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HomeMy WebLinkAbout020-1089-10-000 { 1, f STC - 104.: AS BUILT SANITARY SYSTEM REP OWNER Leh v ADDRESS 'e( SUBDIVISION / CSM# LOT SECTION T(9 ~ N-R W, Town of ~N ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ f ~DD~ Cd 'S e a INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ~ rr BENCHMARK: e ALTERNATE BM' SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: PI'A-V-c~j Q l d C'U Liquid Capacity: Setback from: Well ~y House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM l ~ Width:, Length 36 Number of trenches 1 ed 4 ~ Distance & Direction to nearest prop. line: -3 Setback from: well: ~JoO~ House 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: G~J LICENSE NUMBER: r INSPECTOR: 3/93:jt I' kr'art`siYi KfartMPTiC' 15tYy~ • 29. 19, PRIVATE SJ A& SYS I a Road County: Labor and Human Relations INSPECTION REPORT Safety a:rd Buildings Division (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: E] City E] Village IR Town of: State Plan ID No.: - HILD " 'Ll - lHudson CSTBM Elev.: Insp. BM Elev.: BM Description: ~Iff Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400078 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /,)y 3v do Dosing Aeration Bldg. Sewer Holding St/Ht Inlet (D i~ TANK SETBACK INFORMATION St/ Ht Outlet ~,3 tea, -7 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic las >SO ' >//)C) >16b NA Dt Bottom Dosing NA Header / Man. .U/ Aeration NA Dist. Pipe b• Q ~,j Holding Bot. System o 97. PUMP/ SIPHON INFORMATION Final Grade y2 /oD~b4 Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 161 3~i DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Model Number: System: -00 OR UNIT ~tJ 1 7 DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges - Topsoil ❑ Yes ❑ No ❑ Yes ❑ No 19"TS: (Include code discrepancies, persons present, etc.) _ LOCATION:Hudson.32.29.19, SW, NE, Lot 1, O'Neil Road .x w Plan revision required? ❑ Yes Cg/N Use other side for additional information. FIR SBD-6710 (R 05/91) Date I/` In pecVY►'s Signature Cert. No. SANITARY PERMIT APPLICATION L 0ILHR In accord with ILHR 83.05, Wis. Adm. Code CO STATE SANITARY PERMITt_ -Attach complete plans (to the county copy only) for the system, on paper not less than a Qg9 SS 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 T S 6J % ''/a, S T , N, R E (or PROPERTY OWNER' MAILING D E 671 LOT # BLOCK # i CITY, ST TE ZIPCODE PHONE NUMBER Su nip SION NAME 7 CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST Rp VILLAGE : N ❑ State Owned ~ ❑ 91A AS n ;I I 19 =N W: ❑ Public N 1 or 2 Fam. Dwelling4 of bedrooms - PARCEL TAX u ( 0ao_ I O X9 _ 16 III. BUILDING USE. (If building type is public, check all that apply) 0 7 7 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 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) I A) 1. New X) (3q 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ Repair of an System System Ta my Existing System Existing System B) ❑ A Sanitary Permit was previously issu ermit # - Date Issued V. TYPE OF SYSTEM: (Check only onq 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.) PROP SED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) . ELEVATION 16 ( ` ~ Z . 7 t © Feet jM.t> Feet 4~0 1 1 7 VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks structed Septic Tank or Holdin Tank ow 1,, e ~ Lift Pump Tank/Si hon Chamber 1-1 El Ll El 1 0 El Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on attached plans. PI m Kr's Name (Print): PI is Signature: ( mps) MP Business Phone Number: PA I, A A ~bVA 3 J p Plumber's Ad rass (Stre t, l~ , State, 'p Code): 1, , X 1) ey- f- 7k IX. C NTY/DEPARTMENT USE ONLY Disapproved San}tpry Permit Fee (Includes Groundwater ate Issued Issuing Ag t Signatu Approved ❑ Owner Given Initial 19, 60 ,{~/~j /'aSurcharge Fee) 01 Adverse Determination U~/ ( ~/o ~ 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 applicab'e 3. All revisions to this permit must be approved by the permit i;4suing authority. 4. Changes in ownership or plumber requires a Sanitary Permit ransfe /Rer, ~wal Fiort , 6399) to be submitted tc the county prior to installation. 5. Onsite sew H --ystems must b,= pr!,pe!!y maintained. Th r tankrn . it b licen er.l pumper "the,-eve, necessary, usually every 2 to years. 6. If you isa le questions concerning your onsite sewage systerfi, contact ~Y' ur local c,-,de 1oh.,if>istrator 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 e;..: r lber(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 Farnily 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 existin, tank, :'st tf e total number of tanks and manufacturer's name. Indicate prefab or site construc!e(j and tank mate ial. C-on,!)lz to for all septic, pump/siphon and holding tanks for this system. Check e)operimc.ntal approva oneV i` tanks received experimental product approval from DII_HR. Vlll. Responsibility statement. Installing plumber is to fill in name, license n,,niber with appropri -i.te 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 he submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with cor`)plete dimensions, ;Doation of holding tank(s), septic tank(s) or other treatment tanks; building sewers, .vell:; water maim water service; strear7,s and lakes; pump or siph,.m tanks, distribution boxes; soil abG(..r in -~Ystt✓in,< system areas, anO the location of the buil&nq served; B) horizontal and vertica -le, ti r C) complete specifications for pumps and controls; dose volume; elevat:)r, .;f,•;er<ances fr ir; los3; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorl tion 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 r?urnl-),;r ot[ regulated pr,:c: ices r!rhich can e=ffect groundwater. TFp n-ogres collected thro:jyr• s!.rch•arges arE use(' ~"1h'~'l; Ot i,:, r.'.: G4!~;tEr water ~.c e°arninatio+? ins r sYigatif~ns and establishment r-.,f standards. SBD-6398 (R.11/88) ke t li'y) SW N 3 33 37~©D•0 Br ~Sjf 3z L 3 t. 3 ~ b q4 J, ~tOpose~ EH 11 Access /V OTE . ~/Po~Ty ~ REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES b"o o/ mul /vo ly% P.O. BOX 309, MADISON, WISCONSIN 53701 Of M Y RA0106W 7y LOCATION:SW 'y,, A/E Section 3' ,T?/ N,R/9 E (or) W, Township or Municipality Lot No. , Block No. ~R~I~iy /E'INNf SVIst~/y/S/ON County • 71. Cole 0/)( Subdivision Name Owner's/Buyers Name: /I'//{/lr%/1A/ rrIaV e y Mailing Address:- RT 3 d -WC/Z_ , A01 /VVAJ`W v TYPE OF OCCUPANCY: Residence X No. of Bedrooms L COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEtM~ ENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS DE: SOIL BORINGS -6 - 7 / PERCOLATION TESTS 1- 7- 71 SOIL MAP SHEET 6 NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH HOURS WATER IN TEST TIME NUM- CHARACTER OF SOIL DROP IN WATER LEVEL, INCHES RATE INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P_ ILIA0 2.1-. ;kCIA -41 J-01 P- 2 1"I t, S 2o';f/ /o"Cf 2-11 -0 G G P- G /o ~4 "S/ ~►iEp. s l -0- y 2 1/ 7 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES OBSERVED ESTIMATED HIGHEST TEXTURE, MOTTLING AND DEPTH TO BEDROCK IF OBSERVED IN INCHES B- 7L ~V°NE 7Z /O"A'l?N-L /71 /7" MEA f 100,1e5. B- 2 r(J A10011E d" 80 .Q •,Biv• L to ~1IED, s CS B- 72, DAZE > 7z. to Ok. G "S/ 2G" 70ER S 2~''~S B- 72- 'VbNE t 72 /~v Z. .4 / )"ep- B- S 7L Aolv&C > 72 9" BN. L 2S "S/ to hiEO• S. PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy !u- foie eb Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. pp ol,4a No r TO I OA ;Zls"TitvcEsccU,p,4T~. B~ E - SORE PERG ._co rf e - y3 0 . 40f/ _ jai P F o - E A - zZ _ a_ Pi \C) s 4 ►r 4- . _ }E _ 1_1_4 A Z/04 r { 4 3 ~ E I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord vu th the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. q~ Name (print) haveAr yI /b ~/~~Sj " Certification No. ~j d~' / ~L- Address RT_ ~Q IYVDS0N S .Name of installer if known 1- Copy A -Local Authority CST Signature! QIU&,W_ &ZA / 4 k ke t 11 n , 3~ 3 l W 9 8a+ 6 K0 Ifl 1 P lot s x i, 1 FORM NO. 985-A H.C MI.rCmgen,~ 3 :v ~y FILED O CT 15 380 JAA153 O' CONNELL R•pbNr of Deeds W. Croix comfy, ~l W4condo N I/4 CORNER CERTIFIED SURVEY MAP s g SECTION 32 I W LOT 2 CERTIFIED SURVEY MAP M o 6 s, I RECORDED IN VOL. 2 PAGE 366. N (i ECO DED AS S89005155u W ) N S 8 ° 0 43~' 256.23' 55.03' Z) 67. 4' 133.46' d 393.73' N 35°41'28" W o 0 I 0"'o yOA RECORDED AS THE NORTH 12.68 ° o~ CID Q LINE OF THE SW-NE LEGEND n~ 09 POINT OF BEGINNING -4- COUNTY SECTION CORNER MONUMENT N • I" IRON PIPE FOUND FENCE ,N LU o 3/4' X 24' ROUND STEEL BAR WEIGHING No p 1.502 LBS. /LINEAL FT. SET o O SCALE IN FEET z_ N 0 b 0 100 20O 300 N d O ~ (I" - 100' W 2 11, V, 1 r-- 0 Z m W U; o 1.6406 ACRES a W J 0) cr W I d ~z3 to LlJ 0 a Z (n 0 r (A I'7 ~ W ~ z ~ Oi Z N WZW 0 U] JI ~N I Z WI NWN QI Qua o a F 1 /0 N M ,N 4°49'03W 219.60' I M W o rOi rNi Z tnm I w o n C\j n = 1 l 173024'5911 Lol co CJ CO L` `O 21 SE-NW :D I niz. SW-NE ' I "v I' OI 3 I O 3 3 3 ' 6 6 0 l~ >I cn 0j O O O I w o rz - - - - I I f HOUSE zl CV w coN O (Yr) L(\ 00 2 (3 i = H co c() cf) M 1.5303 ACRES N O I Ems- I 1740/9'01" +r-8~E- Z 4I Q W I o_ I I ~I zi w x - - - - QII of o o 00 01\ or" 1 I wI v ~w_q LLr, w ~ ° N N N < I ► S89°24'03"W 264.73' ~I ~0I II WI ~ I 1' JI I ~I ~P S o 0 0 I I al o H II LLi O r~ N ti JI ii o o o ~ o wl II N 11 3 zl 1F0 ya° 1.3042 ACRES 'OFF , o III O 006' b o qs3 d N M N 89° 2410311 E 272.591 N 616' I ~ I UNPLATTED LANDS APPROVEr) I I S 1/4 CORNER 15 1980 SECTION 32 T 29 N, R 19 W ST. CROIX COU,"1Y 'Ti(k(INS This instrument was drafted by John C~N,p;,E_lro~ ;"t. vc0tAr+ ~iq L1 ~.Il9Ci Vol o 4 Page 710071 TOOT a ~1 ',OA . 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UTSUOOSTM paaagsT&aa `uosnH • H saute f `I •SSGT ao aaout `saaoe 61Z'S Bu?uTequoO •paooaa jo squautasea og goaCgnS •BUTUUTDaq ,?o quTod auq oq aUTT ugaoM papaooaa pTes 2UOTP ~Z°9SZ M,~+,TOo689 aouauq- ` am auq 3o TMS p?es JO auTT ugaoM auq uo Bu?aq se papaooaa adTd „T BUTgsTxa ue og ,8L tlgg M,IIE,TTDOM aouauq- `adTd uoaT „T OUTgsTxa ue oq ,6S'ZLZ H,,~O, E~ 068M aouauq ` i8 aSed `865 aumTOA UT papaooaa Taoaed geuq jo au?T ugnOS auq oq ,86'882 M„80,900 5 saeaq paogo asOgm RTaagseg aneOUOO anano snTpea ,00'L96T e DuOTe mE -68Z fT.zaugnog aouauq tau-[T UOTgoaS i pTes OUOTe ,L9'+165 „O+I,ZT OS 9UTnuTgUO3 aouauq `.SUTUUTSaq jo qu?od auq oq auTT UOTgoaS i S - M aqg SuOTe ,~+*T5~T (~„O+I,ZT OS paumsse OuTaeaq Z8 uoTgoaS pies ,To auTT uoTgoaS t S - M auq- og paouaaajaa SuTaesaq paumsse) g,,O+,ZT OS aouauq `Z8 uoTgoas pTes jo aauaOO -CM auq qe SuTOUGMOO :sMOTTOJ se pagTaOsap `u?suoosTM `fqunoO x?oaO 'qS `uospnH JO uMOZ `METH `146Zs `Z~ uOTgOaS JO TMM auq jo TSS auq pus Tam auq JO TMS auq U? pageOOT pueT JO TaOaed V MOIZdI23OS~Q SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ~ OWNER/BUYER o CG t,bOUTE/BOX NUMBER 4ire Number t v 'CITY/ zIP 00/4 0 STATE o PROPERTY LOCATION: k, Section `T N, R W, Town of St. Croix County, Subdivision o 4 , Lot number {Improper use and maintenance of your septic system could result in jts premature failure to handle wastes. Proper maintenance con- ;sists of pumping out the septic tank every.three years or sooner, needed, by a licensed- *septic tank pumper. What you put into the system can a ect the unct on of tine septic tank as a treat foent stage in the waste disposal system. .St. Croix County residents m be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, bwh c was in operation prior to July 1, 1978. St. Croix County accepted this program in August to keep twith the heir that Owners of all new sstems agree p their system maintained. The property owner agrees to. submit to St. Croix County Zoning a ;certification form, signed by the owner and by a mater plumber, 3ourneyman plumber, restricted plumber or.a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- a,essary), the septic-.tank is less than 1/3 full of sludge and scum. k.Certification form will be sent approximately 30 days prior to , three,year -expiration. y .I/WE, the undersigned have read the above requirements and agree 0 ;to maintain the private sewage disposal system in accordance with %the standards--set forth, herein, as set by the Wisconsin Depart- w ,;went of Natural Resources, Certification form must be completed •d and returned to the St. Croix County Zoning Office within 30 days +of the three year expiration date. - SIGNED' DATE FSt. Croix County Zoning Office 911 4th St. Hudson, WI 54016• 386-4680 `,Sign, date and return to the above address. r APPLICATION FOR SANITARY PERMIT 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 ownet/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 _pab,1tt1_P fPAe/;n - Location of property ! ~V 1/4 /4, Section , T W Township AA obi Mailing address A4 d 16 Address of site Subdivision name Lot number _411 /I L Previous owner of property Y\- 04 Total size of parcels b, n Date parcel was created Are all corners and lot lines ~dentlflable? an o Is this property being developed for resale (spec house)? as _No Volume and Page Number 3 6 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 (out) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty eeee r~ corded in the Office of the County Register of Deeds as Document No. ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been ecorded in the Office _dul of ta:unty Reg ster of Deeds, as Document No. ~RTV Signature of Owner Signature of Co-Owner (If Applicable) s Dat S1 nature Date of Signature 1 DOCUMENT NO. 6 p .387 ~~To Corporation IVO L 9 Q e fw Msnranoe, Option and Tax Clause s'~ ~•i.' ~sa~TE OF WISCONSIN-FORM 17 (Rev. 1953 82 THIS SPACE RESERVED FOR RECORDING DATA R50- I;T§.RS OFHCE KNOW ALL MEN, That Mildred Darlene Regelin, a single Co., wts. woman for tfr•cayd, 1•nis 3rd day of Nov A.D. 19 83- partYof the first part, in consideration of the sum of Twelve Thousand TWO 0 8:30 A:30 A Hundred Sixty One and 39/100 Dollars, in hand paid by Menomonie Farmers Credit Union ~ of e a Corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin located at RETURN TO 704 No. Main St., River Falls , Wisconsin, party of the second part, the receipt whereof is hereby acknowledged, do hereby grant, bargain, sell and convey to the said party of the second part, its successors and assigns forever, the following described real estate, lying and being in the County of St. Croix , State of Wisconsin, and known and described as follows, to-wit: Part of SWk of NEk of Section 32-29-19 described as follows: Lot 1 of Certified Survey Map filed October 15, 1980 in Vol. "4", page 1001. This is a Purchase Money Mortgage. The undersigned mortgagor or mortgagors hereby agree that they will be bound by the provisions of Sections 846.101 and 846.103(2) of the Wisconsin Statutes. This indebtedness, at the option of the holder, shall become due and payable immediately, without notice, if the maker or makers hereof convey or transfer the real property mortgaged as security hereto. It is further agreed and understood between the parties hereto that this mortgage shall stand as security not only for the above mentioned note(s), but also for any and all renewals, partial renewals, and extensions thereof, overdrafts and other indebtedness now or hereafter owing said mortgagee by the mortgagors herein, or either or any of them, in an amount not to exceed at any time the sum of Twelve Thousand Two Hundred Sixty One and 39/100 Dollars. f.;t i together with the privileges and appurtenances to the same belonging, and all of the rents, issues and profits which may arise or to be had therefrom. TO HAVE AND TO HOLD the same to the said party of the second part, its successors and assigns forever. And the said Mildred Darlene Regelin a single woman part _V- of the first part, for herself, her heirs, executors and administrators, hereby covenant s that she well and truly seized of a good and perfect title to the premises above conveyed in the law, in) fee simple, and that the title so conveyed is clear, free and unincumbered and that she will forever warrant and defend the same to the party of the second part, its successors and assigns, against all claims whatsoever. (Section 59.51 (1) of the Wisconsin Statutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon the names of the grantors, grantees, witnesses and notary). MORTGAGE-STATE OF WISCONSIN, FORM NO. 17 H. C. YILLIR co.. MILWAUKEE AND THE SAID Mildred Darlene Regelin, a single woman VOL 676 ,,Acf 368 for herself, her heirs, executors, administrators and assigns, covenant-Sand agrees with tMe " said party of the second part, its successors or assigns, to insure and keep insured the building _ thereon against loss or damage by fire for the sum of the full insurable value Dollars, or over, in insurance companies to be approved by the said party of the second part, its successors or assigns, such insurance to be payable in case of loss to the said party of the second part, its successors or assigns, as its mortgage interest may appear, and the policy or policies of insurance to be held by the said party of the second part, and to pay when due and payable, all taxes and assessments now or hereafter assessed or levied against this mortgage or the note _ secured thereby and on the real estate described in this mortgage, including every mortgage interest which said party of the second part, its successors or assigns may have or be deemed to have in such real estate by reason of this mortgage, and to deliver to the said party of the second part, its successors or assigns annually, prior to the first day of May, receipts showing due payment thereof; hereby waiving and releasing all rights of offsets or deductions against the indebtedness secured by this mortgage, because of the payment of any such taxes or assessments; that the interest of the mortgagor _ and also of the mortgagee, in such real estate shall.be assessed for taxation and taxed together, without separate valuation, to the mortgagor her heirs and assigns; and in case of any failure to keep or continue such insurance and to deliver the same as above provided, or in case any such taxes or assessments remain unpaid after the expiration of the time in which they are due and payable, the said party of the second part, its successors or assigns may effect an insurance upon said building or buildings to the amount above named and may pay such taxes and assessments with accrued interest, officers' fees and expenses thereon and the amount or sums so paid shall be immediately paid to the said party of the second part, its successors or assigns, and shall, unless so paid, be added to and be deemed part and parcel of the money secured hereby, together with interest thereon at the rate of ten per cent. per annum, and form a lien upon the premises so described. PROVIDED ALWAYS, and these presents are upon this express condition, that if the said Mildred Darlene Regelin, a single woman part _V' of the first part, her heirs, executors, administrators or assigns, shall pay or cause to be paid to the said party of the second part, its successors or assigns, the sum of Twelve Thousand Two Hundred Sixty One and 39/100 Dollars, according to the conditions of a certain promissory note _ bearing even date herewith, executed by the said part Y of the first part to said party of the second part, and shall moreover keep such buildings insured as above mentioned and keep the policy or policies thereof assigned, as aforesaid, and shall pay all taxes and assessments herein above referred to, as aforesaid, then these presents and the said note- shall cease and be null and void. But in case of the non-payment of any sum of money (either of principal, interest, insurance premiums, taxes or assessments), at the time or times when the same shall become due, or the failure to perform any oi the covenants or agreements by said part y of the first part to be kept and performed, then in such case, or in either case, the whole amount of said principal sum shall, at the option of the said party of the second part, its successors or assigns be deemed to have become due and payable without any notice whatever, and the same, together with all sums of money which may be or have been paid by the said party of the second part, its successors or assigns for or on account of insurance, taxes or assessments, with interest thereon at the rate aforesaid, shall thereupon be collectible in a suit at law, or by foreclosure of this mortgage, in the same manner as if the whole of said principal sum had been made payable at the time when any such failure shall occur as aforesaid; and the judgment or decree in the suit brought to foreclose the same shall embrace, with said principal debt and interest, all the sums so paid for, or account of, insurance, taxes or assessments, with interest at the rate aforesaid; and it shall be lawful in such case, or in'either case, for the said party of the second part, its successors or assigns to grant, sell and convey the said real estate with the appurtenances thereunto belonging, at public sale, and on such sale to make and execute to the purchaser or purchasers, his, her or their assigns forever, good and sufficient deeds of conveyance in the law, pursuant to the statute in such case made and provided. And in case suit shall be brought for the foreclosure of this mortgage, the said party of the first part for herself , her heirs, executors, administrators and assigns, covenant S and agree S that she will pay to the said party of the second part, its successors or assigns, all expenses incurred for the purpose of the foreclosure suit, and in addition to the taxable costs in such suit a reasonable sum of money as solicitor's fees; to be included, with the expenses above mentioned, in the judgment or decree. In Witness Whereof, the said part y of the first art ha s hereunto set her hand _ and seal this 3 Yst t. of October A. D., 19 SIG ND ALED IN PRESENCE OF ° ^ Q (SEAL) Mildred 1a ene Regelin (SEAL) D J. 4o e -'/J sen A~~ (SEAL) Bett3j eg 0 (SEAL) STATE OF WISCONSIN, St. Croix ss. County. Personally came before me, this 31St day of October A. D., 19 83 the above named Mildred Darlene Regelin. a single woman to me known to be the person who executed the foregoing instrument ano acknowled ed t e. a , D. " Jensen ` a woe •y This instrument drafted by !!1tt)TARY'.. ry Public St. Croix County, Wis. ale Jensen, Manager ,~rv My Commission (Expires) (Is) 1-25-87 off' (Section 59.51 (1) of the Wisconsin Statutes provides that all instruments to be recorded shall b^ a plainly printed or. typewritten thereon the of the grantors, grantees, witnesses s~ ' notary). °Q ~~V` "aGAGE-STATE OF WISCONSIN, Fl . NO. 17 S, t No. 14114 i`v v G F w .-r H cd` QOCUMENT NO. WAiaR M DEED THIS SPACE RESERVED FOR RECORDING DATA S2'ATE BAR OF WISCONSIN FORM 2 -1982 • . 388981 o" 676 An366 y I _ REC71STURS OFFICE Maric~n...~T....K nne~, a ngl.e_._..per on 9T. CR C,17, Co" WIS. ReC'd. ftarf3cand this 3rd day of Nov A.D. 1983 - at 8:30 A 044e l conveys and warrants to Mildred -Daxlene---Rsg-~--l-in-f--a-som----- P-er-sim-------------"- - P,aakla at asdt - - i RETURN TO i i - i! I the following described real estate in -St.._ Croix y~ ......Count i State of Wisconsin: Part of the Southwest Quart er(SW4) of the Tax Parcel No Northeast Quarter (NE4) of Section 32, Township Twenty-nine (29) North, Range Nineteen (19) West, Described as follows: Lot 1 of a Certified Survey Map filed in Volume 4 of Maps on page 1001 in the office of the St. Croix County Register of Deeds. I I $NISA I t W lei I €i I: ii II i This. __.ls not homestead property. 4 (is) (is not) Exception to warranties : i ~I October 83 Ii - Dated this r day of 19- (SEAL).C~tic-c~ k/_..... (SEAL) l Marian J. jinney f -----------(SEAL) (SEAL) i AUTHENTICATION ACKNOWLEDGMENT ~I I Signature (s) STATE OF WISCONSIN 111111; St. Croix Ss' County. came before me ,{]~•s ---day of authenticated this day of 19 Oer oenally tS} C~ O r , 19 the above named N&r1.m.Je-- 3►--------------- f TITLE: MEMBER STATE BAR OF WISCONSIN (If not- - I authorized by § 706.06, Wis. Stats.) to me kUown to be the person who executed the j €org 'krunlent ,bnd ac ovule a he same. )di THIS INSTRUMENT WAS DRAFTED BY f ~j•• ~y y -f"\'°~" / - Marian J. Kinney * - DO _ E es taf - - I t~,!y,Puklilc s r~----- County, Wis. jj (Signatures may be authenticated or acknowledged. Both ~My C961liSisslon 'i permanent. (If not, ate expiration j are not necessary.) 3 I d~te : i :l• = 1 r =S 19_ ) I ii *Names of persons signing in any capacity should be typed or printed below their signatures. 1 STATE BAR OF WISCONSIN Stock No. 3~~2 H.CMiIleiCoff%;ww q FORM No. 2 - 1982 Stock