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HomeMy WebLinkAbout032-1048-70-300 s Ti B E rm .s► STC - 104 ' AS BUILT SANITARY SYSTEM REPORT aV ~If 1 OWNER A/d / e Al ~'r c Z /gm ADDRESS_ 3 G3 ? / l~ liW`R. 2 SUBDIVISION / CSM# ~pW tloL. 7, lk& 7 LOT # SECTION /7 T 31 N-RW, Town of t- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SH EVERYTHING WITHIN 100 FEET OF SYSTEM r!/ sysf~ 2k P, ~G yEP 5A PRO Posy ya~o 4 0 eld a~ ~s 3 L3 d a w g3 6 INDICATE NORTH ARROVI J vp e, t Sww k~ Provide setback and elevation information on reverse of this foi"m• Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: J Liquid Capacity:/~?CJG No 7`' ~ Setback from: Wellouse Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length /a'® Number of trenches v~ i Distance & Direction to nearest prop. line:-S-57 Setback from: well:. N House Other _ stisfwtc kd ELEVATIONS Building Sewer J1,75- ST Inlet. 99.rff ST outlet qQ~a~ PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 7 PLUMBER ON JOB: d ec E /c~ c~CkJ;_0 LICENSE NUMBER: q72 d INSPECTOR:,~E/rf, tj1_ih'1)ns04j 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX '_'afety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION PeLr~i yQ~d r N Z r RANDY & A. SAVID P City ❑ Village R Town of: State Plan o.: CST BM Elev.: WW Insp. BM Elev.: BM Description: X Parcel Tax No.: 1 A, a), I IOC , 00 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6~) S Ct C ZC~ Benchmark 1713 Dosing Aeration Bldg. Sewer Hold.' StlXt Inlet g TANK SETBACK INFORMATION St/ It outlet 7~/' a / Vent irito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Ar Septic }SQ NA Dt Bottom y? Dosing Header /1. 97Z/ Aeration Dist. Pipe 76 97, 7,5-' Holding Bot. System 9?' PUMP/ SIPHON INFORMATION Final Grade Ma urer mand S•(` L g% /da, 79 Model Number GP U Ion m TDH Ft TDH Lift LOSS Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION S /,~"(D DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of rlrwCVA'3 System: try, cpuS b' CHAMBER Moe Number: AIA- OR UNIT DISTRIBUTION SYSTEM Header Distribution Pipe(s) ,i x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length 7 i Dia. ~Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over , Depth Over , xx Depth Of xx Seeded/ Sodded xx Mulched I _Q ❑ Yes No ❑ Yes ❑ No Bed /Trench Center Bed /Trench Edges 21~ Topsoil COMMENTS: (Include code discrepancies, persons present, etc.)' S t 31.19W E NE Lot 3 21 't Avenue LOCATION: Somerset.17. C 0- LL Plan revision required? Yes 1~""" Use other side for additional information. SBD-6710 (R 05/91) Date Inspectors Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i SANITARY PERMIT APPLICATION COUNTY ~al`we■fi In accord with ILHR 83.05, Wis. Adm. Code -57 STATE SANITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than / 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. PROPE TY OWNER PROPERTY LOCATION k/ 91'4f *A 1,6: to i S f~ ' T 31 , N R 41 E or PROP.EP$Y OWNE 'S MAILING ADDRESS LOT # BLOCK # o II~KNo A(V -3 STATE ZIP C0 6E PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER S ~ ht.o ~ 7' u 1-0 iv a II. TYPE OF BUILDING: (Check one) CITY NEART ROAD ❑StateOwned ❑ TOVILLAGE' WN F: o OArf- ❑ Public 1 or 2 Fam. Dwellin of bedrooms PARCEL TAX NUMBER(S) d 4! - 70 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 F] Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground Iv 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 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. Ix New 2.E] 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 19 Seepage Trench 220 In-Ground 420 Pit Privy 13E] 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(QSED (s9. ft.), (Gals day/sq. ft.) (Mint./inch) 1&;t ELEVATION 6Io a1 - S7c Z W, W o A17+ /61 Feet 00+77 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 t,Ut E s bAC. F] El Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the o site sewage system shown on the attached plans. Plumber's Name (Prin • / Plumber's ignatur : (N tamps) MP/MPRSW No.: Business Phone Number: a E~uc(2~ Gks Al o3 q ?G Its' 757.3 S 3s Plumber's Address (Street, City, State, Zip Code): go)( upi 9 2E~s E P- G~J SS~C<) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sad r Permit Fe Includes Groundwater ate Issued Issuing Agent Signature No + Approved I ❑ Owner Given Initial I harge Fee) j`~/~~ ~ Adverse Determination . III X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s 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 takes; 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 'i 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 TV t' ti ~ 1 1 is w Y Sli j '1 tlf~ {IS OWN" d 1 O U-< j' CD d L7 \ Lrj t t 1 i h11v T 0- ED Co 7C 3 D CD n{n t l c cn N. a { ~>i7f.r. l4fly. 9~ a t . t. =it h ~ ~f~lr „t i ~t "Now rlk4 yl_ A 4 V~ 1 f 16. .1 Q z 00 1 } 1# 31 i YI S,F i~ 1 d Idd fcP u~ i R~t --4 Ln =ty Ln, 0) iS1 ~ y ~ 7 CD Cy' C o, kM ~t C r'n W~Cl- m Ul i r-+ y k f S f" roYr i~ C) ~9 c ~n ~ A 1 o;r ~t ~ : f cn .t~ CA.) 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W L O L3 (D r* 0 CND b 0 r+ 7 North 0 U3 rn 9 A m o cn ~En cam ~nNw9vy XXmLn3~m Z z0 M 3 ~ m v' z z ~ z omo• o ' La mWCu N CD U7 I r.~o 3 3 ~ C7 v C CD Z X C7 Ln O - Cn o 1 -4 C CJ C N 3 3 S N Z [T C C t--~ m T Apo 3 3 r C f l b 2- ~ M d m m LO 0 -0 Z o £ cn --4 C] T --4 S CD ro ~p C1 m o o _0 m (D -n - m CO M m Z -4 w N n x = o -i n 9 m b° m m r' m od C) z CD -4 z z r m o m x x LO n 3 O C) - N 3 m ro S CD o m m 1 -4 ro z z z _ d cn ~ rn~ o C: LF) T -4 r r x N ;o M ro m CJ G) m Ln :r ~ z oo , ; c (T1 o n m . 71 -4 M m m ro o n _3r-- £ z G7 r r m o m on r - c-) -0 O m o G7 m m z -4 -hl m cz in n m z r m G7 m x Q -4 M, x d rTl x S m m LF3 :3> Z LO C3 uF3 m o r ro ~1 = r r 0 m t7 LO z m o m m ZN V < r C LP A O ;o y G) m CD xNxm x r 3 Z O S n ~R Ul gm Z Z DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNTd T& LOT NO.:BLK. NO.: SUBDIVISION NAME: SE 1/4 Nr14 17 /T31 N/11191 (or) w Somerset 3 n To COUNTY: OWNER'S B¢ NAME: MAILING ADDRESS: St. Croix Janis Tow 2228 S. Main, Kailispell, Mont. 59901 USE DATES OBSERVATIONS MADE TESTS: NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION © Residence 3 n/a FK1 New ❑ Replace I 7-10-87 n/a RATING: S= Site suitable for system U= Site unsuitable for system MS ENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑U ©S ❑U S ❑U ❑ S ❑ U ❑ S MU conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL Wfflft&RNE'CSS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH la ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 7.00 100.77 none >7.00 .83bl.s.1. 1.17bn.s.l. 5.00bn.m.s. B_ 2 6.83 100.52 none >55.83 .75bl.s.l. 1.83bn.l.s. 4.25 bn.c.s. 3 6.67 99.92 none >6.67 1.00bl.l.s. 1.25bn.l.s. 4.42bn.c.s. B- B. 4 7.00 99.31 none >7.00 •58bl.s.1. 1.00bn.l.s. 1.67bn.s.sil. B- 99.22 6.42 none >6.42 2.00bn.l.s. 4.42bn.c.s. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- P__ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96.92 leb) : -t i i2 F'4 (P _ v....,_._.. 7 i = I i ) ~ i mm~ © - r t L € 3 t( i r i 117 E6 : r ( VV i i A4 / { r a r rJ~ f )r ~~-°w' 1987 ~ i _ ~ 1 ; r i . I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: Gary L. Steel 7-10-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 988 N. Shore Dr., New Richmond, Wi. 54017 2298 17),5-246-6200 CST SIG AT RE: n DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. - ')ILHR-SBD-6395 (R. 02/82) OVER RUCTIC} IS COMPLETING FORM 115 - SRD - To be a -rd accurar your ret o t include: 1. Complev ~.-iption; 2. Tl " clearly ' whether this is c'cmce ore cial pry 1 A be(',-cr, commercial u! d; 4. Is or i -j- cemr t f 5. : suitability I,~'i A SITE IS SU. -E FOR A HOI ONLY IF ALL EMS ARE F J, TEASED ON SOIL CONDITI( 6, ibbrevia , here for Uvriting profile descrip .:mpl. ti plan; 1. t_cGir3LE dia,1- 11 t- iy locating yOur test locatio it ed. A may br t J your benchmarl, < al elevation reference point ar it; all c. o dates, names, addresses, floo(',~1. plain, elevation) dots riot al~pl., ~ UUA, 11, -.ur current address and your certificat distribute as required. ALL SOIL TEu TH THE L' '_uTHORITY VVITHIN 30 DAYS OF COMPLETION. ",ATIONS FOR CERTIFIED SOIL T _ Ctures e ~lls BR SS r J-) LS L HOVV H' 'i r~ Perc _ n 130i0. - - R - - mot E - - fff - d l HWL Civ 1--tares disposal Gm VRP TO TI_~ f l CENTRAL CHORD CHORD ARC CURVE LOT RADIUS ANGLE BEARING LENGTH LENGTH TANGENT BEARINGS :1 #443.00' 49009100" S19005'3311E 368.47' 380.02' S05028'5711W S4304010311E 2 410.00' 4904713011 S18°46'1811E 345.201 356.301 S0600712711W S4304010311E 3 377.001 5003214911 S18°23'38.5"E 321.91' 332.591 S0605214611W S43°4010311E 4 192.001 3904615411 S2304613611E 130.651 133.311 S4304010311E S03°53 09"E 2 2403311011 S3102312811E 61.65' 82.281 3 1501314411 S11°30101"E $0.881 51.031 5 225.001 2700514611 S3000711011E 105.42' 106.411 S4304010311E S1603411711E 6 258.001 16°02116" S3503815511E 71.98' 72.221 S4304010311E S2703715711E .1 AREA INCLUDING ROAD R/W AREA EXCLUDING ROAD R/W Lot 1 136,219 sq. ft. (3.13 ac.) 112,751 sq. ft. (2.59 ac.) Lot 2 261,364 sq. ft. (6.00 ac.) 237,343 sq. ft.l(5~45_ac.) Lot 3 203,654 sq. ft. (4.68 ac.) 151,251 sq. 'fE. (3.47 ac.~ Lot 4 204,397 sq. ft. (4.69 ac.) 193,109 laq. ft. (4-.4-3---a c. `e1o✓ rG311 429023 CERTIFIED SURVEY MAPLocated in the Eh, of the SEh of the NEh of Section 17, T31N, S R19W, Town of Somerset, St. Croix County, Wisconsin. NE Corner Section 17 N N ( unplatted lands owned by others North line of the SE} of the NE} ec bearings are S87034' 02"W 636. 13' - referenced to the east line of the NE} of 3 ' ' 297.62' section 17 assumed to 2J1.76 681' 33.34' 1 611 33.41' bear N02°57'30"W. fence fine I ' d 1 1 d SCALE. 1" = 200' O. ON FN, centerline ~'b, AN 2 00 0 p 40th Street I V .O 'Y. o ;1 T \ N o O " 0 t-n 6 ~~ii J A I c 1 \ ~ ° 6 ^y T id N in SEE DETAIL 5) 15.77 c 624.98' r n i 1 1 4 Q 590.71' N o' i N 34.271 1`i 1 'r o r 1 0. 04 -,0. $87049139"W 640.751 ' co ;2 T N PRIVATE ROAD EASEMENT 50.041 1 I 'x I tail S87049' 394 I F' N 661 (a ' ;rt DETAIL W V ,J,, • V S A' 1 A ~ O I C I ~ - - _ 10 m I = 38.15'• 604.941 I a OWNER 870A9,139"W" 643.09' I I Janis low r 228 So. Main I Kalispell, Montana 59901 4 rI I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER XA +J4y _5,_4y> d9 MAILING ADDRESS 1-~16 00 S`ip ^,'A10n,1 PKV PROPERTY ADDRESS 3 15 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Srr~~2se f 61-4 5-yoa-'57, PROPERTY LOCATION 1/4, 1/4, Section /7 , T_/N-R 1,9 W TOWN OF o/',ie/zSe~ ST. CROIX COUNTY, WI SUBDIVISION O tj LOT NUMBER ,3 CERTIFIED SURVEY MAP F-11- F'7 , VOLUME / , PAGE LOT NUMBER vocu mew t 0: ya 9O A3 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. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property /1 A.ya/y _5'; e,0/fieW r'c~_- * Am/ d1'9(9e P Location of property .5,5 1/41/4, Section /_,T_j /_N-R__W Township 5_ojne1zSe t Mailing address //7~oa S~iA,vnio~ ~x o Rj e v Address of site 393 'C~h~ Subdivision name 7-o(i Lot no. 3 Other homes on property? YesX_No Previous owner of property P'9"IA T li) Total size of property 31-7. A7 2Y Zy3.o9 y. G8 a'-Kes Total size of parcel 3• q-1 0 C47gS Date parcel was created 1222 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes k No Volume r and Page Number /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 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. YA 901~13 , 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. 9 oa3 Z_Z Z_'/ All Signat e of Applicant o-Ap licant v Date of Signature Date of Sianatiira DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-1982 THIS SPACE RESERVED FOR RECORDING DATA LAND CONTRACT IndNid-I snd C-pe-to cro nE USED FOR ALL TRANSACTIONS WHERE OVERT, $25.000 IS FINANCED AND IN OTHER NON-CONSUMER ACT TRANSACTIONS) Dana L. Tow and Linda K. Contract, by and between . . Tow, hus.band..and wife,.-------•--------------•--------••-----._.._.........---- („Vendor", Rand. whether one or more) and ..............Y.A....___Sienkiewicz and Amy..C.....Savidge..__husband..and._wi fe., I' ("Purchaser", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), in r._.Cel"q7.X._..__...__-.......-..._.-._ County, State of Wisconsin: li RETURN To ~I I Tax Parcel No . i! I I Part of the SE 1/4 of NE 1/4 of Section 17, Township 31 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Lot 3 of Certified Survey Map filed August 11, 1987, in Vol. "7', page 1867, as Doc. No. 429023. it ! i li II I i, I I. This iS...nOt . homestead property. ii . 19Mis not) Purcha purchase the Property and to pay to Vendor at ..place Vendor directs gg ttqq the sum of 22 7~0. W 7-590-90 .......2 to the followin manner: (a) at the execution of this Contract; and (b) the balance of $ 15 a. r.QQ . tofmther with interest from date hereof on the balance outstanding from time to tines at the rate ol'........elght {8) Ter .at per unnum until paid in full, as follows: Commencing on October 2, 1994, and on the 2nd ~ay of each and every month thereafter, equal monthly installments of principal and interest in the 1 amount of $121.28. l II ! Provided, however, the entire outstanding balance shall be paid in full on or before the....-.2rld day of -.eptefllber................... 19.95... ( the maturity date). Following any default in payment, interest shall accrue at the rate of % per annum on the entire amount j in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire ii principal balance Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts 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 unless otherwise required by law. j Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time ; khecxxo~ckax~xoa~xoax~azxnt~mci~lci~cx~alt~ic~c«t'oocaioox~ax~a~toaxxx jl II In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long II 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 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 herefroin. Purchaser states that Purchaser is satisfied with'%he title as shown by the title evidence submitted to Purchaser for examination except: None Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on... day-.of-closing. )OOt OM 'Cress Out One. Parcel 032-1048-70-300 02/14/2007 12:02 PAGE 1OF 1 Alt. Parcel 17.31.19.243D 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CLARE, DOUGLAS O & JANELLE M DOUGLAS O & JANELLE M CLARE 393 216TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 393 216TH AVE SC 4165 OSCEOLA SP 1700 WITC Legal Description: Acres: •4.680 Plat: N/A-NOT AVAILABLE SEC 17 T31N R1 9W SE NE 4.68AC LOT 3 CSM Block/Condo Bldg: 7/1867 EZ-U-1141/486 EZ-UT-1427/380 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-31 N-1 9W Notes: Parcel History: Date Doc # Vol/Page Type 05/27/1998 579762 1326/246 WD 07/23/1997 1106/543 WD 07/23/1997 1094/492 LC 07/23/1997 842/252 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.680 56,400 192,700 249,100 NO Totals for 2007: General Property 4.680 56,400 192,700 249,100 Woodland 0.000 0 0 Totals for 2006: General Property 4.680 56,400 192,700 249,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY WISCONSIN 10 1 ✓4`t ZONING OFFICE A u r o u r s■ r..~i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 April 18, 1995 Mr. Al Lunde Valley Custom Homes P.O. Box 686 St. Croix Falls, Wisconsin 54024 RE: Septic Inspection for Randy Sienkiewicz and amy Savidge Address: 393 216th Avenue, Somerset, Wisconsin 54025 Dear Mr. Lunde: An inspection of the septic system for the above address was conducted on December 27, 1994. This property is located in the SE; of the NE; of Section 17, T31N-R19W, Lot 3, Town of Somerset, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. Should you have any questions, please feel free to contact this office. ince ly, T mes K. Thompso Assistant Zoning Administrator St. Croix County, Wisconsin mz i