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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER A / a r V e- M Cf
ADDRESS 7 I`I , 1 r c'
SUBDIVISION / CSMI J & 4
~ T
SECTION 31 T N-R IW, Town of r
r c.
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
b
Q
r
a
INDICATE NORTH ARROVI
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: rue 4t k Q
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: m4 div es tc.ri l Liquid Capacity: GU
Setback from: Wel1NZ4 House c~ Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length k U Number of trenches
Distance & Direction to nearest prop. line: l 6f/
Setback from: well: ~/l House 2 Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet 9S ~S
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATYer'
PLUMBER ON JOB: 41
LICENSE NUMBER: fi) P 1 t" p
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and H_Loan Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.:
HIELKEMA, HARVEY X Warren CST BM Elev.: Insp. BM Elev.- BM Description: Parcel Tax No.:
/~6, e-0 Ca
(
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
p ,
Se tic r~.c J Benchmark , 357 100,
Dosi ~ ~
Aeration _ Bldg. Sewer
Holdi St/ Inlet 8y/
TANK SETBACK INFORMATION St Outlet a S S 10 TANKTO P/L WELL BLDG. Airitontake ROAD Dt Inlet
Air
Septic > ` ( NA Dt Bottom t
.oo
Dosing NA HeaderCM015.
39
Aeration Dist. Pipe A),13
.000 Holding- Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufa emand - S
Model Number G
TDH Lift L Iction System TDH Ft
Forcem Length Dia. H Dist. To Well
S ABSORPTION SYSTEM
BED/TRENCH width 5 1 Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DI
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC Man urer:
SETBACK
INFORMATION TypeO ¢~.y U 1 CHAMBER Mo a Num er:
System: (ye cns 7/((a OR UNIT
DISTRIBUTION SYSTEM
x Hole Size x Hole Spacing Vent To Air Intake
Header / i Q Distribution Pipe(s)/ l/ Z
Length Dia. Length Dia. T Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At--G Systems
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes E3 No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Warren.31.29.18W, SW, SW, Lot 6, 93rd Street
--95- - 61e -~t
!J d/L, - Q3t~ OX-4-
V T Sttby / 1 ~i rr ~:e.~.
o.4 t-wll r . G} a fir. (~ayt i e;
ft- :r,t4
Plan revision required? ❑ Yes to
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signa ure Cert. No.
r
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
V~:L~7A SANITARY PERMIT APPLICATION Bureau of uilding WaterlSystem!
201 E_ Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
ryf^ ,
• Attach complete plans (to the county copy only) for the system, on paper not less Counf~c,C~~
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Per it Number
V3303
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
Harvey Heilkema. SW 1/4 SYi7 1/4, S 31 T 29 , N, R18 k(or) W
Property Owner's Mailing Address Lot Number Block Number
990 Hillcrest
City, State Zip Code Phone Number Subdivision Name or M Number
Baldwin, WI. 54002 ( 715)684-2850 ` U 7 e Z 92- v
11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit~r Nearest Road
E] Public 1 or 2 Family Dwelling - No. of bedrooms 4 Town OF
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 04 a -O _5o,~G
1 ❑ Apartment/ Condo g` `r _ ~s ~dL
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 box on line A. Check box on line B, if applicable)
A) 1. [21 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ® Seepage Trench 22 ❑ In-Ground Pressure 42E] 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 S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
600 1200 1200 .5 93.95 Feet 96.8 Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Ex er.
INFORMATION Gallons Tanks Manufacturers Name Concrete Can- Steel Plastic p
New Existing strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank x 1200 1 Midwestern 0 ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIIL. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibilit or installa on the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum er's Signature mps) rP/MPRSW No.: Business Phone Number:
Joe Stang MP 6646 715-698-2266
Plumber's Address (Street, City, State, Zip Code):
506 Willow Drive W ville, WI. 54028
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved San ary Permitf ate ssue Issuing Agent Signa~((.11niduclesGroundwater
A tJurcnarge fee) s -
pproved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL:
SRO-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS .t
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line 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 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 1/2 x 11 inches must be SUL fitted to the c&.:nty The plans must
include the following: A) plot plan, drawn to scale or with complete dimensio locati an of not,-ling tank(s), septic
tank(s) or other treatrr;enttanl' s, building sewers; well,,; water rains/wale ,e_ , (e; strea ris ;!rid lakes; pump or siphon
ttrnfa; distribution boxes; soil absorption systems; replacement system areas, an.:. the locat o cr! the building served,
[1) t-orizontal and vertical elevation reference points; C) complete speci f°cat;or,, for pumps arv (ontrols; dose volume;
elevation differences, friction loss; pump performance curve; pump model anu ; ump maruf,( D) cross section
of the soil absorption system if required by the county; E) soil test data on a 155 orm; and 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 contamination investigations
and establishment of standards.
Harvey Heilkema
'SW4 SN S.31 T 28 NR 18W
Lot ;#6 '
BM Top of SE lot stake 100'
System Elev. 93.95 1
3: 80x5 Trenchs
Drawn By;
Joe Stang
MP6646
I
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5
X15' e g I
I
DID 3
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100
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 1/2-x, tne);.es in size. Plan must include, but
not limited to vertical and horizontal reference ra7td of slope, scale or PARCEL I.D. #
poirlt (DMh~ ireCfibr~~ pending
dimensioned, north arrow, and location and di~fanc$,tes nearest fthad
APPLICANT INFORMATION-PLEAS . ,R T'' 1FORMA REVIEWED BY DATE
PROPERTY OWNER: 4 i OPERTY LOCATION
i
Harvey Hielkem VT. LOT 1/4_.t,)1/4,S31 T o29 N,R If' g; qv
PROPERTY OWNER':S MAILING ADDRESS s'°~ { 4r OT # BLOCK # SUED. NAME OR CSM #
990 H i 11 c r e s t 6 na pending, csm
CITY, STATE ZIP COD ONE NU []CITY []VILLAGE MOWN NEAREST ROAD
Baldwin, Wi. 540 6 -2 Warren 93rd. ST.
[x] New Construction Use [x~ Residential / Numbe ms 3 [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow _ 450 gpd Recommended design loading rate • 4 bed, gpd/ft2 - 5 trench, gpd/ft2
Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate - 4 bed, gpd/ft2 - 5 trench, gpd/ft2
Recommended infiltration surface elevation(s) 93.95 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material pitted glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for svstem 1 12S ou I tz S ❑ U CAS ❑ U ®S ❑ U ❑ S 4NU ❑ S [M
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence IBourday Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 -12 10 r 4/2 none I 2m,-,hk mfr if C,
1
2 12-32 10yr 4/4 none sicl lfsbk mfr c1w
if .2 .3
Ground 3 2-80 7.5yr 4/6 none sl lmsbk mfr na na 41.5
elev.
96.8 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 -12 10yr 4/2 none 1 2msb'c mfr w if .6
22 2-30 10 r 4/4 none sicl 1 • 2 • 3
3 0-56 7.5yr 4/6 none s1 lmsbk mfr •5
Ground
elev. 4 6-84 7.5yr 4/6 none s osg ml na na .7 .8
97.88 ft
Depth to
limiting
factor
+84"
Remarks:
CST Name:-Please Print Phone.
!
Gar L. Steel 715-246-6200
Address: 1554 200th Ave., New Richmond, Wi. 54017 x
Signature: /!I Date: CST Number:
d5 , 4-26-95 cstm 02298
PROPERTY OWNER H. Hielkema SOIL DESCRIPTION REPORT Page :of 3'
PARCEL I.D. # pending
Boring # Horizon Depth Dominant Color I Mottles Texture I Structure I Consistence JBou dary I Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Rrench
1 0-10 10yr 4/2 none 1 2msbk mfr if .51.6
2 10-2 10yr 4/4 none sicl 2msbk mfr g na .4 . 5
i
Ground 3 24-8 7.5yr 4/ none sl lmsbk mfr na na.41 .5
elev.
96.95 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 10-12 10yr 4/2 none 1 2msbk mfr g if .5 .6
2 12-3 10yr 4/4 none sicl lfsbk mfr g na .2E.3
3 30-7 7.5yr 4/4 none sl lmsbk mfr na na .4'.5
Ground "
elev.
95.8{
Depth to
limiting
factor
+78"
Remarks:
Boring #
1 0-12 10yr 4/2 none 1 2c 1 mfr if na .2
5 2 12-2 10yr 4/4 none sicl 2msbk mfr g na .4..5
Ground 3 28-7 7.5 r 4/6 none sl lmsbk mfr na na.4:.5
lev.
99.5 ft.
Depth to
limiting
factor
+78"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PROPERTY OWNER H. Hielkema SOIL DESCRIPTION REPORT Page of 3'
PARCEL I.D. # pending
Boring # Horizon Depth DominantColor I Mottles Texture I Structure Consistence I Boundary I Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
Bed iTrench
1 0-10 1 0yr 4/2 none 1 2msbk mfr if .511 .6
32 10-2 10yr 4/4 none sicl 2msbk mfr
g na .4 .5
i
Ground 3 24-8 7.5yr 4/ none sl lfsbk mfr na na .41 .5
elev. i
96.95 ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
1 0-12 10yr 4/2 none 1 2msbk mfr g if .5 .6
4;'. 2 12-3 10yr 4/4 none sicl lfsbk mfr g na .2:::.3
3 30-7 7.5yr 4/ none sl lmsbk mfr na na.4 .5
Ground
elev.
Depth to
limiting
factor
+78"
Remarks:
Boring #
1 0-12 10yr 4/2 none 1 2c 1 mfr if na .2
S 2 12-2 10yr 4/4 none sicl 2msbk mfr g na .42
.5
3 28-7 7.5 r 4/6 none sl lmsbk
Ground mfr na na .4'.5
99 5 ft.
Depth to
limiting
factor
+78"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting j
factor I
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Harvey Hielkema 1554 200th Ave.
CSTM2298 SW4SW4 S31-T29N-R18W New Richmond, WI 54017
MPRSW 3254 town of Warren (715) 246-6200
lot #6
N
1"=40'
BM.= top of SE lot stake At E. 100'
~j 13 zCe ' Z ' 73
~o
75-1
~ k
d Z cry \
Gary L. Steel '
4-26-95 g
t
FILED
01 MAY 2 3 1995 ► 4
KATHLEEN H. WALSH
0e91sta of Deeds
co
. S~ C.rd<GI,a40
.9260
CERTIFIED SURVEY MAP
HARVEY HIELKEMA
Part of the Southwest 114 of the Southwest 114 and the Northwest 114 of the Southwest
114 of Section 31, Township 29 North, Range 18 West, Town of Warren, St. Croix County,
Wisconsin.
Owner's Address:
C.IS. M., VOL. 6, PAGir / 580 Harvey Hielkema
C.S.M., VOL•Z,~ I I Century 21 Premier Group
PAGE 492 , I 990 H111crest
- _L_ BBJ-d1N l a-, WI 54002
D b R O Rec,zrData.
_ - --t- - F- Indicates 1"
I SOW 30, 894.06' R1894.17') . iron pipe
t- _ - -S89.00'03"E 9/3.74'R/9/2.76'l._ /9.68• found.
\ - -
/ This instrument drafted by Laurence W. Murphy ~ 6' Indicates 1" x
/ 1 3 I
M J - - _ 24 iron -pLp_e
d `,,t11111111rt~y 4 / N weighing 1.13
CGO ~ 111L0W AREA"~ I M lbs./lin.ft•
, o I I M set. Q
Y 0 3 W
04
~ h LAURENC i ¢ I I
~I 3 W o Q
Dated: 3-26-1995 i `N° M
~°o h S M 2 W MU P O
°o o S 1 ~I mN' W Q W3
2 I '•.,Ri ALLS, - r ROAD SETBACK LINE I N a IN ~I ?
M ? WI -4 J Q
Z,
~ BOV E~ LANp•S,.•`~ LOS AR'A I h I ~ JI
N
O
~I M M ,8~//lillllll~` _~i I M ICI ; h ti
W
,
I
MAY 2 3.'951
Laurence W. Murphy
H 3 0
Registered Land Surveyor 2
V V N B9 x,'18' 34 "E 557, 74 I 0 ' H
M
;t . CROIX COUNT , 535.49" 122. z5' ~ v Q °
~on:prehensive P1annit M 11.
Zoning and o o LOT 5 I
Parks Committee I
LOT 4 3.393 ACRES 66' 147, 798 S0. F r. !01
b Q 3 N
/7.604 ACRES O N 3,Z54 ACRE5 EXC. ROAD R.O.W. I N
If not recorded 766, 843 S0. FT. I cri m
O
within 30 days of I /7.303 ACRES EXC. 141, 760 SO. F T.
o 100' O
ROAD R.O. X
. FT. h N 69. 28' 54 "E 557. 74' * to - _ _ _ - c 2
aptxovai date 753, 793 $0.
approval shat) be I ( 53 4.40 'I 23.34'
,,.,u~vow I t 3 LOT 6 I NI
1{~ 50'' ROAD SETBACK O 2
p .393 ACRES O O "1 Z
hl I t LINE 3
147, 798 SO. Fr. I hlh I
h b o J
IY I 1 N 3.248 ACRES EXC. ROAD R.O. IY.I NIN I
34. /9 141, 470 SO. F r 55 7. 74 I 24. O
rl ~ ~ i ' 44 ~ ~
2 I
- - -I 533.30' '
COI I ~ 3' n 8 ~
O
I N 89. 28 54 "E 911. 93' I W O 3
I
I 589.28'3 4"W 337.74'R(S8 9 •p/'32"W 558.791)b Q ~
I ILO T 7 33 3 03' R15135.60'1 ,I a
- - - - - -I 2 4.7,
I O 3. 723 ACRES m J N h
~I I NMI
/67. 161 SO. FT.
y
M 3.429 ACRES EXC. r., ro 3 C.S.M., VOL. 6,
ROAD R. O. W. m
V I I M e 3 PAGE /3T 1 VOL. 6, PAGE o 3 Q
1 = O Y49, 354 SO. FT. N
' M /662 ` N J
ti O o m ~ Q m h h
I O I 100' O C h
S 88 2
• 0' 38 "E 33.$1.88' M N Q)
h o u t
0 0 2 c
NB8_?0'3B"W 338.09' IN88.29'5011W 338.70'/ Sly COR. SEC. 31, r29N, 2 Q h
R/8W, I2"1R ON PIPE ti y
_ 1351. 4 7' R! 1349.62'1 13/3.38'R t /311.59
UNPLATTED FOUND!
C. S. M., VOL. T, PAGE 1838 I LANDS S LINE SW 174
SCAI.£ 200' I N 88.4204"f 2664.85' R/N88.54'SP"E
025'50'100' 200' 300' 400' 500' 1 266/.21'1
SHEET 1 OF 2
Vol. 10 Page 2924
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Harvey Heilkema
MAILING ADDRESS 990 HillCrest Baldwin, WI. 54002
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
2 9
CITY/STATE
PROPERTY LOCA'T'ION SW 1/4, SW 1/4, Section 31 T 29 N-R 18 W
TOWN OF Warren ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP 529260 , VOLUME 6 , PAGE 1580 , LOT NUMBER 6
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration dale.
SIGNED:
DATE: S - 3 / - 9 S
St. Croix County "Zoning Office
Government Center
1101 Carmichael Itoad
I ludson, WI 54016 11/93
S T C - 100
• M This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property Harvey Heilkema
Location of property Sw 1/4 SW 1/4, Section 31 T 29 N-R 18 W
Township Warren Mailing address 990 Hillcrest
Baldwin, WI. 54002
Address of site
Subdivision name Lot no.
Other homes on property? Yes x No
Previous owner of property
Total size of property 3.39 Acres
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? x Yes No
Is this property being developed for (spec house) ? x Yes No
Volume II( & 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. - 9~ 2_? Y/ , 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 f is of the County Register of Deeds as Document No.
s- 9L ~1(R
VCA4-4- A 44d&"Z
Signatu of App icant Co-Applicant
-3 9S
,5 Date of Signature Date of Signature
N h `25-c,_ ~ c 31
VOL 111.6r3IF416
DGCUMENT r:v STA1'F BAR OF WISCONSIN FORM 11-1982 THIS SPACE RESERVEO FOR RECORDING OATH
LAND CONTRACT •---c'-r
Individual .n, Corporal* •i
~ ~y1 rl'O W t'SH) FOR ALL TRANSACTIONS WHERE OVER REGfIST 'S OFFIC ~y ,I
~lJi otl0 IS FINANCED AND IN OTHFIt NON-CONSUMER CROIX CO., W1
+ ~
ACT TRANSACTIONS)
Rood to Re c : -1
Contract, by and between ._.-.Dale Fo~erty, a/k(a.___.._-_ APRI 1995
...-Dale-- E_,...Fcger.t y........... at A,'
("Vendor", 10:00 A~.~
whether one or more') and-.__.HarVey___N-._
r
Otero, C,>:
("Purchaser", whether one or more). ~y Opp S1
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures and other appurtenant interests (all called the "Property"),
t,
in St...... ro_iX................................ County, State of Wisconsin: RETURN To
See Exhibit A attached hereto and made a C
part hereof..
Tax Parcel No-
EED
This - is not
homestead property.
?iA (Is not)
Purchaser agrees to purchase the Property and to pay to Vendor at _..a..l?1dCe- des gnated by Vendor
the sum of $4.yi 000..-00------------------------------------ in the following manner: (a) 9 , b00 .00.._..........__...------
at the execution of this Contract; and (b) the balance of :$-_37-,_00.00----- - together with interest from date
hereof on the balance outstanding from time to time at the rate of...99!.... (i-n-e).................. per cent per annum
until paid in full, as follows: monthly payments of $277.50, commencing one month
from date hereof, and on the same date of each month thereafter.
Provided, however, the entire outstanding balance shall be paid in full on or before the...2 years from
-date-'hereof--------- --.4H-------- ( the maturity date). If li
Following any default in payment, interest shall accrue at the rate of .9...- is per annum on the entire amount
in default (which shall inclu,!(.. w;thllut limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
~a~k~ssaxxnt4a~c sax>E pcL+d>;x~cacdvxal~g>aepsadxmaaawcuo~d~cCaa3~xDC~cart~anrnc~encDtateaxsaa~saXxt~mca8ipac~n~a>#~c
x~t~alnxxbazceexxt>acx~e xma~~c~~aac>Pa~txaa'PO~aatRnax~xgex~asc~t~;~ax~scQa~as~~ncldee xmt~[otxacotve~ti[~cltao>fixx
x`~x~x x;~'xa~~c xx>m4a~c4ox~sef sc xhtix~ia>xsxxh~l~~d~c~~dnc~a>anx~amc~nt ~axRhaat►§e>~}ox~eav~mexam(x
~sc~cxa>aasa~c~3 aa>~x~x~x~~aht~sc~t~.xh~c~~cax~x~CVa~t~vac~trf~ctx~cxnEaax~ic ~a~4;sdicxotabx~ndxbweatx
Canalessxadlet~dsexixaQic'ssfactlo-x>x s~cx
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after 4AII KY-_-1_-. 1996__X
xDie:ftK]bl(30711X1{3t ~@1xDfiMn7f?bK iidIyCJC~LpC3(tl~fllf~li$t e3E13(~s~nb)tnX~b M6X%
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 ease 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 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:
None
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitled to take possession of the Property on_.-d a t e of c l o 31 riC~
'Croan Out One. ~j
II _ ,
I
LAND CONTRACT -Indivtdual amI STATE. BAR OF WISCONSIN Wi•eonain Lend Blank Ca Ine.
Corporate FORM No. 11 - - 1982 Mil..au Lee, win.
!lave seen prorated between the parties. Purcna5ul
1995 real estate taxes When due. VAJJJGlIF
t.o ay all real estate taxes r,
rirrchaser promises to pay when due all taxes and assessments levied on rvper y n u p Vendor's interest
in it and to deliver to Vendor on demand receipta showing such payment,
as Vendor Propmerty requir.,i w tagainst loss or hout co- r suranae, throughsinsurers app fire, ex-
p
Purchaser shall and such improvements on the
tended eed
an amount more
tended coverage perils
Vendor, r1SUTaf`1P_ Value require
than the in balance tea owed sum uofn>dere'fU-thish.'s••-iCo'--trac.•••• Pu-- . -rchasers-•-•----••-h••all PbutaY thetinsurance o premiun s when due. Che policies shall
riginal
rigs
th notice of loss to
contain the standard clause in favor of he f the Vendor's interest still, unless Vendor otherwise agrees n °i ar`Ce proxc~eds shall d wit ins
f all uranceicompaniesnandhVendor. Unless Purchaserttand rchagreea~er iY give
be applied to restoration or repair of the Pinnerty damaged, provided the Vendor deems the restor,.t?en or repair to be
Pct, and
economically feasible. .o com Purchaser covenants not to commit waste nor allow waste to from l milted on theto them of ke sp t: "ia Property
in good tenantable condition and repair, to keep the Property free to comply with all laws, ordinances and regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions
shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to
the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all lies a and encumbrances, nces, except
any liens or encumbrances created by the act or default of Purartiaid satisfaction as to
y ndor-'-s--expense•-to-..Provi•de••deeds_-in..p
noiyidual-.lots -,upon payment by--Purchaser to Vendor in an__amount of
2,-000-.-00- pe-r acre, -which sums shal_1•-_?... treater] as prin pal pre payments
in - - -
alth_ough__monthly•payments-shall continue in the . amounts state above
Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or t in interest which continues for a period of ....4C~-days following
the speeifie-I due date or (h) in the event of a r tt lfaulti n
performance of any other obligation of Purchaser which continues for a period of ..-~.C'y---• days following w
thereof by Vendor (delivered personally or mailed by certified is o then the entire outstanding baance u rider ri is contract
shall become immediately due and payable in full, at Vendor's option and without notice (wt+,cn Purchaser hereby
waives), and Vendor shall also have the aowitg~ndor may, atehissoptiori, terminate Chiat ons pcro, t land Purchaser's
addition t those provided by law or in equity: hack through strict foreclosure with any equity of
rights, title and interest in the Property a recover the Property interest the date of default tit the rate in eff ct olnsesuch datela dotheramoluntsduehereunder(inwhicheventlall thereo
nfrorn
previously ntal paid by Purchaser shall be forc.eited as liquida~dndamages Sue failupi'cificf ulfil f this C n oif tt andContre t tof co the may Property if purchaser
fails to redeem); or (ii)
immediate and full payment of the entire outstanding balance, with interest thereon ,[t the rate in effect on the (late ortion
default and other amounts due hereunder, which ay sue at law fory shthe eall nti be re auctioned unpaidtte- p at ut r jcuhadiscieal pr vaicele or and PanyuPrchaser
shall be liable for any deficiency; ; or or (iii) Vendor thereof: or (iv) Vendor may declare this Contract at an en- and remove this Contract asacioud on title in a quiet-title
action if the equitable interest Purchaser is to collect a arty and (v) Vendor may have Purchaser ejected from possession the of the Property and have a receiver appointed to
or written`st: (lurictions of Vendor,eanyeleof tiny ction of action
any
under fire (ii) or (idi above. y be Canng any or
e
o[ the foregoing remedies shall ll only he fiin-ien upon N rndur if and when pursued in litigation and all toss an expenses
in-
including reasonable attorneys fees of Von-or incurred to enforce any remedy hereunder (whethM1r abated or not) totbe
paid , by Purchaser, as
extent not prohibited by law and expenses of title evidence shall be added to principal and p
curred, and shall be included in any judgment. Contrac
consents Upon the commencement or during the pendent any action inteforeclosure of
to collect, rents Cis ues handrprofits of
to the appointment of a receiver of the Property, profits when so collected shall be held and
the Property during the pendency of such action, and such rents, issues, and P p assi nment of any
applied as the court shall direct.
Purchaser shall not transfer, sell or convey any legal term equitable interest
any in thr Pay) without the prior written long- lease or in consent rights under this Contract by b lance
payable
consent of Vendor unless either the outstanding a able under this Contract is first paid in full or the interest securit purchasers In ptheRevent of any suchf traPurchaser's
intrest under this Contract nsfer, sale or conveyance with ut Vendor'slwritten consent for
the entire outstanding
balance payable lshall Contract payments n immediatelanyymdue yymortgage out tandingulagainstxtherProperty ontthetdateof
this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Parchaser any
payments makes timely payment of the amounts then due under this Co iimract by u chaser mashal be considered payments invactly de on
the Mort;ragee if Vendor fails to do so and all na%ments so
this Contract. other subsequent or prior default of Purchaser.
Vendor may waive any default without waiving any
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) ' Ofi r ig-. 95
A
Dated this day of
(;;::).L (SEAL) ----(SEAL)
` Aa~Y?y--N He.l.kema.---.... -
Dale--E....F.ogerty.__.....----
-(SEAL)
.(SEAL)
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN
Signature(s) - SS.
$t , Croix County.
Personally came, before me this I•••---day of
authenticated this -day of.......................... 19 " ' 11 (i I---------- 19._95- the above named
-Dal,Q.•-) oge-rty_,----aLX.l.a-- ):_o"9erty
and--Harvey- i3...... Hielkelna....................
TITLE: MEbIBER STATE BAR OF WISCONSIN
-
(If not. -
authorized by § 700.06, Wis. Stats.) to me known to he the person
for g strument and a no .1 j tiJ9
- '
THIS INSTRUMENT WAS DRAFTED BY
1
r- '
Thomas..--
Croi
N ublic
Baldwin w I 54002 St-'.--..-.....
re fition
- ota Commission is permanent. li ,•q~ x U a
- - s may he authenticated or a,knowledged. Both tic date: ....ev 19j. -
re
(Signatu
5
are not necessary.)
,Names of Person signing in any capacity ..lo-ld be tNPed or printed b0 ow thole, signatures.
._.,_+A--i and Corporate - State Bar of Wisconsin, Form No. 11-1982
. VOL 111.6w;418
EXHIBIT A
A parcel of land located in part of the Southwest Quarter of the Southwest
Quarter (SW}SW}) and in part of the Northwest Quarter of the Southwest
Quarter (NW}SW}), all in Section Thirty-Ove (31), Township Twenty-Nine
(29) North, Range Eighteen (18) West, Town of Warren, St. Croix County,
Wisconsin, further described as follows: Commencing at the SW corner of
said Section 31; thence N 88°54'52"E, along the South line of said SW}.
1349.62 feet to the SE corner of the SW} of the SW}; thence NO0°51'28"W,
1013.17 feet to the point
along the East line of said SW} of the SW},
of beginning of this description; thence continuing NO0°51'28"W, along
said East line of the SW} of the SW} and along the East li^e of said NW
of the SW}, 1218.06 feet to the South line of Certified Survey Map. Volume
6. Page 1580, as recorded in the Office of the St. Croix Count Register
of Deeds; thence N89°00'03"W, along said line, 912.76 feet to the Ea
as recorded in said
line of Certified Survey Nap, Volume 3. Page
Register of Deeds; thence"N't.- thenceES8along 8'29'501E.lalonglsaid4centerline,
the centerline of C.T.H. N 1511
338.70 feet to the SW corner of Certified Survey Map, Volume 6,gP e the West
as recorded in said Register of Deeds;
line of said Certified Survey clap, 300.15 feet; thence N89°21'32"E. 558.79
feet to the point of beginning.
IN