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STC - 104 ` AS BUILT SANITARY SYSTEM REPORT,. OWNER e y h a'd„ ADDRESS J✓~ ~✓.C tti~ v~ T~ r ' SUBDIVISION / CSM# LOT # SECTION T N-R W, Town of as ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4h v ~1 h+ 3x S7 c/es -cj A/ -4 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK' S'Q h•~ e Ct 5' l / ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity:// ye Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: 3- Length -3'7 Number of trenches :;:r- Distance & Direction to nearest prop. line: ~y ^s- Setback from: well: House Ile ' Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wiscons Mt ' artmentof Industry, PRIVATE SEWAGE SYSTEM County: Safety ety and W Labor B auildinTngs Relations Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPerm itNo.: Permit Holder's Name: ❑ City ❑ Village Town of: State PA W% HERBERT X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: i _T A -0 -5 -0 Q_ 2- 4- -2 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 'oar ° 00- Dosi ng Aeration Bldg. Sewer 3 Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet Septic ,a S yn S ~aS NA Dt Bottom Dosing NA Header / Man. .7 N ' 46 _!a fo Aeration NA Dist. Pipe 5 ~ 4 q4.S / Holding Bot. System "S`~ gs 5-. G C, 54 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Force main Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _11;1 ,:5'! ' .11, , DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO --Te, , CHAMBER Moe Number: System:',:. `7 41/4 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/Tr nchCenter Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.5.29.19W, NE, NE, Lot 1, Bluebird Drive 6141:~4) 9-1 Plan revision required? ❑ Yes ffj/No , Use other side for additional information. / 7 Q5 per, / SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' T . ' SANITARY PERMIT NUMBER: aE SANITARY PERMIT APPLICATION Bureau Safety of and B Buildiuildinng Waater System,. teri 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 Count than 8 112 x 11 inches in size. Sf- • See reverse side for instructions for completing this application State Sanitary Permit NU b The information you provide may be used by other government agency programs ❑ Check if revision 0prevlo-us application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Ile r- b ee r- Aa rS -A 41er 1/4, S6_ T A 9 , N, R If E (or)&V Property Owner's Mailing Address Lot Number Block Number a 4; L, s 1 City State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ VIl age u{ ❑ Public Df 1 or 2 Family Dwelling - No. of bedrooms - Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) f 1 E] Apartment/ Condo O 30 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10E] 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. )Q New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 210 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14E] 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/da /sq. ft.) (Min./inch) Elevation Yso S ?,S .S''7 9a ' 2 Feet VSO 7 Feet VII. TANK Ca in aacitllos Total # of Prefab. Site Fiber Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank f1?r'dt~ a .9 rep-,tl ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature:( O Stamps) ff PRSW No.: Business Phone Number: e 1P.2- -1 Plumber's Address (Street, City, State, Zip Code): / a 7 d S' c o a~Lp~ 6~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Iss ing Agent Signature (No Stamps) / r VApproved ❑ Owner Given Initial Q/, Surcharge Fee) Adverse Determination ~0 o X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: b SBD-6398 (R. 05/94) DISTRIBUTION: Original to county, one copy To: Safety & Buildings Division, Owner, Plumber t 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line 8 if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX- County / Department Use Only. X. County / Department Use Only. Complete p!~ specifications not smaller than 8 10 x 11 inches must be s.,,br,.itted tz) the county_ The plans must include ` 'I'D lovvirg: A) plot plan, drawn to scale or with complete din ens,or..>, roc--lion of holdinG tank(s), septic or = k : building sewers; well=_; water main,; Vale - s. Ce S-E t r lakes; pump or siphon o' so l ausorption systems; replacement syst2rr e lo,_z.i -~i the building served- d el oh ere,,Ce (JOIntS; Ci COmnle `or pur"~ } _ntlt Js,-; t;f(75e Volume; friction foss; pump performance _urve; puml, M- G) cross section ,rr,;ic;~,y ~e;r. isrcqu y sail ~estdata-r, , i1,; sizing infarmatfon. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Qv ` ems?' * ~~e .s~el~ .U~~f ,I/~% s T""a 9 l9 LJ l y tJ,rJ off" 3 T,Jas e~ 6' ,~.~Ts~c s ~ b'~ a-s X~T r, a .D~ ~ ~~~1fa I 9.' Y..~ ~yl~ ~ • i l i I ,~OLmm .t~~~~~fip`1~d~ 1 ~~~J ~ -ewe ~ % ~ - -r ~ _ Ka -ti-, - ~k . ~ - ~--r ~ , - . W1Sfo'pagrnent of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor ura4n Relations Divisiow of Safety & Buildings in g =.d yyijh ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not le thary8 1/2 x 11 incTtas lrfh' e. Plan must include, but PARCEL LD.# not limited to vertical and horizontal refe int ~BM),Oectiond~ of slope, scale or dimensioned, north arrow, and location rtd istande.to n load:,'` c3 Q 7' APPLICANT INFORMATION-PLE 61~ PRl T A~L• IIfF'~f MA t0 REVIEWED BY DATE LO t r, PROPERTY OWNER: t ! PROPERTY LOCATION Herbert Blaisdell C) `~Z GOVT. LOT NE 1/4 NE 1/4,S 5 T 29 N,R 19 fir) W PROPERTY OWNERS MA!I_ING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 484 Bluebird Dr., 1 na Bluebird Dr. ~Jyf CITY, STATE ZIP CODE ❑CITY ❑VILLAGE JgOWN NEAREST ROAD Hudson, WI. 54016 ( na St. Joseph Bluebird Dr. [x} New Construction Use P ] Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate ' 7 bed, gpd/0 ' 8 trench, gpd/ft2 Absorption area required 643 bed ft2 563 trench, ft2 Maximum design loading rate ' 7 bed, gpd/ft2 ' 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.60 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for svstem ® S ❑ U ❑ S ® U CAS ❑ U ❑ S :El u ❑ S C3U ❑ S 0U_ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure ConsistencelBound3y Roots GPD/ft. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed -Trerxf~ 1 -84 10yr5/4 none Cos osg ml na na .7 .8 Ground elev. 98.6 ft. Depth to limiting factor +84" Remarks: Boring # Kv><- 1 0-14 10yr4/2 none sil lfsbk mfr gw na .2 .3 2 g0~ 2 14-22 7.5yr4/6 none is osg mfr gw na .7 .8 3 22-84 7.5yr4/6 none s osg ml na na .7 .8 Ground elev. 98.4 ft, Depth to limiting factor ' +84" Remarks: CST Name:-Please Print Gar L. Steel Phone- 715-246-6200 Address: 1554 200th Ave-, New Richmo d, Wi. 54017 9-6-95 Signature: Date: CST Number: PROPEMOWNER Herbert Blaisdell SOIL DESCRIPTION REPORT of 3 PARCEL I.D. # O & 0 . P, WWI ^ 7 `COO ~ " y Boring # Horizon Depth Dominant Color I Mottles Texture Structure Consistence Botrffiry I Roots GPD/ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Mmnch 1 0-84 10yr5/4 Cos osg ml na na 7.8 i Ground elev. i i 98.00 ft. Depth to limiting factor +84 Remarks: Boring # 1 0-29 10yr4/4 none lfs osg mfr gw na .5 .6 2 29-80 10yr4/6 none s osg mfr na na .7:..8 Ground elev. 98.Q Depth to limiting factor +80" Remarks: Boring # 1 0-80 7.5yr4/6 is osg mfr na n .7 .8 5 Ground elev. 97.7ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. j ft. I Depth to limiting factor Remarks: SBD-8330(R.05/92) Ni. v STEEL'S SOIL SERVICE Gary L. Steel Herbert Blaisdell 15514 200th Ave. CSTM2298 NE4NE4 S5-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 1 lot #1-Bluebird Dr. I N 1"=40' Bm.= top of basement walkout door sill plate C el. 100' fi 07a 30 01 )A- o c !5Oc Gary L. STeel 9-6-95 Ktl'UK I U14 SOIL UUNINGS A14U ,Mr INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7909 1-HUMAN RELATIONS MADISON, WI 53707 (H63.0911) & Chapter 145.045 e^e J. _ f J4 -a - LO .A) ISN S€CT ION IIPNysYMltlff•'RCTTT~ OT NO. BLK. NO. ikw : " 1DtIsl AME: eer~~- p S 7-os ~ ~ti.~` I., NE 1/N 1/ S' /T,2►1 TOWNSI COUNTY: YVN€Z /BU 1 c_ 51, Coo: ~A6t Srf,~S~L>T•'• .r cY6 USE DATEfOBSERVATIONS MADE No, eEUnTwS : CO T ~C1rTCT5E3L`TilPfi1SN s ~rRYN 7'R ~Residance "7 ~d 1 ~Naw ❑Replacs f. I ~ : /7 RATING: S- Site suitable for system U- Site unsuitable for system left jg dt4 _!!C / oil . eill ~O fT IM LN GROI R I N IT1F~ D 7MMINTFF I O~ 4 RECOMMENDED ENOED SVSTEMaoptionell i I Aa 11'XJ NS UP N Ou If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.1163.0915111)), indicate: Floodplain, indicate Floodplain elevation: / PROFI`E DESCRIPTIONS BORING "FOFAL PI'11 TO GR UN DWATER~GME!! CIIARACTER OF SOIL WITH 7HIEKNESS, COLOR, TEXTURE, AND DEPTH NUMBER UEPIIIoW. ELEVA I ION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) B- / .a' _p4•.y' ,~ldwce _ 7 tJ' 7 Q(s/, 6n s/ S e- 2 f 0' ._7 ll , 7 An _r 6 ICA S B- 971 7 4,51_1~10 1811-C B. S t/'~r 9~ y 1~dute_ 7 .V' / T G, ~n S l S S B. grJ~ 9Y. v' ~,cLt 7 -J' r BI S/ S Sr 00 14A S PERCOLATION TESTS TEST DEPTIiir WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAT MINUTES NUMBER LOIC~1Lt AFTERS, INTERVAL-MIN. - Ipp t R PER INCH P- % 0 3- G3 P. 1 1! a 1 o -3 3 P. Alo -3 . e..SL w• _9r?,_et ' ww 6 P- L - Tel y/2 a _Ssli)~ Y &-t P-3 117' 51k~5,v_ PLOT PLAN: Show locations of percolation tests, soil borings anti the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hors :ontel and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all bxings and the direction and Parent of land slope. SYSTEM ELEVATION 9,1. 2 ' eG 41 ve,4- / a / ee F.. ~q ast~; f t tai e- S. cYr,"e-. ujeit rip P3\~ 8' / ! of f} /",(ot C'M ITT t~8 6,t ~f/b, dt b TJ ~o•~j ; (~.vy~ due,' 1 P,t~ ~ ~ ~ 113; d, ~e ' P j'u FL. = 9.t•Y') t-~r~t ~,og I T .41. *4411 AA -f Tow.• Ar! Yr(o 9o J~°if ,N fill of 1.0 h ~-~1-~9 a jr.. *~aw :?Lg 7aF F t"u1scosi I, the undersigned, hereby certify that the soil tests reported on this form were made by rite in accord dh (h prose urea end -ire e s sgpeci fisid ed in t a reeonsin Administrative Ctule, and thal.)he data recorded and the location of the tests are correct to the best of my knowledge and holier. y a f 9,~• 1' Oct Y--AY-/(a . NAME 1 rintC TESTS WERE COMPLETED ON: a'- /.Z- Q r ADDRESS: t s ~r~ly CERTIFICATION NUMBER: PHONE NUMBERloptional): ~eer¢l Ave GlJss. SzfIYIle, fyv !r - CS A U RE: DISTRIBUTION 01-11nal , -t une sully to Local Authouty. ProPtvty Owner and Soil Tester. DILI OR Sill) G395 111. U7;A"l.l - OVER - a STC-105 SEPTIC TANK MAINTENANCE AGREEMENT HF_k_,RER7- St. Croix County OWNER/BUYER _81A s b a MAILING ADDRESS 260 IV. ~M C~.c sT ~S 0 PROPERTY ADDRESS y d~1 we Of- (location of septic sy/stem)I Please obtain from the Planning Dept. CITY/STATE I4,,kkso N - i - w3 1 PROPERTY LOCATION ~j E 1/4, 1/4, Section T_Q~_N-R_j_~_W TOWN OF S~- ~pC ST. CROIX COUNTY, WI SUBDIVISION , LOT NUMBER L CERTIFIED SURVEY MAP , VOLUME L, PAGE, LOT NUMBER A- 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 a piration dilate. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property_U _F1/4~I X1/4, Section ,T9,5 N-R_11_W Township Mailing address 26( Address of site wcw% C e Subdivision name Lot no. a, Other homes on property? Yes No Previous owner of property ~7eCv\, 0Wk Total size of property S% R Total size of parcel Date parcel was created A Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume 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 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 ffice of the County Register of Deeds as Document No. E s o'Qp~ , 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 Date of Signature Date of Signature 1 2 FILED MAY 231980 ~/~ES 0' CONNEII N CERTIFIED SURVEY MAP NE I/4 - NE 1/4- SEC-5, T29 N , R 19W BEARINGS ARE ASSUMED Nw LEGEND N880-42'-44"W ALONG THE NORTH LINE OF THE NE 1/4 •----FOUND I° IRON PIPE OF SEC.. 5 10075 50 25 0 100 o----I°X 24" IRON PIPE SET, WEIGHING 1.68 LBS./LIN. FT. SCALE IN FEET 1/4 COR. MON. NE COR. :C.5 / CO. MON. L< ~ 1rl-• NORTH LINE OF THE NE I/4 SEC-5 NSP RIGHT-OF-WAY S 00°-49'-14°W N88°-42'-44"W VOL.. 149, ,PAGE, 355 83.00 335.00' S 880- 42'- 44° E 618.04' ~90~ 309.02f 309.02 Oti % 43 0 z ~n 0 :z v:y o° L 0 T I o LO T 0 w w , n 3 rn Oi A • 1 a 0 2.58 A. 4 (D ' co p 2. 58 A. , m _ O p v r - c 0_ JD P M ;z 'o :w O~ ~9 o 40 309.02' 309.0 2' s~4 U! N 88°- 42'- 44 W 6 18.04' w - - w CENTERLINE OF TOWN ROAD _ w UNPLATTED LANDS ~x~,J~„•tr`+~9~~pnt THIS INSTRUMENT WAS DRAFTED BY GCS 78 - 30- 280 IEPI C. 0 8~ 7 _Joc~ z-211 .r aO f~c rcb~ c`:rtify th-~t this Cer't1.tiF?d purvey .~_-:y> h:,... bee, a~.rOved by th, I'O'v~Yl Il (L ~l. c i tit . tl o eA }1 th1 d;: Y of Vol APPROVED M & 21 Lez n Clc of t. Joseph `J OL . 1a ~Ga 949 ST. CROIX COUNTY C _C: TIr` I D ti lJi V_ 1 l i P COMF.iEHEKwvz ?,1Aio KA `i'. C.Joj` CCU,'7'Y, I. ~reo 2oNMG i Ali is1€ Volume 4 Pare 949 SURVEYORS CISIIFICAT:L: 1, Gillen C. l yh aaen, reCistered L.:. nd . urveyor, hereby certify that by the direction of D<e n Lindc tram, I h ed, described ti o urvcy and mapped the land parcel uhich is represented by this Certified Survey Map; that the exterior boundary of the 12nd parcel. :purveyed and mapped is described as folloys: A part of the KE 1/4 of the TE 1;14 of Section 5, T-29-H, R-19-W, ~o,.,ey~~h St. Croix c,ou.1~, Town of St. ' 1,, ,;i.~con i.~, further " described _;•s follows: CommencinE at the Northeast cornier of said Section 5; thence N 880-421-44" ! along the North line: of the 11~ 1/4, .35.00 feet thence S 000-49'-14" 83.00 fret to the point of beginning; thence continuing; S 000-491-14" L, 364.00 feet to the North eight-of-way line of a Town Road; thence N 880-421-44" W along said North Right-of-way line, 618.04 feet; thence X 000-49'-14" , 364.00 feet; thence S 880-42'-44" L, 618.04 feet to the point of be6i.r_nine. that this Certified Survey Zap is correct representation of the exterior boundary surveyed and described; that I have fully complied uith the current provisions of Chapter 236.34, iscon.si.n revised Statutes, ~ and ~ , in ; ~arvc. y in ..n~. mwppine same; Certified this.JaPy, day of /~/~aitc.4~ 1980, zt Hudson, Visconsin. a iEn.ed : G. ie Allen C. Nyhvfen, H.L. ; . No. 1407 & Land Curvo 'lnf" 108 Walnut St. Hudson, Wisconsin m L ~ ~ p2 a 'fc;.j, I. dJ t)4!'~`'S. r•vy t.. III 1 R V II I I Volume Page 949 I I L, CT i State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED 53200 VOL 1133PAGE 331 7 DOCUMENT NO. C: 1,0 a lur F; Dean K Lindstrom and Linda C. Lindstrom, AUG f 1995 husband and wife, faw 2:30 P. a~.q er ert ais e and of ts o E.ubiE :fit ~fi conve s d warran B y isetta I. ai.s e , us an an wi e, THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS 00 n), the following described real estate in St. Croix County, State of Wisconsin: t rI (Parcel Identification Number) FEE Part of NEk of NEk of Section 5, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map filed May 23, 1980, in Vol. 4, page 949, Doc. No. 354370. This is not homestead property. Kqg~ (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this \ day of August (SEAL) _i'1Q0o (SEAL) Dean K. Lindstrom (SEAL) (SEAL) Linda C. Lindstrom AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this day of 19 Personally came before me this day of August 19 95 the above named Dean K. Lindstrom and Linda C. Lindstrom, husband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, A&x T- Conn= authorized by §706.06, Wis. Stats.) to me known to be the person S AfotaU j1%*HVcuted the f o' g instrum t nd ackn *wL'htf 4WsCOAS~It THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland Alice o C nors Attorney at Law Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, tate expiration date: necessary.) 19-q-7.) *Names of persons signing in any capacity should be typed or printed below their signatures. i NX' l1Ll NXX_r~VVIN cT .'r is 11 1 V M- ~Nr Cf'(1N CIN W-rnn- I anal Mink Cn Inc r r Stock V9,1 11,42 .14 3"' PAGE332 %isconsin Bankers Association 1993 REAL ESTATE MORTGAGE (For Consumer or Business Mortgage Transactions) f 1~; a iu+ r Herbert E. Blaisdell and Lisetta M. Blaisdell, husband and AUG 1: 1995 wife, each in his or her own right ("Moriga or," +~'l r 2 whether one or more) mortgages, conveys and warrants to The First National Bank O sh. K: :30 P' . Baldwin . u l .c.,,.:.e;~..• .:.1„ 1•..u: ("Lender") r,od: . , ;its in consideration of the sum of Cbe Hundred Fifteen Thousand and no/1 00 -----------------------------------------------Dollars($ 115,000.00 loaned or to be loaned to Herbert E Blaisdell and Lisetta M. Blaisdell ("Borrower," whether one or more), Return To evidenced by Borrower's note(s) or agreement dated ~clist 1 , 199-9 , l - the real estate described below, together with all privileges, hereditaments, easements and appurtenances, all rents, leases, issues and profits, all claims, awards and payments made as a result of the exercise of the right of eminent domain, and all existing and future improvements and fixtures (all called the "Property"). 1. Description of Property. (This Property i c the homestead of Mortgagor.) Tax Key # (is) (is not) Part of NE4 of NE4 of Section 5, Township 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed May 23, 1980 in Vol. 4, page 949, Doc. No. 364370 ❑ If checked here, description continues or appears on attached sheet. ® If checked here, this Mortgage is a "construction mortgage" under § 409.313(1)(a) Wis. Slats. ❑ If checked here, Condominium Rider is attached. 2. Title. Mortgagor warrants title to the Property, excepting only restrictions and easements of record, municipal and zoning ordinances, current taxes and assessments not yet due and 3. Escrow. Interest n /a be paid on escrowed funds If an escrow Is required under paragraph 8(a) on the reverse side. - (will) (wilt not) 4. Additional Provisions. Mortgagor agrees to the Additional Provisions on the reverse side, which are incorporated herein. The undersigned acknowledges receipt of an exact copy of this Mortgage. NOTICE TO CUSTOMER IN A TRANSACTION GOVERNED BY THE WISCONSIN CONSUMER ACT (a) DO NOT SIGN THIS BEFORE YOU READ THE WRITING ON THE REVERSE SIDE, EVEN IF OTHERWISE ADVISED. (b) DO NOT SIGN THIS IF IT CONTAINS ANY BLANK SPACES. (c) YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN. (d) YOU HAVE THE RIGHT AT ANYTIME TO PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS AGREEMENT AND YOU MAYBE ENTITLED TO A PARTIAL REFUND OF THE FINANCE CHARGE. Signed and Sealed Aucrust 1 , 1995 (Date) (SEAL) % (SEAL) (Type of organization) Herbert E. Blaisdell By. (SEAL) (Title) Lisetta M. Blaisdell (SEAL) By: (SEAL) (Title) AUTHENTICATION OR ACKNOWLEDGEMENT STATE OF WISCONSIN ss. Signatures of County of St - Croix This instrument was acknowledged before me on -A11LpTCt 1 19-9-5-by by Her hL- i' t' al ai srlo1 l and - T i setta M Rl ai sd(ml 1 (Name(s) of person(s)) authenticated this day of '19 • as....., s J (Type of authority. e.g., officer, trustee, eta, M any) Title: Member State Bar of Wisconsin or o ' ~p be 9lNnlarlf was OxeCUI 8n authorized under §706.06, Wis. Stats This instrument was drafted by County, Wis. Tht- Fi rci- Nai-i nnal Rank of Baldwin ommissl6n (Expires)(Is) Noterv Ptt 918 Ut My Comrrtbssion Expires March 22,1993 'Type or print name signed above. • ` 5. M Security. I his Mortgage secures prompt payment to Lender of (a) the sum stated in the first paragraph of this Mortgage, plus interest and charges acc6rdin erTAof the promissory notes or agreement of Borrower to Lender identified on the reverse side, and any extensions, renewals or modifications signed by any Borr such promissory notes or agreement, (b) to the extent not prohibited by the Wisconsin Consumer Act (i) any additional sums which are in the future loaned by Lender to any Mortgagor, to any Mortgagor and another or to another guaranteed or endorsed by any Mortgagor primarily for personal, family or household purposes ar1d agreed in documents evidencing the transaction to be secured by this Mortgage, and (ii) all other additional sums which are in the future loaned by Lender to any Mortgagor, to any Mortgagor and another or to another guaranteed or endorsed by any Mortgagor, (c) all interest and charges, and (d) to the extent not prohibited by law, all costs and expenses of collection or enforcement (all called the "Obligations"). This Mortgage also secures the performance of all covenants, conditions and agreements contained in this Mortgage. Unless otherwise required by law, Lender will satisfythis Mortgage upon request by Mortgagor if (a) the Obligations have been paid according to their terms, (b) any commitment to make future advances secured by this Mortgage has terminated, (c) Lender has terminated any line of credit under which advances are to be secured by this Mortgage, and (d) all other payments required under this Mortgage and the Obligations and all other terms, conditions, covenants, and agreements contained in this Mortgage and the documents evidencing the Obligations have been paid and performed. 6. Taxes. To the extent not paid to Lender under paragraph 8(a), Mortgagor shall pay before they become delinquent all taxes, asessments and other charges which may be levied or assessed against the Property, or against Lender upon this Mortgage or the Obligations or other debt secured by this Mortgage, upon Lender's interest in the Property, and deliver to Lender receipts showing timely payment. 7. Insurance. Mortgagor shall keep the improvements p e on the Property insured against direct loss or damage occasioned by fire, extended coverage perils and such other hazards as Lender may require, through insurers approved by Lender, in amounts, without co-insurance, not less than the unpaid balanceof the Obligations orthe full replacement value, whichever is less, and shall pay the premiums when due. The policies shall contain the standard mortgage clause in favorof Lenderand, unless Lender otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Lender. Mortgagor shall promptly give notice of loss to insurance com- panies and Lender. All proceeds from such insurance shall be applied, at Lender's option, to the installments of the Obligationsln the inverse order of their maturities (without penalty for prepayment) or to the restoration of the improvements on the Property. In the event of foreclosure of this Mortgage or other transfer of title to the Property, in extinguishment of the indebtedness secured hereby, all right, title, and interest of Mortgagor in and to any insurance then in force shall pass to the purchaser or grantee. 8. Mortgagor's Covenants. Mortgagor covenants: (a) Escrow. To pay Lender sufficient funds at such times as Lender designates, if an escrow is required by Lender, to pay (1) the estimated annual real estate taxes and assessments on the Property, (2) all property insurance premiums when due, and (3) if payments owed under the Obligations are guaranteed by mortgage guaranty insurance, the premiums necessary to pay for such insurance which Lender may cancel at anytime. Upon demand, Mortgagor shall pay Lender such additional sums as are necessary to pay these items in full when due. Lender shall apply these amounts against the taxes, assessments and insurance premiums when due. Escrowed funds may be comingled with Lender's general funds; (b) Condition and Repair. To keep the Property in good and tenantable conditon and repair, and to restoreor replace damaged ordestroyed improvements and fixtures; (c) Liens. To keep the Property free from liens and encumbrances superior to the lien of this Mortgage and not described in paragraph 2 on the reverse side; (d) Other Mortgages. To perform all of Mortgagor's obligations and duties under any other mortgage or security agreement on the Property and any obligation to pay secured by such a mortgage or security agreement; (e) Waste. Not to commit waste or permit waste to be committed upon the Property; (f) Conveyance. Not to sell, assign, lease, mortgage, convey or otherwise transfer any legal or equitable interest in all or part of the Property, or permit the same to occur without the prior written consent of Lender and, without notice to Mortgagor, Lender may deal with any transferee as to his interest in the same man- ner as with Mortgagor, without in any way discharging the liability of Mortgagor under this Mortgage or the Obligations; Alteration or Removal. Not to remove, mov lg) o e e, demolish or materially alter any part of the Property, without Lender's prior written consent, except Mortgagor may remove a fixture, provided the fixture is promptly replaced with another fixture of at least equal utility; (h) Condemnation. To to Lender all compensation pay received forthe taking of the Pr g operty, or any part, by condemnation proceeding (including payments in compromise of condemnation proceedings), and all compensation received as damages foinjury r' to the Property, or any part. The compensation shall Y P be applied in such manner as Lender determines to rebuilding of the Property or to the Obligations in the inverse order of their maturities (without penalty for prepayment); (1) Inspection. Lender and its authorized representatives may enter the Property at reasonable times to inspect it, and at Lender's option to repair or restore the Property and to conduct environmental assessments and audits of the Property; U) Ordinances. To comply with all laws, ordinances and regulations affecting the Property; and (k) Subrogation. That the Lender is subrogated to the lien of any mortgage or other lien discharged, in whole or in part, by the proceeds of the note(s) or agree- ment identified on the reverse side. 9. Environmental Laws. Mortgagor represents, warrants and covenants to Lender (a) that during the period of Mortgagor's ownership or use of the Property no sub- stance has been, is or will be present, used, stored, deposited, treated, recycled or disposed of on, under, in or about the Property in a form, quantity or manner which is known to be present on, under, in or about the Property would require clean-up, removal or some other remedial action ("Hazardous Substance") under any federal, state or local laws, regulations, ordinances, codes or rules ("Environmental Laws"); (b) that Mortgagor has no knowledge, after due inquiry, of any prior use or existence of any Hazardous Substance on the Property by any prior owner of or person using the Property; (c) that, without limiting the generality of the foregoing, Mortgagor has no knowledge, after due inquiry, that the Property contains asbestos, polychlorinated biphenyl components (PCBs) or underground storage tanks; (d) that there are no con- ditions existing currently or likely to exist during the term of this Mortgage which would subject Mortgagor to any damages, penalties, injunctive relief or clean-up costs in any governmental or regulatory action or third-party claims relating to any Hazardous Substance; (e) that Mortgagor is not subject to any court or administrative proceed- ing, judgment, decree, order or citation relating to any Hazardous Substance; and (f) that Mortgagor in the past has been, at the present is, and in the future will remain in compliance with all Environmental Laws. Mortgagor shall indemnity and hold harmless Lender, its directors, officers, employees and agents from all loss, cost (including reasonable attomeys' fees and legal expenses), liability and damage whatsoever directly or indirectly resulting from, arising out of, or based upon (i) the presence, use, storage, deposit, treatment, recycling or disposal, at anytime, of any Hazardous Substance on, under, in or about the Property, or the transportation of any Hazardous Sub- stance to or from the Property, (ii) the violation or alleged violation of any Environmental Law, permit, judgment or license relating to the presence, use, storage, deposit, treatment, recycling or disposal or any Hazardous Substance on, under, in orabout the Property, or the transportation of any Hazardous Substance toor from the Property, or (iii) the imposition of any governmental lien for the recoveryof environmental clean-up costs expended under any Environmental Law. Mortgagor shall immediately notify Lender in writing of any governmental or regulatory action or third-party claim instituted or threatened in connection with any Hazardous Substance on, in, under or about the Property. 10. Authority of Lender to Perform for Mortgagor. If Mortgagor fails to perform any of Mortgagor's duties set forth in this Mortgage, Lender may after giving Mortgagor any notice and opportunity to perform which are required by law, perform the duties or cause them to be performed, including without limitation signing Mortgagor's name or paying any amount so required, and the cost shall be due on demand and secured by this Mortgage, bearing interest at the highest rate stated in any document evidencing an Obligation, but not in excess of the maximum rate permitted by law, from the date of expenditure by Lender to the date of payment by Mortgagor. 11. Default; Acceleration; Remedies. If (a) there is a default under any Obligation secured by this Mortgage, or (b) Mortgagor fails timely to observe or perform any of Mortgagor's covenants or duties contained in this Mortgage, then, at the option of Lender each Obligation will become immediately payable unless notice to Mortgagor or Borrower and an opportunity to cure are required by § 425.105, Wis. Slats., or the document evidencing the Obligation and, in that event, the Obligation will become pay- able if the default is not cured as provided in that statute or the document evidencing the Obligation or as otherwise provided by law. If Lender exercises its option to accelerate, the unpaid principal and interest owed on the Obligation, together with all sums paid by Lender as authorized or required underthis Mortgage orany Obligation, shall be collectible in a suit at law or by foreclosure of this Mortgage by action, or both, or by the exercise of any other remedy available at law or equity. 12. Waiver. Lender may waive any default without waiving any other subsequent or prior default by Mortgagor. 13. Power of Sale. In the event of foreclosure, Lender may sell the Property at public sale and execute and deliver to the purchasers deeds of conveyance aursuant to statute. 14. Assignment of Rents and Leases. Mortgagor assigns and transfers to Lender, as additional security for the Obligations, all rents which become or remain due or are paid under any agreement or lease for the use or occupancy of any part or all of the Property. Until the occurrence of an event of default under this Mortgage or any Obligation, Mortgagor has the right to collect the rents, issues and profits from the Property, but upon the occurrence of such an event of default, and the giving of notice by Lender to Mortgagor declaring that constructive possession of the Property is in Lender, Mortgagor's license to collect is terminated and Lender shall be entitled to such rents, issues and profits and may, after giving Mortgagor any notice and opportunity to perform required by law, notify any or all tenants to pay all such rents directlyto Len- der. All such payments shall be applied in such manner as Lender determines to payments required under this Mortgage and the Obligations. This assignment shall be enforceable and Lender shall be entitled to take any action to enforce the assignment (including notice to the tenants to pay directly to Lender or the commencement of a foreclosure action) without seeking or obtaining the appointment of a receiver or possession of the Property. 15. Receiver. Upon the commencement or during the pendency of an action to foreclose this Mortgage, or enforce anyother remedies of Lender underit, without regard to the adequacy or inadequacyof the Property as security for the Obligations, Mortgagor agrees that the court may appoint a receiver of the Property (including homestead interest) without bond, and may empower the receiver to take possession of the Property and collect the rents, issues and profits of the Property and exercise such other powers as the court may grant until the confirmation of sale, and may order the rents, issues and profits, when so collected, to be held and applied as the court may direct. 16. Foreclosure Without Deficiency Judgment. If the Property is a one-to-four family residence that is owner-occupied at the commencement of a foreclosure, a farm, a church or owned by a tax exempt charitable organization, Mortgagor agrees to the provision of § 846.101 Wis. Slats., and as the same may be amended or renum- bered from time to time, permitting Lender, upon waiving the right to juddKent for deficiency, to hold the foreclosure sale of real estate of 20 acres or less six months after a foreclosure judgment is entered. If the Property is other than a one-to: Foufffamily residence that is owner-occupied at the commencement of a foreclosure, a farm, a church cr a tax exempt charitable organization, Mortgagor agrees to the pr6visi8ns ofi§ 846.103 _Wis. Slats., and as the same may be amended or renumbered from time to time, permitting Lender, upon waiving the right to judgment for deficiency, tftol4 the foreclosure sale of real estate three months after a foreclosure judgment is entered. 17. Expenses. To the extent not prohibited by law, Mortgagor shalkgay II reasonable costs and expenses before and after judgment, including without limitation, attorneys' fees, fees and expenses for environmental assessments, inspections apd audits, and fees and expenses for obtaining title evidence incurred by Lender in pro- tecting or enforcing its rights under this Mortgage. 18. Severability. Invalidity or unenforceability of any provision of this (vlor 4*Vall not affect the validity or enforceability of any other provision. 19. Successors and Assigns. The obligations of all Mortgagors are jointland several. This Mortgage benefits Lender, its successors and assigns, and binds Mortgagor(s) and their respective heirs, personal representatives, successors and assigns. 20. Entire Agreement. This Mortgage is intended by the Mortgagor and Lender as a final expression of this Mortgage and as a complete and exclusive statement of its terms, there being no conditions to the full effectiveness of this Mortgage. No parol evidence of any nature shall be used to supplement or modify any terms. J