HomeMy WebLinkAbout032-1048-70-050
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER---- r1 er "`I
ADDRESS O.e
SUBDIVISION / CSM#~r ~LOT
SECTION_ ZZ T/_N-R,4$P' _W, Town of
~i,~ rsC
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
3Y~ ~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: A4Z1e- ® ✓ L ~~`r~"`"~
/yp o P/.../ UQ -t-
ALTERNATE BM I
EPTIC TANK / UMP CHAMBER / HOLDING TANK INFORMATION
o
Manufacturer: Liquid Capacity: le ,e
i
Setback from: Well-~ House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
Building Sewer f $r ST. Inlet; ST outlet
PC inlet PC bottom Pump Off
Header/Manifold_ 6 Bottom of system f
Existing ,Or'- Z Final grade -
DATE OF INSTALLATION: l0 1/5 -
PLUMBER ON JOB: ~
LICENSE NUMBER:
INSPECTOR:
3/93:jt
4
LOMTT-C*tarEMltte etK,17'.31.19WRRI T JWA40f 9ySftUe Lake Wdfity:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings"Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar r4M
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P
X
r E BM Descriptiop.u Parcel Tax No.:
1001 O 100. di-ko
TANK INFORMATION ELEVATION DATA A9400119
TYPE MANUFACTURER CAPACITY STATION B5 HI FS ELEV.
Septic
/j_)011 Is Benchmark /Os, 5t 16d,
Dosing 16a,yg 16 6,
Aeration Bldg. Sewer lb~,~S
Holding St/Ht Inlet Jrg,~- j~
TANK SETBACK INFORMATION St/ Ht Outlet 6, [1 qq
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic NA Dt Bottom
Dosing NA Header/Man. L,q-5 •/5'
Aeration NA Dist. Pipe (~.SS 99
Holding Bot. System 76/ PUMP/ SIPHON INFORMATION Final Grade c/,,( /o/.
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss Forcemai n Length Dia. H Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Lengthg No. O renches PIT No. Of Pits Inside Liquid Depth
DIMENSIONS /11~ DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O , d Moe Number:
System: ~PZI_16 l ~o (1,4 ' CHAMBER 1,"44 OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over _~4~y Z xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center
11 Bed/ Trench Edges Topsoil E] Yes C] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) d V~~ I Y~/~w J
NATION: Somerset.17.31.19W, SE, NE, Lot 7, Rice Lake Ro d
a~~~ ff Ll
✓ r ~!3 .fir r Ci.E.. ~ t 1 f I' J
Plan revision require? ❑ Yes ❑ No
Use other side for additional information. a, 44- 6 ,
SBD-6710 (R 05/91) Date Inspector's Signatur~/ Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION COUNTY
v'~~■'■R In accord with ILHR 83.05, Wis. Adm. Code
C.
• STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than C~02; l r
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 OW ER e ~ PROPERTY LOCATION
r z ' '/4,S T ,N,R E(o
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE • ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ,f
CI G v e r e R
CITY NEAREST ROAD
[3 jj
II. TYPE OF BUILDING: (Check one)
❑ State Owned ❑VILLAGE ~,z-- er fea %
❑ Public 91 or 2 Fam. Dwelling-#of bedrooms 't PARCEL TAX N MBER(S)
III. BUILDING USE: (If building type is public, check all that apply) e,913,;z r 0/0"'~~6
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 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. k New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ICJ 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
45 'tv lgs-T --r- - Z, ? IPZdg~ Feet /off Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass' Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank 02~ G C'
Lift Pump Tank/Si hon Chamber El 0_ 0
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumbe ' ignature: (No Stamps) MP/MPRSW No.: Business Phone Number:
Plumb Address (Street, City, State, Zip Code):
_ IX. CO NTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A ent Si ature (No mp
Approved ❑ Owner Given Initial Surcharge Fee) :!y1Vt9A
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewei 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
11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers;,wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
5028'72
.CERTIFIED SURVEY Located in part of the Southeast one-quarter of the Northeast one-
quarter of Section 17, Township 31 North, Range 19 West, Town of
Somerset,,St. Croix County,. Wisconsin...
OWNER: River Hill Family-Trust LEGEND
Gary Gifford, Trustee. FOUND ST. CROIX CO. MONUMENT
452 280th St. • FOUND I" IRON PIPE
Osceola, Wi•. 54020 o SET I" x 24" IRON PIPE WEIGHING
1.68 LBS./LINEAR FOOT..
UNPLATTED LANDS
SCALE 1" = 200'
NORTH LINE OF THE SE V4 OF THE NE 1/4 MIT
N87034 02 E 694.60' 200 100 0 200
294.93 399.67
a -1 m
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DOUGLAS J. yN 00
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HUDSON, _n m
193,860 SO. FT. 180,036 SO. FL Wis. Q► z m
4.450 ACRES 4.133 ACRES -t Iv '4O N X :D
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~C N SETBACK-----..„-. A 0 I
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(A N
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D m 690 g6 32 e , 3 99 ~~2i;~ • m
,rn 40 3• Oi EXISTING 66 ROAD EASEMENT - TO BE
0 DEDICATED TO PUBLIC i-A I
1 -4 U1
jr' a, DETAIL iS I
I D m , 11
I
I~ a 6 5 Iw 10 iU>
()Dp r J_ N87.439"E
3 - I' 0.42' I i
0) 234,729 SO. FT, O(V~ 225,063 SO. FT. j-J
N. 5.389 ACRES - 5.167 5.167 ACRES m I
0 NE CORNER
o) V* M m y - SECTION 17
tD 0 a, 0) to
<D
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CD 1• N
w 1_ ~
'-P 10D
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EI/4 CORNER
SECTION 17 m
T3.IN,R19W N
284.62 409.99' S 87049' 39" W 645.43'.
5870 490 39" W r.94,61',, SOUTH LINE OF THE NE 1/4. z m
o a
N 0
• W 1
Ci E:
UNPLATTED LANDS
This instrument was drafted by Douglas, J. Zahler N
o~
C9 ~ m
rn
m
s FILED g
SE CORNER
SECTION 17
JUL2 719930. 0
JAMES O'CONNELL
ftister of Deeds
SL Croix Co., WI
i VOLUME 9 PAGE 2651
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S0NI2i~13g SN39NKS QHOHO GHOH0 MUM Tdumao SQIGV'd 3A*dnO
3'ISKI KZKa HAMD
. li
THIS SPACE RESERVED FOR RECORDING DATA II:
d I
DOCUMENT NO. WARRANTY DEED
•
R STATE BAR OF WISCONSIN FORM 2-1982
502873 623 _ _ ;
_ _ li -ll PkGF:- - ItM:5TER'S OFFICE ii
ST. G1~G;X CO., Wf ~j
Gary Gifford! Trustee of the River Hills
t'.:c'd for eco- d
ii
Trust 2 7 1993
Family
!,!~I JUL Township 10.0 M
~
, -
jj conveys and warrants to o.f.. S-ome rs.e -:;l
' d9
F UI e
I
RETURN TO
..County,
St Croix
I
the. following described real estate in
II State of Wisconsin: Tax Parcel No:
see attached Exhibit "A"
.i
i.
;r
This _..Ls...no.t,......... homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way
of record, if any. "
-icy ..3
Dated this day of .
River Hills Family Trust
by • A )
(SEAL)
.Gar•y...Gif•for•d•,...Tr•ust.
_
_ .I
ALi
...........(SEAL) -
IL 1:7
`
J~
AUTHENTICATION ACKN0 WLEDGMENT II
II
...{,i.. STATE OF WISCONSIN
Signature (s) °~J• 1 ss.
I
P.. ` ......County.
day of I;
authenticated this 19...... Personally came before me this
day of u 19q.-3 the above named
ric I
G lam, f ~o r
li ti r
I
TITLE: MEMBER STATE BAR OF WISCONSIN
I
i (If not .
I authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
I; foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY '
. stina gland
O gland it
.k .....................County, Wis. II
t;c-- Attorney at Law Notary Public !
Y... My Commission is permanent. (If not, state expiration ,I
(Signatures may be authenticated or acknowledged. Both date:
' 19. j
Y-n
k-
r
are not necessary.)
I
-
-Names of persons signing y capacity should be typed or printed below their signatures.
DOCUMENT NO. li WARRANTY DEEQ' ii THIS SPACE RESERVED FOR RECORDING DATA
•,ISTATE BAR OF WISCONSIN FORM 2 -1982j:
5028'74 'VOL 102PhcE
625 LR.b 0FFIi
- ! ST. CMIX co., wi ~i
Dana..L..... T.ow...and•, Li nda...K..... T.o.W.~ I Lc`d fbr gfcora
;
husband..:and...wi.f e......:
i,
J U L• 2 7 1993
i A
I conveys and warrants to ......`'oxn.Shl.p...Q ...Somer.set ~
PVC. i.
. ~.A~6r of K)eAd~
\ ~A~IJWI n. Y i
I r..
~I
' RETURN TO ~
I .I
. . . .
the following described real estate' in t.~...G. Q.i.?5 ...................County,
State of Wisconsin:
'Tax Parcel No:
A parcel of land located in part of the Southeast 1/4 of the
Northeast 1/4 (SE1/4 of NE1/4) of Section 17, Township 31 North,
Range 19 West, Town of Somerset, St. Croix County, Wisconsin j
being part of Lot 3 of Certified Survey Map in Volume 7, Page
1867 as recorded in the office of the St. Croix County Register
of Deeds, more particularly described as follows:
Beginning at the northwest corner of said Lot 3; thence along the
north line of said Lot 3 N8704913911E 590.71 feet to the westerly
right-of-way of the Town Road (40th Street); thence along said
right-of-way southerly 51.03 feet along the arc of a 192.00 foot
radius curve concave westerly whose central angle measures i;
15°1314411 and whose chord bears S11°3010111E and measures 50.88
feet; thence along said right-of-way S0305310911E 15.80 feet;
thence S87°4913911W 599.01 feet to the west line of said Lot 3;
thence along said west line of Lot 3 N02°3210911W 66.00 feet to
the point of beginning.
This Deed is given to the Township of Somerset for roadway
purposes and as part of the,requirements for acceptance, approval
and certification of a survey of Gary Gifford,.Trustee of the
River Hills Family Trust.
This i.g...n0t....... homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way
of record, if an-y
Dated this jo day of ...May 19...9..
w Z
'•c~T'.. (SEAL) U
!L.-QSEAL)
Dana L. Tow Linda K. Tow j
(SEAL) (SEAL)
I
:4 W
AUTHENTICATION $ ACKNOWLEDGMENT
~i
I'
' STATE OF ~wi&@@#m'N._ ouw
Signature(s)
ss
.
County.
authenticated this ........day of.......................... 18....:. Personally~me before me this .......day of
i Ir......... 19' ~ the above named
. .
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized b •
I
I . Y § 706 06, W1s. Stats) . " c
to me known to be the person .3:........ wlio'e.Cecuted- the
f oregoing in trument and ow 'dge th•e'.same.
Ii THIS INSTRUMENT WAS GRAFTED BY
Rr1 .
I sting Ocgl.and
ii Ataorney.at '.Law-
Public .....................:ac ..r( k . County, Vgft.'~'-
I (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (I~ not, state expiration 1
are not necessary.)
date : .....................................:1! 19..~✓..~)
.
jl 'Names of Persons signing in any capacity should be typed or printed below their signatures. II
. . IAIi.. r...n:.. 1 r. r...l 1)I., ..L (`n I..r
VOL
EXHIBIT "A"
A parcel of land located in part of the Southeast Quarter of the
Northeast Quarter (SE1/4 of NE1/4) of Section 17, Township 31
North, Range 19 West, Town of Somerset, St. Croix County,
Wisconsin, described as follows:
Commencing at the East quarter corner of said Section 17; thence
along the south line of said Southeast Quarter of the Northeast
Quarter (SE1/4 of NE1/4) and the south line of Certified Survey
Map in Volume 7, Page 1867 as recorded in the office of the St.
Croix County Register of Deeds S87°49'39"W 645.43 feet to the
southwest corner of said Certified Survey Map; thence along the
west line of said Certified Survey Map N02°32'09"W 634.54 feet to
the northwest corner of Lot 3 of said Certified Survey Map and
the POINT OF BEGINNING; thence Northwesterly 106.39 feet along
the arc of a 167.00 foot radius curve concave northeasterly whose
central angle measures 36'30'0011 and whose chord bears
N73°55'21"W and measures 104.60 feet; thence N55°40'21"W 94.73
feet; thence Northwesterly 62.93 feet along the arc of an 80.00
foot radius curve concave northeasterly, whose central angle
measures 45°04'10" and whose chord bears N33°08'16"W and measures
61.32 feet; thence 377.19 feet along the arc of an 80.00 foot
radius cul-de-sac, whose central angle measures 270°08'20'1 and
whose chord bears S34°19'39"W and measures 113.00 feet; thence
Southeasterly 62.93 feet along the arc of an 80.00 foot radius
curve concave southwesterly, whose central angle measures
45°04'10" and whose chord bears S78°12'26"E and measures 61.32
feet; thence 555'4012111E 94.73 feet; thence Southeasterly 148.43
feet along the arc of a 233.00 foot radius curve concave
northeasterly, whose central angle measures 36°3010011 and whose
chord bears S73°55'21"E and measures 145.93 feet; thence
N87°49'39"E 0.42 feet to the west line of said Lot 3; thence
N02°32'09"W 66.00 feet to the point of beginning.
This Deed is given to the Township of Somerset for roadway
purposes and as part of the requirements for acceptance, approval
and certification of a survey of Gary Gifford, Trustee of the
River Hills Family Trust.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
Liyt-
MAILING ADDRESS PO 601K o;t9 SOS CAL 5~T (,~)1 s boas oaf 1
PROPERTY ADDRESS 3~Q( 6
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE 5 o-v-) (S2 S& T t "L) I &;-q 0-a 15-
PROPERTY LOCATION 51!7 1/4, iU (1 1/4, Section 1:7 T 3 ~_N-R 9 W
TOWN OF SO VVI ST. CROIX COUNTY, WI
SUBDIVISION k I VDT ~1~ BLS LOT NUMBER -7
CERTIFIED SURVEY MAP S-oZ`6-7 OLUME IW3 PAGE (,o ;Z 3, LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 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 date.
SIGNS
DATE: - d
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This.application form is to be completed in full and signed by the
.owner(s) of the property being developed. Any inadequacies will
`only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property_ 1
-
T ~LLjv
±c:~l
Location of property_1/4 k-)r 1/4, Section 1Z, 31 N-R /9 W
Township Mailing address Po aoX 22'1 1
~n 6-r t s'4 oaf oa 1
Address of site -3(,
1
)
Subdivision name R-) V L (t_ O p Y_S Lot no.
Other homes on property? Yes X No
Previous owner of property Xz, T ,y G 1l=raYL ~
Total size of property 44 5 R%9--r,-s
Total size of parcel
Date parcel was created u c~ 3
Are all corners and lot lines identifiable? 7C Yes No
Is this property being developed for (spec house) ? )_Yes No
volume lU'aY and Page Number 4 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. t5 O ~ b--14 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
~"O o`7 4
Signature of plica t Co-Applicant
Date of Signature Date of Signature
_ i VOL 1028 465
RESERVED FOR RECORDING DATA
DOCUMENT No. " STATE BAR OF WISCONSIN FORM 11-1988 THIS SPACE
j LAND CONTRACT
~i Individud and Corporate
~(TO BE USED FOR ALL TRANSACTIONS WHERE OVER i
•.50~0~~ ;1$25,000 IS FINANCED AND IN OTHER NON-CONSUMER 11
e --Z-- ACT_TRANSACTIONSI -,.i! C►4I~~~_RrS OFFICE
1VL. 1 -
ST. CROIX CO., W
eco1d
River Hill Famll Tru_ s a a
Contract by and between °-y_----- ---te---.
II River Hills Tamily _ Trust b _ Ga_ _ Gifford_ a a_ Gar • E. ec AUG ~d 1~8 1993
x _ lkl x . f
Gifford at-
___Gifford Truste and
whether one or more ) e andLenora _
M.M fe .--.vendor , I'
Richard J McGill>vra and Karin
•--------__J: i at 8:30 M 11
---cGi{or
_ llivray, - husband- and_ wi
i ("Purchaser", whether one or more). ft.~tster of Deeds it
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser, the following property, to[ Aher with the f
rents, profits, fixtures and other appurtenant interests (all called the "Property"), _
m__..._.__x------------------------------------- County, State of Wisconsin: R[ruRn To -
I
j
Tax Parcel No.......
i Part of SE1/4 of'NE1/4 of Section 17-31-19 described as follows: j
Lot 7 of Certified Survey Map filed July 27, 1993 in Vol. 119", page
I 2651.
i i.
EEC
~I
This is__.nO.t......... homestead property.
I~ (is) (is not) i
Purchaser agrees to purchase the Property and to pay to Vendor at plam..Yendor..dizeLct
the sum of 23..11Q0 ._011 in the following manner: (a) 4;51011..0-Q_:_______-_-__----------•-
at the execution of this Contract; and (b) the balance of 1_$A.5QQ,_QO............ together with interest from date
hereof on the balance outstanding from time to time at the rate of .............1,5 per cent per annum
until paid in full, as follows:
8~.~.
Commencing September 136, 1993 and on the thirteeab day of each and
ii every month thereafter, equal monthly installments of principal and
~j interest in the, amount of $126.00.
1 Purchaser to provide Vendor a copy of the paid tax receipt for real
1 estate taxes after each installment payment is made (first half due:
last day of January of each year; second installment due: last day of
July of each year).
Provided, however, the entire outstanding balance shall be paid in full on or before the 1._.__h_.-.--___ day of
1lgLSt----------------------- , 19.---9.5 ( the maturity date).
Following any default in payment, interest shall accrue at the rate of 9 % per annum on the entire amount
in default(which shall include, without limitation, delinquent interest and, upon acceleration or maturity the entire
principal balance). Non-payment of any tax installment for real estate taxes shall be
considered a default.
~i Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amot.nts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor
Vendor agrees to apply payments to these obligations- when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
II unless otherwise required by law, i
i
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
i.. amount may be prepaid without premium or fee upon principal at any timeXXXxxxxg7~(~,7,Q~xxxxethRit
j ~~arxex~cacap>~o~nmc~c ao~rat~t~cxloxX
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
j as the unpaid balance of principal, and interest (and in such case 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
iI 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:
it
i
i
ii
i;
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.
da of closin
Purchaser shall be entitled to take possession of the Property on__..__.___..x is
*Cross Out One_
i
LAND CONTRACT-Individual and STATE. BAR OF WISCONSIN Wisconsin. Legal Blank Co. Inc.
Corporate FORM No. 11 - 1982 t Milwau+e, Wis.
von 28fta466
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 shall keg the improvements on the Property insured against loss or damage occasioned by fire, ex-
tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved
by Vendor, in the sum of s...... n/a but Vendor shall not require coverage in an amount more
than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall
contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original
of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to
insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
economically feasible.
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 an~ 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 liens and encumbrances, except
any liens or encumbrances created by the act or default of Purchaser, and except :
c 5cMQAt;5.-- xeSlr1ctimta---an_d_rlghts--cif:-lray...of---re.CDrd.,_._i1 c-MY-
Purchaser agrees 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 ..50.-- 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 .170---- 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: (i) 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 outstanding 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 previously
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 performance 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 (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 &cloud on title in a quiet-title
action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession
of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action
under (1), (ii) 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 in-
curred, and shall be included in any judgment.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents
to the appointment of a receiver of the Property, including homestead interrest, 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 indebtedness 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 become immediately due and payable in full, at Vendor's option without notice.
Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of
this Contract (except for any mortgage granted by Purchaser) or under any i:ote secured thereby, provided Purchaser
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to
the Mortgagee if Vendor fails to do so ar.3 all payments so made by Purchaser shall be consider payments made on
this Contract.
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives,
successors 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.)
Dated this . -t day of Augu3t 1993:
River Hill Family Trust a/k i River Hills
(SEAL) by (SEAL)
_ y Eford st
Richer illivray Gary /a Gary E. Gifford, Trustee
' t................
' _
(SEAL) by: x /---EAL)
• Karin M. McGi li a .Lenora V Giffor Trustee
--y--------••-----•-_....
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Richard-_J.__MrGilliyray, STATE OF WISCONSIN
K rin M. McGillivray. Gary Gifford
ss.
_Gitlfardr__Lenora _-J-.. County.
Gifford
authenticated this J..~~>__day of ARgR!st . 19. 93 Personal) came before me this ................day
19-------- the above Kr i nam
sti Ogland N
' .........................................................a, .rJ
TITLE: MEMBER STATE BAR OF WISCONSIN fill
(If not-
authorized by 4 706.06, Wis. State.) to me- known to be the person who--;;ecuted ~s
foregoing instrument and acknowledge the siane.
THIS INSTRUMENT WAS DRAFTED BY V%
Kristina Ogland
Attorney at Law
• . .
Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19--------.)
'Names of persons signing in any capacity should W typ%d ,or'print4 booty thelr; signatures.
LAND CONTRACT Individual and Corporate - State -Bar a< Wisconsin, Feri i i. 11-1982
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of
Labor and Human Relations
eivision 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
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP7~'4' OWNER' PROPERTY LOCATION
_ GOVT. LOT s~ 1/4 1/4,S T ,31 ,N,R /or 0
PROPERTY NER':S M ~~G ADDRESS LOT # BL . K# SUBD. N E OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY V LLAG [DOWN NE EST R AD
C Y
~q New Construction Use M Residential / Number of bedrooms [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow gpd Recommended design loading rate gibed, gpd/ft2__2 trench, gpd/ft2
Absorption area required ? bed, ft2 y trench, ft2 Maximum design loading rate tubed, gpd/ft2__J trench, gpd1ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / si a considerations
Flood plain elevation, if applicable ft
Parent material /I 4'Z a,
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ® S ❑ U ® S ❑ U [Z S ❑ U ®S ❑ U ❑ S IX U ❑ S 0 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch
-A. A
y
114 s ou)
Ground 24 '~2
-
J
elev.
Depth to
limiting
factor
Remarks:
Boring #
Al/
Ground - - i
elev.
1,6L2 ft.
Depth to ,
limiting
factor
111
Ic -1, j 1.-
Remarks:
sr 3 CST Name:-Please Print / Phone:
J
Address:
Signature: Date:
S-- _ r
yz:~Z' I/ 5~1-~'
PROPERTYOWNER SOIL DESCRIPTION REPORT Page,,;2of
PARCEL I.D. #
Boring # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Horizon
in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench
•4{kv'.vn .v.
14,
Ground
elev.
Depth to
limiting
factor
y 5'/
Remarks:
Boring #
it
Ground
elev.
/4~,z ft.
Depth to
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factoQ/
Remarks:
Boring #
3 9z / 5~
-
Ground
el~eY
J~ ft.
Depth to
limiting
factor
>
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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BANK OF SOMERSET LFNDRY
Save With Us- LANDSCHPING
Help Build Your Community
MEMBER FDIC Black Dirt - Crushed Gravel
Driveways -Landscaping
SOMERSET, WISCONSIN PhonQ: 247-3480
Phone: 247-3348
SOMERSET
t quarter of Section 17, Township 31 North, Range 19 West, Town of
Somerset, St. Croix County, Wisconsin.
OWNER: River Hill Family Trust LEGEND
Gary Gifford, Trustee FOUND ST. CROIX CO. MONUMENT
• 452 280th St. • FOUND I" IRON PIPE
Osceola, Wi. 54020 O SET I" x 24" IRON PIPE WEIGHING
1.68 LBS./LINEAR FOOT.
UNPLATTED LANDS All st4kcS Lf
NORTH LINE OF THE SE V4 OF THE NE 1/4
N67034'02"E 694.60'
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LOT 5: $22,500 m
LOT 6: $22,500
LOT 7: $23,500 SE CORNE R
SECTION 17
LOT 8: $22,500
L
r nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
r and Human Relations
rvision 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
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I. b. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNE PROPERTY LOCATION
GOVT. LOT ,5c 1/4 1/4,S T 31 ,N,R /(Or yak
PROPE TY NER':S M AILI.NG ADDRESS I<at # BL K # SUBD. N E OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER CITY LLAG 19 N N EST R AD
- -
41 lwz-
New Construction Use Residential / Number of bedrooms [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow gPd Recommended design loading rate gybed, gpd/ft2_2trench, 9Pd/112
Absorption area required 6,1,1--? bed, ft2 ,<~n3 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 J trench, gpd1ft2
Recommended infiltration surface elevation(s) ,S 7, l ft (as referred to site plan benchmark)
Additional design / si e Considerations
Parent material Flood plain elevation, if applicable ft
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE T SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ® S ❑ U ®S ❑ U ®S ❑ U OS ❑ U ❑ S o u ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tr2ndl
- s y
Ground -
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
_z 2, Z'
Ground
elev.
1,fzz ft.
Depth to i
limiting
fact
i
Remarks:
CST Name _Please Print Phone:
Address:
-A" S_ S Z
Signature: / Date: CST Num r
6, j- - 72 77~1
PROPERTY OWNER (-;;SOIL DESCRIPTION REPORT Page, ui
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Tw&
h _
Ground
elev.
ft.
Depth to
limiting
factor
> y/
Remarks:
Boring #
77- 91-
Ground
elev.
/ ft.
Depth to
limiting
j
factor
Remarks:
Boring #
hh !v
Ground - C
ele .
~ ft.
Depth to
limiting
factor
>
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
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PLOT PLAN
PROJECT c~ia G-r/i~vra DDRESS_
1 /4 /0'E 1141S17/TN/R,5P' TOWN ' COUNTY
MPRS Byron Bird Jr. 3318 DATE BEDROOq4rf + CLASS PERCH CONVENTIONAI~IN- UND PRESSURE
CONVENTI NAL LIFT__ MOUND_ HOLDING TANK
SEPTIC TANK SIZE, ',LIFT TANK SIZE
DOSE TANK SIZE - HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE t
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark L Hof Sf~
* H.R.P.
C7 Borehole Q Well Scale = Feet
0 Perc Hole System Elevation
Vent
12
Grarlp
TYPAR COVERING
2" f
12" 3' 4 6' 4O 3' X8'
Sewer Rock
6 " 12' No3
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