HomeMy WebLinkAbout038-1172-10-000
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• Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa
Labor and P -ran Relations
Division of Y & Buildings
It in accord w'tttt►4e1 Adm. Code COUNTY
-
Attach complete site plan on paper not less than 8 1/2 Kf*6hes ia*, e... Plan lude, but
not limited to vertical and horizontal reference point ( koiIrect0 a8d f slope, I or PARCEL I.D. #
dimensioned, north arrow, and location and distance c9figarest road.`"
APPLICANT INFORMATION-PLEASE PRINT L~ INFO'R1AATI6N`''i? REVIEWED BY DATE
PROPERTY OWNER: PROPE CATION
1/4 "".1/4,Sa T / N,R E (or
L T # BLOCK # SU D. NAME OR CSM
PROPERTY OWNER':S MAILING ADD SS
-co
4
CITY STATE P CODE PHONE NUMBER (]CITY ❑VILLAGE [NTOWN NEAREST ROAD
,Zi
r. ,
New Construction Use Residential / Number of bedrooms 3 Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 . trench, gpd/ft2
Absorption area required 6X bed, ft2 6 35rench, ft2 Maximum design loading rate / 2 bed, gpd/ft2 . ~trench, gpd/ft2
Recommended infiltration surface elevation(s) i'. 1 ~ a ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation; if applicable A It
S = Suitable for system C NVENTIONAL M UND IN-GROUND PRESSURE AT-GRADE SYSTEM .I_f ILL HOLDING K
U= Unsuitable for system S❑ U S ❑ U .I S❑ U A., ❑ U El S M El S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
S r 7
-ID .31k Aa~~
51 z22Z r:! rq NO
Ground
elev.
Depth to
limiting
.fac r~
3.~
Remarks:
Boring #
::41-1a ~d 3 /In ap r 7
4 m V
Ground
elev.
ft.
Depth to
limiting
fact ~oQy
r7T~11 Remarks:
CST Name:-Please Print Phone: ! c
Address: `
r
Signature: Date- T Nu ber:
~j&M-*bzV SOIL DESCRIPTION REPORT Page of
o ?
Depth Dominant Color Mottles Texture Structure GPD/ft
orizon Consistence Bax>dary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground
elev.
Depth to
limiting
factor
A
e~~'
S
p? Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
,r- /
Ground
le .
ft.
Depth to
limiting
factor
J~ Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
r'
Soil Test Plot Plan
Project Name Charles Borgstrom Byron Bird Jr.
Address 2033 Co. Rd. C
Somerset Wi 54025 TM #3479
Lot 5 Subdivision Country Livin Date 8/31/94
NE 1/4 NE 1/4S29 T 31 N/R19 W Township Star Prairie
Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Base of White Stake Red Ribbon
System Elevation 96.2 *HRPSame as Benchmark
350' Property Line 150'
150'
Pro 3
Bedroom
House 15'
5' M.
B-
0
N ~
30'
Pri A
° , B-3
B-2 0 -4
30'
30' ep A
7%
B-5 lope
350' Property Line
w
Parcel 038-1172-10-000 03/18/2005 09:43 AM
PAGE 1 OF 1
Alt. Parcel 29.31.18.836 038 - TOWN OF STAR PRAIRIE
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
" HAYES, JAMES B,& SUSAN A STEPKA
JAMES B,& SUSAN A STEPKA HAYES
994 198TH AVE
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 994 198TH AVE
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 4.620 Plat: 0202-COUNTRY LIVING
SEC 29 T31 N R18W PT NE NE LOT 5 COUNTRY Block/Condo Bldg: LOT 05
LIVING 4.62 ACRES,,-,--
yy_ Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-31N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1150/23 WD
07/23/1997 1150/22 WD
07/23/1997 1114/319 LC
2004 SUMMARY Bill Fair Market Value: Assessed with:
31027 186,600
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.620 45,100 149,700 194,800 NO
Totals for 2004:
General Property 4.620 45,100 149,700 194,800
Woodland 0.000 0 0
Totals for 2003:
General Property 4.620 22,700 111,700 134,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 124
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROIX COUNTY
WISCONSIN
ti
ZONING OFFICE
IINNI►11~n■ rrrrb
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
I
October 26, 1995
David Bracht
ReMax
103 Main Street
Somerset, WI 54025
RE: Septic Inspection for James Goodpaster
Address: 994 - 198th Avenue, Somerset, WI 54025
Dear David:
An inspection of the septic system for the above address was
conducted on June 15, 1995. This property is located in the NE 1/4
of the NE 1/4 of Section 29, T31N-R18W, Lot 5, Country Living, Town
of Star Prairie, St. Croix County, Wisconsin. At the time of the
inspection, this septic system was found to be code compliant for
a three (3) bedroom home. Should you have any questions, please
give our office a call.
qames rely, elo
7
K. Thompson
Assistant Zoning Administrator
St. Croix County, Wisconsin
db
STC - 104
AS BUILT SANITARY SYSTEM REPORT
s~'EeS OWNER `s
ADDRESS
SUBDIVISION / CSMJ LOT #
SECTION~_T-.f
ZN_R W Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Ak'
~j t 3 9'9~
ry
~C
I
INDICATE N RTH ARROW
I
-J
Provide setback and elevation information on reverse d this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK • 7~g m~ fr f
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: 4,)~ Liquid Capacity:
Setback from: Well House ~S- Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line: 14-- r~
Setback from: well:__,,Q,i_ House Other
ELEVATIONS
Building Sewer .22 ST Inlet. 9/!'/ ST outlet QZ 7
PC inlet PC bottom Pump Off
Header/Manifold 9/d/ Bottom of system
Existing Grade 9L/ Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor andY.uman Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village a Town o : State PI
GOODPASTER, JAMES X
CST BM Elev.: Insp. BM Elev.: BM Description: FiEalrie Parcel Tax No.:
Ce A9509969
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ~Pe S ~dw. Benchmark
Dosing ) 4v' 97, di~ /
Aeration Bldg. Sewer
Holding St/ Inlet' 9~~1
TANK SETBACK INFORMATION St/ Outlet 9/70
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic E d sf~ NA Dt Bottom
Dosing NA Heade . /.3~ 91161",
Aeration NA Dist. Pipe 90, 9&
Holding Bot. System ?Q, 63'
PUMP/ SIPHON INFORMATION Final Grade
Manuf _ Demand &-/o eto < ~7 3 a
Model Number G M
TDH Lift Lriction System TDH Ft
Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width 1 Length J- / No.Of renches PIT No. Of Pits Inside Dia. Li uid Depth
DIMENSION o~ S~ DIMEN I N
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHIN adurer:
SETBACK
P4AIER Moe Num er:
INFORMATION TypeO ne, -
System: (fwd; beo OR UNIT
DISTRIBUTION SYSTEM
Header 1 U Distribution Pipe(s) Hole Size x Hole 5 g Vent To Air Intake
C"I
Length CD Dia. 7 Length s7/,/ Dia. Spacing /
SOIL COVER x Pressure Systems Only xx Mound Or At-Gr a Sys I /
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed / 1Center Bed / Irieih Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Star Prairie.29 31.18W,,NE, NE, Lot 5, 100th Street ~j
l`~
CJ
Plan revision required? ❑ Yes ig lqo, / /
Use other side for additional information.
1,9 1
R
-6710 (R 05191) Date Inspector's Signat re Cert. No.
R
SBD
ADDITIONAL COMMENTS AND SKETCH
R
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
f
STATE SANITA PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than a a37
8% x 11 inches in size. 1:1 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.
PROPS OWNER PROPERTY LOCATION
''/a '/a, T~ , N, R ji/(or&
PROPERTY OWNER'S MAILING AD RESS OT # BLOCK #
CI STAT ZIP CODE PHONE NUMBER SUBDIVISION MNE OR SM NUMBER
a
II. TYPE OF BUILDING: Check one CITY ~ NEAREST ROAD
1`71 ( ) F1 State Owned 001 VILLAGE ~
J2 ;OWN OF
❑ Public ~I 1 or 2 Fam. Dwelling-# of bedrooms _ PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) o-S e-1/7,24
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 9 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 ./'nch) ELEVATION
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 Holding Tank
Lift Pump Tank/Si hon Chamber F-1 El 1 11 El I L] 1 1:1
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installati of the opsite sewage system shown on the attached plans.
Vber s Na (Pr' t): Plumb is Si at m ) MP/MPRSW No.: Business Phone Number:
PI tubers Address ( reet, City, State, Zip Code .
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved San' ry Permit Fee (Includes Groundwater ate Issued issuing em Sig ture (No mps)
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination '
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 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.
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, 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)
see - -1A1, elOd
~,ner- / 7~ glee
[~q SiZ c kS' i4 4
=-~D sc,---
Py" -td .i
~,~mrusko
e I F~
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PAGE OF
C r U S S S e :J1 u n O r t~l e n S y s ~1
Fresh Air Inlets And Observation Pipe
1 Approved Vent Cap
Minimum 12` Above
Final Grade
I
20- 42` Above Pipe - 4` Cast Iron
To Final Grad• Vent Pipe
i Min. 2' over Pipe
Morsh Hay Or SyRAggregate
Distribution
Pipe - Tee
6Perlorated Pipe Below
B-Coupling Terminatin
g At
Bottom Of System
PrpDo1C~ ~tnwl gr~,clc
SOIL FILL
DISTRIBUTIOVI PIPE
APPROVED ~4NTIIETIC COVER
J
° "~/r1ATERI~I OR 9 OF STRAW
Z"OFAGGREGATE OR (1ARSU HAy
(o OF 12-Zt/2 AGGREGATE
ALEV. QP~ FEET-,
r'
D651-11115UTIOU PIPE TO BE AT LEAST G2 - INCHES BELOW/ ORiGIQAL GRADE
AMU AT LEASTZO INCHES BUT 1.10 MORE THAQ 4Z IMC14ES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVAT100 FKOM ORI&WAL 6KAoF- WILL BE Ll IAICHES
MINIMUM 9EF" of EACAVATION FROM. OIK 6111JAL GRAVE WILL BE -2/- INCHES
SIGIJED:
i
LIGEUSE AJUMBER: Z~2L 2
a DATE: l`
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page J of
Labor and Human Relations
pivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I. . #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP TY OWNER: PROPERTY LOCATION
s~ GOVT. LOT " 114 1/4,S T ,N,R ~(or&
PROPERTYOWNER':SMAILINGA DRESS LOT# BL CK# SUBD.NAME RCSM
CITY, TATE ZIP CODE PHONE NUMBER []CITY VILLAG 0 N NEA T ROAD
V IS-) im _n/
New Construction Use A Residential/ Number of bedrooms [ ] Addition to existing building
j j Replacement [ ] Public or commercial describe
Code derived daily flow ,a6 gpd Recommended design loading rate ~Z ed, gpd/ft2_,S trench, gpd/ft2
Absorption area required bed, ft2 S trench, ft2 Maximum design loading rate _,_Z_bed, gpd/ft2_,2 trench, gpd/ft2+
Recommended infiltration surface elevation(s) ~61C ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material, Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ES ❑ U L] S❑ U OS ❑ U 0S ❑ U ❑ S o u ❑ S 91U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
vv.....n nu.., _ /
Z,2 ~e
Ground dzz
elev~
"IV 2
Depth to -
limiting
factor
Remarks:
~7
Boring # -Z L2 4!~
Ground
elev. 7
ft.
Depth to
limiting
factor
W, L I
Remarks:
CST Name:-Please Print Phone:
Address:
Signature: Date: CST Number:
PROPERTYOWNER, rHf~ ~n~ SOIL DESCRIPTION REPORT Page, df1
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
47Ground
elev.
2?8 ft. - -
Depth to
limiting
factor
Remarks:
Boring #
Ground Z,
elev. _ x
ft.
Depth to
limiting
factor
Remarks:
Boring #
:<s
Ground
elev.
_
Z4Z
Depth to
limiting
factor
Remarks:
Boring #
th~
:i ti?v
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
o~3
AcIF
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.33
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
O WNER/BUYER J Poa a A S
7
MAIIJNG ADDRESS 76
PROPERTY ADDRESS
(location of septic system) Please obtain from the tanning Dept.
CITY/STATE ~~jE,r_l Lt,
PROPERTY LOCATION 1/4, 1/4, Section, T 3 l N-R J? W
'SOWN OF ST. CROIX COUNTY, WI
SUBDIVISION _ C-VL"f ✓7l'_C7 LOT NUMBER S
SAC 9.R US;?iw C /f~
CERTIFIED SURVEY MAP , VOLUME , PAGE-)"I , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July I, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three /y17piration date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full. and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
_~_1gme_ "
Location of property j11;= 114W 1/4, Section gq-, `T' :311 N-R I $ W
Township _I'(2~1-t2,~,____Mail.ingilddre:~~ ~(13~ I'7DHt-_
N GU ivW CrLJ ~ 5: 01'7 - . - -
Address of site 1 ct
Subdivision name r1c) tn~7`Yr-S L y, Lot no.
Other homes on property? -Yes-X_ No
Previous owner of property C04g::cC_-s- 90 &2-
Total size of property _ 4w _
Total size of parcel 41, b z I-cre't _
Date parcel was created Cac7` f7~/°~ _
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? _x__Yes No
Volume and Page Number 31 a:> 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 decd 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. Co 7Cv ~r~ ci, 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 af; Document No.
/S.i.c ira ur of A1)pii.cant Co Applicant
Date of Signature Date of Signature
vL II4►A,E319
T"'• •/AC• Rass~evea' /OR eae0ao1N0 wTA
• DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-19e2
LAND CONTRACT
526'768 IatloNaat dad Car/ara1~
(To BS USED FOR ALL TRANSACTIONS w8 ERE OVER
ere.00e IS FINANCED AND OTHER NON CONSUMER 'S Or, 1 e
ACT TRANS AOTIONS R ~1GG/7IS~7M1Gf1 J N
ST. CROD( Co.. W1 Contr ot, b and betty Charles H. Bor4strom and Rtc'dforReccrd
Dolores~or,~ia~ran: ~a/a YSororeg•: ""Rorstrom........... ; MAR & 199$
~_.~f118 8TIQ.Wet....... ..............•_..._...N~... ("Vendor';
whethp;, one or more) and...__...James J _ Goo Paster..._..... 1330 A.~~
Lt.+~:><eXa.
a,~;,.......,-r./ ("Fnrcbasee, whether one or more). Repfaterof Deeds
r abtli{ ia~ees to convey to Purchaser, upon the prompt and fall per-
forplana~+'osthL'R gpi act by Purchaser, the following property. together with the
ream p>~fit~ and other appurtenant interests '(all called the "Propsrte);
s.(Irni
County• State of Wisconsin: uRR TO .
Jib ..~..K Rsr
Borgstran
Charles' & C99res
k 1a - to .k>, Scmarpet"L 54$25
1~" 1 toil 40000
.
Tax Parcae No.
Lot S, Plat of Countty Living in the Town of,Star prairle, St, Croix County, '
Wisconsin.
Thin is not hoiaestead property.
.
Purchaser •creas to purehase the Property and to pay to Vendor at ...V org direct
is the folio manner a} b
the dam of V!b[._....._..... (
at the execution of this Contract; and (b) the balance of t...184WAS DM together with Interest from date
hereof on the balance outstanding from time to time at the rate of ....._-.._Atl W cant pet annua .
onto paid In fu% as follows: Principal d all be due and- payable upon the sale of spec
home to be constructed on the lot or February 24F 1996'31, whichever comes first..
Prodded, however, the entfle_ outstandina balance ance shall be paid in fag on 'or before the day of
F......_ 1s..33!_- the maturity date).,
lrolloaing any default to psyment, interest shall accrue at the rats of-. t per annum as the entire amount
In default (which shall include, without limitation, delinquent Interest, and, upon acceleration or maturity,. the eatirt~
principal balance
Purchaser. unless excused by Vendor, agrees to pay monthly to Vendor amount sufficient to pat reasonably aatki
V posted annual taxes, special awesaments, fire and required insurance premiums when due. To the anent received by Vendor,
Vendor agrees to apply payments to thew obligations when due. Such amounts received by the Vendor for payment of
taxssll assets end Insurance will be deposited into an escrow fund or trustee account, but shall not boas interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rats specified and then to prinelpeL Any
saoast =W be prepaid without premium or fee upon principal st any thnse• )
In the event of any prepayment. this contract shall not be treated as Ia default with respect to payment se long
r the unpaid balance of principal, and interest (and in such can accruing interest from month to month shall be 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 say pro..&
ad insurance or condemnation, the condemned premun being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Pwchsaw
for examination sxapt: None
Seller will give Buyer $100.00 credit for title insurance at the tame the above
lot is deeded to the Buyer.
Purchaser shall be entitled to tab possession of the Property on.....dsx .Of ClOSing.___• it
N;/... Ole Da•.
LWW cONTRACT-uarleoal and 14 uAS or WISCONSIN w1womia 1460 shok " Ian
Cc rprate FORM No. 11-19" lmoau"t. Win.
r
Man!
' en ft"03~~ te tip Property orupo><rendosasrmnt peerre to pay w d~~~rise ,
to it aad~ v to Vendor on demand pis slawing'suaD payment. 4 ,
Purchaser shat) keep the bn vsmenyy on tits ProPertpt insured ~t Zaa os damaggs i)►D7J~ +I x i h1surers n.~ pa red h►a:ards as Vendor may regwm ut winsurana.
thion , .
tead~d cove its a sued ii as smouat; tlort`r
Yendor, b the nom of ;-....._N M ,bet Vendor shall not Mum wbea dae~ policift
tban the balance owed under this Contract. Purchaser shalt Pay tine insnsanosa ASIF
contain the standard chase in favor of the Vendor's Interest and. unless Vendor agrees >4 writing. t6s extols
of all polices covering the prey shalt a dePaiteda Vwith; end r ol6erwise Purchaser mace prosesds alla>TS "In writins '
insurance companies and vendor. IInNa Purchaser agree f
damapd, Provided eDe Vendor deeae tDs reebrsetw~ err rspde m Ds-
be applied b restoration or repair of the Property
.oonomieally feasible, Parehsser acrenaata not te commit wants uor Aaw waste to be committed on the Property. b keep 60
se sued tenantable Condition and repair b kqW the property free from Yens superior to the lien of this Ceantraat, r
p aQiating tla Propst#..- ` . # x 7
b nom ly with all laws, ordinances and regu
paw sad esadWaa
agreea the* in cast the purchase Prior with hetor"t and Other moneys shalt be
Vendor fy1ly ~
sun bs Sn do Performed at the tisses and bn tits sanaer above specified, Vendor *At on demanlh; ez ea0t alsihee' tf t.'"
~ era
Warran4 Dwd.LL fa simph,,d the PtoPerh►, free sad slow, of
ties Purchaser, ~ - ti
I by "tor
lam: Ceacun'rone.9 s~
s Purchaser asr+es that time L of the ......nda (a) in the event of s. default in the payment4f W primalpak ell
of « days tdtoaring ids spedried dw,dsb of (D) is the evens ed's1 difJtalt iaf
interest: whisb continues for a Period
of -4her obligation of Purchaser which continues for s erg of ~..rh! . days t wrftMs
tllereot by~ Vsndaar dsH•s;ed personally or mailed by certified mail). thus the ci tiro "Wending balance
Ptrahas 4
shulk become lately chw and p+tiyabls is Mr. st Vendor's option and Without notice (which
waives), and V • shall also have the t rights and remedies (subject to any limibtbas proridsd T -
addittoet to !dace prtvided bT law err is egnityt (i Veadoi may, of hit opera, terminate this Contract sari
risdt tttitU sad L!at is the Propert7 and recover the Property hack through strict foreclosure wftb p~
isterssttDe:eaaFaa~
rrse33ssmmytion to be conditioned upon Purchaaer's full payment of the entire outstandia balance, with
the dale of default at the rate is effect on such dateaudetberamounteduehereunder (inwhich eventall shuns s
by Purchaser shall bo forefeited as liquidated damages for failure to fulfill unit Contract and as rsn~
# itpurchaserpay fails to redeem)). or (hit) Vendor my sae for specific perform ance of this Contract to r
sad fdt ment of the entire outstanding balance. with Interest thereon .st the rate b sffsct`oas d .
default and other amounts due hereunder. In which event the Property shall be auctioned at judieial sate aad[dlsaeA'°
shall be liable for may deficiency' or iii) Vendor my sae at law for the entire unpaid purchase price or any
therm!: or (tv) vendor may deaf M this Contract at an end and remove this Contract" &cloud on tWe hs
Pesssasio~s
action U the equitable Interest of Purchaser b Insignificant; and (v) Vendor may have Purchaser ejected from
of the Property and have a recwereappointed to collect any reds. issues or profits during the pendency at any aetiosr a-
(i ii or 1v above ing any oral or writ im statements or actions of Vendor a~n eMettoa of apt f
Cads f (
of tM oregoing remedter shall only be binding upon Vendor if and when pursued in litigation and alb costs and
Including reasonable attorneys fees of Vendor incurred to edorecany remedy bereander (whether abated or sat} -
- extent not prohibited by law and expenses of title evidence shall be added to principal and paid by T=Cbmwe
eareed, and shall be Included to any judgment.
up" do coam~ence ant or the P4 of nay
tbs property during the aetlea of tonelosare of thin Cootraatf esese~s' v
a the appointment of a reedver of the Propert~ty heap homestead Interest„ to collect the rents. asses, and ~o~s eP ~ pendency of such action, sad sae6 rentR issues, sad P*oAts
whet so ooUsetsd sDal>F N 1s1i1 sly
an the court shall direct.
Pso~ ~
applied Purchaser shall not transfer, sell or Convey any IMO or ~italele tnterest in the (by smip~ bfrseo
of Purchaser's rights antler this Contract or by option. longterm leant or is any ad wayT wltboat the Dsior wrlt0ort
comment of Vendor unless either the outstanding balance payable under this Contrast is first pehd is fait er the inbsesC'
emway i• a pp~ or aasi~t of PurchaoWs interest under thin Contract solely as security ter alt iadebttlness ~
Purchaser. In the event of any such transfer. sale or conveyance without Vendor's written eoussuk the entire outstnndhn:
balance ppaayy-ode under this Contract shall become Immediately der and payable in full, at Vendee% optiose without notiaa
oi€ . r
Vendor shalt make all payments who* due under any mortgage outstanding against the Property on the date
this Contract (ex so for any mortgage granted by Purchaser) or under any nob seemed thereby. p:evidod Pasehas
makes timely payment of tit amounts then due under this Contract. Purchaser may make any such ~ymea~ dbreetly
tDe Mortgagee if Vendor talk b do so and all payments so made by Purchaser shall b eomsidered ya7menb made un
Cenltaet.
this
Vendor may waive any default without waiving any other subsequant or prior default of Purchaser.. -
Alf' terms of this Contract shall be bindle! spun and Inure to the benefits of the behrej legal ra~psesaeltatiwe.
Vimdoe ~teerr a►vdsabls
nee M"M and~p~ of Vsmdor and Purchaser (If pat sn owner of the Property the spo'w or
!Dm eaes eft eetba -
2+erda to release homestead rights in the subject Property and agrees b john in d
seaddoratioa low
dssd b be nmWW is falfilmeat haeeof i
1.44 day Of T''ellSt
natsd this
Ch e, "4 8i<AL)~
ie G /'~!is~ (saAt) - .
arles .Tames J. ter,
: teas - - _ Goodpas.~-
(SEAL)
OhFPA_. 4?~8d 8.DO1Gle8 SE _ =
•tA ~ ..34. 4' Z
- - r -
Bar8~tsathE
' -«ea,H iradt * STATZ Or . CONSIN#^
a/k/a Dolores S. Borgstra~ ' ....«-•«CoanYS w v 4 r
-
• gebcwr F 9 Permosaft cam. before mew thin. e ' F
aatl~r y
=
.
STATE BAIL O! WISCONSIN
s' " a
by 4 706.06. Wis. States) « b me known b lie the perom « .......who am saesd ffiar
foregoing instrument and admowleda* the same. TNIe INSTRUMENT WAS DRAFTED sY
Kristine Oglaid g-....t-
Attorney at Lars Yy ^ii:- t~ aet.~'state
(Signatm4d may berauthenticated or acknowledcaL Both ;
an not necessary.) dab: »-=-----+k
4 ~ _ 4 f.a - 4~4bs_
T T .r _ i~._oor r ~k .
sr&esss or pw ~ de ben in W eapaslb should be
uxs cele'raACr-wl.lew ..a cesx•N-ears sh,..r wa.e...as. sties xa u-aea