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HomeMy WebLinkAbout040-1114-40-000 AS BUILT SANSTC - ITARY 104 SYSTEM REPORT OWNER a ADDRESS_ lS5 S/t,L SUBDIVISION / CSMI evil- LOT ~ SECTION ' D T_22 e N-R 1 t W, Town of ST. CROIX COUNTY, WISCONSIN P VIEW SHOW EVERYTHING W THIN 100 FEET OF SYSTEM _ Apr d Scpf~~ Q Taw` D' ~ 1 1t 17) 13 ~o INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. t BENCHMARK: Tow el l ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~1Qc,~py„ Liquid Capacity: 1111)0 Setback from: Well SO House Other ' Pump: Manufacturer W Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 7 S Number of trenches Distance & Direction to nearest prop, line: A) ' t - Setback from: well: 59House $ fl Other P Z , 4o ELEVATIONS Building Sewer , q ST Inlet. qD, q $ ST outlet 4, ¢ PC inlet k/ ,b-- PC bottom rv !a- Pump Off Iv P f1 7`► a, X77 0~.© 81,51 88.s I ` Header114ae-i€A1.d Bottom of system g8,off d, f 0. !v Existing Grade Final grade I-W 1(. 0 Z- / 0,- I l 3~ DATE OF INSTALLATION: 2 9s~P q 8, PLUMBER ON JOB: Q ~li. Fpf l Z LICENSE NUMBER: 3379 (30 INSPECTOR: Q~ r ~ tiro $g, 3/93 : jt /-3 Q ~~.D~ liscoNsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor d Human Relations S INSPECTION REPORT ST. CROIX Safety fety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 268544 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: OWEN, RODERICH D. TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A960025 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 00; Dosing Aeration Bldg. Sewer Holding St/Ht Inlet a/ TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic We) O . . NA Dt Bottom Dosing NA Header / Man. /a. q, 99, gl Aeration NA Dist. Pipe Holding Bot. System !3' Y4, 1319a 8.08 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand, y. m Model Number GPM TDH Lift Friction System TDH Ft oss Head 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 25 ` DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manu acturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: p ' AJ1A_ 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 a Topsoil E] Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.30.28.19W, SW, NW, Skyline Drive Plan revision required? ❑ Yes tj_/No Use other side for additional information. g L SBD-6710 (R 05/91) Date s ct s signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t y SANITARY PERMIT NUMBER: 7 N 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 8 112 x 11 inches in size. 7 Iro ' • See reverse side for instructions for completing this application State Sanitary Permit Number A PeQ ~P ! y The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop C(> O ner Name Property Location O e V. 0-j 5 1/4 yll) W 1/4, S30 T_2 g , N, R( 9 *~(or) W Property Owner's Mailing Address Lot Number Block Number )SS S k, 't 9 S70IaP, V0 A City, State Zip Code Phone Number Subdivision Nat or CSM Number Qo j Lilt I (7~y >4~s- 9G TA el II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road E] Public 1 or 2 Family Dwelling - No. of bedrooms x Towan OF Td. o ,5 III. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment / Condo D40- 1114 -40 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. X 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 XSeepage 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 ~SQ ~ quired (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft) (Min./inch) Elevation AMMA 68, Feet Q0, Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. - Fiber- Plastic Exper- New Existin Gallons Tanks Concrete Con Steel glass App. strutted Tanks Tanks Septic Tank or Holding Tank /QQ I 60q y11 t Cs~Grh ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage 4 stern shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: ( Stamps) MP/ P No.: JBusiness Phone Number: A.Ij ~ 337 S -f S-oZI7S mrl F. et e Plumber's Address (Street, City, State, Zip Cod 16 4 srn 5. 6 Liee F(k 50~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater at Issue Issuing Agent Signature (No Stampp. ^ VApp roved Flo ~J[ Surcharge Fee) I wner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBU-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3_ All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwe"ling. 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, re(onnection, 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 (-allons, numb=, of tanks and manufacturer's narm indicate prefab or siiv cscnstructed and tank material- Complete for a// s~ )tic, pump/siphon and holding tanks €or this svJ,tern. Check experirmc~,Lal approval only if tanks receives expe irT-ent.- )rodc,c1 approval from DILHR_ Vill Responsibility state enL- Installing plumber i, to fill in name, license number wit i app opriai-e >refix ((?.g. MP, etc.), address and phone ,umber. Plumber must sign application form. IX_ County/ DeparL.rnent U.,e Only X- Coun,u i Depar'ment Use Only x ..r _ t - - ~1fr- 1., p .--ty T'ne plans must nz: tc,nk(s), septic ks; purnp or siphon !rlfrl.,ildingserved; ClOse volume, ros> section 1. JY ig nformatio`l. GROUNDWATER SURCHARGE 0 '+:'rJded the creation of surcharges (`ees) for a number of ren,. !atec nriu. whiz.h can I he ' hese surcharges are used for monitoring groundvjatp~ ~ on u rir <:,,i investigations and esiabl' e- Freoh Air Inlele And Obcervollon Pipe - - - - Approved Vent Cop ~ r 'For , ulnimum 12" Above Final Grade _ _ l~f lall L 20- 42" Above Pipe. 4" Cool Iron To Final Grad Vent Plpe e q _ _ n . SynlMlb Covering. 4' 1 uln. 2e Aggreqale Sc., t 1 40 Over Plpe DWrlbullon Pipe - 0 0 0 0 0 T•~ 6" Aggregate a CJeie 2 Beneath Plpe 0 _G 4, ' -2 86,E P 0 o aksa {d 0 Vito tvo0 Gr<1- 0 (34 pyc- r 43 ~S a z I~ 1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page J_ of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 57 C~ ro kA PPARCELI.D.# not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arro w, and location and distance to nearest road. 19 " 4,7 DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION ROA. e_yv k P, 0 u) e. Pt GOVT. LOT CJ 1/4 01/4,S30 T AR 9 X(or) W .2 Ll PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 155 s 0A. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE MOWN NEA EST ROAD Fall s-eo aa (715) 4aS- 7 rN~ Qrrut [ ] New Construction Use D4 Residential / Number of bedrooms [ ] Addition to existing building P4 Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate 0, fi bed, gpd/ft20,L trench, gpd/ft2 Absorption area required 900 bed, ft2 75D trench, ft2 Maximum design loading rate Q_bed, gpd/ft2 0. B trench, gpd/ft2 Recommended infiltration surface elevation(s) i o b, ft (as referred to site plan benchmark) Additional design / site considerations t ro-" Ss4e n Parent material 0v -("'J ~ Flood plain elevation, if applicable ft S = Suitable for system . CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑ U NS ❑ U CRS ❑ U MS ❑ U ❑ S AU ❑ S H U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell C lu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I o to YR s si l I sb~. m a 2 3 2 4-2o 10 U ' 4 1Z fs b/v m~r as I o f . 2 0.3 »vl Ground 3 2a -z4 lo-VIZ si u `f s 0 5j cA L I v `f 6 0. ft. 'P9-jQ 10 YA ~f,a Is r 0 6,3 yn 0.? 0. Depth to limiting factor r 7 8 Remarks: Boring # of ~,Z 6 n"' ( la-7 to S 3 S; I Ifsbk Mu -2 ry 7 -22 10 ~R 3 Si' 2 su Zz-3$ lo YR S; a~~ rn~r w I of ,7 D. 4 3 3 Ground elev. 38-9~ 10 YR S o 5,5 >h I - - 0. 91.7 ~ ft. Depth to limiting factof~ u Remarks: CST NVe: I Please Print Phone: 42r .1Z 7,~_ Address: 10 a s m C=w tl~ w 5-41192 Signature: Date: CST Number: 7 9 C117✓no 3314 PROPERTYOWNER 11Odefick, 9, Owen SOIL DESCRIPTION REPORT Page _Z of PARCELI.D.# 040 - 1114 -40 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Twich 1 0- 10YR 5 _ I fsIL rX U4 t 2u~ Z -21 jo K 413 ~7Stk rnfr 0,5 T 0,Z 0,3 Ground 3 ZI -38 1 n m, S;I 2 + Sbk W I) b, 2 0 3 e~' ft 4 30-1o0 10 YK `f/G s 6 I Depth to limiting factor Remarks: Boring # )a Q S 3 rhuf r a 5 zvf 2 't3.3 "/A 10 Yk d13 Si ` Z~56k 1"4 a 5 t d 6,1 10,3 75 iq-lg +v YaZ s/~ - 6s 1 as t of 0,~ 0. Ground` lev, 19x48 l u Q M~ S 6s ny - 6.7 iD 0. , ft. Silo Depth to limiting factor~~ r 7 Remarks: Boring # ,A Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) . ~wt►J ~.0 9 acre '1'4rt[. ` Scat C 1 ~ ~ O ~ ci 3 63~ A r QOM t o Top WCI! 0 (344 AB) ~I a ~ Qa I K 1 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER G e r t e o t~ MAILING ADDRESS PROPERTY ADDRESS Sat h« (location of septic system) Please obtain from the Planning Dept. CITY/STATE u e,, PROPERTY LOCATION S W 1/4, 1/4, Section :30, TJ9 __N-R_Lj W TOWN OF Tray 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: j lr 0'.) 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 o~oA emzk D, Owe,- 4 6Z o5evha.r E O Location of property SW 1/4 JI) Q 1/4, Section 3_, T Ze N-R ) Q W Township Troll Mailingaddress 155 Address of site subdivision name J Lk c( ~s Lot no. Other homes on property? Yes 1i No Previous owner of property Total size of property s 0 Q 19 o- Total size of parcel S, Q Q Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume -4-Y and Page Numberj/ 112 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. 3L, , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant a1_ 9 l Date of Signature Date of Signature i LAND CONTRACT-Insurance Clause. STATE OF WisrnNSIN-I:ORH No. 33 H. C. MRttA CO.. MILNAVF[C 3M31 This Article of Agreement, Made and concluded this o day of A. D., 1970 i by and between .1 annyA. J»Ql fs. a single mangy 1 Ii of the first part, and _RDder_iQk_Ravjd Omen and Rosemary Marie Owen, husband and wife,_as_ joint-tenants _part _.ic:3_--of the second part. i WITNESSETH: FIRST, That the said party,; .s_of the second part hereby agreo_and bind .them5elV_QS._8rid____ their legal representatives, to pay, or cause to be paid, to the said part-Y_of tho first part,--. h1s _ heirs or assigns, the sum of Five Thousand Ninety and No/100 - - - - - - - - - --Dollars, I in the manner following: Three Hundred and No/100v - - - - - - - - _ - - - - - -vouars, i at the ensealing and delivery hereof: -Balance payable at rate of $0.00 per Month, __which -includes { interest of 92% per annum computed monthly on the unpaid principal balance. First payment due August 1, 1970. Payments thereafter to be paid on the 1st clay of each month until entire principal and interest paid in full. Purchasers may prepay installments at any time. Buyers assume all legal abstracting and survey costs in this transaction. Legal costs assumed are'$75.00 and shall be paid at execution of this agreement. i as ma reasonably The said payments to be made to the part ~_of the first part, at such place a`~ _he _direct v and the same being intended to apply, when f - ~ >~y completed.as the :-purchase money for the following tract,.pit'-ce or parcel of land, situated in the Qounty of St. Croix and State of Wisconsin, to-wit: w 1. A parcel of 5.09 acres, being the West 168 feet of the East 504 feet of the SWzl; NW4, Section 30,' Township 28 North, Range 19 West, together with an easement for public and private vehicle and pedestrian use, together with utility easement rights on the following described property: i The West 66 feet of the East 86 feet of the NW41 of the S';3 1d~ of Section 30, Township 28, JJ(~ Range 29 West, Town of Troy, St. Croix County, Wisconsin, and; i~ I The South 66 feet of the SW~ of the Nk1~ of Section 30, Township 28, Range 19 West, I except for the West 177 feet and the East 20 feet, all located in the Town of Troy, St. Croix County, Wisconsin. (Buyers shall install own fencing.) (Buyers further agree that, as a covenant to run with the land, not more than one permanent house trailer at a time shall be on the property.) The said pan ies of the second part further agree-that they- ___wiu pay, when due and r~,,u,yab) f,{{all taxs and assessments which have been assessed or levied on the above described premises since the 1st day of yfKYii ii 7,0-1 and also all such as may be hereafter assessed or levied thereon or upon the interest of said part X- of the first part in said :i premises; and also all taxes and assessments now or hereafter assessed or levied against any Inortgago which may exist against said premises or against the note _or the indebtedness secured by such mortgage or against the interest in said premises of any party holding a mortgage i B against said premises during the term of this contract, and promise and agree _-that the interest of the part.y_~_of the first part and the interest of the parties of the socend punt i-o said real estate and the interest of any party holding a mortgage against said real estate during the term of this coutruc t, :hall be a ;se -,sod for taxation and taxed together, without separate Valuation as unincunrbered real estate and shall ho puid by tho said part iesof the second part and the said Dart a of the second nart hPrwhv mnlvn 77 o =J { ~ Al } Ali?: ~'~rr ~((•'JJN,L~ r ~,.,h,~ak=Kre..._ . yo-,': _ r~ 4 ~~,t . . . Ya.'t•~p •3. r WE the second part shall pay the premium on such policy or policies whoa duo, and ir, case of tits i,lilnro nc u , k rt of ;he said part of the second part to pay such premiums when duo, said part of the first par heirs, legal representatives or assigns may pay the same and charge the cost thereof with httore:,', tlu;r:x-n :;t th., kcal rate, to the said part o1 the second part, and the same shall be considered and tah n to i;r, ,'n w":.lip loi,e:', ; _c t ^t i no con- sideration of this contract. ~I The part les of the second part further agree-to hold the said pretn': c th r;;uaa 5.. by sufferance of the said part Y_of the first part, subject to be removed as holding over, by process under the statute in such case made and provided, wh.. i,, to ! mont of any of the installments of purchase money, interest, taxes, assessments or : , eC:fled; and also to keep the building-., fences and improvements on said premises in as good rapa:r ,ar! cundiL , :1 e;s tile} 1;ow are, except ordinary wear and decay, and not to do any act whatsoever which tends to deprociate c 6aua :,f : ;:,fd l,rcn.i es. { SECOND, That the said part Hof the first part, hereby agree _ and bind m < L t r • _ _ _ heirs, executors and administrators, that in case the aforesaid sum of Y©.'~1Q11 .lt'. i l~<,y _ and IIo,~1C~ - - -------Dollars, . with the interest and other moneys shall be fully paid and all the conditions herein proo;d,id cliall be fully parformod at the times and in the manner above specified, he will on domi.gid, t:ioraaftvr causo to bo executed and i~ delivered to the said part iesof the second part, or their heirs or logo.] representatives, a good and sufficient Warranty Deed, in foe simple, of the premises above described, free and clear of all le; al hens and incum- brances, except the taxes and assessments herein agreed to be paid by the part 18x. of the second part, and except any lions or incumbrances created by the act or default of the part ies of the second part,, their heirs, legal representatives or assigns I, THIRD, It is distinctly agreed and understood by and between the parties hereto, that If the said part?es of the second part shall fail to make any of the payments of purchase money and interest above specified, at the tunes and in the manner Above specified, or fail to pay the taxes and assessments, or fail to insure and keep insured the premises herein as above stipu-. lated, or fail to pay any or all insurance premiums herein specified, or violate any other terms or conditions herein contained, this agreement shall at the option of the said part Y_of the first part be henceforth utterly void without any notice what- soever, and all payments thereon forfeited, subject to be revived and renewed only by the act of the part _y -of the first part, !I j or the mutual agreement of both parties; and whenever such default or violation shall occur, the part ies of the second part shall have no further right to collect rents from tenants, if any of the said real estate, or any part thereof, but such rents i shall be collected by, and belong to the part Y_of the first part. I The said part ies of the second part further promise and agree that in case of the commencement of an action to foreclose this contract and also in case of the foreclosure thereof, they will pay in addition to the taxable costs and expenses incurred, a reasonable stun of money as attorney's fees. IN WITNESS WHEREOF, the said parties have hereunto set their hands and seals this day of - July ;A. D., 19 70. Signedmnd,Sealed in Presence of - (SEAL) 4& ' i ~ SEAL) deric Day gn C. M. By - (SEAL) Mary oung• STATE OF WISCONSIN, i ss. Pierce county. y Personally came before me, this. day of Thy A. D., 19 M_, the above named Clancy A. Juelfs, Roderick David Owen and Rosemary Marie Owen 40 to me known to be the person who executed the foregoing instrument and acknowledged the,ga t4 i l1 Q~ f) zr C.) 70 C_ M j, Notary Public, . Rieltc~J! 'Cotraiity,Wis. Drafted by C. M. Bye, Attorney My Commission t®c is' l r g IF- thereon the (Section 59.51 (I) m the Wisconsin Statutes provides that all instruments to be recorded shell have DIdn r Prln i IIFf"r names of the grantors, grantees. witnesses and notary). i f i -c Ei : ; _ III II a asl I I