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HomeMy WebLinkAbout032-2054-20-000 v 0 on N Op 0 M 0 _0 0 O O 0 N fl.iL a Y i -o o a o f6>s ' fi ~ L O E 2 4 m x a) O Z` O c Y CI- 0 '0 Oa LL - O S~ ' a y 0 a) (D 3 v c z EY c 7 a 7 O LL C C O U a E € - a N a) m CL CL 0. CY) m v Cl) vl! ~ z d a m 0 m o z _0 c w 0 z U a o _ o in P aci z c Q) E v 'a O M L N a) _ N m N U) C •N 0 CL L L C C 0 U d o Q z z o N z N d C C N C i m E >m 7 N w C L m aS C) CL t0 w O C In ~ N N d 0 _r O a~ o O O a Q E 333 ° U' zo 0 0 0 •w ro a a a cl) EL CL) (rl i m CO N c N E ) J V1 fA ~ ~ cu CD N O m N C Q) ~ E 1~{_~1 r rn Q 0. N Q) y O 7 w !~i O O O N C ~i 0 CO CN r- ~i O O L a) C C Cwt CL 5 0 N I- _ m ~C Y N N c c: V W O y N C LO 00 E a) .~i N o° E rn L, Z` R r • }a M ui O U Q) 0 N m m M U y O U) U) O rL (n O it = ~ W r x~ V L m a a • ~ a d i' d d c rra~j i E c l c 3 "'1 A edam!, 0U)0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER- Salllrz ADDRESS SUBDIVISION CSM / ~ LOT # -AIA SECTION T N-R W, Town of_,-9) E SE% ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ H ouS~ oC-n (9) a A00+ FAs? 7y- )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: f STEEL f ~U iTR 444zz ,-I.af~e'~!c' ~L ♦ny, D . ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: WE&Liquid capacity: /,Zoo Setback from: Well House 66 I Other Manufacturer Model# S' Float seperation le: le Al ation -:SOIL ABSORPTION SYSTEM L Mr&_S Width: Length Q Number of trp~%S 3 Distance & Direction to nearest prop. line: / ev i- Setback from: well: 25-0'0` House 12,4 ~ Other ELEVATIONS Building Sewer ST Inlet, .10j,17- ST outlet PC inlet- MA PC bottom ~Q Pump Off Header/Manifold Bottom of system Existing Grade Final grade fQ~, .S DATE OF INSTALLATION. . - PLUMBER ON JOB: LICENSE N ' UMBER: QS 32 INSPECTOR: 3/93:jt LOCATION: SONRSET 15.30.19.702B Wisconsin Departmento Industry, PRIVATE SEWAGE SYSTEM County: L?aborAn&HumanRelations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitary er it Permit Holder's Name: ❑ City ❑ village [Town of: State Plan o.: CHMITT, JOHN F & KATHLEEN M SOMERSET CST BM Elev.: Insp BM Elev.: BM Description: Parcel Tax No.: `J L' ' ,J , ~ tF e ms . TANK INFORMATION ELEVATION DATA A9300352 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e- a7t~,:> Benchmark / Dosing Aeration Bldg. Sewer fly,`, A., Holding 1771 St/ Ht Inlet ~3~ fry ' TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P / L WELL BLDG. Air Ito ntake ROAD V% Dt Inlet A Septic C) NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe a-SSA Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width LengA r No. Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS l61 /j DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: 111r_19 ~o~CJt3` 1'16 ~1J4 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. I Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Oyer xx Depth Of xx Seeded/ Sodded xx Mulched No Bed /Trench Center Bed /Trench Edges Topsoil [I Yes E] No E] Yes E] COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 15.30.19.702B IV- Plan revision required? Yes No Use other side for additional information. SBD-6710(R 05/91) Date Insp or Signature Cert No. ADDITIONAL COMMENTS AND SKETCH 1 SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION V'~L■7■'l In accord with ILHR 83.05, Wis. Adm. Code COUNTY ` STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S=M,ffJr_ J- '/4 S T , N, R E (or W CTO /M/ PROPERTY OWNER'S M ILING ADDRESS LOT # BLOCK # (o 01464,EX A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 5 C L _5 TYPE OF BUILDING: (Check one State Owned 13 CITY NEAREST ROAD ❑ VILLAGE : _ 3-a T,S! TOWN OF: 5 L ❑ Public X 1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. )Aj New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only ' ?22 Existing System Existing System B) A Sanitary Permit was previously issued. Permit ZZ& Date Issued L/ - .oZ 9- in ! 3 V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 N Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION coo ~pO D I A- ~ ,S, Feet . Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank L Lv r _K~ El F1 F-1 Ej I El I F-1 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown attached plans. Plumber's Name (Print): Plu 's Signature: (No Stamps) M PRSW No.: Business Phone Number: 17- 7' 3A 0s- y Plumber's Address (Street, City, State, Zip Code): /_g- -/D IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa nary Permit Fee (Includes Groundwater Date Issue Issuing Ag t Sign a (No S ps) Surcharge Fee) pproved ❑ OwnerGiven Initial. ~ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08193) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. 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 in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental 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 plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY -.e...,...~,....~ ) 7 X12 STATE SANITARY PERM-Attach complete plans (to the county copy only) for the system, on paper not less than / 8% x 11 inches in size. 1:1 Check Uelv? on to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION / 71 CV Y4 tV Y4, S /J~ T :30, N, R 9 E (orlo BLOCK # PRERTY OWNER'S MAILING ADDRESS E~ ~~t LOT # ^ ~T 6_86 d V / T CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER O s- s N II. TYPE OF BUILDING: (Check one) 11 State Owned ❑ VILLLLAGE : L3/QS NEARS -ROAD 7❑ Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms -F PAR EL TA NUM ER( ) 111. BUILDING USE: (If building type is public, check all that apply) -20 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. N New 2. ❑ Replacement 3.E1 Replacement of 4.E1 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 X Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) Min./inch) ELEVATION ©d r5/GN IA4 o Ys A P-7-1-= 76. Feet 5?57, -2 Feet VII. TANK CAPACITY Site in allons Total it of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 00 F1 El F1 1 El Lift Pump Tank/Si hon Chamber El n VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum 's Signature: (No Stamps) / Business Phone Number: D^44AW'OL &C'tef/ rr ~ Plumber's Address (Street, City, State, Zip Code : S IX. COUNTY/DEPART EN USE ONLY ❑ Disapproved Ssnary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved El Owner Given Initial Surcharge Fee) r 3 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. ' 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SE1D 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, purnp/siphon and holding tanks for this systE:m. 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 plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; (Jose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. 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, ground- water contamination investigations and establishment of standards. SBD-8398 (R.11/88) t i - - L: A 0, 1--7 M • } j i oso 1 tQ©i I i I i I I ~ I y I ; ~ l i l l l ; y I I } • i t f I r • 4 - I I i I i i i_ I I ~ t ~ I I- ' i I i I ~ I! I j I ~ i~~ U i _ ~ j I I IPA i I - - ► { - I - ! i I , ~Acvi- ,T 1 r - s~86 vGG~ /tu f X86; U~IG~ /Ecv _ r ~ sir M4 - ~'f-~ aA5 Po t s ! / :I - o~ s - , • 3~0 • -r ~ ~ , _ t i j ~ I i I ~ I 1 ~ t ~ I i ~ I i Ir - - i- _ I, i i I i _ _ ~ t ~ - _ _ I ~ i i ~ ~ _ i ~ • i I } _ _ _ I i ~ - - i I j _ t ~ ~ j j ~ i i i i , I i ~ I _ i i i - i t ~ i~ i ~ 1 ~ i ~ . i , j ~ I _ i ~ ~ j ~ ~ ~ _ ~ _ I i i ' i . i I _ . j ~ ~ i - ~ ~ - - , j _ ~ I I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATION: SECTION: P/NICUMMUM L T NO.: BLK. NO.: SUBDIVISION NAME: SW 141 15 /j30 N/R19K(or1 W Somerset /a n/a n/a COUNTY: CPVQEXDqEMYER'S NAME: MAILING ADDRESS: St. 'Croix i John Schmitt .R.#2, Box 295A, Somerset, Wi. 54025 USE I DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMM R AL DESCRIPTION: PROFILE DESCRIPTIONS : N TESTS: LResidence 3 n/a UNew ❑Replace I 9-27~ 7n,/ a b I RATING: S= Site suitable for system U- Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUNDPRESSURE: S STEM-IN-FILL HOLDING TAN RECOMMENDED SYSTEM: (optional) s❑ U 9S ❑ U SD U ❑ S S U 1:1 S® UK: conventional If, Percolation Tests are NOT required DESIGN RATE: /a If any portion of the tested area is in the under s.H63.09(5) (b), indicate class 2 n/ a indicate Floodplain elevation: T decimal' PROFILE DESCRIPTIONS page 34 COC2 BORING TOTAL PTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHS ELEVATION OBSERVED EST. E T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 8.91 100.35 none >8.91 .75bl.1. .83bn.s 1. 3.33bn.s.1. 4.00bn.l.s. B-2 8.49 100.10 none >8.49 .83bl.1. 1.00bn sil. 2.83bn.s.1. 3.83bn.1.s. B 3 18.25 100.00 none >8.25 .83bl.1.1.25bn sil. 6.17bn.s.1. B 4 8.16 101.20 none >8.16 .83bl.1. 1.08bn sil. 2.58bn.s.l. 3.67bn.l.s. B-5 8.08 101.01 none >8.08 .83bl.1. .75bn.6il. 3.17bn.s.1. 3.33bn.l.s. B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D PER INCH P- P- P.see design. rate P- P P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. i i SYSTEM ELEVATION 95.95 I t y ► i - i _ ~ _c el: is o Ib~ t elev tin 90 ~ a i -too 2 t , ~ A v r , t ; t ~ t t t , i i : ~ ~ i ~ ~ . J I { {l;t i I, thle undersigned hereby certify that the soil tests reported on this form ,d1 re made by me in accord witg the procedures and methods specified in the Wisconsin Adrr)inistrtive Code; an)i that•Rhe data recorded and the location of the tests Ire correct to the best of my knowledge and belief. NAME (print : ; TESTS WERE COMPLETED ON: art L Steel AD. DRESS: CER14FICATION NUMBER: PHONE NUMBER (optional): 88 N.':Shore-dR., New Richmond Wi. 54017 ? 229 15446-6200 C CST S'GN URE: rI DISTRIBUTION: Original and orre copy to Local Authority, Property Owne TER Spi l Tester. DILHR-SBD-6395 (R. 02/82) - ' 'I STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 40M (Z C. #Z7 / T 7- ROUTE/BOX NUMBER 414 /.7O 7ff eS ~C FIRE NO. CITY/STATE ZIP PROPERTY LOCATION: U,Ll/4 /4, Section I T 30 N, RW, Town of d0'Yl~ , St. Croix County, Subdivision &A , Lot No.&4_. 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 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 $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE 023 ` -3 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address + 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 r/d 1~/V c-)/'_. r T T Location of property 1/91/9, Section, TN-R1.9_W Township G T1m . ' -r- /jj/ address seo!r o~4Gz,_4= _(l/FLU "/E( , T' Address of site loZ46 711 Subdivision name- Lot number AA Previous owner of property T~}wo1,0 [r/2.4A(6e-A Total size of parcel ~Z Date parcel was created f/(/d Wly Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes 0 Volume and Page Number Syr as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of th Znty Regi ter of Dee s , as Document No. ~/8kl peeos~, as Document No. nature of owner Signature of Co-Owner (If Applicable) 3 - V-~ Date of Signature Date of Signature vt: Pa~~ DOCUMENT No.. STATE BAR OF WISCONSIN F RM 11 •1982 THIS SPACE RESERVED FOR RECORDING DATA LAND CONTRACT ~y+ ua Individual and CCa (1116 (~5,00013 FINANCED ANO N O THERS WHERE OVER 45//~~886 S HER WHCONSUMER ACT TRANSACTIONS) REGISTER'S OFFICE Contract, by and between Harold J. Granger and ST. CROIX CO., WI Jeap O Granger, his wife Recd for Record ('Vendor", whether one or more) and John F. Schmitt and Kathleen M. JAN Q a Swanson as joint tenants with right of 3:20 P.-~ MA~ (*Purchaser*, whether one or more). survivorship C~n'C Vendor 30113 and agrees to convey to Purchaser, upon the prompt and full per- yr• Re9f~terofDeetis formance of this contract by Purchaser, the following property, together with the rents, protits, fixtures and other appurtenant Inters3ts (all called the 'Property"), in St_ Croix County, State of Wisconsin: RETURNTO Gwin & Gwin All of the SW of the SW 14 of Section 15, Town- P. O. Box 106 Hudson, Wis. 54016 ship 30 North, Range 19 West, EXCEPT the follow- ing two previously conveyed parcels: Tax Parcel No. 32-2054-20 Commencing at the SW corner of said Section 15; thence North 546.74 feet; thence East 858.78 feet to the POINT OF BEGINNING; thence due North 508.77 feet; thence N43603'E 356.1 feet; thence N866211E 210.0 feet to the center of a Town Road; thence along said centerline, SO0°51'W 810.88 feet; thence N86°16'W 441.43 feet to the POINT OF BEGINNING. Commencing at the SW corner of said Section 15; thence North 546.74 feet; thence East 858.78 feet to the POINT OF BEGINNING; thence S86616'E, 441.48 feet to the centerline of the Town Road; thence SOe51'W, along said centerline, to the South line of said 3W} of the SW}; thence West, along said South line, to a point which is directly South of the POINT OF BEGINNING; thence North to the POINT OF BEGINNING This is not homestead property. (13) (IS not) 1620 Euclid St., St. Paul, MN 55106 Purchaser agrees to purchase the Property and to pay to Vendor at tha sum of S 3 6 , 500.00 in the following manner: (a) t at the execution of this Contract; and (b) the balance of $ 7 o 2 Q n n n ,together with Interest from date hereof on th3 balance outstanding from time to time at the rate of_ E: i gh t- a nr3 n nP -ha l f ( 8 - 5 )per cent per annum until paid In full, asfollows: In 60 installments of not less than $600.00 per month, principal and interest, beginning on January 15, 1990 and continuing on the 15th day of each month thereafter until fully paid within 5 years from the date hereof. Interest shall be calculated on the unpaid balance on a daily rate basis of 1/360 of the annual rate. Provided, however, the entire outstanding balance shall be paid In full on or before the 6th day of ja n11 a rv , 19()i_( the maturity date). Following any default in payment, interest shall accrue at the rate of 12 - 0% per annum on the entire amount in da:feuit (which shall include, without limitation, delinquent Interest and, upon acceleration or maturity, the entire principal balance). Purchaser, uMeerexeused•boy-Yerlder, agrees to pay4r4athgr-te-Vender-0"wros-ftNiebeM-tebetrreasenaby-errtict• Paged annual taxes; special assessments, fire and required Insurance premiums when due. io4*e-extent.( Ived by-Vendor, vender-sgrees-torappty-payments-tt7vm;lu ubftgatlom-whart'tlv6'~n*r'arn-amg-r iFE rgw-bV-M-We-ndo7To? payment of te1«esI-aseeeements• at+d-ff+auf0nee-wik~ -~s -depeeltee~-kko- err eaerow -fund-or ~re»teo- aoeonnt;- •bat-shelf-net -bear-Irrteresl unless o4heFw4esegriFed uy-laAov+ Payments shall be applied first-to Interest on the unpaid balance at the rate specified and then to prlnci al. Any amount may be prepaid without premium or fee upon principal at any time after-January F 19-ytl -tet) tharo -y-be slo prapaysaept pr l." peg..w Hlwut-permaaeleno#-VendoFi In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and Interest (and In such case accruing Interest from month to month shall be treated 1 as unpaid principal) Is less than the amount that said Indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall he countinued In the event of credit of any proceeds of Insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title all shown by the title evidence submitted to Purchaser forexam ination except: Undefined Riqht of. Way Fasement for Rural Electric Line, dated August 3, 1939 and recorded October 11, 1940 in Vol. 263, at Page 212. 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 13 paid. II Purchaser shall be entitled to take possession of the Property on h da t.(~-4 F q 1.Q=_ i rig f g c(o„ Out One. - 11 I _ - - I~ I LAND CONTRACT-Individual and STATE PAR OF WISCONSIN NTF 2278 Corporate FOP.M No. 11 - 1982 Neico Forms, P.O. Box 1075, Green Bay, N11 54305-10751, tarty Purchaser promises to pay when due all tax" and assessments levied on the Propthty or Von In it 4nd to deliver to Vendor on demand receipts showing such payment. vPA6E~~ ^ -'Purchaser shall keep the Improvements on the Property Insured against loss or damage occasioned by fire, ex-Y- tended coverage perils and such other hazards as Vendor may require, without co-Insurance, through Insurers approved r R~ 29, 200.00 but Vendor shall not require coverage In an amount more N han the Vendor balance sum owed of i under this Contract. Insurance premiums when rue. The policies shalt ' than `n hall a Purchaser My the contain the standard clause in -favor of the Vendor's Interest and, unless Vendor otherwise agrees .n writing the original' ~f all policies covering the Property shall be depoolted with Vendor. Purchaser shall promptly give notice of loss b XzPnsursncef companlee nd Vendor. Unless Purchaser and Vendor otherwise agree in writing, Insurance proceeds shalt be applied to restoration ol,repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. " 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 stove 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 actor default of Purchaser, and except:J1nde fined Right of Way Easement for Ruzal Electric Line. at31o1-263-•-at--Dage Purchaser agrees that time Is of the nce and (a) In the event of a default in the payment of any principal or interest which continues for a period of_days following the specified due date or (b) In the event of a default in Purchaser riod which days thereof by Vendor (deliveredbpe slonallyf or mailed by certified contmailinues thentheeen ire outstt riding ba and ewunderythis contra shall became immediately due and payable In full, at Vendors option and without notice (which Purchaser hereby waives), and Vendor shall also have the' following rights and remedies (subject to any limitations provided by law) addition to those provided by law or in equity (11) Vendor may, at his option, terminate this Contract and Purchaser a rights, title and Interest in the Property and recover the Property back through strict foreclosure with any equity" redemption to be conditioned upon Purchaser's full payment of the entire outstandingg balance, with Interest thereon (root` the date of default at the rate in effect on such date and other amounts due hereunder (In which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for t Property if Purchaser falls to redeem); or (it) Vendor may sue for specific performance of this Contract to com immediate and full payment of the entire outstandng balance, with Interest thereon at the rate In effect on the date, default and other amounts due hereunder, In which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (III) Vendor may sue at taw for the entire unpaid purchase price or any thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a qu et-t action if the equitable interest of Purchaser Is Insignificant; and (v) Vendor may have Purchaser ejected from possess of the Property and have a receiver appointed to collect any rents, Issues or profits during the pendency of any action, under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued In litigation and all costs and expenses including reasonable attorney's fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to t extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, , curreo, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser C0lteen to the appointment of a receiver of the Property, including homestead Interest, to collect the rents, Issues, and profits the Property during the pendency of such action, and such rents, Issues, and profits when so collected shall be held, applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest In the Property (by assignment of; of Purchaser's rights under this Contract or by option, long-term lease or In any other way) without the prior wrf consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or rite ,interest - conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security or an Indebtedness Purchaser. In the event of any such hansfer, sale or conveyance without Vendor's written consent, the entire outstandl balance payable under this Contract shall become immediately due end payable In full, at Vendor's option ~withoutjngi Vendor shall make all payments when due under any mortgage outstanding against the Propertyoa th64date this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided PurchaaK_ makes timely payment of the amounts then due under this Contract. Purchaser may make any such paym ants direc made ow the Mortgagee It Vendor fails to do so and all payments so made by Purchaser shall be considered this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. 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.) Oat d his 6th day of Ja r 1990 SEAL) Eli Ha a ng~6 John F. Schmitt (SEAL) (SEAE Jean O. Grande Kathleen M.` Swanson - , AUTHENTICATION ACKNOWLEDGMENT S gnature(s) Harold J. Grangfar & Jean O. STATE OF WISCONSIN SS. Gram& JOhn F. Schmitt & Kathleen M. Snson County. k auIhe led t s d of January 19 90 Personally came before me this day oir1~~ - • 19 the above named - N/A H h- H. Gwin _ 3-- - - _ : TITLE. MEMBER STATE BAR OF WISCONSIN lif not- ►o me known to be the person who executed the author i ed by § 706.06, Wis. Slats.) foregoing instrument and acknowledge the same. } THIS INSTRUMENT WAS DRAFTED BY Att Hu h H. Gwin Gwin_&-Gwin___ Notary Public -County, Wis. 430 2nd S,.reet, __Hudson, WI 54016 My Commission is permanent. (If not, state expiration i (5 gnatures may be authenticated or ackrowie0ged. Both ;lire 18_ ) me riot necessary.) N T F 2278A ":..nary of p,R 5pn5 Solo nlq .n u.,y ,:a{.n dy Sh,.c:r h, rr rP,d ur In in!n,l [!slow IhCr ~:gnalWey. State Bar of W iscontiln I AND CONTRACT-Individual and Corporate Form No. 11-1992. Nelco Fuwms, P.0 Box 1075, Green Bay, WI 54305-1075