HomeMy WebLinkAbout030-2009-30-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 556382 0
GENERAL INFORMATION State Plan ID No: rte/
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
608 C . Rd. E Land Trust, C/O Ro er Keuhn St. Joseph, Town of 030-2009-30-200
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
1 o tog • 2 G8 'Z_ -F~ 61,7- 34.30.19.382D-20
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
L C Benchma Septic v a, l0q,
D v_ t. BM
Aeration d LA) Bldg. Sewer ~n
Holding V~ ~ St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet , S,n 21 106- 39
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inlet / kv- 7
Septic 1ST )ZJ6 ! 5-1 LV e7
m &5 p 6,0
) / ead@r/ an. S f /oh Is)-
77'
S 0
Aeration Dist. Pipe C
Holding Bot. System a S
93.
PUMP/SIPHON INFORMATION Final Grade
y
Manufacturer L~ Demand St Cover r I p
1 V GPM 2(.~~ T7 ✓ a-, K D 11
Q I
Model Number
TDH Lift Friction Loss Head TDH Ft
Forcemain Length D' . Dist. to
SOIL ABSORPTION SYSTEM 20 p
BEDITRENCH Width / Lengt No. Of TrenFhes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREAM ,LACHING Manuf ctur
INFORMATION Typ f System: HAMBER Oj
U
r 0 5;* Model Number:
Za
lS IBUTION SYSTEM
Head anifold Distribution tionQQ f x Hole Size Hole Spacing ent to it Intake
/
Pipe(s) S
~ /r O j / 7
Length << Dia Length Dia 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
Bed/Trench Center Bed/Trench Edges Topsoil [E Yes [9 No EF Yes Na
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 608 CTY RD E Hudson, WI 54016 (SW 1/4 SW 1/4 34 T30N R1 9W) NA Lot 6 Parcel No: 34.30.19.382D-20
1.) Alt BM Description = -7 /V
( Cf
2.) Bldg sewer length = L
- amount of cover =
Plan revision Required? Fn Yes o r
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's Sign ture Cert. No.
2 Ta
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Can~,sw` pj ~h~oe~' =~scc/s¢a,/ Rye a
be4esamll, drivecml
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Proposed dzytrsul Cel. 7riru.(3) 61 -a,el(ed
a 3~ 8 3' /.Z O sr~,~'/Era for "Q-SJ"~x5~ d-=/
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►r County
q Safety and Buildings Division St. Croix
201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
( Madison, WI 53707-7162
•r '
AIN
saction Number
hal~lt Application State Tran
In accordance with SPS 383.21(Ijfis dm. Code, submission of this form to the appropriate govemt it Na
is required prior to obtai m ary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. Same
1. Application Information - Please Print All Information
°r^^..s-Name
. g 7 ~ Parcel #
And Norlin v-t 0 v( 030-2009-30-200 i 3 YZ-b Z b
Property Owner's i 'ng Address Property Location
608 Co. Rd. E Govt. Lot
City, State Zip Code Phone Number SW SW '/4, Section 34
Hudson, WI 54016 (763) 202-3929 (circle one)
T 30 N; R 19 E e w
H. ype of Building (check all that apply) Lot #
1 or 2 Family Dwelling - Number of Bedrooms 4 6 Subdivision Name
El Public/Commercial -Describe Use Block # Na CSM Vol. 16, P g. 4344
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Vilklge of
Vol. 16, Pg. 4344 q]ffown of St. Joseph
III. Type of Permit: (Che of one box o line . Complete line B if applicable)
A. ❑ New System ement ❑ Tmatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit N ber and Date Issued
Before Expiration Owner
IV. a of POWTS System/Component/Device: (Check all that apply)
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Componen vice exp
V. Dispersal/Treatment Area Informatio nfiltrator "Q-4 Plus" Stan and chambers endca s, Pol Lok PL-525 effluen e
Design Flow (gpd) Design Soil Application Rate(gp trs pose s y on
04
600 Gpd 0.50 Gpd/Sq. Ft. sq. ft. 1,230.60 Sq. Ft. 94.00'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units
New Tanks Existing Tanks c tS
Z5 E;
Septic or Holding Tank W320-MR ,000 1,320 2 Wieser Concrete/Unknown X
Dosing Chamber
VII. Responsibility Statement- I, the un ersigned, assn a responsibility for i tion of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' Signature MP/MPRS Number Business Phone Number
James K. Thompson MPRS 30021 (715 248-7767
Plumber's Address (Street, City, State, Zip Code)
340 Paulson Lake Lane, Osceola, WI 54020
VII. Coun /De artment Vse Only
Approved El Disapproved Permit Fee Date ssued I ing Agent Sign re
❑ Owner Given Reason for Denial $ 75, 1 / 5 12pl,~J
UL i i oval/Reasons for Disapproval
1. Septic tank, effluent filter and i v d't~~ ~n~ JG
dispersal cell must be serviced /maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances. d
Attach to complete plans for the system sub1ai~to thktounty only o a1pr~12
!/-c ~hes size
SBD-6398(R.11/11)
Conventional POWTS Index & Tilte Sheet
Project Name: Norling 4 bedroom Replacement Conventional POWTS
Owners Name: Andy Norling
Owner's actress: 608 Co. Rd. E, Hudson, WI 54016
Site address: Same
Project Location:
Subdivision: Lot 6, CSM Vol/ 16, Pg. 4344
Legal Description: SWl/4 SWl/4, Sec. 34, T.30N., R. 19W., Tn. of St. Joseph, St. Croix Co., WI.
Parcel ID 030-2009-30-200
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calcualtions
Page 4 System Cross Section
Page 5 System Management Plan
Page 6 Filter Specifications
Page 7 Septic/Filter Tank Cross Section
Page 8 Parcel map
Page 9 Septic Tank Maintenance Agreement
Page 10 Certification for Utilization of existing septic tank
Page 11 Waranty Deed
Attachments: Soil Evaluaiton Report
Mater PI er Restri ed Service: James K. Thom son, Dept. of Comm. Credential #30021
Signature: s Date: 0/2
L_
Page 1 Of 11
Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01)
zso.70' _
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elw`: f0~c =9fo: ~
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NQ.ING DISPERSAL CELL SIZING CALCULATIONS
1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.000 Gpd design flow
2. Infiltrative capacity of native soil = 0.5 gpd/sq. ft.
3. Absorption area required: 1,200.00 sq. ft.
4. Absorption area as proposed: 1,230.60 sq. ft. (60 chambers total)
Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft, EISA
1,200.00 sq. ft. - (6 endcaps)(5.10) =1,169.40 sq. ft./20.00sq.ft. EISA = 58.47 chambers required
Number of trenches: 3 na, 20 chambers per trench (60 chambers total)
Trench width: 2.83'
Trench length: 83.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 21.00'x 83.00'
Pg. 3 of 11
Soil Absorption System Cross Section
4R ~ ft 9~. Sp r-
98.tz / ft
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ?5 .00 ft
Leaching -
Chamber t-- 9Y 06 ft
` System Elevation
2•03 ft 61.00 ft
Soil Absorption System Plan View
83 o ft
2.fd3 ft
{
6.00 ft Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model
'/~•'~+<y~
EISA Rating 20.0 sq ft per chamber Soil Application Rate o• S gpd/sq ft
&6V•6 gpd Design Flow r 0.5- Soil Application Rate - -2o,0 EISA = Gd Chambers
3 rows of .24 chambers each.
I
Page_ 7 of
Conventional Septic System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be S 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October-March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715)
248-7767 or the St Croix County Zoning Department at (715) 3864680.
Pg. 5 of I I
Yl
• Filters
PL-525 EFFLUENT FILTER (CIMMER I )
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of quality effluent filters. The
PL-525 is rated for over 10,000 GPD Alarm
(gallons per day) making it one of accessibility _o(- Accepts PVC
the largest commercial filters in its extension handle
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16° w
removed for cleaning, the ball will filtration slots Rated for over
float up and temporarily shut off 10,000 GPD
the system so the effluent won't
leave the tank. No other filter on x
the market can make that claim! Accepts 4" & V
SCHD. 40 Pipe'
PL-525
Maintenance.
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified"
by an alarm when the filter needs
servicing. Servicing should be cs Gas deflector
done by a certified septic tank Automatic shut-off
pumper or installer. ball when filter
1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed
septic tank. 5,871,640
2. Remove tank cover and pump
tank if necessary. PL 525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
tank. Make sure all solids fall 4" or 6" outlet pipe. If the
back into septic tank. filter is not centered under the
access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
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DRAWN BY: SME SCALE: 1/4"=l'-O" PRE-POUR:
= W320-MR MIESERGORDRETE
° m SEPTIC MANUAL REV. NO. 2
\ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2012 DATE:. 3/6/12 POST-POUR:
° REVISED JAN. 2012 800-325-8456 FILE: W320-MR ,
Wisconsin Department ofCommercg j z SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildi r7 In accordance with Comm 85, Wis. Adm. Code
a County
Attach complete sites gilw Ness than 8 % x 11 inches in size. Plan must St. Croix
Include but not limltatd=tb: vertical and horizontal reference point (BM), di*ZWn]4 Parcel I.D. O3 200930200
Percent slope, scale or dtmonsiot lp~tb"w*, and BM referenced to nearest rofd7 /2 ^ U"~ viewed by Date
j l ~lease print all information
Personas information you provide maybe used for secondary purposes (Privacy Law, s. 15.0 m))~`
/ I/ /
~ (
Property Owner Property Location
And Norlin Govt. Lot SW v. SW % s 34 T 30 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
608 Cty. Rd. E 6 CSM# 16-4344 030-2002
City State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road
Hudson WI 54016 763-202-3929 St. Joseph C Rd. E
0 New Construction Use: 0 Residential / Number of Bedrooms _3 Code derived design flow rate 450 GPD
0 Replacement ❑ Public or Commercial - Describe:
Parent Material Loess over Outwash Flood Plain elevation if applicable N/A ft.
General comments and recommendations: Install the infiltration bed surfaces at 40" below surface so the base of the bed is in the
single grain loose sand. > 3 (c „
1 in g Boring
g 0 Pit Ground Surface Elevation 97.6 ft. Depth to Limiting factor >91 in.
Soil APDlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2
1 0-4 10YR3/3 - SIL 3-m-gr fh cs 3f 0.6 0.8
2 4-10 10YR3/3 - SIL 1-co-pl dvh gs 1f 0.4 0.6
3 10-19 10YR4/4 - SIL 2-m-bk dvh gs 1f 0.6 0.8
4 19-30 7.5YR4/4 - GRS 0-sg dl gs 2f 0.7 1.6
5 30-51 10YR4/4 - (GRS 0-sg ml gs 1f 0.7 1.6
6 51-91+ 10YR6/3 - FS 0-sg M1 as - 0.5 1.0
6(Layers) 51-91+ 10YR4/4 FS 0-m mfr - - 0.5 1.0
Boring # ❑ Boring -7 .Z -
®pit Ground Surface Elevation 98.3 ft. Depth to Limiting factor >92 in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
1 0-7 10YR3/3 - SIL 1-co-bk dh gs 1f 0.4 0.6
2 7-12 10YR3/3 - SIL 2-f to m-pl dvh gs if 0.0 0.2
3 12-24 10YR4/4 - CL 2-m-bk mfi gs 1 f 0.4 0.6
4 24-39 7.5YR4/4 - GRLS 0-m mvfr cw - 0.7 1.6
5 39-56 10YR4/4 - RS 0-s9 ml CW - 0.7 1.6
6 - 2+ 10YR5/4 - S 0-sg ml cb - 0.7 1.6
6(Layers) 56-92+ 10YR4/4 y-0 , - - FS 0-m mvfr - - 0.5 1.0
* Effluent #I = BODs> 30!s 220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = BOD5 5 30 mg/L and TSS 30 mg/L
CST Name (Please Print) ~Sipnature CST Number
Mark Iverson - 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 September 20, 2012 715-796-5664
Property Owner Andy Norling Parcel ID# 030200930200 Page --Z -of 3
3] Boring # [3 Boring
Wit Ground Surface Elevation 95.4 ft. Depth to Limiting factor >95 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2
1 0-12 10YR3/3 - SIL 1-co-bk dvh gs 1f 0.4 0.6
2 12-19 10YR4/4 - CL 2-m-bk dvh gs 1f 0.4 0.6
3 19-28 7.5YR4/4 - GRS 0-m ds gs 1f 0.7 1.6
4 28-54 10YR4/4 - GRS 0-sg dl gw - 0.7 1.6
5 54-95+ 10YR4/4 - S 0-sg ml Cw - 0.7 1.6
5 (layers) 54-95+ 7.5YR4/4 - FS 0-m mvfr - - 0.5 1.0
O Boring
4 Boring # Elpit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. M nsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
a Boring
Boring #
QPit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil ADDlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Ettluent # 1 = BOD5> 30 220 mg/L and TSS > 30:S 150 mg1L * Effluent #2 = BOD5 S 30 mg/L and TSS 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
Need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
• Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft.
N
Shared well located east of house.
House
BM#2 - Edge of cmcrete, west edge of 91--~
westmost garage door 109.2'
c9CP
B-1
4L 976 BM#1 - Top of 3/4" PVC pipe D
100.0'
X_
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BM# & Description =Bench Mark B 1
Elevation 100' - Boring Location & Elevation
-
Owner: Andy Norling Site Information: Completed By: Mark Iverson, PSS #197
608 Cty. Rd. E SW1/4, SW1/4, S34, T30N, R19W 680 Larcom Street
Hudson, WI 54016 Town of St. Joseph Hammond, WI 54015
St. Croix County 715-796-5664
Phone: 763-202-3929 CST# 46672
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) X ,06 0, , 14vy.E /-X&Aa?, 1,J/• s/oI( located
at: .540 1/4, -5k7 1/4, Section .35( Town__3o N, Range 1,9 W,
Town of :s& SoseeX , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service 4-22 20 /1
Did flow back occur from absorption system? Yes No P-'
(if no, skip next line.)
Approximate volume or length of time: fjL_ gallons minutes
Tank Capacity: T 9,W
Construction: Prefab Concrete k--' Steel Other
Manufacturer (if known): g„ awn
Age of Tank (if known): 7 CGr,,L/no~vn
erml umber (if known) 1,tn ~riawn
5---- min-e5 J\ • / f2omip5d~
icensed Plumber Signature) (Print Name)
44. A ~ # ,36OZI
(Title) (License Number) YAV~-MPRS
(Date)
Form to be completed Y licensed plumber (Dept of Commerce Chapter 5
b and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
X11 n~ i¢s~~e /~~ir nfn IdfiY T 1j4_ e
Mailing Address ~~cs fie.
Co, ~w . E
Property Address 5a"Je
(Verification required from Planning & Zoning Department for new construction.)
City/State 11-4,ds 6", Parcel Identification Number D 30-_2aX- 30 -2-W
LEGAL DESCRIPTION
Property Location 614) 1/4 , 5CJ 1/4 , Sec. 3 T 36 N R_/j _W, Town of
Subdivision Plat: /to, , Lot #
Certified Survey Map # (Q g , Volume & , Page #
S<.3f
~aArra~ty "ee ?_4 ~ q (before 2007)Volume , Page #
~
Spec house 0~ W16- Lot lines identifiable P1yes 0 PW
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms GV ~ S~ Z CD r0fL ~v2 (ZfJ
7
IiA"y A&4;~` /O/3///z
S NATU OF APPLICANT(S) DATE
* * *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 09/07)
II I I I I illlllllll I Ili II
I
' State Bar of Wisconsin Form 11-2003 8 0 4 6 7! 5 9
Tx:4034357
LAND CONTRACT x
(TO BE USED FOR NON-CONSUMER ACT TRANSACTIONS) 9488! 5
Document Number Document Name BETH PABST
REGISTER Of DEEDS
ST. CROIX CO., WI
CONTRACT, by and between 608 County Road E Land Trust, Roger W. 01/13/2012 12:31 PM
Kuehn as Trustee ("Vendor," whether one or more), EXEMPT#: NA
and Andy Norling REC FEE: 30.00
("Purchaser," whether one or more). TRANS FEE: 525.00
PAGES: 7
Vendor sells and agrees to convey to Purchaser, upon the prompt and full
performance of this Contract by Purchaser, the following real estate, together
with the rents, profits, fixtures and other appurtenant interests ("Property"), in Recording Area
St. Croix County, State of Wisconsin: Name and Return Address
i Midwest Guaranty Title Company 7
R See Attached Exhibit "A" 971 Sibley Memorial Highway
Lilydale, MN 55119
(651)552-2309
s
' 030-2009-30-200,
Parcel Identification *umber (PIN)
Purchaser agrees to purchase the Property and to pay to Vendor at 1835 This is homestead'property.
Northwestern Avenue Stillwater, MN 55082 (is) (is not) 3
This is not a purchase money mortgage.
the sum of $ 175,000.00 in the following manner: (is) (is not)
(a) $ 10,000.00 at the execution of this Contract; and t
(b) the balance of $ 165,000.00 , together with interest from the date hereof on the balance
outstanding from time to time at the rate of 6 % per annum until paid in full as follows:
See attached addendum A
x k"
~ i
s t
t
provided the entire outstanding balance shall be paid in full on or before September 23, 2014 ("Maturity
f Date'). Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal.
C
CHOOSE ONE OF THE FOLLOWING OPTIONS; IF NO OPTION IS CHOSEN, OPTION A SHALL APPLY:
X Any amount may be prepaid without premium or fee upon principal at any time.
❑ B. Any amount may be prepaid without premium or fee upon principal at any time after s
❑ C. There may be no prepayment of principal without written permission of Vendor. 1
k
.
' State Bar Form I 1-Page 1 C 2003 STATE BAR OF WISCONSIN
i
1 f7
Zit ~v t l l~uU~
s
r
S
3
ExIt "A"
Legal Qescrlption
III
Lot 6:~~ i~aet~it'Led S~?v bo reoorifed in Valume, IS on page 4344 as Documetit No_
685L} trill ds,q t a i" rti t cl rvey Map recorded In Voiumd 3 czn: page 843'b ing a
p6rt c thL-,96utl't ast- Quarter ofLt. t SopthweSt Quarter, -Sectlon 34, Town.shilp 30J .^Orth,; ~
Range 19 , opuq of Sti-j ply, i og her with end sub~ect to 66 foot "00 access
eases s sttovvrt carp ertlftod auiveY Mop
~I
$ F
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f
1 Z
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ADDENDUM A
$10,000.00 cash acknowledged as received (includes earnest money already received). c
{
$165,000.00 Contract balance and uncollected adjustments from closing. Payable in installments of
$1,226.69 per month or more at the option of the buyer. Including interest at the rate of 6.00% per
annum computed on the unpaid balance, this loan is amortized over 3 Years. First payment shall be due
and payable on November 15', 2011 and each succeeding payment will be due within 15 days of due
I
i
date. Interest shall begin n the day of closing. Payments shall be credited first to interest and then to ;
any principal balance. All or any portion of the principal balance hereof may be prepaid at any time
without penalty.
Insurance is to be aid to the appropriate r i the borrower w r . Purchaser shall p e pp opr ate place, when due, by a o e provide
evidence of Insurance payment to seller upon payment. Taxes at this time for 2010 are $2,852.22 Per
year, per the county are paid in full. Taxes are one year in arrears in Wisconsin. Taxes are due January
3n
IY 31"' year. each
1 and 1u Taxes are included in IY payment to seller and seller is responsible to pay these when due to St. Croix County. Purchaser has been given a prorated portion of the
2011
ownership portion of the taxes on the closing statement. .
4
The entire balance is due and payable in 36 months. The loan is being amortized over a 3 year period.
f
The final payment is a balloon payment. The seller may renew the contract if payments have been made
I
on time. If payments are postmarked 5 days after the due date an $80.00 late fee will be charged. There
is a $40.00 NSF charge for any returned checks.
Balance to close (Cash, certified funds, or cashiers check) subject to adjustments and prorations.
The terms of this Contract for Deed do not allow any liens to be placed on the property by the
Purchaser. Any improvements over $5,000.00 must be cash or credit card and must be approved by the
Contract holder.
The property is to be owner occupied and not sub leased.
F
a
0e
g r W. Kuehn
3
Andy Norling
5of7
APPROVED ..s ,z,
ST. CROtX COUNTY
Planning 7~ni7,n vie' V OL 16 PAGE 4344
JUL 2 5 2002 XATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CaOIX GCj. , W1
aPPlo ~ repgftl9 tub 30 days of
at oval shall be RECEIVED FOR RECO}iu
BEARINGS ARE REFERENCED TO THE ~`~-~~'-td01 12:30 r
m WEST LINE OF THE SW1/4 OF SECTION CERTIFIED SURVEY 1SAF'
34, ASSUMED TO BEAR 500'26'37"E
100, REC FEE: 13.00
~COPY FEE:
3.00
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