-67 toin A/4~ 4e Code derived daily flow _ gQd Recommended design loading rate 7 bed, gpd/ft2 ~ trench, gpd/ft2 Absorption area required _426 bed, ft2 10J .,anch, ft2 Maximum design loading rate 7 bed, gpd/ft2~<E- trench, gpd/ft2 Recommended infiltration surface elevation(s) 1jl ft (as referred to site plan benchmark) Additional design / site considerations ;2 Parent material Flood plain elevation, if applicable i?,! e - - - S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S ❑ U S El U WI S ❑ U S ❑ U ❑ S P9U ❑ S ®f1 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots JPD in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Ground >:w > : Z41 Z~- v. ft. Depth to lim iting factor - - - - - Remarks: Boring # Ground elev. Depth to limiting factor Remarks: CST Name: Please Pri Phone: ddress: Signature: Dat : CST Number: _ .7 r ~ PROPERTY OWNER Z0v SOIL DESCRIPTION REPORT Page fof . L # PARCEL IA Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench :air .c; p Ground c Dy $ fI v. ~ ft. Depth to limiting ct r Remarks: bring # o n Ground ~-.z ft. Depth to limiting fart-or j Remarks: Boring # / Ground ~t. Depth to limiting factor 5 Remarks: Boring # FT Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 1 0. Soil Test Plot Plan Project Name Byron Bird Jr. Address ST 3479 Lot Subdivision Date's J/1/45ec- 71/4 SAFTV N/R,W Township irk. ❑ Boring O Well PL Property Line County L BM or VRP Assume Elevation 100 ft. System Elevation f A' 40 -7 ow51~~ -1647- J J' I 27- n Scale 1/4" .10 Ft. When dimensions aren't stated inDepartrnentofIndustry, SOIL AND SITE EVALUATION REPORT Page of Human Relations Div of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code lete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but I Attach comp EPARCELLID4 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCAT N O~ M. OA C~ GOVT. LOTS ( 1/45E 1/4,S)- /T AR ~ E (or) PROPETT OWN1:S MA ING ADDR Ss LOT # BLOCK# SUBD. NAME OR CSM # CITY, ESTATE DC ZIP CODE PHONE NUMBER []CITY EIYILLAGE OWN, NEAREST ROAD Uildin _ New Construction Use ' Residential I Number of bedrooms Addition to exi tin ~ ~ Replacement Public or commercial describe, _ ~a.~ ~ 7-5 j . trench, gpd/ft2 Code derived daily flow _ gpd Recommended design loading rate .2-bed, gpd/ft2 Absorption area required Q bed, ft2 /0,5_4 nch, ft2 Maximum design loading rate _bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s)) r ft (as referred to site plan benchmark) Additional design / site considerations ..Z Parent material Flood plain elevation, if applicable Z~171_5;1_1_-ft tU= =Suitable for system CONVENTIONAL MOUND N-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK suita ble fors stem S❑ U @ S ❑ U S❑ U S❑ U El S Su ❑ S RU SOIL DESCRIPTION REPORT Boring # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tre & 01 "g f Ground O 7 I ; 7~2ft. Depth to limiting factor Remarks: Boring # 4 Dy Ground elev. or t Depth to limiting factor Remarks: CST Name:-Please Pri Phone: Address: Signature: Dat CST Number: 7 r PROPERTYOWNER /ia~ tea. ~ SOIL DESCRIPTION REPORT Page - Of PARCEL I.D. # Boring# Horizon Depth' Dominant Color Mottles Texture Structure Consistence Bocncl3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh l 4 -5 Ground c Q~ ? $ f Z, ft. Depth to limiting ~cfa t a s' Jam/ Remarks: Boring # 4d /01 Ground Depth to limiting fart or Remarks: Boring # Zop "OF d Ground I 159V - /"p ~~'t• Depth to limiting factor pl-5 Remarks: Boring # ak•~ii'~v :xi•: : •f~n'•\k.\\ Ground elev. ft. Depth to limiting _ . factor Remarks: SBD-8330(8.05/92) Soil Test Plot Plan Project Name Byron Bird Jr. Address ST 3478 Lot Subdivision Date ,r 1A0-71A S N/R,/L51W Township ❑ Boring O Well PL Property Llne_ 7rCounty' 11 BM or VRP Assume Elevation 100 ft. System Elevations - *HRP 04 /h APO' 1/4 =10 Ft. When dimensions aren't stated y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~0"I`r° r MAILING ADDRESS ; 7 PROPERTY ADDRESS j y d J (location of septic system) Please obtain from the Planning Dept. CITY/STATE 2/ N-R PROPERTY LOCATION 1/4, 1/4, Section T_ W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION , LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost. of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. , The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted,plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office_ ' Government Center 1101 Carmichael Road 11/93 Hudson, Wi 54016 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 --7 T` e"4°`' Location of property'/ 1/41/4, Section A- f-- -W Township •rr Mailing address,& Address of site subdivision name Lot no. _Yes No Other homes on property? Previous owner of property Total, size of property r Total size of parcel 5 z 5 Date parcel was created /fi ~r fS Are all corners and lot lines identifiable? Are No Is this property being devel&d for (spec house)? Yes _,Z No Volume 1)121K and Page Number -1177 as recorded with the Register of Deeds. - - INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a' warranty deed recorded in the office of the County Register of Deeds as Document No.' , and that I (we) presently own the proposed site or the ewage disposal system or I (we) obtained an easement, to ru_r_the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant Date of Signature Date of Signature 53n STATE BAR OF WISCONSIN FORM 11 -1" 1128 PAGE 477 0793 LAND CONTRACT VOL ladlvld ial and CorP'M" ((TTOOAeaaE USED FOR ALL TRANSACTIONS WHERE OVER S23 ISFI*iANCED AND IN OTHER NON-CONSUMER DOCUMENT NO. ACT TRANSACTIONS) t~~ ru:p { t~ Ralph S. Mondor andPAIdufxF4:00 r Y t COnt[SCt by and between j Mary K. Mondor, husband and wife v U V 199$ ("Vendor", Brian S. Mondor and 9:30 AM) whether one or more) and Beth A. Mondor, husband and wife as survivorship marital l?l'Vf uchaser",whetheroneormore) Rt,;(ti~uetGebs 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 Ahu RETURN ADDRESS REMINGTON LAW OFFICES 126 S. Knowles Ave. New Richmond, WI 54017 Part of Southwest Quarter of Southeast Quarter of Section 2at3the8Northwestdcorner follows: Beginning e of Lot 1 of Certified Survey Map recorded 038-1120-20 August 10, 1987 in Volume "7", page 1866 p~lldentifcationNumber) (No. 30 v thence South along the West line of said Lot 1, 544.50 feet to the Southwest corner of said Lot 1; thence North 89°42'19" West to the West line of the Southwest Quarter of Southeast Quarter of 114.~ said Section 29; thence North along the West line of Southwest Quarter of Southeast Quarter of said Section ioutheaso the Northwest corner of Southwest Quarter of Quarter; thence East along the North line of said Southwest Quarter of Southeast Quarter to the point of beginning. This deed to is given county between neighbors and does not create a new parcel subject This is homestead property. (is) (is Eot) an reasonable location , Purchaser agrees to purchase the Property and to pay to Vendor at none the sum of s 51000.00 in the following manner. (a) S _ together with interest from date Of)0 00 at the execution of this t;ontracC and (b) the balance of S ~ ~ am (0 ► * percent per annum until paid in full, as follows: berwf on the balance outstanding rom time to time at the rate of Two thousand the same daydofdeaand no/10C3 ch dollars untilapaid8, 1996 and in full. *Purchaser agrees to pay all Seller's costs of closing in lieu of payment of interest. R>IOIi<ly&la:aa W KMuoMMNWdm9~~ xawe s°om >sxxx~~p. 0 annum on the antis amount in default (which shill Following any default is payment. interest shall accrue at the rate of % per include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). I 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 lbws 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 nee 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 closing ,14 PC1oF6iftAx x without premium or fee upon principal at any time after 3IkXW )W ]l;66EEti6W In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded berefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: None Seller shall pay all 1994 real estate taxes when and payable 1995995• Seller and Buyer shall prorate and pay their able ti share of h-- tha r become due and payable 8 P~6E 418 n Vendors interest in it and to deliver to Vendor X12 nts levied on the Property or upo purchaser promises to pay when due all taxes an assess rill sad meat. full nsurablg on demand receipts showing such pay ri insured against loss or damage occasioned by fire, extended cover a remiurtls Purchaser shall keep the improvements on the Property roved by Vendor, in the sum of 5--- -'Va ue the insurance p i require, without co-insurance, through insurers approved such other hazards as Vendor may unless Vendor otherwise agrees ra wt:ting, the promptly give Purchaser shall notice a of loss to insurance companies n the stannount more dard clause in favor o! t the Vendor's Cbaser interest shall and, unless but Vendor shall not require coverage pay of re air of the property when due. The policies shall coma shall he applied to restoration o p the property shall be deposited with Vendor. original of all policies covering r to be economically feasible. good tenantable and Vendor. Unless Purchaser an d Vendor otherwise agree in writing, insurance proceeds to keep the property in B , Pro vided the Vendor deems the restoration or repair with all laws, ordinances and purchaser covenants not to commit waste nor allow waste to be committed on the property damaged free from liens superior to the lien of this Contract, and to comply dormed aid and all conditions shall be fully s condition and repair, to keep the Property pplf in fee im e, o regulations affecting the Property pate by the act qr Warranty tf ons rchaser, and Vendor agrees that in case the purchase price with interest and demand, execute the manner above specified. Vendor will oC7dimandy execute and deliver to then r chaser, re the a r ld Deed, en delive auto the mbranc except at the times and in Hari s asements the Property, free and clear of all liens and encu e 10 except: payment of any principal or interest which continues for a feed due date or (b) in the event of a default in performance of any other obligation of Purchaser Purchaser agrees that time is of the essence and (s) in the event h a default in the or mailed by certified ma" without "Olicte period of _fill- days following the sped endor (delivered persoaally od of days following written notice thereof by' a able is full, at Vendor's option ro ided by law) its which continues for a pen ' rights ly and remedies (subject to any limitations p then the entire outstanding wa lan and Vendor shamtract shall ll also have the following immediately due sn p ! n Purchasers full Payment (which Purchaser hereby i Vendor may, at his option, terminate this Contract co die o' ed urpoha' title and interest is the uit of redemp e hereunder addition to those Provided by law or in equity: ( ) as renal for Property and recover the Property back through strict foreclosure with any eq Y mire outstanding balance, with interest Cher eon from sm the date of default at the rate in o such date and compel other amounts u which event hall be forfeited as liquidated damages for failure to fulfil l this Contract and aailur immediate and full Payment of the a reviously paid by Pure ific formance of this which event all amounts p Vendor may sue for specPer the Property if Purchaser fails to redeem); or (ii) defi ciency; or (iii) Vendor may sue at law for the entire unpaid of the entire outstanding balance , with interest thereon hats~e sail' effect for a ay to of de[aultaawnde t~ amounts due ue & cloud hereua on under, r and have a title is aquiet-tick the property shall be auc roe of tae property tioned a judicial ale and have Purchaser ejected from possess purchase price or any portion thereof; or (iv) Vendor may declare Vee Contractor at an end and re or above. Notwithstutding ant orrueal or d in issues or profits during the pendency of any action under (i~ (ii) (iv) n Vendor if and when pa action if the equitable interest o[ Purchaser is insignificant; and he remedies shall only be binding upon hereunder (whether abated or receiver appointed to collect any rents, remedy incurred, and shall be fees of Vendor incurred to enforce a d Pad by Purchaser. ss written statements or actions ensepn including reasonable attorneys foregoing of any of the litigation and all costs and expo not) to the extent not prohibited by law and expenses of tit!t evidence shall be added appointment of a to principal PloPe ri during the pendency pendency of any heactionrenofts,issuesforeclosureandofpthis o[ the Plarrc y ~ consents to t of such action, included is any t of judgment. Upon the commencement or during the Pe lied as the court shall direct receiver of the property. including homestead interest, to c. a he t, rt~ignntent of any of Purchasers rights ender and such r=ats, issues, and profits when so collwted shall be held and app or equitable interest in the property (by or n a convey 14: way) thout the prior written consent of Vendor unless either the outstanding balance any this Contract or by option. or assignment of Purchaser's interest under this Contract solely as purchaser shall not long-term m sell of d in full or the interest conveyed is a pledge o on without : otiose nee of Pnrchaser. I'M the event of any seu or conveyance without Vead°o[tti Contract (n~ the en payable under this Contract is first paid transfer, r, due We and payable in full, at Vendor's except for ear security for an indebted eirut the Property on the date this outstanding balance payable s .der this Contract shall become immediately me trortgage outstanding erg ment of the amounts then due under hallbe Vendor shall make all payments when due under era! provided Purchaser makes timely paY meatssomale by purchaser age granted by Purchaser) or under any note secured thereby, Mortgagee if Vendor mortg paY Contract. Purchaser may fails to do so and all make any such Payments directly cowddeied pgyments made on this Contract r subsequent or prior default of Purchaser. ra end asses of Vendor waive any dc[ai•it without waiving any oche representatives, successo ria the Vendor may n and inure to the benefitsof the heir, legal joins herein to release All tams Of this bomestead g Contract shall be binding h~ spouse Vendor for a valuable consideration rep to join in the exccutioa June of the deed to be made in fuif►Ilment hereof) and Purchaser. ([f not an owner of the Props ! , 19 9 S subject Property and erg ,t 9 tk day of Dated this (SEAL) l~l0,,,o 6v (SEAL) BRIAN J. MONDOR RALPH S . MONDOR~ Cl fln~q yLfs~t'1~ (SM) • (SEAL) BETH A. MONDOR Ry K, MONDOR ACKNOWLEDGMENT AUTHENTICATION STATE OF WISCONSIN sa Signature(s) ST. CROIX County. wl day of personally came before me this 19 9 5 the above named ; 19 Mond r e authenticated this day of Ral h S . Mondor and Mar K - husband and wife ando Tian d Mondor and Beth A. • TITLE: MEMBER STATE BAR OF WISCONSIN and wife to me known to be the pecsoa g --•`w' (If not. Slats.) foregoing instrument and acknowledge the sear .,.ihorized by §706.06, Wis "I e ^ /2....I