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HomeMy WebLinkAbout036-1014-90-000 C c 3 0 1 3 o O v> O E» N y N O (n O E O CL N _ I M L N a C ~ tY cc E i _ N F. ~ N I CL N ° N CD > i I.- 0 0 .0 z z U U c N m n co LL O LL O ~0) c C O 1 l~ ~ -p O ~ "O 0)~ Q U Q O C N C O 3 M U N V O 4i Z ill E J 0 00 0 E L z ~ d d d w CL a CO c (7 c U O y O` m O ar 2 d c 0) aci Z 0) I- r 0) C c E - - 0 m O y O N 0) O O N 7 Q N a) • ~v (n .C (n "c 0 a O U 0~ p O N Q 4= O Z m z Z co z N ~ N i ~ d N In CL M 0) ►~i C n E E v w E 0 = 4,) co 0 (0 .C CL M - 06 E~ N w 0 O c > N L NI O N a II30oa` E 0 ~ o H o H a El ~o ~n E H H awl O E d a o v O L o E 0 0 0 0 a a N • ►r~ a a a 3 a a~ z Lo U.) 0) 0) o N a~ rn 0) - 3 rn rn } V) / J U Z 0) rn c 7z Z (U t- 00 U~ O M N > 0 0 0 O a~ ao O 5 Q 04 N = E Q o = T5 I o m ~ a I L 'd m y C:73 N cn O Cif N Z U1 O N '6 N QI } ',f) O 'C N Q 0 d 04 d O N O O p N C H W p E O I' C E ti8 O 00 O 6 CO E O co O O Q C O y "O E c ~ C aci 00 0 0) 17 c -2 CO co (D `rye)' ^1 co c}a v v, E m U w M O v co O (n O ' N N O (n Z V) O ~ r w Ed L 0) IL 4) IL L` c/~ E` 3 ; 0 3" O Wiscons rrDepartmentof Industry, PRIVATE SEWAGE SYSTEM County: ST. CROIX Labor and Human Relations INSPECTION REPORT Safirty and Buildings Division Sanitary Permit No.: (ATTACH TO PERMIT) GENERAL INFORMATION 7r%q 79 pe ri;65 NaripyaM ❑ City ❑ Village R Town of: State Plan o.: Star Prai CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAP Y STATION BS HI FS ELEV. 4'.. 01 A ,~r, ~ Benchmark Septic S Dosing _0p _j ,AZ IM Aeration Bldg. Sewer 4-y- 1 St/Ht Inlet Holding `s TANK SETBACK INF RMATION St/ Ht Outlet TANK TO P/L WELL BLDG. vent to ROAD Dt Inlet Airlntake Septic -'/p' >aS' y /D > 2 NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM I Loss Friction System TDH Ft TDH Lift Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width T4KWELL, PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS M LEACHING anufacturer: SETBACK SYSTEM TO LAKE / STREAM ,A,.- - ModelNumber: INFORMATION TypeO CHAMBER System: (OR UNIT DISTRIBUTION SYSTEM [Headei 1 Manifold Distribution Pipe(s) Ix Hole Size x Hole Spacing Vent To Air Intake th Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No El Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Prairie.25.31.18W, SE, SE, Lot 1, Highway 64 f~ ~"Z-e U - v Plan revision required? ❑ Yes ❑ No h Z Use other side for additional information. SBD 6710 (R 05/91) Date Inspector's Signature Cert. No Safety and Buildings Division SANITARY PERMIT APPLICATION 2o1 E w shingt nAve.erSystem! 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 81/2 x 11 inches in sizes C r • See reverse side for instructions for completing this application state sanitary Per It Number The information you provide may be used by other government agency programs E] Check if revision co prey us application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMAT ON Property Owner Name Proper' Location Q.5 J ~jy, R /4_ 1/4, S Q.r T N, R Iabr) W Property Owner's Mailing Address Lot Number Block Number 11 City, Sta Zip Code one Number Subdiv ame or CSM Number II: TYPE F B ILDI G: (check one) E] State Owned ❑ 7t~ _ Nearest Road ❑ vil age Public I*Wl or 2 Family Dwelling- No. of bedrooms ~ Town OF +e 5f ` III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) o 3a-103 ~o - a 1 Apartment/ 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 S ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ❑ Replacement 3, ❑ Replacement of 4.(Reconnection of 5. ❑ Repair of an System System Tank Only ~xlstingSystem Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 76D Feet Feet VII. TANK Capacity Site INFORMATION in gallons Total # of Prefab. Fiber- Plastic Exper. Gallons Tanks manufacturer's Name Concrete Con- Steel glass App. New Existin structed Tanks Tanks / Septic Tank or Holding Tank /oZw~ ! dw~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersi ed, assume responsibility for ins tion of the onsite sewage system shown on the attached plans. Plu rs(Name:(Pri t) Plumber'sSigna ure: No amps) [15P/MPRSWNo.: Business Phone Number: ~f c) I W Q 4`5 S' ~ 71,S- alb ~~J Plumber's Address (Street, Cit ate, Z p Code): ~b ) 1Glvrr, o wr o IX. COUNTY / DEPARTMENT USE ONLY Disa roved San, ary Permit Fee (includes Groundwater ate Issued Issuin Agent Signature (No Stamps) E] pp Approved El Owner Given Initial Surcharge Fee) Adverse Determination X. C NDITIONS OF PPRO AL / REASQNS F~PP OVAL: V WA SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One ropy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. I 2. Your sanitary permit may be 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 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total galons, 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 1/2 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. GROU,„NDWATER 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. f ~ t t - - , ~-m c - S I , I , , f r 3 A } , , I i , i. , 41 j i , , 1 , , - , 1 I i _ 1 _ , s I ~ } Wisconsin Department of Industry, SOIL AND SITE EVALUATION R it P O R T Page 1 of 2 Labor and Human Relations D°isic`af Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code f COUNTY St. Croix Attach complete site plan on paper not less than 81/2 x 11 ' as in arse. n must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (B t;~rbco"o,mand sldo, scale or dimensioned, north arrow, and location and distance *4 st ro7ld. 038-1103-60 yA. ° REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRIN INFORM040N PROPERTY OWNER:` PRO LOCATION Tom Rickard i 0 SE 1/4 SE 1/4,S25 T31 N,R 18 )E (or) W PROPERTY OWNER':S MAILING ADDRESS a LOT BLOCK # SUBD. NAME OR CSM # 1430 220th. Ave. a na CITY, STATE ZIP CODE PHO R C ❑VILLAGE 12kflWN NEAREST ROAD New Richmond, WI. 54017 (713, Star Prarie St. H #64 [ ] New Construction Use [x] Residential I Number of bedrooms 4 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd/ft2 etzm ;ande infiltfatien gurfsce Mpvation(s) 96.27 exsisting systetnft (as referred to site plan benchmark) Additional design / site considerations reuse of exsisting system 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 fors stem 13 S ❑ U I ®S ❑ U ®S ❑ U ®S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trertdi 1 0-14 10yr4/2 none L 2msbk mfr gw 2f .5 .6 2 14-22 10yr4/4 none sl 2mgr mvfr gw if .5 .6 Ground 3 22-84 7.5yr4/6 none S Osg ml na na .7 .8 elev. 99. OR. Depth to limiting factor +84" n~i iai nom. Boring # i Ground elev. \ Depth to limiting factor T-7 Remarks: CST Name:-Please Print GAry L. Steel Phone' 715-246-6200 Address: 1554 200th. Ave. N Richmond, WI. 54017 ST Number: Signature: Date: csCt 02298 • 6-20-95 PROPERTY OWNER SOIL DESCRIPTION REPORT rFage_of PARCEL I.D. # y Depth Dominant Color Mottles I Structure Consistence GPD/ft Boring # Horizon Texture Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed (Trench I Ground elev. i ft. Depth to limiting factor Remarks: Boring # ~vk Ground elev. ' ft. Depth to limiting factor Remarks: Boring # :v:•\Uf4iii':i' Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor I Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Toml Rickard New Richmond, WI 54017 MPRSW 3254 SE4SE4 S25-T31N-R18W (715) 246-6200 t town of Star Prarie N 1"=40' BM.= top of septic tank clean out pipe C el. 100' a 0 Zb' N Iv x l ~m 0 S cp~-i° ~z 5C g)A /oD14- Gary L. Steel 6-20-95 r 7-a sv c. T- lt~ i iC I",-,l A ,-f2.e C= FILED MAY10 1983 u 88452 ` oofs 6o} Ards homy, ~ ST. CROIX COUNTY CERTIFIED4 4; el' 4~ 3SURVEYnMAP LOCATED IN PART OF THE S 1/2 OF THE SE 1/4 OF THE SE 1/4 OF SECTION 25, T 31 N, R IS W, TOWN OF STAR PRAIRIE, ST. CROIX W //4 CORNER COUNTY, WISCONSIN. ~"SrAl ,ountgt~, COUNrY SECT/ON 25-31-18 MONUMENT LEGEND N 1Go' 444 O I"X 24" IRON PIPE SET DUANE a MARY JOHNSON ALLEN C. WEIGHING 1.68 LBS./LIN. FT. ROUTE 3 yNYHAGEN ' 3/4" IRON PIPE FOUND NEW RICHMOND, WISCONSIN o • 1" IRON PIPE FOUND °s' S-1407 7 b M--~--CHAIN-LINK FENCE 54017 (N. 900 00' EA DATA OF RECORD HUDSON, r~ 3 THE EAST LINE OF THE SE wig, 1/4 OF SECTION 25-31-18 IS ASSUMED TO BEAR '<~N ""-~Yl 1y' Op M N. 00 18' 44" W. ~6SU o h W E 0 N Z O S _ UNPL AT rJE D LANDS OWNED BY OTHERS THE NORTH L/NE OF THE S //2 - SE 114 - SE 114 OF SECT/ON 25 y N. 890 38' 54" W. 520.76' -v ° l/ I N I II/ 1 NE CORNER OF rHE S 112 - SE I/4 - y SE I/4 (U I \ li I~. t1i ~ 1L ~ ~i O IAJ L0 v O N 41 N S. 84 O ° 44' 15" E, rc) Z 120.20 1 ` I. / LL w / co NOTE: LOT- 3 IS SHOWN ONLY O Ali o 'D REPRESENT A DESCRIPTION m M C Q ° CORRECTION, AND NOT TO CREATE ~I A NEW PARCEL. O ~ 31 S..,890..16' 45" E. z 127.38 LOT "B =1 LOT 2= 276,351 SQ. FT. ~I O~ tia 25, 973 SQ. FT. (6.344 ACRES) 00 ~1 (0.596 ACRES) L" EXCLUDING RIGHT-OF-WAY 0 Vi z Q Q1 in N ~~3G N 292,555 SQ. FT. N N I N M (6.716 ACRES) N JI 60' o - 900 j0 INCLUDING RIGHT-OF-WAY r N ° (48 5q" E Z N hl 62.50 36.00 35-64- m Z N 79 ' 4 (52,5, )820 186q' ~ APPROVED M Z S. 880 44' 11" E. / E. r (N. 880 42'W.) r - > N ~ Z: (N. 820 16' W. 714) ^ ~ ~ MAY 41983 W p ST. CRO!IC COUNTY z ►a.HENSWE PARF'S i. S n S. 890 35 51 E. 144.68 3 OVAITTE 0 ° 0 RIW LINE O . I O r S. 890 35' 51" E. 0 tmm S. 890 35' 51" E. 407.33' 'n THE SOUTH LINE OF THE SE 114 OF SECT/ON 25 SE CORNER STATF TRUNK N/GHWAY "6Q'- SECT/ON 25-31-18 RAILROAD SPIKE SCALE: ONE INCH EQUALS NINETY FEET SEE COUNTY SURVEY OR FOR TIES. J b, 1C tf VIA ~i `NOSORH A. 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J individual and Corporate l 1 C'1 s 1 11 (TO RE USED FOR ALL TR:\NS.\t IONS %HERF OVER S25,W0 IS FIN:\NC' D AND IN OTHER NON-CONSCVIFR ST ?C; iX C J.._ DOCUMENT NO. AHTRANSACTIOFS) n` Contract, by and between _Duane_F._Jchnson and_-_____ NOV 6 :996 Marv E.-JOh^son, husband and wifei ;.t 4:45 P• - ("Vendor", Lisa whether one or more) and Tom' t J • Rickard and Rickard husband and wife, ("Purchaser", whether on: or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full perfor- mance of this contract by Purchaser, the following property, together with the rents, n profits, fixtures anu other appurtenant interests (all called the "Property"), in 0'r.'1TW$ SPACE RESERVED FOR RECORDING DATA St. Croix County, State of Wisconsin: NAME ANO RETURN ADDRESS Attorney Kristina Ogland P 0 Box 359 Hudson WI 54016 (Parcel Identification Member) Part of the S1/2 of the SE1/4 of the SE1/4 of Section'25-31-18 described as follows: Lots 1 and 2 of Certified Survey Map Y 10, Vol. rr5rr, page 1283. TR ANS~ER This iS not homestead property. X)W (is not) lace Vendor directs Purchaser agrees to purchase the Property and to pay to Vendor at p_ thesumofS90 000.00 in the following manner. (a) S , VUV. L" . together with interest from date , at the execution of this Contract; and (b) the balance of S -50-1".00 hereof on the balance outstanding from time to time at the rate of _ el ht 8~ ~x rc ent per annum until paid in full, as follows: Commencing en the 1st day of December, 1995, and on the Ist day of each and every month thereafter, equal monthly installments of principal and interest in the amount of $366.89. - 31st day if Provided, however, the entire outstanding balance shall be paid in full on or before vie - - Octoher,!, _2-OW- - (the maturity date). Following any default in payment, interest shall accrue at the rate of per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special assessments, fire and required insiyranee premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shali not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid -cc= AQ991 without premium or fee upon principal at any time - w 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 a principal, and interest (and in such case accruing interest from month to month shall he treated 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 be continued 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 as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to pay the cos: 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 entitled to take possession of the Property on _ day_ Of _closing._-_, f*/= 'Cross Out One. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. LAN!' CONTRACT-Individual and Corporate FORM No. 11 - 1982 Milwaukee. Wis. VIK 1148FA,~E 4f Purchaser prom;>cs to pay when, due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor n 1--nand receipts s,.o.ving such payment • Purchaser shall keep the improvements on the Pr. ;+;rty insured against loss o. damage occasioned by fire, extended coverage perils and .u:h other haratds as Veni ~r may require, w;;hout co-insurance, through insurers approved by Vendor, in the suns of S _ _ _NLA_ _ nut Vendor shall not regaire coverage in an amount more than the balance owed under this Contract. Purchaser shall pa-, the insurance premiums u hen due. The poticres shall contain the standard clm,sei15 favor )f the Vendor's interest and, unless Vendor uthcrwue agrees in writing, the - etnal of all policies covering the Property shat; be depot:%'zd with Vendor. Purchaser shall promptly give notice of loss to insurance companies ,_r,i Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property <maged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit wade nor allow Waste to be committed on the Property, to keep the Property in good tenantable •ndition and repair, to keep the Property free from liens superior lc, the lien of this Contract, and to comply with all laws, ordinances and -=galations 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 nt :he times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of he Property free and clear of all liens and encumbran -es, Kx pt any ens or env hrances eat by the act o: default of °urchaser, and txcepc asementsi_restrictions-_and ri~ffl ~`-way_otmrecorc`~, l 'nay. Purchaser agrees that tame is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a -nod of .___t►.r2days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser rich continues for a period of ___45_ days following written notice thereof by Vendor (delivered personally or mailed by certified mail); yea the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice n Fich Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in aidition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the :PTopertv and recover the Property back through strict foreclosure with any equity of redemption lobe conditioned upon Purchaser's full payment -d the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder ,a which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for -:3e Property if Purchaser fails to redeem,, or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment cdthe entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event :.be Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid rchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title anion if the equitable interest of Purchaser is insignificant: and (v) Vendor may have Purchaser ejected from possession of the Property and have a -rceiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or %ritten statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in .aiigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or 7nt ) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be mcfuded in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract. Purchaser consents to the appointment of a ceiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendancy of such action, mrd such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under _4as Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance -nayable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as j ;.ecunty for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance withL•It Vendor's written consent, the entire -wtstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property nn the date of this Contract (except for any z o"gsge granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be :csassidered payments made on 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 acd assigns of Vendor iad Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the ,shied Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Mated this -Lrf- day of October 19 95 I (SEAL) r - (SEAL) Duane F. Johnson Tom J. Rickard L 71 I . (SEAL) (SEAL) --T "Mary E. Johnson Li Rickard AUTHENTICATION ACKNOWLEDGMENT Signature(s) Duane F. Johnson, Mary E. STATE OF WISCONSIN Johnson, _Tom J. Rickard, Lisa Rickard _ County. amhenticate thi: day of October 19_95 Personally came before me this day of _ 19__ the above named LOU& Kristin Ogland TILE: MEMBER STATE BAR OF WISCONSIN of not. - - authorized by §706.06, Wis. Slats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY j Kristin Ogland _AttOrnek at Law Notary Public _ County, Wis. 7Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: mccrssary.) 19---.) '.ames of perwns signing in anv opacity should oe typed or printed below their sve tatures. a_♦%D CONTRACT - Individual and Corpnrate - State Bar of wisconsln, Form No. 11 - 1982 r STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County Q , OWNER/BUYER O C4rd MAII.ING ADDRESS 144; O PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept.. CITY/STATE M p 1C%r l yprNd 'ems S~_tC~O PROPERTY LOCATION S 5-1/4, S 1/4, Section T__W TOWN OFa ST. CROIX COUNTY, WI^ SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE LOT NUMBER q 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) h 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- UVIe, 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 exf?ir ti on d SIGNED: DATE St. Croix County Zoning Office Government Center 1 101 Carne chacl Road Hudson. W1 54016 t I;y: 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. p Owner ofproperty v\ Rl~lpr-L Location of property-l/4SE 1/4, Section ,T~N-R W Township Mailing~a-d~dress ► ~ ac ve. Address of site I Subdivision name Lot no. Other homes on property? Yes-No Previous owner of property _ Q V\-'R o V"- Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes P 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 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) 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. G- Signature of Applicant Co-Applicant Date of Signature Date of Signature .-~-b.•- FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT a OWNER „ TOWNSHIP _S-y, e~ SECTION_7_T_,U~N-R-42_W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION A/1 LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~a h~ r L ~9~eS~ ~o &1E~1 INDICATE NORTH ARROW BENCHMARK:Elevation and description: ' Alternate benchmark SEPTIC TANK:Manufacturer: klw Liquid Cap. Aqr) Rings used:..2-Manhole cover elev:.~Final grade elev: Tank inlet elev.:_Y_2~2-2_Tank outlet elev.: 91,,y No. of feet from nearest road:Front , Side , Rear Ft. 3~ From nearest prop. line:Front , Side, Rear Ft. No. of feet from: Well Building: L~ ` (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE • r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_~ Rear Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width:-42, Length ®Number of Lines: Area Built, Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: ~ ~L No. feet from nearest prop. line:Front , Side, Rear Ft..';~ No. feet from well:_,/~No. feet from building_ HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE : /D- 142 - 9- PLUMBER ON JOB LICENSE NUMBER: 6/90:cj Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LabcrandHun)anRelations INSPECTION REPORT St. Croix safety ar~d Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION SE t- SW'- Sec 7 -RJ7,220th AN 7- 1491 63 Permit Holder's Name: ❑ City n Village Town of: State Plan ID No.: Tom Rickard Stanton CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: D, D Zc~,6 1 G 96B TANK INFORMATION ELEVATION DATA Q TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~Oa Benchmark lo6, J, /OU, Dosing Aeration Bldg. Sewer Holding St / Ht Inlet S o2 , TANK SETBACK INFORMATION St/ Ht Outlet 3,gN of TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic U,S I7 / NA Dt Bottom _6_5 '21 Dosing NA Header / Man. g, cI 9 I S Aeration NA Dist. Pipe Holding Bot. System ~J X10 6 PUMP/ SIPHON INFORMATION Final Grade 5j 0 qq, Manufacturer Demand ~y Model Number GPM TDH Lift Friction System TDH Ft oss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth S (1 19- 0 DIMENSIONS DIMENSION LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Mode Number: System: vzrl Jr `J a $ / 7 OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) , Ct r i - Plan revision required? ❑ Yes Ej'No Use other side for additional information. SBD-6710(R 05/91) /,3~ Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH jr SANITARY PERMIT NUMBER: DI~.HR SANITARY PERMIT APPLICATION 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 /4/ 9 / 6.3 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. PROPPTYOWNE% PROPERTY LOCATION '/a '/a,S `f T3 ,N,R E(or PROPERTY OW R'S AILING ADDRESS LOT # BLOCK # Al /.101 CITY, STAT ZIP CODE PHONE NUMBER SUBDIVIS O NAM OR CSM NUMBER :AA NEAREST ROAD/ II. TYPE OF BUILDING: (Check one) ❑ State Owned 0 VILLAGE: ❑ Public 1 or 2 Fam. Dwelling~# of bedrooms -3- PAR EL X NUMBER() III. BUILDING USE: (If building type is public, check all that apply) tff 1 ❑ Apt/Condo 10 ❑ Outdoor Recreational Facility 2 ❑ Assembly Hall 6 1:1 Medical Facility/Nursing Home 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 19 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 X Seepage Bed 21 ❑ Mound 300 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 12. 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 c 7~ Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 0 1 L-1 F1 1 11 El Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation f the onsits sewage system shown on the attached plans. Plumb 's Name (Pri9t): PlumbeZsig/n ure N m MP/MPRSW No.: Business Phone Number: '1~ 1~ -9, l191 s ddress reet, City, `Ste, Zip Code)' JJZ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sary Permit Fee (includes Groundwater [Date Issued C~ INoS ps r S hrgeFee) Approved El Owner Given Initial ~^p~ f` . A v rse 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 (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 y-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. M 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) • APPLICATION FOR SANITARY PERMIT 9TC-100 This application form Is to bs conplntod In full and signed by the ovntr(s) of the property being developed, 1ny Inadequacies will only result In delays of the pttn It Iatuance. -Should this development be Intended for rttaIa by ovner/contractoe,(sVec house), then A socond torn should be tataIned and completed vhan the property Is sold and submitted to this a f I I c a with the ■ppropclate deed rteording. O vn t r o t, property Location of property ,]_1/4 •„$1j(_ 1/1, 6ectlon Z T_-.[,__r•R_ZYV T o vn s h l p_ ~~,4ionw/ Kalllnq addtasA ~q Al 10,16e,754 z46Z Zee~'V //it Address of alto lubdlvlslon new* - • Lot number T PteYlous owner of property 4- Total Nile of parcel Date parcel was created Ara all corners and lot liner Identifiable? Yox _ }fo is thin pro patty being developed for resole (spec hou8a)1__Y4s1Ko Yalvr.r 1115---and Page Humber ■N recorded wlth the Reglstet of Deeds. INCLUDE VITA 711I9 APPLICATION TIIY FOLLOUIHCI N vAARKXTr DIED which Includes a DOCUHjIjT IVHngR1 VOLVHa XYD PAOt lruxaI;t and the 81<AL OT THE. 118010THR OF DRRDQ. In addition, a eertlfled survey, I( available, would be helpful so an to avoid delays of khe tevlew(nq ptoceee. It the deed description tafeteneea to n Cettltled Survey Map, the Cattlfled Survey Hap shall also be required, PROPERTY OVIIt ll CERTIFICATION I(ve) cettlty that all statements on this form are true to the best of my out xnovltdgel that I (we) am (Ace) the owner(s) of the property dtactlbtd In this Intotmatlon form, by virtue of a warranty dead recorded In the Office of eht county Rtglstet of Dees as Document Ho. Y/. presently own the proposed slte for the sewage oi 1 • Sys nl oand r that ( Iva) obtained an Ointment, . to turf with Ilia above describeproperty,lvtoc hI.he consttuctlon o IN Id ny em, and the same lies been duly recorded in the o I I I c a 01 thh CoVht 1191 Lot t Deeds, as Document No. slgnatut11 of Ownsc Signature of Co-ovner 11I Applicable) Date of elgn urr Data of Signature DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 45642 ® t ri. 86~!. 5pAGE 2 9 REGISTERS OFFICE This Deed, made between First S..: tate Bank sr. CR •i w) Q~X .of••Bayportt a corporation organized under the•d rQ6Mrd nking laws of the State of Minnesota ;I - - - Grantor, MAR 0 6190 ~i and.._...Tommy.A,.._Rickard_.and--Lisa.-C.---Rickard-,_ 9:50 A. M ana_wife,--.as-_3oint._ ten-ants-___ . _ - - RrOtNKOfGb Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... ~I .RETU O conveys to Grantee the following described real estate in _ _ S-t . _ - -CrO l Y First %Ecna1 Bank of NEW Rids crld County, State of Wisconsin: 109 E 2nd St Bzt C Nov lti,~Ilrnd, 1n1I .54017 - ~ The West 200 feet of the South 4.35.6 feet j of the Southeast One-fourth of the Southwest Tax Parcel No:.-03.6-.1.01.4.-.9.0.. . . . ...li One-fourth of Section 7-31-17. I ~j I I FA j This .....is-_.nat......... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except None and will warrant and defend the same. Dated this /0 day of - -`~_dnCa~ .:-a/Z~-...--""•-"""--•--, 19-~4 ~ FIRS STATE BANK OF BAYPORT SEAL . (SEAL) A 0 ..I A6 By - - President - * * (SEAL) ' (SEAL) - - * - Executive Vice President AUTHENTICATION ACKNOWLEDGMENT Signature (a) STATE OF W9 XXW MN ss. -ing..o..--tn ............County. 1-a-a- sh----- authenticated this day of 19 Personally came before me this ....day of 19.70- the above named Greg. orY. L_ Bens 0n, President.. n.d...... M. I. Friedrich Executive Vice President TITLE: MEMBER STATE BAR OF WISCONSIN If not, authorized by § 706.06, Wis. Stats.) to me known to be the person ..a who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY { PAMELA K._ FQR.O------- Dwight P. Cummins 1 '_NOTARY P 8liGMlN~YESOTA . ...3 5t A. h ............venue No..... rtfi * 't a w 36 ASHiNGTOs COyNTt( Uin i99i! lay _ 'Wg'}'f9 fir -•$ay-pc3r-t•,"-"14in-ne~ota-.55-OA3"--""""-•-----"••""- Nota Ptttiiie °.....-"""""F ..County, 'Vft MP (Signatures may be authenticated or acknowledged. Both My hlAt:'('tP'!1 't-hate expiration are not necessary.) date: 0 •Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY nSBn__ STATE, nAR OF WISCON,,? Wisconsin Legal Blank Co. Inc. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /Q ADDRESS: FIRE NO: LOCATION : j, 1/4, _SW 1/4, SEC. 7 T 31 N-R_J_~W, TOWN OF: ~WI/~A ST. CROIX COUNTY SUBDIVISION: LOT NO._ 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 to help with the cost of the 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 the 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 from 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 DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : o~ Q St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 r DEPARTMENT OF SAFETY & BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 5379069 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION:/ (o TOWNS HIP/ML*N4f R~4NTY: LOT O.:BLK. O.: SUBDIV ION NAME: COUNTY: 0 NER'SS/BUYER'S AME: MAILIN AD RESS: g~~ A, 4 4,-, 1 AMC "I USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERC14A DESCRIPTION: PROFILE DESCRIPTIONS: E OLAT ON TESTS: ®Residence XNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system o CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) 0S ❑U IZS ❑U S ❑U ❑ S ®U ❑ S ®U _71 If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ~J BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- f 9,1, 91-1 in - 42 4Y;, Z=2 -31 ZelsZ_TZ -396' ~ B- ? B- 961' AIA, & /10 /Z -/46 JeJ-1,41 13- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD PER INCH P- 3 1./_ P- P_ 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. SYSTEM ELEVATION ?~2 9 = t t . 4ec ae _ 3 i 1. i = E II ~ % f - j - . _ 3 [ [V ` - i [ ly a t I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures a d methods specified the Wisc nsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and bell f. NAME pr' t): TESTS WERE COMPLETED ON: ADD S: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST IG .AR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or cornmercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for ;writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address a,td your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st Stone (over 10") BR Bedrock cob- CGbble (3 - 10") SS - Sandstone gr - ivel (under 3") LS - Limestone *s - , _ rd HGW - High Groundwater cs C arse Sand Perc - Percolation Rate med s - Medium Sand W - Well I's - Fine Sand Bldg - Buildincf Is - Loamy Sand j - Greater Than "sl - Sandy Loam < Less Than *I - Loam Bn - Brown *sil - Silt Loam BI Black si - Silt Gy - Gray "cl C' y Loam Y Yellow scl- S;dy Clay Loam R - Red sic[ _ C;ay Loam mot Mottles sc - dy Clay wf with sic - 'y Clay fff few, fim rt c ay CC; cC7rlt...t p'ta rnrn - Many, r ns Muck d - distim p - promi~, HWL - Hit,ri Ir Six general soil textures s01„= _ for liquid waste disposal BM - Renck M, VRP Vertir TO THE OWNER: T+ i` tha fii- st- ar ,,ri- ",-y p-mit. The co`i-.,.. DF;` it ~ ioy recUOSt t I 'i r' mance, A c, - 'w private al Ii - must he - 1_be approp'iz order to a i rrrrit. The sanitary permit mi-si be obt- riorto the start of action. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRYL LABOR AND DIVISION PERCOLATION TESTS (115) P.O. BOX 7969 -HUMAN RELATIONS MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: O/T ' u/e' r : BDIVISION NAME: COUNTY: 1' 11 ( 1 OWNSjIP` UNPALITY: LOT NO.: BLK. NO. SU l L ~ OW ER S B ER'S NA E: MAI ING AD R S: Sf ~r,7iX 21 USE e d r ~ !I-e NO. BEDRMS : COMMER AL DESCR PTION: DATES OBSERVATIONS MADE Residence ? ❑New 54 Replace PR F NS. TESTS: RATING: S- Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUN EJU : S~TE -IN-FILLHOaLDI1NG TANK: RECOiMENDED SYSTEM:(optional) S ElU S oU S S U S If Percolation Tests are NOT required DESIGN RATE If any portion of the tested area is under s. ILHR 83.09(5)(b), indicate: in the Floodplain, indicate Floodplain elevation: / PROFILE DESCRIPTIONS BORING TOTAL PTH TO ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED E HEST TO BEDROCK IF OBSERVED (SEE ABBRV, ON BACK.) 06111C.7- y~,~ - y~_ 96- sue,, s- s- B- -G17~ PERCOLATION TESTS NUMBER DEPTH WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES AFTER SWELLING INTERVAL-MIN. p R RATE MINUTES P. PER[ PER INCH L ,3 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe whpt 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. SYSTEM ELEVATION , j~~3y'~ ~H v ~r hG / I a o Ito L r 'o P. I, ?Ant or A I, the undersigned, hereby certify that the soil tests reporton tfiis form were-made A.'* iNaccord w~fvthe procedures and methods s ecifie Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, p din the Wisconsin NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICAT ON N MBER: PHONE NUMBER(optionall: ry 7 ~J ~i CST SIGN UR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. )ILHR-SBD-6395 (R. 10/83to, ~ rn~ara joya s s sE~ 7 7-S-IA✓ 7 r.~ ~~~ora G✓~ S~6/ 7 O lt~I ~ j9, ~s d7~ ry~d~nk.QitZ ~ ►O ~ m ; n ;mu~Y►'l 5 ~ p~.ra,{ ► tsn ~ , Ilk WK11 E . 1 « PAGE OF C,rvSS S~Q~11)1, o~ A tJrl7 SYsven-I few fr.►h Alt In1a16 And Ob►►rvollon Plpo ~'---Approrif Vonl Cap /11 ~C 7/Ll~//A Mfi0Y0 12* Above /Vf=~ / I'G/•~`79Q.~b final Croa• . s~oi7 ' 20• 42' Above Plpp 4« Coal Icon To final Or.aa Vanl No alorah Hor Ot Synthetic Covotiny MIA 2'Ayyrapolo Orot pip. Clalrl►rllon a 11L I qip:0 0 0 -Too V AOpropalo 0 Po(8014149 Pipo bolov, 11anaalk Pipe o Co.plno TaraJnallny AI 1191100 01 Slalom SOIL FILL DISTRIBUTIOM PIPE APPROVED S4)jp TIC COVCR / `-MATI:RIM. OR 4" OF STRAW 2" OF AGGREGATE OR MARSH HAy ler0PlL-21~2 AGGRCGATE ELEV. OF FET_.. L DIST'RIBUTIOM PIPE TO BE AT LEAST IIJCHES BELOW ORIGIIJAL GRADE AIJU AT LEAST LO IUCHES BUT IJO MORC TNA►J tit IUCHES BELOW FINAL GRADE ,i MAXIMUM DF.P.T.F{ OF EXCAVATIOP FROM 0K16VJAL 6R)\0~ WILL BE IUCHES MINIMUM ©EPrN OF E CAVATION FOY 04k%6INAL C3RAPE WILL. BE: INCHES SIGIJED: LICCUSC IJUMBER: r r DATE: T > o