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HomeMy WebLinkAbout020-1167-70-000 (D q (3) 0 00 0(0 0te. a ti o (3) ti 0 cco M ~ G C CL O Y Lo 0) i N U r rn I L t (0 3 '3 I ~ .n ° ° 3 .r y ~ a y D x 0 m y a a y Z Z c a~ U. 0 a°i a U. o d 3 mY o m =o € =o m a Q a E Q IL-~ 3 `r I ~ v v Z ° y y w E E U) ° ° ° ° 0) 0)r a m a m N FN- !n 0 O Z c c co E r O y 7 y d 2 ° (D z r C 2 z v v rn M N N N M C N N N y a) y C a L a L L O Q Z m z Z N Z w N _ z 3 m E ° E N L d Z' a ~ + C~ c y d ►O. N N to H d O O ooa EL o'ccIL o 6 hw o' mtom o tomm n. .2 L) r- EL EL N 000 Z •'v aaa 3 aaa IL y (V 3 O N C U) L y Lc) LO y co ) 00 M 0 ) 0 0 ) N J C) y 0 0)) } 0 a) O N N M O N - j m 0 00 c ° ° N m y 0 ° ~ m y 0 O C m N Q} U) N d Q} CO 0 0 O 7 a0. CO 7 +O+ O~ 00 LL N c y H C N C 0 0 co 3 It `m l aci o d :0 LO o 0) n o 0 E •e a c o 0) O co r~ O O m N `p Q C co M C r y N ` L p r 0 O ` 1p V! V L O 0 U Op r ,'V) N yr 0.0 r N •y0 yd. O O Ecco) y O F- C L • y?',~ O N 2 :3 0 m (D 04 C~0 O Z S S 11 N O Z C' U) C~ I rL I a.m:S dad L:a~ E ` c c c 0 m ° 0 o r A 0 at m0 03 U) 0 ST. CROIX COUNTY WISCONSIN - ZONING OFFICE r r r r n p s n■ ,,,,ne ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 = (715) 386-4680 June 8, 1995 Mr. Dennis Fernholz 462 Frontage Road Hudson, Wisconsin 54016 RE: Septic System located at 462 Frontage Road, Hudson, Wisconsin 54016 Dear Mr. Fernholz: Enclosed is a copy of the As-Built for your septic system. This septic system was installed on January 13, 1995. We are sending this As-Built to you at the request of Zappa Brothers, Inc. If there is anything else that you need, please do not hesitate in contacting our office. Very sincerely Marilyn Zai Administ ative Secretary mz Enclosure STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Lexwis 1 ~W049: ADDRESS SUBDIVISION / CSM# LOT SECTION ? _T,;?q N-R 19 W, Town of ftu'0 3 vn/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~x r3Ti N L (.JEtL I 1 Z -V~~~~/~,0 Cxrs~nr6 / Soya rt:~ A) IPA, A) rit- Z < 7~' iPEMOV66 V'E f'~E 60 11, -~nJ $OCCTFQ Ex t gTi.V t. ` - - - - - - - - - - - -/vEl u SOS $S P✓L L Ff~1 iivE /4111' - 7$' ,r 0 DROP SST E ~tlL G' Drsrpreu r7' YCNTS ,?a o' INDICATE NORTH ARROW ~nj o.v r ~tGF l ~Q . 'V" Sc A c E ~/Y1 / of eAr✓_ E A . Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: n7l/ i BQ , E,5✓ ALTERNATE BM: ~X 15TiA-~6 SEPTIC TANK / R / Manufacturer: Gc/~ESE~ Liquid Capacity: /~?So Setback from: Well House Other Pump: Manufacturer Model# Size Float separation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length '/S Number of trenches Distance & Direction to nearest prop. line: i SouTr{ Setback from: well: 1/4,' House Other ~5_0' SEPnc -7-;j,v,r ELEVATIONS Building Sewer ST Inlet. ST outlet - PC inlet PC bottom Pump Off Header/Manifold Bottom of system4 / ow 3d fj yg yo' Existing Grade,4 /'C26. 4S' Final grade4 /yC.A? o h S / 0 3- DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER:( INSPECTOR' 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town o : State Plan o.: FERNHOLZ, DENNIS F. I "A CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: IN,60 /lJd, C~rn~ QS TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic See L iS i%1 6 she>yl fZ, 0R !/i" Benchmark 57 Dosing Aeration- Bldg. Sewer Holding S 1}0 Inlet TANK SETBACK INFORMATION St/J0 Outlet /i TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >Sp' ~0?5 ~S NA Dt Bottom Dosing NA Header/ Man. ~a3 dam/ ' Aeration Dist. Pipe ' g,aS -,as Holding Bot. System - o~ /oa ~ s~o PUMP/ SIPHON INFORMATION Final Grade Ma urer -77nd Model Number PM TDH Lrlction System TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH widths / I Length No. Of Tenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS N 403-nufacturer: C SYSTEM TO P / L BLDG WELL LAKE/STRE_A_M~ SETBACK M INFORMATION TypeO t'. i Number: ' R NIT System: trcr+allz t 5~ 77 l7 1 7-L, DISTRIBUTION SYSTEM Header / Distribution Pipe(s), i , ole Size x Hole Spacing Vent To Air Intake Length _t1_1 Dia. Length 7 Dia. Spacing L 1 i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst O y Depth Over Depth Over xx Depth Of xx Seede odded Mulched Bed /Trench Center Bed /Trench Edges Topsoil s E] No ❑ Yes COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.29.29.19W, SW, SE, Lot 7, Frontage Road ~ j,1~ D C'' /P f~,t CLC G' ~,c~Gc^ , ~j fJ~--~ ~ 9' C/ Plan revision required. ❑ Yes 0140 Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ j_ZO1~1L.HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code coTY' STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a a8 30 -7 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION E/V/Vl5 ERN 4042 w'/4 s~'/4, S a'q T-?9 , N, R /q E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # C~/(r 0A/-r.~}GE Ra• CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER y,gj,V r7 171 II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State owned VILLAGE OSon/ ~vNTi9GE T/~ ❑ Public [N1 or 2 Fam. Dwelling4 of bedrooms PAR AX NUMBER III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ❑ New 2.,N~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 # - 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 0.7, 30 E d oFV9IION DSO Sq 14- 7S0 sjz ."r' • 91 Q 99• 'YOFeet B o 3.30'Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holdin Tank Sv I (.~Jir'S~/t Lift Pump Tank/Si hon Chamber. VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' ign re: (No S s) MP/MPRSW No.: Business Phone Number: A 15,Pos C. , (~~PS 3395 9/s- 38"',6 WVS0 Plumber's Address (Street, City, State, Zip Code): 9/ S 7--4 S A/ sv v LJ, SYoi IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e su Issuing Agent Signatu ) Approved ❑ Owner Given initial OOsurcharge Fee) Adverse Determination 1 $ I X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: Ce2~itle~~ion 54.4ef" e-mi ;OrL e Is+,, 9 Sept ~~'4nK ~o bt conplc~eo SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber _s INSTRUCTIONS 1. A sanitary Permit is valid for two O 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. 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Fancily Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approvai only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 81A 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; v~ell i; water mairshvate~ service; streams and !akes; pump or siphon tanks; distribution boxes; soil absorption systems; repla -ement system areas; and the location of the building served; B) horizontal and vertica! ~_Ievation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; f ir:tion loss; pump performance curve; pump model and pump manufacturer; D) cross section of the so'l absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - GROUNDWATER SURCHARGE 1983 ~Ivisconsin Act 410 included the creation of surcharges (fees) for a nun?L or r;' regulated practices which can effect groundwater. TIC ri;onoc^s collected thrf ugF', these surcharges are used for mc-Mitorincg grcuE idw,~ter, groin, Jwader cor0arnination investigations and establishment of standards. - i SBD-6398 (R.11/88) Ijor'r: I"X1 s„AJ` OfAi,4 Ftl,o T /3E ~I//SL n vet IELT~~ A-r TinAE of /vEw Tq£Al c }F ;C;Q1'01 t ATIO•V PLO 67 PLOT & CROSS SECTION PLANS ZAPPA BROS. EXCAVATING INC Ex,s, I N` PLUMBING. UNIT G~JEC~ PROJECT Ex IS T I.v C. i IQESIDE.vc£ aliA IS N OLD I wEST EO c~rrlF.vr ~E,v Ss~s PRop~IPr~ n of o s onl c-.Ji Sr ~ o/x u CrGec K EcISriN /?sv 4" go. SSfPT.c itvK . C>FFC K AAA T.V sor i Eac,SriM` Fcsutt XwlF --J nn . ~t~r To,6s ?---4ov&o /A! f/EL Jc - - - - - - NEw S0f36 EFFU~E 4/AE- ~S - /-~l'c~P Box '~ET T FquatcY ~ Aoa_ - - TAA Qox . ~ortrN f'~iPojOE('Ty .~/nlE 15 B. C \ ' e Irv ~y SCALE .7NT/IG~ RO £~E1/. = /ov. oo' s FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE SIGNED: ' MARSH HAY OR SYNTHETIC COVERING LICENSE: _ CM IM-11 33 `~S MINIMUM 2' AGGREGATE DATE: /-17/3! OVER PIPE DISTRIBUTION PIPE . • • TEE SOIL ESTING BY: 'ell o~J ELEVATION BED 6' AGGREGATE • BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TEST IS • COUPLING TERMINATING A. =/o~. FT. AT BOTTOM OFSYSTEM C. = 9 7 . 4/0, Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 . Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 'S7 6e6 1A 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 PR PERTY OWNER: PROPERTY LOCATION a t--r,) is 0 14 ny- Z- GOVT. LOT SW 1ASL 1/4,S29 T Z9 N,R E (or) W PROPERTY OWNER':S MAILING ADDBESS LOT # BLOCK # SUED. NAME OR CSM # 2 gt2o tjTA4t Kb1 C TY, STATE ZIP COD PHONE NUMBER []CITY LAGE OWN NEAREST ROAD A N Aso ~.1 W j `S'9 ( ) ~h KA4kY '0& New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building jIV Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Max* um design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 0#j PAye 3!0r It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL OUND IN-GROUND PRESSURE AT GRADE SY TEM IN FILL HOLDING TANK U = Unsuitable fors stem S ❑ U S ❑ U I IV S ❑ U trS ❑ U WS ❑ U ❑ S wo SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends or - A -9 7.s k b 5 Ln~7 Cr r C5 2 O.5 L 5 O.~ 8; 19-14 7'-i Yie 'Z/6 L n1 ' 6 Ground /6-46> mye 41 S r), c S 6,7 O SS elev. _ S /6 Yoe Depth to limiting factor Remarks: Boring # A 10-0 Y 'S L, Z c_r M-Vr C W O.b L /3-2n 161 3 3 L Sbe- m •r CL-.,, l .4 3.S R/4 m l C w 1 a.~ Ground elev. rg S3 y q 3 s,L My r w N~•N~p IP' /07s/Q ft. Depth to 3 /py 3 /h limiting factor Remarks: CST Name.=Please Print N SON Phone: Address: O / U QS4si LJ 1 SA (I / 6 Signatu Date: / Q a CST Number:c o0 PROPEFtTY.OWNER b6-140 NIS VUMaOL7~- SOIL DESCRIPTION REPORT Page Z of -PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Sh. Consistence Boundary Roots Bed rends Boring # Horizon in. Munsell Qu. Sz. Cons Color. Texture Gr. SSz. tructure 3 7.~Y~2 d L- t' cr !'1'1 r O W 2r►~ o.q v.S ® Ground -016 3 /dt.elev. ft. Depth to limiting >faQ Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor i Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD-8330(R.05/92) a r ll r~ 1 N d i7 m Z _ t f,yi JiaY Cd ~euNr Cl1 g O t~ ~i Z pt ' a ~ a 3 ScoP~ ~ 3 M /447%T ` r o z' a o V1 4 (A) 'A ~ I I . 12 a G. 2 t D ~ o~ -c Co m Q A. SwbM1 H 1( ForL P~A o~ -t G,t 7 ~ tR M R~eK 4 94evFL,P a~ T~~ t d ST. CROIX COUNTY ZONING OFFICE l'~S P<tt~a~ d CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the l/i~'ninfrs 15 L7- residence located at: -_S X1/4,_1/4, Sec.T_,.ZLN, R_Z? _W, Town of &UDS64Y Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 9 Did flow back occur from absorption system? Yes No no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Grvcco.v Construction: Prefab Concrete Steel Other Manufacurer (if known) : G✓st..r.ti¢ Age of ank (if known) : (Sign u (Name) Please rint (Title) (License Number) (Dat ) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name~Z. Signature. ~7~ /MPRS ~-c 5/88 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County / ~G -•~~1tj /Z OWNER/BUYER ~e n n 4G 4,07d_ MAILING ADDRESS Z Troy 7 %d"s~',•~~ lvZ-- PROPERTY ADDRESS F g rA E Arl /A& r c-,/ /Z - J-Yo e • (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~V-- z PROPERTY LOCATION s1,1 1/4, 1/4, Section Z 9 , T N-R W TOWN OFs J ST. CROIX COUNTY, WI SUBDIVISION Ye Sk~ 5~~-Q s 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 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 propertyl~zr r T 9` a,n~ /y rnkorl Location of propertySy,,. 1/4 S,j 1/4, Section 27 ,T 29 N-R 1 9 W 17-7 Township Mailing address It45-0i,! Address of site (oZ n' 1;0'k Subdivision name ~~ScK~,; ~5 f~ Lot no. 7 Other homes on property? Yes_V_No Previous owner of property /Vc~Jv~ Total size of property Total size of parcel Date parcel was created ?k- yG f4. / 9t~ S Are all corners and lot lines / identifiable? Yes No Is this property being developed for (spec house) ? Yes ~_No Volume 7a2 and Page Number ZQ.7 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 th' 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 Count Register of Deeds as Document No. ;&4f and that we) pres n own the proposed site for the sewage disposal system or I we) obtained an easement, to run the above described property, for 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 o Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORD[ 1-198f MACS *a""= ran "KO"D1NO DATA t TMie WARRANTY DEED w i 1107488 .vet VFAGE 403 REGIVERS-WOCt This Deed, made between am.li._.1li ST. mix CO., Wis. P.Oc'& for Pi-cord this 27th i di-tr or Nov A.D. 19 85 Grantor, and.-..Dennis-.F...Fernholz..and--Diana_do--Fernholz. ~ 3:00 P husb ad. ..VU.q.4$.40 t-..~enants> ` , Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... conveys to Grantee the following described real estate in St...Croix........... Ilzma" To First Federal S&L of LaCrosse County, State of Wisconsin: p n ~ j. H i~con%i a63 54016 Lot 7, Country View,in the Town of Hudson, a plat located in part of the NWik of the SEh and part of Tai Parcel No: the SWk of the SEh of Section 29, Township 29 North, Range 19 West µ z 0.00 ZQV This is- not---.---.- homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Sam... E.-.easMillers..a•single man warrarts that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements of record, if any and will warrant and defend the same. Dated this 27th day of November 19..85... a (SEAL) ~ (SEAL) SAM E. MILLER (SEAL) --------.------------••---•••--•--------•------............(SEAL) AUTHENTICATION ACHNOWLBDOMBNT Signature(s) STATE OF WISCONSIN ss. $C._..~.i 91X .................County. authenticated this day of........................... 19------ Personally came before line this -.217th day of NQM9:14}2~x--------------- 19._$x_. the above named $_l.Ea..Mi~ler} a sing e Win--------------------- . TITLE: MEMBER STATE BAR OF WISCONSIN (If not, . authorized by 4 706.06. Wis. Stats.) to me known to be the person 1516 executed !hte, fore¢oi rumen and acknowledge t3te•9ame. THIS INSTRUMENT WAS DRAFTED BY ~ t•. He ood, Cari & Murray - P. 0. 9ox__229 j `A~ . ---Hudson y- ` ~ r- Notary Public -----Wis.', (Signatures may be authenticated or acknowledged. Both My Commiss' n is permanent. (if nog; state expiratiA are . of necessary.) ' date: - 71 •Nams of persona signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN - f Wisconsin Legal Slunk Co.. Inc. FORM No- I - 1982 Milwaukee, Wis. 1 1 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Scz 4z TOWNSHIP y ~ e~ !2 SEC C. ZeJ T 71N- R / W .04 ADDRESS '.L 40 f„'_ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE Z, 33 ~ ~ S PLAN VIEW b2o- -7--7(6//64 Distances and dimensions to meuirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I y 1. s s`k~ FiV, l a 9 , y C~~i§C ~Yo4s~ 2.?Y 56 tyrty I ~s + 1v t %3 1 SIG C) Ys 5 ' a S. ~.T YoT INDICATE NORTH ARROW BENCHMARK: Describe, the vertical reference point used ~~~,~;pc 5. GJ (oir+`✓ _ Elevation of vertical reference point: /D0, O Proposed slope at site: fj SEPTIC TANK: , Manufacturer; /LS s✓ Liquid Capacity: Z Number of rings used: / Tank manhole cover elevation: 7- 6, Tank rnlet Elevation: 0S40 Tank Outlet Elevation: /l~S. SQ a Number of feet from nearest' Road: Front, Side,O Rear, O qy feet From nearest property line Front,60Side0Rear, 0 Z.- feet Number of feet from: well building: 2-Zre ~h'ozt,~ Z_ (include this information of the above plot plan)( 2 reference dimensions to septic tank) !"I" V. 10*111 ~ f 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: ~ 1 Length: `.S 2 Number of Lines: 3 Area Built:9365 Fill depth to top of pipe: _`f Z. Number of feet from nearest property line: Front, n Side, O Rear Ft Number of feet from well: ~O ~ Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: . ~ . . - Number or pits: Diamefer: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: l Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, Side, Rear, Ft. O O O Number of feet from well: R' Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector. • ~ y Dated: J Plumber on job: T License Number. 7 Q 3/84:mj Ff. DEPARTMEOVT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LAIIQR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 5370.7 MCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number • ~ (lf assigned) F-1 Holding Tank ❑ In-Ground Pressure 1:1 Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Sam Miller R. R. 1, Box 282, Hudson, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SW SE, Section 29, T29N-R19W, Town of Hudson, Lot#7, Berlin prop. Name of Plumber. MP/MPRSW No.. County'. Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 64915 SEPTIC TANK/HOLDING TANK: M 107. S MANUFACTURER: s LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER / PROVIDED: PROVIDED 1 'z / v5-5-Z2 YES LINO DYES LINO BEDDING: VENT DIA.: VENT MATL : HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING: J VENTTO FRESH ALARM FEET FROM LINE . E AIR INLET: YES LINO G (I DYES LINO NEAREST 3 DOSING CHAMBER: MANUFACTURER. JBEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES LINO DYES LINO DYES LINO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING: I (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES LINO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1 FNr,Tl DIAMETER MATERIAL AND MARKING 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 IND OF DISTR PIPE SPACING COVER NSIUE DIA #PITS LIQUID TRENC7 PIT' DEPTH: DIMENSIONS ,LJ( ISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH rELEVI BELOW P PE I f ABOVE COVER'. N LET ELEV. END. PIPES FEET FROM LINE: r ~D AIR INLET: D,~3S /D NEAREST MOUND SYSTEM: 10 Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAMOFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO SOIL COVER TEXTURE JPERMANENT MARKERS OBSERVATION WELLS OYES LINO DYES LINO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED'. MULCHED. CENTER. EDGES. DYES LINO DYES 1:1 NO DYES LINO 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. ID ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. CIA.. ELEV.: PIPES. DIA.: ELEVATION AND . DISTRIBUTION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS. DYES LINO DYES LINO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES LINO DYES LINO INEAREST-- Sketch System on Retain in county file for audit. Reverse Side. SI N T RE: TITLE: s DILHR SBD 6710 (R. 01/82) + -)WISCOnsln APPLICATION FOR SANITARY PERMIT , DILHR OUNTY (PLB 67) ~ UNIFORM SANITARY PERMIT # OEPRRTR OF InOUSTpV, LR lriBOR 6 MURIRn FELfiT10n5 /U j / / 6 # 22-57 -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER M LING ADDRESS .4 //1 / 1lGr / '&o '*'Z Z PROPERTY LOCATION OW: 114515 1/4, S Z`/' , T , N, R So (or TOWN OF: /4/'-44, LOT NUMBER BLOCK NUMBER JSNEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ~ 61.6 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair El Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Z Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 `t r--r- 9 3 6 S F"r Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: 'A I A,* -f I I P1 9► 3 3 3 r. Plumb 's Address: D14- me of Designer: M Donal COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial 9, Gt/~ a 9 do a ~ Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber I r INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 i To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. r 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. l uj,scons,n APPLICATION FOR SANITARY PERMIT / ~COUNTY DILHR (PLB 67) PE # OEPFIRYTErIT OF UNIF~M S,4N% ARY PERMIT IfIOUSTRV, LRBOR 6 HurnRn RELRTions _ /U 9 S -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS ~Q / Rox 2$-~_._ PROPERTY LOCATION CITY: 4/, VILL SuJ1/45jF-7/4, S , TZ, N, R (o W 110-W-N o LOT NUMBER BLOCK NUMBER SUBDIVIS ON NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ?"HYPE OF BU116NG OR USE SERVED 1 or 2 Family Number of Bedrooms: ' F1 Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. j N Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Sail Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity ®Q d 11*1 Lift Pump Tank/Siphon Chamber Holding Tank capacity manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity i Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: ! MP/MPRSW No.: Phone Number: Sf m (L 7) 3 Z33 Plumb 's Address: Name of Designer: U_ `f lUa~ W i S ~~Uf /~1, ` r c COUNTY/ DEPARTMENT USE ONLY Signat re of Issuing Agent: Fee: Date: ❑ Disapproved / ~ ~t~J 11P ❑ Owner Given Initial (,,~(j(,U °(U J Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBO-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT 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 y Location of Property Section - 2!, T N - R zf-w Township flu /-5C%-7 Mailing Address Uno/ fjp 1075 Subdivision Name Lot Number -Z Previous Owner of Property Total Size of Parcel 2. 3 Z Date Parcel was Created fj/ /IP Z5~: Are all corners and lot lines identifiable? ZN: Yes No Is this property being developed for resale (spec house) ? Yes No Volume ~o 7 and Page Number 3_ as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contrac 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPFRTy OWNER CERTIFICATION I (We) ce4ti6y that a.P.Q statement6 on this 6o4m arse true to the be.6t ob my (ouA) hnowtedge; that I (we) am (o e) the owner(s) o6 the pnopehty desc&bed in -thi,6 in6mmation 6o4m, by vi tu.e of a wagAanty deed Aeconded in the 066ice o6 the County Regizten o6 Deeds as Document No. AW 7 -1,~~; and that 1 (we) pnes entt y own the ptopo.b ed site 6o4 the sewage cazpozat system (oA I (we) have obtained an easement, to tun with the above descAi.bed ptopehty, boA the condtAurt%on o6 baid .6y6tem, and the same ho-6 been duty Aecoa.ded in the 066ice o6 the County Regiz teA o6 Deed6, a6 Document No. 3 73-© 7 Z SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) II DATE SIGNED DATE SIGNED VOL )7~~,E OOCUMUNT No. ~ VATN US Ot WOWN8IN FORM 11- mi THIS erACa aesnttna Von NWA AlMe DATA a LAUD CONTRACT 3930'x' a 1110 J~ «n CWPWRU MKIM :,ov ACT TMANaACrloso) Re"TMtt OWE „ b aM beRweae »»l{it»:hnt..A...DtuClio.._.at tltidatt.... ST. CROR GO., VAL ........dt.ll .1lQlNl~ta........._..........» gw,C. F. r ro\r.~t+ti ft. 7th ijy wlelbo ens W stop) and.»........... SM-E.._l UJAX ....................`YV~~. ` 1 of_ May A'0. 19 4 G1 8:30 A ("Atrclsaasr". whIMLIM pots Of Mors). Veadar 11114111111 and agrow is convey to Purchaser. upon the prompt sad full per- yrw feeMases at tats eestraet by Purcbaser, the following property, together with the Hatst, pe'odt% 6arrs asd other appurteaaaca"rests (all called the "Propaw), in. ..............~.iaW1X................................... Ciounty, State of Wisconsin: C n"Un" TO The Soouttbrast Quarter of the Southeast Quarter and aotu C w4w.etr~ three (3) acres off the South side of the Northwest - - - Qua ter of the Southeast Quarter, all in Section - rl 29 Northa Tonaship 29 North, Range 19 West. 71az Pared No. This homestead property. 5709 Hyland Court Drive, alooslit~ton, Porebaser agrese to purchase the Property and to pay to Vendor atMinnosatAL.SSd31..cJcL.Ummmto.J*gxell this sons of f.244500.00 in the following manner: (a) 0.40Q.-QQ............................... at the execution of this Contract; and (b) the balance of $ 69,500.00 together with interest from date hereof on the balance outstanding from time to time at the rate of........ .13X per cant per annum sdil paid In fall. as follows: Payments of principal: 6/6/84 $5,000 3/6/86 $5,562.50 In addition, the purchaser will on December 6th 9/6/84 $10,000 6/6/86 $5,562.50 of each year during the term of this contract pay, 12/6/84 $10,000 9/6/86 $5,562.50 interest at the above specified rate an the balsmce 3/6/85 $5,562.50 12/6/86 $5,562.50 of principal from time to time outstanding. If 6/6/85 $5,562.50 the purchaser makes his final payment before the 9/6/85 $5,562.50 required date all interest accrued to the date on 12/6/85 $5,562.50 which payment is made will be paid on that date. Provided. however, the entire outstanding balance shall he paid in full on or before the.. Atli day of ..............DR~hCL......... 18 ...6 ( the maturity date). Following any default in payment, interest shall accrue at the rate of..13..... % per annum on the entire amount is default (whieb shall include, without limitation, delinquent interest and, upon acceleration or maturity, the eatMe principal balattu)- No amount of principal or interest tray be prepaid except as a w. P Iobrerr stated a r. 'osyta7'mentill, to Vend++r0 Mo to suftieietttforpsy-Tessohl fy'Mikii, *at" YiYYYYiNlata~ljia.bYa~MM.-ised. na• fts" P-o-a-4a+04 ,.theadae.T.s.ths -1--Al It. P 3r-.A mu YaadacjogMa *a ►i~i+►y~,eoi~iasher►gi,liKatiwaaas►tea~l{w..i"4A.Aswaate-aeesi+seJ1-jo-ike-Vsadm pareaeai4i. iaa<ee.~seseawenie awd~aws~,see-wi1LLs.deRea iwio~a-weww-irwd~oFiwsiw-a,Mew~irbut shall -aet~earaawtepsa Payments shall he applied/gaa-ieiaw~~►Sir~wfl+wd~{Slweee-N-ii,e-race-speeiAed•snd•~ew-es-pr+eeigei, Any amouct may be prepaid without premium or tee upon principal at any time after- ..1aaluar.y..1........ IBM-. (9!) ti+ese-aiatl-loa;sapaya~ewi ot~swwip{►Lasiih~++t tpewi+ss+w~ef- X~wdw.• In the event of any prepayment, this contract shall not he treated a9 in default with respect to payment so long as the unpaid balance of principal, and interest land in sued va" accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indehtedne,s would have been had the monthly payments been made as first specified abr.ve; provided that monthly payments shall he continued in the 4-vent of credit of any proceeds of Insurt rice or condempat,on, the condemned premises being thi-reafter excluded herefrom. Purchaser ,fates that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: none. In the event of partial condemnation. the inability of the Vendor to convey full title shall not constitute a uefault on tae part of the Vendor; but the Purchaser shall be entitled to the entire amount of the condemnation award. Purchaser arree. to pa\ the cr,st of 'utare title evidence. If title evidence is in the form of an abstract, it shall e retained by Vuridor until th, full purcl;t<e price i, paid. Purchaser sriall beentalal w take !--,es inn of the Property on ~laN,, , 18 84 T Individual anA ~f\IF II\It nl' Nh, u♦-1\ H. I.v+' l1ant. r' it., {lilt\I ♦,11 . .'.I,.M to MP ia'it art/ 91 ondot~oa 401114" tames and assessments levied on the Psaperty or open Via/ry b>II~r11B i reoaipts showim arch paymat, , .+~.d.a r•~.~tw .V .l~..J~J .h. t • • - - AL- P1 ~e~'1-daa~a/eie-lei ~ieri+e~e-the ` ---A 114mantable PWahassr covenants not to commit waste nor allow waste to be committed on the Property, to keep the pal F 4 PI; ff" all eoodition and repair to keep the Property free from liens superior to the lien of this coalaaul.- and Jews, ordinances cad regulations affecting the Property. t' .q biMdw ~eOS QU is case the puce pries with interest and other moneys shall be full paid and all Ooaditioee Y performed at th' times and in the manner above specified, Vendor will on y domau4 execute am dellm to c , ta+ Atrebaaar# a Weeraaty Deed, is fee simple, of the Property, free and clear of an lime NeaOt and 608111111111"a "N OW Hasa Or a111151111mbeaeess crated by the act or default of Purchaser, and except: ...adatiaa bil;bu~~t>t..sAd..lu itx..s~s~aeaxf~ .of..zeaes~xsi.......... 4 4? i,..si..kx..aRh....i! lea by -cei>rifiea m.4_... ~i..~tA..~t~i........~.... a,.P. • 0. Box 282, Hudson, WI ~40>l P%Odmwm 6 somas that time is of the eessaee and (a) in the event of a default in the payment of any prbWpd or h t which "slinues fee • perbd of ..60.... days following the specified due date or (b) in the event of a default in ~r Of other Obligation of Purchaser which continues for a period of... .611 days foUowi% written notice Y% becin aiorddivend personally or mailed by certified mail), then the entire outstanding balance under this contrast y dos and payable in full, at Vendor's option and without notice twhith Purchaser hereby waives), and Vendor shall able have the following rights and remedies (subject to any limitations provided by law) in addition to those mided bylaw or inequity: (1) Vender may, at his option, terminate chic Contract and Purchaser's rights. title and 1 retest in the ProperV and recover the Pt operty back through strict fort-closure with any equity of redemption to be conditioned npgn Purchaser's fell payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect oa such dateandotheramountsduehereunder (inwhich event all umounts previously rrod by Purchaser shall be torefeited ae liquidated damages for failure to fulfill Ciis Contract and as rental for the f purchases fails to redesm); or (ii) Vendor may sue for :lpvcilic Perfornhanee of this Contract to compel mediats and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due be. uadsr, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or iH) Vendor may sue at law (tir the entire unpaid purchase price or any portion thereof action if or v) Vendor may declare this Contract at an end and remove this Cont ract as a cloud on title in a quiet-title of the Property interest of Purchaser is insignificant; and (v} Vendor may have Purchuser ejected from possession sad have a receiver apppointed to collect any rents, issues or profits during the pendency of any action of err flu). (11) or (h) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any regoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor Incurred to enforceany remedy hereunder (whether abated or nct) to the extent not prohibited by law and expenses of title evidence shall be udded to principal and paid by Purchaser, as in. curled, and shall be included in any judgment. Upon the commencement or during the pendf any action of foreclosure of this Contract, Purchaser consents theProportappointment tead inte duringtthe pendevency ofhsuch to on, a anae' o e home and nd su rents, issues anti collwhtq-t be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or a uitable mterem in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term Itaae ur in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under an>• mortvuge outst:..,ding against the Property; on the date of this Contract of mat (except for any mortgage granted by Purchaser) or under any note secured thereby. pprovided Purchaser the Mortg e" if Vendortfailsamounts so then due and all payments so Contract. made h u Purchaser aihall lie Lrn hied payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior dcfa:dt „f Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, suceessors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable eatsideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this 1* ,64 day of Ma) ;y 84 (SEA 1.) ESTHER A. BERLIN SAM E. MILLER (.SEA 1.) t5EAl.1 AUTHENTICATION ACiKNOW ,.HDGMENT ~ign.{ruc(.:) Esther A. Berlin and Sam E. sl kil: 4:1 pct>tn1l, 1. Miller ..::thonlit•:tttpl this ' da,. of Ala)' _ 84 :..c of -JQM D. HEYWOOD I'IT1.F.: NIF%II1FIV ~'I' C'I'F: R 11; t1 N' t l' not. autlvnvod Lc 704 (W, 1C;- John 1). Ile woodd tit Ilevwood, C;iri ?Itirrlty J t'. 11, box 224, i`ud-;„n, KI 5;011, id,; t ~ H W y r ST C- 105 r y SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER/BUYER~,'V'- ,t~'/All,- H ROUTE/BOX NUMBER _/A 0P Fire Number CITY/ST AT E~_S~J-i ZIP,j~rJf {o PROPERTY LOCATION:Sw 5C Section, T_qN, RZY-SW St. Croix County, Town of 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 falling 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-pite 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. y 0 :z I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ~o ment of Natural Resources. Certification form must be completed and returned to,the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED"~ DATE 4 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. . c r x m a ~ m f -i w N N N 3 p N W =r cl) 0) =r c c V N N N x o A (D 7 W 03 -0 3 C 'o m a O A y po n C= N A - a A CD Co p~j 00 (gyp 7 (O M~oo- C MDWp~A ~ - ~ (D (D N a N A3o oo°M(D00 0CD CCOowoco m~ =r mgo§ 13: ~Z~ c~Q~~o w , ((D N N w N o ~o a% M Q. c D ccm a o ~ti~N S. E co t G) -0 00 o_ a CD 0 m o N~ 0,5 C CD N (D w 5D N Z D f (o O Q U) N N (D (AD W? O o 3 N (p N D O N =r A w a ac ?a(o N CD m~~~ 3? 0 a 1P 7 N(D (D N (D to (p W 7Q W = 4 D O N p n ,C.tG a 7 O N N CD -i )J) O a p C 0 w 3 su m- 3 aw o m CL a.=«~ aa(D 3 C C _G N O• Obi 3• m N N O O C (D N 1 3 d OA A O 0 N O ~ a0a o(ma c CD CD s a 3 a , o w CD a O O • I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR RELATIONS PERCOLATION TESTS (115) MADISON W 7969 HUMAN (H63.090) & Chapter 145.045) LOCATION SECTION: OWNSHIP/ + OTNO.:BLK.NO.:S E 17 ~'ONNAIVI:~~J W / /a a2 /T~9H/R/9t(o (/~~~J COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSE VATIONS MADE NO. BE COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence x New ❑Replace /7 S~ I`/ M~ ~ Ova v RATING: S= Site suitable for system U= Site unsuitable for system G, ~p tZw CONVENTIONAL: MOUND: IN-GROUN PRESSURE: rYSTEM-IN-Fl LLIHOLDING TANK: RECOMMENDED SYSTEM: (optional) QS ❑U RS ❑U .fY1S ❑U ❑S U ❑S DU 0*,wwAA-eA1 Awl 'X3 ' If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: el E DESCRIPTIONS Pp BORING TOTAL/ DEPTH TO GROUNDWATER-ANS! art CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.) B- 00'.~' /s/ ~.s s/ / Rdr 4 cs ~ cs B- 7-0 , 103" r • ' 4fe- .01 . I 9 1 1. r X 2. It O GP cs 2• BH 6N C S B-3 7, ' la r. 7' 77 -Sr' s 2. to sJ 3.7 .8 cr B- 9.,V /d3.7` e 77~~ .7 /S/ 2.3 OnS/ On Grts .2.38AC'es A4WC . S O s l on ~sf s 3 / A VI' -If S B- PERCOLATION TESTS TEST DEPTH' WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I^iruGe' AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P- 0 3 Z' / P- Z A10 P- Alb -7 3 3' 3' P P- P` PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. p2- JFX ZZ Oho. 7 ' 4 7 B1sYj A Opt V, It R on Gr e5 SYSTEM ELEVATION 00, A~ j D .}I _i a ~ r- 01 o 3 &eai ,6 r C I cc 3 !gz 'CIA - - S4I /to C_ i 4- A _k _r~// Wt Ta Be M&iG Aft%&m, a 2 - PA. e i - P~ To MaS,.-fA• !/,~.t:rd( ®qY~ ~~K..~,u.I . I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : g TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): =3 / re/ a drb /S'7 /_f CS AT RE: DISTRIBUTION: Original and one copy to Local Authority, rty Owner and ster. DILHR-SBD-6395 (R. 02/82) t, - I STRUCTIONS FOR COMPLETING FORM 135 - SR13 - To be a and accurate soil test, your report must include: 1. Cornpl )tion; 2. The use s, early indicate r this is a..; or comr~aerr 1 MAXI'S ~ r of bedrooms nmercial use p' 4. to , " p-cenle.nt sy t, 5. C ability rating k,. A SITE IS SUI ' FOR A HOL.DINt I ' IF ALL. OTHE "AS A,• RULED BASED ON SOIL CONDITIONS; 5. Pl 3s shy -e for writing profile descriptio completing the ,plot plan; 7. acr- locating your test locations. F I to scale is preferred. A ,_•riu rlesi , levation ref t,e point an ta= ry shown,. :r' rmanent; ho:. es, names, as, floc ata, , e>.emp- r; us f lood ,,;ain, (!levai~ion)does mly, pi =n the, box; 1 I . lace your current: address and your cation n 1 . and distribute required. ALL -JIL TEST BE FILED WITH THE (WITHIN S - ` OF COMPLETION. 'F. -VIATIOI e OR CERTIFIED SOIL TESTERS _ ind Textures Other Symbols ` 10"1 FAR - Bedrock cot, (3 - 10") SS - S ~stone l€ ~l {under 3"i LS L 's HGW r as - C i Pr' n R, 5 - l si n [ - I Bn BI {;.a y R _ mot - hoc _ vj g , tt, sic - - HVt/L - Hir,,. soil i Ii -rastE 6M - 2, VRP vtis , _.:..4 T€ e t I Ak- ti kA l l 111 ~ ~ ~ J 1 1 J'~y o / F d A T 1 c ~ o I o P *P a c U ~ C °Cr~ ~ IV 1 ~b I I ~ I~ I ~i ~ rn ~Q 0 W 0 o H~ N P P 1~3 ~ . 1 r it -Z s R'41 ~,~3 N ~ Ji, Aw L n 0 b U ` d ?M. tA VA 1, x Cx) ~~~1 P\ ~~Ry as W 14 'F Go fQ (k o ~e~ INW S Q a N t - ~a ti oa ❑ Q► y s w a JV r P ~ p H L