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AS BUILT SANITARY SYSTEM REPORT
OWNER& A/ Pir- Ue ~ o .rr r/i e c-
r
ADDRESS _46/j/2,6 SUBDIVISION / CSM.'j/`~~ LOT # G~
SECTION__~~T 291 N-R Lf g) Town of ~c d moo,,/
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
_:~x -5~ Tv«cj~ec
- - - -
s
f
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form-
Provide 2 dimensions to center of septic tank manhole cover.
r
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: /mm d
Setback from: Well House / 9 ' Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Jr Length_ . -7 Number of trenches 2
Distance & Direction to nearest prop. line:
Setback from:,,well: House pf Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
`r{ i 2rtr P§r SJy7.29.19W, WfUtE SEA 5ME10 "PASS County:
-Aabor and Human Relations INSPECTION REPORT
Safety,and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 20R191 3
Permit Holder's Name: ❑ City ❑ Village `R Town of: State Plan ID No.:
CST BM Elev(:~} Insp. BSA Elevj.:~ BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9400034
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV-
Septic Benchmark
Dosing
Aeration Bldg. Sewer 7 ,SS 9~
Holding St/~ft Inlet 73~
SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG- Ventto ROAD Dt Inlet
Air Intake
Septic >-56 s 114- NA Dt Bottom
Dosing Header S ✓ r
r
Aeration NA Dist. Pipe 3,3
Holding Bot. System g~
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer nd ~O~° S
Model Number GPM
TDH Lift Fr Syeaem T
Forcemain Length Dia. FHi Dist. To Well
SOIL ABSORPTION SYSTEM
I PIT No. Of Pits Inside Dia. Liquid Depth
BED/TRENCH Width / Length , No. Of Trenches
DIMENSIONS S S DIMEN I
SYSTEM TO P / L BLDG WELL LAKE / STREAM CHING Manufacturer:
SETBACK CRAM
INFORMATION Type O ✓ cr,<, a a. r del Number
System: ~-~p'6 -/o OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s).1 x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. 7 Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems
[D~e pt h Over Depth Over / Sodded xx Mulched
d-/Trench Center &e,&/ Trench Edges X_ ?may Topsoi ❑ Yes El No E] Yes El No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: UDSON.17.29.19W,SW,SE,LOT 1105,OVER LOOK PASS
1 Plan revision required? Yes E] No
Use other side for additional information. cv 1 1,91
SBD 6710 (R O.S/, 1) Date Inspector's Signatur Cert. No.
.0 SANITARY PERMIT APPLICATION
DIL:HR In accord with ILHR 83.05, Wis. Adm. Code CoS
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~gq 1 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.
PROPERTY OWNER PROPERTY LOCATION
`-r~e~Ca lrl~ n1 .5'4E-''/a, S TAT, N, R /9 E (or)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
rlwe4aLQv41 3 -7` j
CITY, STATE J ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CC/SfM NUMBER
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
State Owned
VILLAGE a~
a 4W
❑ Public & or 2 Fam. Dwelling-#~ of bedrooms %Y_ PARCEL AX NUM ER()
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. LOU New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 -Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) IFy,33 ELEVATION
37te) e G" Feet f7t $3 Feet
VII. TANK CAPACITY Site
INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper.
New lExisting Gallons Tanks Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank FX F]
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa a rPrmit Fee (includes Groundwater a e ssue Is uing Agent Sig lure (NStamps)
Surcharge Fee) )~Approved Owner Given Initial LVI-
Adve e 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 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.
It. 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'/z 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)
S' /7 7A9/P1f ,T /,r/aF/y-~s~.r/ ~•C7`/ate /s~'.'d~
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let
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT r Page of ?
Labor and 14uman Relations . ,
Division 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 S/
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP ;TY OWN : PROPERTY LOCATION
Q GOVT. LOT sly 1/4 S,' 1/4,s/7T Z~ N,R /9 -%orlo
PROPERTY OWNER':S MAILING ADDRE LOT BLOCK # SUED. IAN ROR CSM # CITY, STATE ZIP CODE PHONE NUMBER VILLAGE WN NEAREST ROAD
( ) e~ l o,-'- ss
Q~New Construction Use,M Residential / Number of bedrooms Addition to existing building
j ] Replacement c [ ] Public or commercial describe
Code derived daily flow / -S0 gpd Recommended design loading rate bed, gpd/ft2 . trench, gpd/ft2
Absorption area required bed, 11:2 trench, 11:2 Maximum design loading rate 7 bed, gpd/ft2 . $ trench, gpd/112
Recommended infiltration surface elevation(s) g`~ 33 It (as referred to site plan benchmark)
Additional design / site cpinsiderations
Parent material 41 5'5/ sd`rjb,, ' (S ood plain elevation, if applicable ft
S = Suitable for system ONVENTIONAL MOUND I GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
JUS ❑ U aS ❑ U S ❑ U ❑ U *S ❑ U ❑ S
U = Unsuitable fors stem
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh
v rye z s/ s'064- o2v : y s
Rome _'7
Ground QY/I z/ l ZA AO-" tf tj /rP 5 . G
elev.
Depth to
limiting
factor
Z3
Remarks:
Boring #
/a yx Axle,
ti,•s,
/o y ~f r
Ground J /
elev. c/ ~p" s' /
-7 1
t. /P S/r
f
Depth to
limiting
I or
Remarks:
T Name- lea a Prin Phone:
aH~✓ /S ~~G-G pal
Address: D D 3S fc.~9dh l , S'~D/1
Signature' , Ol Date: CST Number:
M *I
Fly
Jolosl
MPH
of yld
aa Cv
'11 0
nala p
punog)
Lv\} 42
Cl
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# 6upos
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~Y7 -r,47 21411--l i punoi9
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O
4 1 Pa8 yS aoloo luoJ'zS,no Ilasunw u!
sloob ~rio8 aoualslsuoo ain,:xal uozuoH # 6ulao8
ll/adJ aanlonjlS saploW aoloo lusulwoa 43dad
#'0'I l3~!l11d
10 7 a6ed JLHOd3a NOlldlHOS3a im U3NMOA183dOUd
10
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SANITARY PERMIT APPLICATION
OILHFR In accord with ILHR 83.05, Wis. Adm. Code C017
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than 0099 I -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.
PROPERTY OWNER PROPERTY LOCATION
ka 7`_ 4,S/7 TAOF, N, R E (or -Ze-l C_ PROPERTY OWNER'S MAILIN ADDRESS LOT # BLOCK #
/ -.11, lwl~ck&f_ / e157 I E
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
u-also./ w ~'YO /G 1. AC-99,2 GJ, l C8 `ol = .Q T
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑
❑Public IN 1 or 2 Fam. Dwellin VILLLLAGE NEAREST ROAD
e a S
LYY g- # of bedrooms %3- PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) ra- (~w
1 ❑ Apt/Condo r
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
i
5 ❑ Hotel/Motel 9 ❑ Office/Facto 13 ❑ Other: Specify
Office/Factory
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ® 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) d-/2 ELEVATION
lySQ 3 ,5-Feet 7. 12 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
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system sho on the attached plans.
Plumber's Name (Print): Plumber's Signature: ( Stamps) PRSW No.: Business Phone Number:
_3 2 71S -3 la 2
Plumber's Address (Street, City, State, Zip Code):
I- G
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (include g roun Water Date ue Issuing Agent signature ( tamp )
Approved ❑ Owner Given Initial
Advers 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 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; close 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)
-A An
l
I q
~a s s I
onsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of 3
Latipr and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but T Ceo ;x
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
eve-,(a ' GOVT. LOT S 4j 1/4 S e_1/4,S/'7T Z-21 N,R /1 Jpr(c
PROPERTY OWNER':S MA LING/ ADDRESS T LOT!# BLOCK # SU,B/DI AMY 0 #
ltg 't, X,
A; lla'941 Z/1 I CITY, STATE ZIP CODE PHONE NUMBER []CITY VIL GE OWN NEAREST R AD.
L
01rk'_ /00
[ New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow ~TO gpd Recommended design loading rate 7 bed, gpd/ft2 -1f trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2. .5 trench, gpd/ft2
Recommended infiltration surface elevation(s). /l r ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ~'S ❑ U pida, ❑ U OS ❑ U 0S ❑ U ❑ S ,®U ❑ S ,CCU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo GPD/ft
ur>dary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
/ l d / u Zr 5
~i
L C
Y n
Z ~
Ground 6 -~r7 0Y-fY 0',C St M4, 4 "J i"/
el_ex
sft. Q
Depth to
limiting
facto,
Remarks:
Boring # /
Ad A9 ye- AIL_ 4,V
V4 c.) d 7 Y
roundv' 3 y" /d /Q mi( Id
elev. y -/,to ` G~ y y si"'
~S ri^ 1 4
ft.
Depth to
limiting
factor„
Remarks:
CST Name:- e rlt/ l Phone:
Address: /®,,O 25[
Signature: Dat : CS mbe
I(A/ 14"
Al
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of*-k-,
PARCEL I.D. #
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouclay Roots GPD/ft
in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Tmr&
7X
Z i- 3 y ,C 6 / b- r~~N L w' ,f~
Ground 7
elev.
Depth to s '-/V 7-
G' !t
limiting
factor ,
Remarks:
Boring #
15
Ground.... 3 23„ lo ye yl 14
&,ev. cl 7 @ 0 Ye YA
S w, 1'''l 7
ft.
Depth to
limiting
to
Remarks:
Boring #
Alw~
' 3 z ` /4 e 411 46 s 1 /mar 7
J Z = 5~' o 6 S M C,r^ r C c.~ w~ 7
3 0 /oyie 1 2,~atr #I(,.
Ground
elev.
/ ,O ft.
Depth to
limiting
factor ,
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PC 3d- 3
5y f'7`S S~ L 3
aL of
ez
y~, 830 sl Nw C.", /o f IOS
8i
yam, p,
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y NVVVa3Hs
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S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER_ ue/ n1nold ~__5,L.
ADDRESS /7c'c~~FIRE NUMBER A46
CITY/STATE ZIP
PROPERTY LOCATION :.IS L1/4 , .S E 1/4, SECTION T Z % N-R c W
TOWN OF St. croix county,
SUBDIVISION 1lle/ti' /«C14t 6~f , LOT NUMBER LS~
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 tAe 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/Ile, 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 Co. Zoning Officer within
30 days of the three year expiration date.
SIGNED:
DATE:
St. Croix co. Zoning Office
911 4th St.
Hudson, 111 54016
STC-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), thentasecond form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording. ,
owner of property
Location of property Sw 1/4 ~ 1/4, section 1.1 T 2`i N-R__29 W
Township
Mailing address A,
8
Address of site
~dT
Subdivisi.Q_n_ name ~L///C`!u, 'e'
Lot no. _
her homes on property? X ,yes No
Previous owner of property Aef1u W.P/^.~" onl
Total size of parcel / <ett f
Date parcel -was created
! 'Are all corners and lot lines identifiable? X" Yes No
Is this property being developed for (spec house)? .,Yes _>e No
Volume ^~3 and. Page Number _5~Z 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 & 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. 39S 02e , 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 County Register of deeds as Document
No.
Signature of aq~ scant
Co-applicant
Date of Sig; ture Date of Signature
ST
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9RANMW
f- X ExCBPT the following `pests qf~~ f~Lo~wa:de cribed'tracts:
All land included wittier the 1?411 of Willow Ridge Second
° . Addition 1
to fibs;?an4=41f "M" OMacsibed. in Vol. 4 of
Plata; pzge - 2S, r s
y Parcel deeded to Marlin p. land Ruth L /Amdahl as
described is Xol 7 517; lb.'. 324368;
Psrotl deeded"tp- 8s$sble 401"deacribsd,in,Vol. 517,
page 114, Document >haber
324430,.;
x TOGETHER with an easement o r amet purposes aver the Easterly
33 feet of said g
parcel deeded to lto er E. Hetchler as described
in Vol. 517, Page 114, DocuMe-t,>lueber 324430.
k ° SUBJECT TO the r'
"A" ~.gbt-+q►t-qty:LOf•t said St. Croix County Tru.lc Highway i
-and to telephaoe'easemegt•adjacent.to said highway as recorded
in the off ice of said 1tesi. t Itof Dwda. ? •
'7. 717
Purchaser agrees to purchase the"Property and to pay to Vendor at: St. Croix !
- i Heights, Hudson, Wisconsin, the Base•Purchase Price of $100,000.00, together with
additional payments per lot, as `follow:
1. Base Purchase Price. The base purchase pr`ce of $100,000.00
OhaM be paid in the following manner: $15,000.00 at the
execution of this Contract, and the balance of $85,000.00
r together with interest on such portions thereof as shall
remain from tine to time unpaid, at the rate of 1OX per
annum, until paid in full, as follows:
(a) For each individual lot developed and sold by the Purchaser,
Purchaser shall pay to Vendor a $2,000.00 principal payment, to
be applied to the $85,000.00 base contract balance outstanding.
(b) A ninimim annual payment of $15,000.00 principal shall be
paid each year, excluding the year of sale. Each per lot
principal payment required above, shall be credited toward
this $15,000.00 annual payment.
(c) On December 1, 1985, and on December lot of each year
thereafter, Purchaser shall pay to Vendor the differential
between the required minimum principal payment of $15,000.00
and the total $2,000.00 per lot payments made during the
preceding twelve (12) months, until the Base Purchase Price has
been paid in full.
(d) Interest on the principal balance of $85,000.00 shall accrue
from the date of closing, with annual payments of interest due on
the lot day of December, each year, commencing December 1, 1984.
wI 1 rUMrp 2. Additional Per Lot Payments. In addition to the foregoing Base Purchase
.r►o.sr.~►nw Price payments, Purchaser 'shall pay to Vendor additional per lot payments
totaling not less than $150,000.00, as follows:
502somw S1. (a) No interest shall accrue on the principal sums paid to Vendor
Nudw• was. under the terms of this Paragraph.
51016
715966.621
~C:era'
! f¢ ~M~ ..y(b);.Beschasr shall pay to Vendor the sum of $3,000.00 per
lot on *11 residential lots developed and'sold by Purchaser,
subject to the condition that the minimum amount of payments
to be, Mde to Bertelsen under this Paragraph
at least $150.000.00. shall total
(c) During each year of this Contract that there is an
outstanding contract balance of the Base Purchase Price
(Paragraph 1(a)) there shall be no minimum annual principal
payments under this paragraph. Commencing with the year
following completion of payment of the Base Purchase Price,
Purchaser shall pay to Vendor a minimum annual sum of
$15,000.00 per year.
(d) On the 1st day of December of each year, Purchaser
shall pay to Vendor the differential between the minimum
annual payment of $15,000.00 as provided in this Paragraph,
and the total $3,000.00 per lot payments made during the
preceding twelve months, until the entire $150,000.00
minimum sum has been paid. Thereafter, if Purchaser sells
any lots in excess of 50 lots, Purchaser shall pay to Vendor
the sum of $3,000.00 for any such additional lot sold, up to a
total of 53 lots. ($159,000.00 total hereunder)
Purchaser shall not be required to pay monthly payments to Vendor sufficient
to pay reasonably anticipated annual taxes and special assessments.
Any amount way by prepaid without premium or fee upon principal at any time.
In the event of any prepayment, this Contract shall not be treated as in
default with respect to payment so long as the entire balance of principal, and
interest where required, is less than the amount that said indebtedness would have
been had the monthly payments been made as set forth above.
Purchaser states that Purchaser is satisfied with the title as shown by the
Abstract of Title submitted to Purchaser for examination, except:
Real estate mortgage to Sam E. Miller, dated February 1,
1980, recorded in Volume "608", Page 152, Document Number
362685. This mortgage shall remain the obligation of
Vendor, who shall keep said mortgage current and in good
standing. In the event Vendor fails to pay any required
mortgage payment, Purchaser shall have the right to make
such payment, and to deduct any payment so made from the
sums due under the terms of this Contract.
Purchaser agrees to pay the cost of future title evidence.
Purchaser shall be entitled to take possession of the property on Closing.
Purchaser promises to pay when due all taxes and assessments levied on the
Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts
showing such payment.
Purchaser covenants not to commit waste nor allow waste to be committed on
the Property, to keep the Property in good tenantable condition and repair, to
keep the Property free from liens superior to the lien of this Contract, and to
comply with all laws, ordinances at;d regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys
shall be fully paid and all conditoos shall be full performed at the times and in
the manner above specified, Vendor will on demand, execute and deliver to the
Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all
liens and encumbrances, except any liens or encumbrances created by the act or
default of Purchaser, and except, subject to utility easements and covenants and
restrictions of record.
Bertelsen shall have the right to purchase one (1) lot from B b H for
the sum of 55,000.00• Bertelsen may select his lot after B 6 H picks its first
five lots.
-2-
voL
Vendor shall consent to the platting of the premises into residential
subdivisions by Purchaser and Vendor shall be under an obligation to approve
aml astute subdivision plats prepared and submitted by Purchaser.
In addition to the Warranty Deed which Vendor shall deliver at time of
ultimate closing, Vendor shall execute and deliver to Purchaser, individual
r,TM Warranty Deeds covering the separate residential lots which Purchaser may sell,
upon payment of the per lot payments set forth above. All costs of platting and
costs incurred in preparation of individual deeds shall be Purchaser's expense.
Purchase. at-see that time is of the essence and (a) in the event of a default
in the payment of any principal or interest which continues for a period of 60 days
following the specified due date or (b) in the event of a default in performance
of any other obligation of Purchaser which continues for a period of 60 days following
written notice thereof by Vendor (delivered personally or mailed by certified mail),
then the entire outstanding balance under this contract shall become immediately
due and payable in full at Vendor's option and without notice (which Purchaser
hereby waives), and Vendor shall also have the following rights and remedies (subject
to any limitations provided by law) in addition to those provided by law or in
equity; M Vendor may, at his option, terminate this Contract and Purchaser's
rights, title and interest in the Property and recover the Property back through
strict foreclosure with any equity of redemption to be conditioned upon Purchaser's
full payment of the entire outatanding balance, with interest thereon from the
date of default at the rate in effect on such date and other amounts due hereunder
(in which event all amounts prev:ov:sly paid by Purchaser shall be forefeited as
liquidated damages for failure to fulfill this Contract and as rental for the
Property if purchaser fails to redeem); or (ii) Vendor may sue for specific
peformance of this Contract to compel immediate and full payment of the entire
outstanding balance, with interest thereon at the rate in effect on the date of
default and other amounts due hereunder, in which event the Property shall be
auctioned at judicial sale and Purchaser shall be liable for any deficiency; or
ti (iii) Vendor may sue at law for the entire unpaid purchase 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 action if the equitable interest of
Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from pobsession
of the Property and have a receiver appointed to collect any rents, issues or profits
± during the pendency of any action under M, &i) or (iv) above. Notwithstanding
any oral or written statements or actions of Vendor, an election of any of the
foregoing remedies shall only be binding upon Vendor if and when pursued in litigation
and all costs and expenses including reasonable attorneys fees of Vendor incurred to
enforce any remedy hereunder (whether abated or not) 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 included in any judgment.
ti
Upon the commencement or during the pendency of any action of foreclosure
of this Contract, Purchaser consents to the appointment of a receiver of the
Property, including homestead interest, to collect the rents, issues, and profits
of the Property during the pendency of such action, and such rents, issues, and
profits when so collected shall be held and applied as the Court shall direct.
Purchaser shall not transfer, sell or convey any legal or equitable interest
in the Property (by assignment of any of Purchaser's rights under this Contract or
by option, long-term lease or in any other way) without the prior written consent
of Vendor unless either the outstanding balance payable 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 security for an indebt3dness of Purchaser.
In the event of any such transfer, sale or conveyance without Vendor's written
consent, the entire outstanding balance payable under this Contract shall became
immediately due and payable in full, at Vendor's option without notice.
Vendor may waive any default without waiving any other subsequen- or prior
default of Purchaser.
•
-1-
i 49 ,
VOL
al
r'
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 over of the Property the spouse of Vendor for a valuable consideration
loins 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.)
Dated this 29th day of May, 1984.
VENDOR: PURCHASER:
D B.5 H EVELOf"ENT, INC.
BY: /c `
Arnold R. Bertelsen a/k/a A.R. Bertelsen Donald E. Bjornst , President
ATTEST:
Virg a A. Bertelsen
William C. Harwell, Secretary
A l,f
r Authentication: yt _
Signature(s) of Arnold R. Bertelsen,
y , G p
VirrRinia A_ Bart la n- his wife- and S.Q w gL
. Donald E_ Biarn_.tad and William C. •
Harwell, President and Secretary
pectvely of B_g H_>kvelnpment. Inc.,/)
day of May, 19
William J. Radosevich
Member State Bar of Wisconsin.
This instrument drafted by:
William J. Radosevich
Attorney at Law
Hudson, Wisconsin 54016.
I
ST. CROIX COUNTY
. t WISCONSIN
ZONING OFFICE
w r N r ""'"i ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
- (715) 386-4680
June 16, 1994
Mr. Daryl Bjornstad
613 7th Street North
Hudson, Wisconsin 54016
RE: Septic Inspection for B & H Development Property
Dear Mr. Bjornstad:
An inspection of the septic system for B & H Development's property
was conducted on June 15, 1994. This property is located in the
SW; of the SE; of Section 17, T29N-R19W, Lot 105, Willow Ridge
East, Town-of Hudson, St. Croix County, Wisconsin. At the time of
the inspection, this septic system was found to be code compliant
for a three bedroom home. If you have any questions with regard to
the above, please do not hesitate in contacting our office.
ince ely,
77 ~~pS
ames K. Thompson
Assistant Zoning Administrator
mz
(CO,Qo