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030-1081-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552319 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Tolson, Albert R. St. Joseph, Town of 030-1081-50-000 CST BM Elev: Insp. BM Elev: BM Descri tion: Section/Town/Range/Map No: /471), /0010 29.30.19.2938 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Gr / /OO ,l Benchmark D OD • D Dosing Alt. BM Aeration Bldg. Sewer Holding Slnlet TANK SETBACK INFORMATION St/Ht Outlet Z g 7 d TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet V S 2. L d l ~ ottom ✓ ^-L y v ! G, seg~ic r~ IN o~7 • sing Or 3 5 / Bader D S,D 03y Q -7 Aeration / Dist. Pipe /!t /h s~ o: 3 Holding Bot. System 6 r Final Grade PUMP/SIPHON INFORMATION <1- 5 r S & .U Manufacturer Demand St Cover e4l,45J &L" +V 14-7rlh Model Number ade co > El! Friction Loss Sead T UH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width 7- 1 Length No. Of Tren es PIT DIME SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C l SETBACK SYSTEM TO P/L S BLD WELL LAKE/STREAM ACHING Manurer~' INFORMATION Typ f System: > I ✓ / CHAMBER UN T OR Model Number: (N y111 Gt) 'T DISTRIBUTION SYSTEM /0" Hea o d .rro Distribution / x Hole Size x Hole Spacin~ Vent to Air Int ke I ? p?c/ Pipe(s) / Y / Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 2 S Depth Over 1 Depth Over IS -Depth of xx Seeded/Sodded r Mulched Bed/Trench Center'( • S lBedrrrench Edges 4-~ opsoil N;Yeess N No ® Yes 0 No COMMEN : (Include code discrepencies, persons present, etc.) Inspection I~(Vlnspection #2: Location: 1381 Fox Ridge Trail Houlton, WI 54082 (W 1/2 NE 1/4 29 T30N R19W) metes & bounds Lot 6 I Parcel No: 29.30.19.293B 1.) Alt BM Description=Tp rwTl ~ ~Cfu-e1L-dX-'6 s 2.) Bldg sewer length = J?i~I ~►M,, ~~(i►v~.~ ~itl`~ ~~I G~ - amount of cover = J Plan revision Required? ❑ Yes W /No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. f County eommeree.W`•gow Safety and Bungs Division 1 rte,, 20 W. Washington Ave., P.O. Box 7162 yr Ew Madison, WI 53707-7162 Sanitary PerrmittNNumber 9by tiamerit a late Transaction NumbS nits A lication lj /r s. Adm. p¢~missi n f this form to the appropriate govern In accordance with s. Comm. 8 .21(2), ` f I ation forms for state-owned POWTS are Project Address diffesubmitted to the Depart rtment f unit is required prior obta f a Com i on you provide may be used for secondary in , Slats. purposes in accordance with th 1 1. Application Informatio ease Print All Information Parcel # l Property Own 's Name 0-30-/06 75 Property Location Property Owner's Mailing Address Govt. Lot r Phone Number AA Z_'%, _A16 1'° Section City, State Zip Code circle one J 0 1c~'J t 7 ' ~15~ T~N. R E0 ~-~C.J Lot # II. Type of Building (check all that apply) Subdivision Name, f or 2 Family Dwelling - Number of Bedroo s I~ dYJ I ~~fl +rti✓t Block # - ❑ City of ❑ Public/Commercial -Describe Use CSM Number ❑ Village of El State Owned -Describe Use Town of .05- 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) ❑ Other Modification to Existing System (explain) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only u j R. Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued ❑ Owner C f a fGt Before Expiration IV. T e of POWTS S stem/Com onentMevice: Check all that a l 24 in. of suitable soil Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound a in El Pretreatment Device (exp ) ❑ holding Tank El Other Dispersal Component (explai ' t V. Dispersal/Treatment Area Information: Dispersal Area Proposed (sf) System Elevatio Design Plow (gpd) Design Soil Application Rate(gpdsf) rspersal Area Required (sf) i VI. Tank Info Capacity in Total # of Manufacturer N p .b Gallons Gallons Units FiIVw New Tanks Existing Tanks F r' U a daQ Septic or Holding Tank P p Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume sibifity for installation of the POWTS sshoowwnRS heat ached plans.us Hess Phone Number MP Number Plumber's Name (Print) Plumber's re ~7 [j~J/ c'' r- / / t 2C C ~LZQ4G Plumber's Address (Street, City, State, Zip Code) 7~ 0116 - VII oun /De artment Use Onl pproved El Disapproved Permit Fee Date Issued Isstiing Agen ignatttre A g erD °3/-7 j J77 ❑ Owner Given Reason for Denial G b A q oval/l;~asons (or Disapproval ~u f V~ L C,()R/Yt c GY '1 o epti c an , tuenii T1 ter an 3 ~1 S dispersal cell must all be serviced / maintained (k~(~ t' ~!~✓✓1~~J-rte as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. na not less th n st/2z1l i cv m size Attach to complete plans for the system and submit to the n only, paper ~ ~ f SBD-6398 (R. 02/09) PLOT PLAN PROJECT Albert Tolson ADDRESS 1381 Fox Ridae Trail Houlton Wi 54082 NW 1/4 NE 114S 29 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 3/27/12 DATE BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 901 # of chambers 44 ,BENCHMARK V.R.P. Top of manhole cover ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 92.0/90.5 4' below qrade Scale is 1" = 40' unless otherwise noted To Fox Ridge Trail Valley View Trail All piping shall be SDR 30/34, within 10' Plans Designed Using of tank, piping shall be Schedule 40. Conventional Powts Manual Version 2.0 Well 0' Existing 3 Bedroom House Vent >6" Quick4 Standard 20' of Coffer Leaching Chamber -W- with 20.0 ft2 of Area Ict''~k 10.2ft^2/pair of end caps 12" Valve ~ 4' Long 5 4„ Grade at System Elevation Failed 20' ilter Tank 20' 96' B-3 40' Property Line 18' X 36' Bed Vents B-2 94' Vent 15' B-1 85' Ad03 2-3' X 90' Cells with 16% Slope >3' spacing 600' Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 3/6/12 Owner: Albert Tolson Location: NW1/4 NE1/4 S29 T30 N,R19W 1381 Fox Ridge Trail St. Joseph System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-5. Maintanance and Contingency Plan 6. Filter Sp/ecifica heet Signature License n6900 PLOT PLAN PROJECT Albert Tolson ADDRESS 1381 Fox Ridae Trail Houlton Wi 54082 NW 1/4 NE 1/4S 29 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 3/27/12 DATE BEDROOM 3 CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 901 # of chambers 44 BENCHMARK V.R.P. Top of manhole cover ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.0/90.5 4' below qrade Scale is 1" = 40' unless otherwise noted To Fox Ridge Trail Valley View Trail All piping shall be SDR 30/34, within 10' Plans Designed Using of tank, piping shall be Schedule 40. Conventional Powts Manual Version 2.0 Well 0' Existing 3 Bedroom House Vent ALo Quick4 Standard 20' Leaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps Valve T „ -No.. 3 4„ Grade at System Elevation Failed 20 20' Filter Tank 96' B-3 40' Property Line 18' X 36' Bed 20 Vents 40 B-2 94' Vent 15' i B-1 85' 2-3'X 90' Cells with 16% Slope >3' spacing 600' Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 10.2ft^2 pair of end plates Finish grade elevation Typical Installation 96.0' Vent Vent Grade 3' 4„ 3' A-;~30/34 Septic Tank 5' Long 119 5' S' Long 1 Grade at System Elevation 3619 Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A_92.0 B--90.5 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the end:, of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the sy:3tem. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. If system fails, determine cause of failure, use alternate area and install new system in tested replacement area. Option #2. Jlnstall system at a lower elevation, by removing chambers, removing bionlat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 LLI cn L, r~ st lip -f yell c ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A4~1* Mailing Address i ?3 Fox 2-i~ Property Addresses--- / (Verification required from Planning & Zoning Department for new construction.) City/State Nt ,X 71 m Parcel Identification Number (3v LEGAL DESCRIPTION 1(~ Property Location v.-J 1/4 , E 1/4 , Sec. , T 3 U N R W, Town of57 , SD Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # ~7 S , Volume Page # Spec house yes no Lot lines identifiable (yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in § Comm. 83.52(l) in Chapter 12 - St. Croix County Sanitary Ordinance. and The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number bedrooms Z 7 :7: 7A OF APPLICANT(S) SIGN DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank. present-1y s(: v~.g the 4 residence located at.: n ~ -t- 7 _ r T- 30 N , R_._w, Town c) Section Z ~ Upon inspection, I certify that I have foi.ind `S a ' rs to be the tank and baffles to be in good condition, and it appea functioning properly. least time serviced: - - I)i.d flow back occur from absorption system? Yes No (if no, skip next line) _~s Approximate volume or length of time: gallons minutes Construction: Prefab Concrete Steel _ Other_ Manufacturer: (If known) ncIe of T k (.f known) ( a (Name) Please print g' ture) S (License Number) - `itle) 1)ato Por.m 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: Iii accepting the above statement regarding existing septic tank condition, I certify that the tank to the St y knowledge will xcept for Code (e conform to the requirements of ILHR $3, inspection openin over outlet baffle). N a m e J Si9natur MP/MPR!S___ ,c. Wisconsin Departmen f Commerce OIL EVALUATION-F 4`0 Page --Lof- Division of Safety and ildings in~a~bF omm 85, Wis. Adm. Code ~ on r \X ~G County r ! i Attach complete site pI p /2 x 11 inches in size. Plan must J `f include, but not limited t 4l: verti I reference point (BM), direction and Parcel I.D. percent slope, scale or dkn arrow, and location and distance to nearest road. 0 3/) - iease print all information. Re awed Y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner / Property Location 14 lLel TO ! v Govt. LotA,/L,) 1 /4 1 /4 S Z T 3(~ N R E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Cod Phone Number ❑ city ❑ Village Town Nearest Road C New Construction UseXResidential / Number of bedrooms Code derived design flow rate JZ~ GPD Replacement ❑ Publi r commercial - Describe: Parent material -C t~d7 ood Plain eleva 'on l livable A-11 General txlrmlan PP ft. and recommendations: g/}•u.~ i -r 3~ o v~ Lc'I 1?~ = 7 yr ~ y /3el ~ ~lJ✓t/c~ (?~c fj s' p System Type System Elevation © Boling # Boring / i Pit Ground surface elev. L ft. Depth to limiting factor /~J in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 z - 3 l 1 11 a.~ ,6 , 4 r Boring # ❑ Boring c ® pit Ground surface elev! / ' ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color / Gr. Sz. Sh. •Eff#1 •Eff#2 --7 46 442 AV-01~ 17 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Alarm (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017r 715-246-4516 Property Owner _ Parcel ID # Page of Boling # Boring ® RJ- Pit Ground surface elev.°f ` ' 0 ft. Depth to limiting factor - E in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 b- 0 31,L - S 09 r,-, t3x- E Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eif#2 Effluent #1 = BODS > 30 1220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Project Name Albert Tolson Soil Test Plot Plan Shaun i Address 1381 Fox Ridge Trail Houlton Wi 54082 C #226900 Lot Subdivision 3/27/12 Date N W 1/4 NE 1/4S 29 T 30 N/R19 W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of manhole cover System Elevation 92.0/90.5 *HRpSameasBenchmark Scale is 1" = 40' unless otherwise noted To Fox Ridge Trail Valley View Trail Well 0' Existing 3 Bedroom House 20' T Failed 20' B-3 96 40' Property Line 18'X 36' Bed J~ 5' J40' B-2 94' Vent 15' B-85 16% Slope 600' Pro e Line 1840PA~-T 4-398 k-3 ` STATE BAR OF WISCONSIN FORM 3 - 1998 QUIT CLAIM DEED Document Number KATHLEEN H. . MA LSH This Deed, made between Albert R. Tolson and Monica G. Kenney REGISTER OF DEEDS Tolson, Uk/a Monica G Kenney,' husband and wife ST. CROIX Co., MI RECEIVED FOR RECORD 02-21-2002 9:30 AM Grantor, and Albert R. Tolson and Monica G. Kenney Tolson, husband and , wife, as survivorship marital property WIT CLAIM DEED EXEMPT # 1 REC FEE : 13.00 Grantee. TRANS FEE: Grantor, quit claims to Grantee the following described real estate in COPY FEE: CERT COPY FEE: St. Croix County, State of Wisconsin: PAGES : 2 Recording Area Name and Return Address Dwight P. Cummins A See legal description attached 363 5th Avenue North Bayport, MN 55003 '030-1080-50-000 Parce! Identification Number (PIN) This is homestead property. (is) (ice) This document is exempt from the fee and return since it is not a conveyance by definition per sec_ 77.21 (1) Stats. Together with all appurtenant rights, title and interests. Dated this J day of . Alb rt R. Tolson . Mon ca G. y Tolso LEDGMENT AUTHENTICATION STATE OF WISCONSIN ) ss. Signature(s) WASHINGTON County. ) Personally came before me this ~j day of -;X,-:) the above named authenticated this day of , Albert R. Olson and Monica G. Kenney Tolson, husband and wife TITLE' MEMBER STATE BAR OF WISCONSIN to me known to b person(s) who executed the foregoing (If not, instrument ledge the same. authorized by § 706.06, Wis. Stats.) - THIS INSTRUMENT WAS DRAFTED BY Dwight P. Cummins 363 5th Avenue North, Bayport, MN 55003 Notary Public, State of Wisconsin My Co I' q P11011 e iration date: (Signatures may be authenticated or acknowledged. Both are not ) necessary.) Mp iB~r AIL 1t, j00S 'Names of persons signing in any capacity should be typed or printed below their signatures IM-Nor STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3 - 1999 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 500-633-2021 01i;8i2000 FRI 13.41 FAY 1351 687 2680 UNISYS 002 yni '10 f PAGE `-1 39 > i1BIT "A" Part of the West Half of Northeast Quarter (W112 of NE1/4) of Section Twenty-nine. (29), Township Thirty (30) North, Range Nineteen (19) West described as follows- Commencing at the N114 comer of said Section 29; thence N8905919"E(True Bearing) 1292.13' along the N line of said NW1/4 of the NE1/4; thence S002WO7"W/ 55.00' along the E line of said NW114 of the NE1/4 to the point of beginning; thence SO°2T07"W 1304.70' along said E line of the NW1/4 of the NE114 and the E tine of the SWIM of the NE1/4; thence S89°45'46"W 860.95; thence SO°2T07"W 17.31'; thence N76°49'W 146.21'; them NWly 99,31' along a 300.00' radius curve concave NEIy whose chord bears N67120IN 98.86'; thence N57051'W 351.63'; thence My 44.55' along the Ely line of a proposed public road on an 80.00' radius curve concave Wly whose chord bears N8°09'SVVV 43.98';thence N6S°52'52"E 122.537; thence N48028'35"E 1466.09` to the point of beginning TOGETHER WITH An easement for public road located in NE1/4 of the NW114 and the NW1/4 of the NE114 of Section 29-30-19 Town of St. Joseph, described as follows: Commencing at the N114 comer of said Section 29; thence N89°59'19"E (recorded as East) (true Bearing) 13.44' along the N fine of said NW114 of the NE114; thence S872.00'; thence W 685.00'; thence SEly 246.38' along a 197.01' radius curve concave NEIy whose chord bears S54°10'23"E 230-SW to the point of begi- ring; thence E 325.70'; thence S82°2T04"E 180.71'; thence SEly, Sly, Sally. Wly and Nutty 337.ST along an 80.00' radius curve concave SWly, Wly, NWly, Nly and NEIy whoa+G chord bears S38°32'20"W 937.16; thence Nally 122.35' along a 100.00' radius curve concave SW ly whose chord bears N55°14'08W 114.04`; thence W 325.70'; thence N 66.00' along the Ely right of way line of an existing public road to the point of beginning. I I Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP J T_ r-, SEC. T N-R I I W ADDRESS r ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE f~Y? CO I PLAN VIEW Distances and dimensions to meet requirements of ILHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM at ~ Dri vfWAY 5 \41 ~ i ~S s lies: r,1. 55 /3 M o vLa2 Joo' INDICATE NORTH ARROW L1'.,. E Na S c AL,- BENCHMARK: Describe the vertical reference point used / ~If/v P1,04 Elevation of vertical reference point: /CSC?' Proposed slope at site: ~a SEPTIC TANK: Manufacturer: rc 516 le Liquid Capacity: /000 ~f,.Aj__ Number of rings used: y' Tank manhole cover elevation: Tank Inlet Elevation:,,hTank Outlet Elevation: Number of feet from nearest Road: Front,Q::Pideo Rear, O CVe1E' Soo' feet .From nearest property line Front 10 Side,(DRear, O Qyc < A510, feet Number of feet from: well, building: ~ (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Rump 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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench Width: Lenth: ~w Number of Lines: 3 Area Built: y~ Fill depth to top of pipe: 36 Number of feet from nearest property line: Front, O Side, O Rear, ~t.-0 Number of feet from well:G Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: r License Number : 0 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOXi7969 , - BUREAU OF PLUMBING MADISON, M,53707 ,53707 CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: Ilf assigned) ❑ Holding Tank 1:1 In-Ground Pressure El Mound NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Harvey L. Anderson 38 Evergreen Rd. White Bear La55, 10 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. EF. PT. ELEV.: CST REF. PT. LEV.- NW NE, Section 29, T30N-R19W, Town of St. Joseph,Lot#6, Fox Ridge Name of Plumber: MP/MPRSW No.. County Sanitary Permit Number. Gar Zap pa 3300 1St. Croix 75024 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: Cf C' S YES ❑NO ❑YES MNO BEDDING: VENT oil A.: VENT MATE HIGH wATEHI NUMBER OF ROAD' PROPERTY WELL BUILDING. JVENT TO FRESH ALARM FEET FROM LINE O ` AIR INLET. ❑YES NO C ❑YES NO NEAREST _ ;2X'n ' DOSING C AMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL jP1IMP,SIPHON MAN111 AC /111111/ WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: P IMPtPN DC TROLS OPERATIONAL NUMBER OF PHOPEHTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM uNE AIR INLET. PUMP ON AND OFF) YES ❑NO NEAREST 10 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing JIAAMF TEH IMATERIA1- AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: _ OIA SPITS 11-1111D WIDTH I J LENGTH NO OF DISTR PIPE SPACING, COVER 71:~]711111 BED/TRENCH _ TRNCHES MSEHIAL oDIMENSIONS / V' GRAVEL DEPTH FILL DEPTH J'E~S TI I PE PE DISTR NO D_TH NUMBER OF PROPERTY WLLUILDINGVENT TO FRESH BELOW PIPjES t ABOVE CO ~ r VER Lf E NO PIPES FEET FROM LINE AIR INLET ki ~ .l ,Z C/ NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PEHMANI NT MAHKEHS JOBSERVATION WELLS _ ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH RED DEPTH OVER TRENCH HEU Uf PTH OF TOPSOIL SOUDFp SEEDED MULCHED CENTER EDGES ❑YES. ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING IGHAVIL DEPTH BE LOW PIPI- FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMNO DISTH UISTR. PIPE UISTHIBUT ION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION BOLE SIZE HOLE SPACING DRILLED CORRECT LV COVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PR OPERTV WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST Sketch System on Retain in unty file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710 (R. 01/82) unsconsln APPLICATION FOR SANITARY PERMIT fLHR (PLB 67) OUNTY UNIFORM SANITARY PERMIT # OEPRRTTEr'IT OF InDUSTRV,LRBOR 6 HUMRn RELRTIOnS /7/'~D~ L~ -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PRO AARUEY PERTY OWNER MAILING ADDRESS VAEgso~ 3 rug G1ZF-6~ (NON iT£ deAr /k/ICf 1l,~Ia P OPERTY LOCATION C4+r.. S15//0 M IJ 1 /4 10 61 /4, S Z9 , TPN, R / E (or) W TOWN OF: , -30S, erN LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NE EST ROA, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ~D fio x R i D6 E TYPE OF BUILDING OR USE SERVED • a~ 25 1 or 2 Family Number of Bedrooms. 3 Public (Specify): THIS PERMIT IS FOR A: C. 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. S Seepage Bed ❑ Seepage Trench U 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 000 v 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 iFeet): (p i Ue x ((o3a 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: /MPRSW No.: Phone Number: G , Z CFA JP4 -ipso Plumber's Address: Name of Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved _ ~s~j ` f ❑ Owner Given Initial ry kj VApproved 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 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 Harvey L. and Vera A Anderson Location of Property W? k NE 1%, Section 29 T 30 N - R 19 W Township St. Joseph Mailing Address Rt 1 PRESENT ADDRESS: .38 Evergreen Road ,St. Josebh Wisconsin 54082 White Bear Lake, Minn. 55110 Subdivision Name Fox Ridge Lot Number F Previous Owner of Property TPrr,y Pi ri 13S + Total Size of Parcel 20 Acres - Date Parcel was Created 1982 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes X No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed X2. Land Contract , 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. PROPERTY OWNER CERTIFICATION I (We) cati,sy that aU a.tatement6 on .thi.6 6o4m aAe tAu.e to the but o6 my (oun) hnowtedge;--that I (we) am (ame) the owneA(b) of the pnopenty de6CA.ibed in thiA in6o4mafiion JoAm, by vi,%tue o6 a wan.Aanty deed Aeeonded in the 0j.6ice of .the' County Regd bteA o6 Deedb ab Document No. ; and .that I (we) p&"entty own the proposed e.i to Got the sewage pob sy4tem (on I (we) have, obtained an eabement, to Aun with the above de,&cA bed paopehty, joA the eonetn.uc do n o6 e aid a y.6tem, and the a ame hab been duty neeoAded in the D 6 6ice a6 the County Reg-i.6teA o6 Deed6, a6 Document No, ) 0-CA-0--l CIL SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 3-'3-,q12 3DATE SIGNED DATE SIGNED - g E--- zo, ---~oai P14 6 2 } ; y r ► 10 l~LvT /two L,/2ov • SLOPE ALT J'L-GT2arv /~LiorvS : SZTE ~ OVE'2 /o0 7v ~ WE,~.T_ //tap-2TY 12oJ~~T Lr~E OVER /Do/ 70 /1.,'oaT14 /AopA2TY LxNE ~~AnV~Y /yivot~doN BAOPoSEO 43 LO) 6 Fox fizOG,E GNIII~GE , J T- t1ej rEPN /own,.SNxp b Aopacto ArzorNGfi SLope y IfT CAO-xx Co, O - OVER /Oo r TO EATT ~/top,~R7Y LS,vE Moo GAL. -rZE sr. 7pN►~ ~aN T 3 6 6 3 A' P AoPoSEO bvE1L A✓3SaAPTTo.,/ FieLO 30 VEPVT VA c K P/zoFasko D/LtVEVVAY T, K--1 No .fCAJuL 3 ❑ /2-M /00.00 /3.,.7 J ' T2 L e G Tvn of PIPE NE)rT To 194?10tA 7;iEE tti,z r/J REo /2raao v ovE/2 loo' To SOWN P noPElt7Y Lz,,.E FizEsN ArA -2; LExr /9>un DLU'EXVAT-Tv,,, lospF .SozL TtsT2tiG 13Y ~2o13F2T l/L13~cr~►T 0~--- AMIZoVED vENT C^P /yli,"zmum ~~~~Al3ovE .~o..~EO fz vA L CnAo r LscEn,ccE '~/OX~~'►~urt ~ u A,aa F- C/9ST ~I 47o ~e AL C/zrvoIE ~ ✓cNr /'rPE SYN7N6T2G Co✓~rzxNG ~ i DVF_2 I'~=('E i I_J7S'J'R=QNT2o~ y' /~1F0E O o p -.1 i L-LE✓ATxvrv &0 ,607Tary► Prt SbTL i3 t NEATN I PE 0 AE0cl=o/LaTED IIpE ~EI 7~s-r is- 00 F;r OTTD Ote -f >'S I 5/n 6r - .2 0, 3 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; DIVISION 7969 LABOR AND PERCOLATION TESTS (115) MADISONP.O., WI BOX 53707 3707 HUMAN RELATIONS 1.24p o .e f6 X Rt D LOCATION: ; , • SECTION: ~9 TQWbISIAWM NICIPAAL TY: Old IBLK- NO.: SUDIVISIO 9 /T -N/R E (or) W s; • p S COU TY: OBNEWS BUYER'S NAME: MAI N ADDRESS: mip USE DATES OBSERVATIONS MADE T : COMM R A DESCRIPTION: ~~-y/ 17/79/ DESCRIPTIONS PERCOLATION TS: E New ❑Replace 10-7- ~~Residence RATING: S- Site suitable for system U- Site unsuitable for system ONVENT ONAL: MOUND: IN-GROUND-PR URE: S ST -IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) S ❑U OS DU OS [:]U OS EU DS 3U ~'u`k/f If Percolation Tests are NOT required DESIGN RATE: I If any portion of the lot is in the under s.H63.09(5)(b►, indicate: I Floodplain, indicate Floodplain elevation: .PROFILE DESCRIPTIONS BORING TOTAL rP HT R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION BSERVED E TO BED CK IF OBSERVE SEE ABBRV. ON BACK.) .G! t t Arta C I b, 7 t.5 B-3 9v to1. 1~im~ f'o J-,.,J . 1-,-13N. L , 3g n,F'.1.4- S. 3 '1 Y. 104 7 7t( 7 7 37 .7 „ 1W /34J ,5~ 16 L7 . B- /J Q / qIq• y ~c tri `J~- 0 U 44- M C ~i•.°r8. 5;0; 4 42 7r-04, Ski e-0 Po nr_ s S1 S F' " o p s 27 13,v . B- ` PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP-IN WATER LEVEL-INCHES RATE MI ES NUMBER INCHES AFTERSWELLING INTER L-MIN. p PER INC P- T. Cn ICD P- /Cn 7/5 P- P P_ PLAN VIEW: 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 I do on jhe plot plan. Show the surface el vatiop 8t all r1'ngs and tI~ di ecti ~nd percent of land slop. /30TToM 0f li ~i►~GL E L ~fq/7! y f / /duJ' /.7M ~`c P T SYSTEM ELEVATION F% to 7/L''V 6F 96. U FT o ~A r VLF - .y No _ o 2-1304 -A 9 tN - N 01 r .73 _ _ E s ~ 1, the undersigned, hereby certify that the soil tests reported on this form were made by nmilp 1r; accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the ie of my knowledge and belief. NAME print : TESTS W RE,9oMPLETED ON: e r 7 ~~iP/c' Li T / p / CF~RT PIC 10 ER: PFfO UMB6Ei nai tJMJI_ A ORE 3 V ttif 1L e !~G/SOIV i~ 9~° CS G~ DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. J DILHR-SBD-6395 (N. 03/81) H z a r STC - 105 a H ' H SEPTIC TANK MAINTENANCE AGREEMENT o x St. Croix County d 9 H tj7 OWNER/B,LMR/ Harvev T end Vera A Anderson Fire Number ROUTE/BOX NUMBER Rt 1 - .CITY/STATE St Joseph Wisconsin ZIP 5408 W'-z NE29' T 30 N, R 19 W~ PROPERTY LOCATION: -14, Section - Town of St. Joseph St. Croix County, Subdivision Fox Ridge Lot number 6 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 um er. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. + St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement: of a failing system, which was in operation prior.to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new sistems agree to keep their systems properly maintained. The property owner agrees to sihel ownerSandCroix a master plumbera certification form, signed by journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than /3tfull of sludge Certification form will be sent app E three year expiration. ° z I/WE, the undersigned, have read the above! requirements and agree En to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form mCstwithcompleted and returned to the St. Croix County Zoning Offs, of the three year expiration date. I j- SIGNED t'..~. D AT E 3-3-86 St. Croix County Zoning Office P - 0. Box 98' Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. T 3ON, R19W NORTH LINE OF THE NW 1/4 OF THE NE 1/4 N d9' 59' IV E 1292.13' - 1276.69' PgINT Of BEGINNING C FOR PARCEL 0 \ 24• DIA. \y OCCU►IE ~M1 i ~ x- 41 PARCEL 5 1 0 20.01 ACRES u Oa r zn Ow Q 60 R ti 91 o .I f Oq W W 6 ~ V ti NW-NE 0 z n wM W o- Z 0 r IA 4 - 0 !y \ PARCEL 6 Z \ 20.16 ACRES W OYD X11 yb ~h 1. w Dt., 1:31-54' 24' so' L• 44.53' -T N 6'0'{6" W 43. 103' 01'02 4° a 60.00' OA 143.64' 4' C3, ~d. • C W M 47' E Co T 5.23 0 4~ R+60' q w Lam-66.03' d• b N 32. 06'59"E 69' 45' 'YY 660 95' w 66.00' 99, -133:6P W JF~.2p 6.21 402.09 26.66 x N 0 POINT Of o PROPOSED 1Y HOUSE A-19-5 Y BEGINNING OF L: 121.E 81. Y2 PARCEL 7 IS O A ° DOCUMENT NO. STATE BAR OF WISCONSIN - FORM 1 I 1 LAND CONTRACT-Indlvldoal and VUL 636 PA( E2 S ll Corporate ~~3721 THIS SrAG6 RESERVED FOR RECORDING DATA I., REGISTERS OFFICE Contract, by and between Tern y ..E-._-.Fix ius.._,_-..-_,..... ST. C:;CIX CO Rec'd. iGI R-rt.~ordit• s 2nd ("Vendor". Oct 1 whether one or more) and..Harvey_..L,• And~rsQn__a d__ Ve day o.'f~~^ q, Dr' 9 81 A.__.Arnderson,..his... wif_e,__Aa._Jzint._Tenants at 2:20: p ("Purchaser", whether one or more). Vendor sells • and agrees to convey to Purchaser, upon the prompt and full per- a T formanee of this eoI}Qract by Purchaser, the following property, together with the Rr»k1K ~t De+dt rents, profits, fixtures' and other appurtenant interests (all called the "Property"), St..,.Cr.pXX County, State of Wisconsin: I Part of Wj of NE-41 of Section 29-30-19 described a RETURN TO follows: Commencing at the N4 corner of said Sec- tion 29; thence N89059119 E (True Bearing) 1292.131'along the N line of said NW4 of the NE4f thence S00291 07"W 55.00' along the E line of said Tax Key No j NWj of the NEJ to the point of eginning; thence SOo27'07"W 1304.70NEllong said E line of the NA of the NE-41 angl the E line of the SW4 of the 4 Ithence S89045146"W.660.951;thence SO 27107"W 17.31`1; thence N76°491W 1~r6.2111; thence NWjy 99.31' along a 300.00' radius curve concave NE1y whose chord 11 !.bears N67 201W 981861; thence N57°511W 351.63'; thence Nly 44.551 along the;'; Ely line of a proposed public road on an 80.001 radius curve concave Wly whose chord bears N800915611W 43.981; thence N65°52152"E 122.531; thence N4802613511E 1466.09' to the point of beginning. TOGETHER WITH An easement i. for public road located in NE4 of the NW4 and the NW4 of the NE4 of Section ,29-30-19 Town of St. Joseph, described as follows: Commencing at the 444 jcorner of said Section 29; thence N89059119"E(recorded as East) (True Bear 'ling) 13.441along the N line of said NW-41 of the NE4; thence 5872.00,; thence W685.001; thence SE1yy 246.38' along a 197.011 radius curve concave NEly I. (whose chord bears S54°10'23"E 230.64' to the point of beginning; thence fE 325.701; thence S82°27'0411E 1$0.711; thence SEly, Sly, SWly, Wly and NWlyj 11337.871 along an 80.001 radius curve concave Sally, W1y, NWly, Nly and NEly , (whose chord bears S3803212011W 137.161; thence NW1y 121.35' along a 100.00' f) radius curve concave Sally whose chord bears N5501410811W 114.041; thence W 325 701• thhe ce 4466.001 al n the El right-of-way line of an existing public Poad o the point o~ Degnnin~. This p. n p)t . omestea prop y. • Purchaser agrees to purchase the Property, and to pay to Vendor at%QO.. e.GQnd.. t-•.f-- IU-d l~Sl t-• W* I the sum of $.'1~.}QQ0...0------------------ in the following manner: $.5QQ0- .0Q--------------------•--------------- at the exceution of this Contract, and the balance of $26_,_O.QO_._oa--------------------- together with interest from date hereof on such portions as remain from time to time unpaid, at the rate of--------- fl.__-__._•_-.-.-_-- per cent per annum, until paid in full, as follows: Two payments to be paid to Terry Pirius, 700 Second Street, Hudson, Wis. as follows: December 1, 1981 $10,000.00 January 2, 1982 $16,000.00 If there is any remaining principal after January 2, 1982, it shall bear interest at 129/6 per annum. ~ ' F+;,~wl4aaepr-unless-axeused-~3~•-~el~ieiti-wgsees~to-i+a a t#~e--pa3a~~eat-e~-takes,-apesial-essesermm ,Are-eenel-required-iaenrasiee~premia ns--9'o•-t}ea -extent-received-~dor. Vendor 9912 payment 0 AF1 these igation&- wises-due'-S'' 10+2 &a.-a-Fad by the ' Ven taxes,-seeessi<rents-and-incur-anee-il-be-dei~ositecl-i►Lc~~r►-esorovv-#tiad ter-trustee soe°utlt, but-ehel Paymerrts•-shall- -be-eppiied--first-tv-interest en 43~e-unpaid-baltiresee-at the-rake apee+fled-arni-thett-to-principat:-Any 1 j anlonsrtr-InaS'-be prepe►id-witlleut-prcrliusrr es-feeupox-principal at-arry-ti:s:e-seT---,------.--- 2_49 f0'* I titers rm~'^be'Tte'Prepe7rnels~ a€ Prn~eips~ ~vitheatr per~rrisaien-at-Vendor.' In the event of any prepayment, this contract shall not be treated as in default with respect to "payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall he treated 1 as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been 1 made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds j of insurance or condemnation, the condemned premises being thereafter excluded herefrom. i Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: NONE Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitle to take possession of the Property on... OCtnbex•.-1...• 19.81... *Cross Out One. (TO BE USED IN NON-CONSUMER ACT TRANSACTIONS) j LAND CONTRACT-Individual and STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. Corporate FORM No. 11-1977 Milwaukee, Wis. (.lob 34408) VOL' 636 Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. '33 3, -11- am- I- fisa ex tended coverage p4rils and such other hazards as Vendor may require, without co-insurance, I ro proved by Vendor, in the sum of a--------------------------------------------- but Vendor sh coverage in an amount more than the balance owed under this Contract. Purchaser shal ranee premiums when due. The policies shall contain the standard clause in favor of the Ve ' ' and, unless Vendor otherwise agrees in writing, the original of all policies covering the Pro IF eposited with Vendor. Purchaser shall promptly give notice of loss to insurance com an' or. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be s oration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: X._l.alad...contr_ar-t.. from- Gary W._Jenki.ns_.and__Por_athy..Ana__,7enkins.,_hi.s...wife.__to..D..__David__Fearing_-. and_.~I s-..J~~_- F~ar_~xlg.,_.-xeeor_ded..~x~--~a7,-..-.49Q•,_.-rage •.491.,•..Da~.._..312~7.9,Which. Y~as_ been. ss ~,meci by_._D,_•_Dav d..F ari ng•_ax~d__M..__ June.- Fearing.._to.•Tex'x_~~tt_..F_..•_. Pi_r, ~_.us. Said. id assignment recorded in ..VOl. 548, Page 5 9,_.Doc _3374~?0 snd Purchaser agrees that time is of the essence and in case of default in the payment of any principal or interest when due, or in the performance of any of the conditions, covenants, or promises of Purchaser, and such default shall continue for a period of days, then Vendor may, at Vendor's option, declare the contract at an end, all rights of the Purchaser under this agreement cancelled, and the amounts paid by Purchaser hereunder forfeited, the same to remain Vendor's property as rental of said premises and as liquidated damages for the failure completely to fulfill this agreement; and Vendor shall forthwith and without notice have the right of re-entry; or, at the option ~*f Vendor and without notice to Purchaser, notice being hereby expressly waived, the whole amount of unpaid principal shall be deemed to have become due and payable, in case such option shall be exercised, the unpaid principal and interest together with all sums which may be or have been paid by Vendor as herein authorized with interest on such disburse- ments at the rate aforesaid shall be collectible in a suit of law, or by foreclosure of this contract in the same manner as if the whole of unpaid principal had been due at the time when any such default occurred, and the indebtedness shall embrace, with unpaid principal and interest, all the sums so disbursed with interest as aforesaid. In case of legal pro- ceedings to enforce any remedy hereunder, whether abated or not, all expenses, including reasonable attorney's fees, shall he added to the principal, become due as incurred, and in case of judgment shall be included therein. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property, during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Vendor does hereby agree to make all payments under sAid land contract to the Vendors thereof, as they become due. Also easements of record, if any. Dated this 1st day of October 1981. ----~=~-'~-----•---------(SEAL) (SEAL) • 'ERR 'ZR~I7 • HARVEY._.L, . DER QN_.._ _ • (SEAL) ?(SEAL) . VERA_--- SQN_-------•---------------- AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN as. Jt_,--- Cro ix----------------County. Personally came before me, this I_St day of Qctober.,.i.98'l_.- the above named _-HAryey-_.L,. TITLE: MEMBER STATE BAR OF WISCONSIN Tekien dr~rn~'a.x'auA. Ax1S~'SQI.. (If not "l authorized by § 706.06, Wis. Stats) --)P - ~•s,.- - ,1 . h0 W04 the THIS INSTRUMENT WAS DRAFTED BY to me known to be th pL1rson aX -4-W foregoing instrument d acknowie cn ~ ~i Sue H•. Auf------------------------------ (Signatures may be authenticated or acknowledged. Both Notary Public 5.._.~ix'Q_.._..::: 'Cgantg,'Wis. are not necessary.) My Commission is permanent. (If'ngt,' state expiration The use of witnesses is optional. date: ..Q_ctober--- 7......................... 19.82_-.) l r t~ 'Names of persons signing in any capacity should be typed or printed below their signatures. 40 n' 1 . n LA1•ID CONTRACT-, Individual and Corporate - State Bar of Wisconsin, Form No. 11 ad Parcel 030-1081-50-000 05/31/2006 05:11 PM PAGE 1 OF 1 Alt. Parcel 29.30.19.293B 030 - TOWN OF SAINT JOSEPH Current IX-1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - TOLSON, ALBERT R & MONICA G ALBERT R & MONICA G TOLSON 1381 FOX RIDGE TR HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1381 FOX RIDGE TR SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 20.030 Plat: N/A-NOT AVAILABLE SEC 29 T30N R1 9W PART OF W 1/2 NE 1/4 Block/Condo Bldg: COM N 1/4 COR SEC 29 TH N 89DEG E 1292.13 FT ALG N LN NW 1/4 NE 1/4 TH S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ODEG W 55 FT ALG E LN SD NW 1/4 NE 1/4 29-30N-19W TO POB TH S ODEG W 1304.7 FT ALG E LN OF NW 1/4 NE1/4&ELNSW 1/4 NE 1/4THS more... Notes: Parcel History: Date Doc # Vol/Page Type 02/21/2002 671705 1840/338 QC 07/25/1997 1253/403 WD 07/23/1997 1014/66 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 38,300 249,100 287,400 NO PRODUCTIVE FORST LANDS G6 1.030 19,200 0 19,200 NO ENTERED BEFORE'05 CLOSE W8 18.000 146,400 0 146,400 NO Totals for 2006: General Property 2.030 57,500 249,100 306,600 Woodland 18.000 146,400 146,400 Totals for 2005: General Property 2.030 57,500 249,100 306,600 Woodland 18.000 146,400 146,400 Lottery Credit: Claim Count: 1 Certification Date: Batch M 302 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 . 'Parcel M 030-1081-50-000 12/02/2005 12:26 PAGE 2 OF 2 F 2 W' Legal Description: cont. 89 DEG W 660.95 FT TH S 17.31 FT TH N 76DEG W 146.21 FT TH NWLY 99.31 FT ALG 300.0 RAD CURVE CONCAVE NELY -CHORD BEARS N 67DEG W 98.86 FT TH N 57 DEG W 351.63 FT TH NLY 44.55 FT ALG ELY LN OF PROPOSED PUBLIC ROAD ON 80 FT RAD CURVE CONCAVE WLY -CHORD BEARS N 8DEG W 43.98 FT TH N 65DEG E 122.53 FT TH N 48DEG E 1466.09 FT TO POB m ~ ° o c ° cv 3 ~o 0 :3 p N F- O~ O p to Of O C p 0 N V i U) O C p V m L- O p C O N y t 3 C p i 01 0 O C cA .0"O"a .p. = ~ LU _o cc la==0 c°ov co °z _ v E c V cn°~~m c ca ~ cn m.c rn°... ° ~ ~ cm 0 U) 0.2- ca Z U to 4) G V N N- o N y C f w cc ~c a) b.. 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