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020-1284-20-000
f ~ ~r E L 1 ~y~,py~ L~arttr4?ust • 29.19W, ~V/~~E~~~C~~Y51 tM RIDGE E ou ty: Labor and Human Relations INSPECTION REPORT ,41afety anti Buildings Division (,ATTACH TO PERMIT) Sanitary sq, Permit o.: GENERAL INFORMATION SQ a 11 No.: Permit Holder's Name: ❑ City E] Village Town of State an99964 (J~U ' j e- X_ )l HIJUSCIN ST BM Elev.: Insp. BM EI B Description: n Parcel Tax No.: y 5 s 0'20-11 284-20 000 TANK INFORMATION ELEVATION DATA A9300367 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 00 Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet ivS. J FS TANK SETBACK INFORMATION St/ Ht Outlet a 8 8 ~oS /6 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe G 33 /6/ 7z Holding Bot. System 6,30 , o/. -7,1 PUMP/ SIPHON INFORMATION Final Grade X0'1 731 . S3 J /0( Manufacturer Demand 77 Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM PIT No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width t Length f No. en es DIMENSIONS DIMEN I N Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING INFORMATION TypeO a) CHAMBER Model Number: OR UNIT System: f G-4, Aj DISTRIBUTION SYSTEM Header /Manifold I Distributn Pipe(s) I x Hole Size I x Hole Spacing I 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 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes, ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ;rry% LOCATION: HUDSON.29.29.19W,SW,SE,LOT 121,WILLOW RIDGE E II,CTH A (1 L,iYy Plan revision fJJequired? ❑ Yes ❑ No a / Use other side for additional information. SBD-6710 (R 05/91) Date S00 nsp ctoPs Signature Cert. No. , E7:1:1 SANITARY PERMIT APPLICATION COUNTY U ' ILHA In accord with ILHR 83.05, Wis. Adm. Code STATE SANIT~1Fj~' P RMIT ~ -Attach complete plans (to the county copy only) for the system, on paper not less than (7X~j! 8'ft x 11 inches in size. Chi 2k revis onto evious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 3 PROPERTY OWNER PROPERTY LOCATION ` C L L(/'/a ,5' '/a, S T„l , N, R r E Q07 P OPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 7,79 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER o (o GJ; aa1 .,,sT 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLAGE : OF: J1 J 70-1-1 4 ❑ Public II~~11 911 or 2 Fam. Dwelling-# of bedrooms PAR GEL AX NUMBER( S) Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. X New 2.E] Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 300 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) A4 de. a ELEVATION 4:rod -o 2, Feet { 0 3 ~ Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION App New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic Tanks Tanks structed Septic Tank or Holdin Tank t3lJ' i -17 Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P/ PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): afy 6 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued issuing A nt Sig ur (No Surcharge Fee) Approved ❑ Owner Given Initial Adv rs Determin lion X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber t T 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. Il. 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 systE+m. 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'f2 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) F N \J1 STC - 104 AS BUILT SANITARY SYSTEM REPORT a At' OWN` G~ F F 450 Yi vi; V-r- la l SUBDIVISION / CSM~1# SECTION f~ T yj N-R W, Town of ST. CROIX COUNTY, WISCON IN17 ~ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 3y. 3 u z IN ICATE NORTH ARROW I Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r a BENCHMARK: Q S f'l ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /olio Setback from: Well,"0 f House /7 Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Jam- Length 5-7 Number of trenches Distance & Direction to nearest prop. line: ~d Setback from: well: / Go- House : y Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: p~ PLUMBER ON JOB: LICENSE NUMBER: 2n"X2 INSPECTOR: 3/93:jt DtLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUPTY/ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 Ylou, 8% X 11 inches in size. Check if r vis onto prapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Ae- 1/4, S 1? T.1 f , N, R Z~Z E (Or raw '/a PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 470 &0( U41 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER &eA~ ?,6/ AgO L-744-11-7F6 F/15 I./ II. TYPE OF BUILDING: Check one CITY NEAREST ROAD r ( ) ❑ State Owned VILLAGE ❑ Public D 1 or 2 Fam. Dwelling- # of bedrooms _T_ AR EL TAX NUM ( ) 5 1- Ill. BUILDING USE: (If building type is public, check all that apply) Q U w la f l?l - a O 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) rul ldj New 2.E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an A) 1. 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 2 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ~Sfd r Nom- Q 2. G Feet Feet CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holdin Tank led 41 e 7 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY W❑ Disapproved Sanitary~rmit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved El Owner Given Initial Surcharge Fee) 7 Q~ Adverse Determinati n X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber-requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. - 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; (Jose 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) fill ~r »y N 89'09'27'E 1029.31' - - - - 0.00' 380.00' 209.31 18 949.31'- 104 105 S. 102 103 57 357 SQ. FT. ui 54641 SQ. F 59568 SQ. FT. 56986 SO. FT. W 1.317 AC. N 1.254 AC. " N 1.366 AC. 1.308 AC. C = W in h~ in in NO O ~ All N - - C m o N 2 fA 15 i 5.204. 21 c _ 22' .5 S - N 89001'01" E N -7 „w 24 90.00' i i . 83 18 RLO Teo 47' 37 N 89 0 'OS E 241.83' 17 E~ 8 - 37 - - 19 578017 , ~ 20 89'01'01"W 241.83' J S - in 1 15 ~ f IIO tn 40 f NN N 122 66.oo f 53708 S0. FT. W p = to 1.233 AC. F 47590 SO. FT. N _ 123 0 1. 093 AC. N 67211 S Q. FT. iO 44 ap 1.543 AC. 44 *4 N 89'43'37"E r M fh N N 231.07' o o M 3 3 81'18'07"E of Z 306.91 0 12 I 14 ` 15 I I I 50 752 SO. FT. 47260 S0 FT Is ~ 1.165 AC. / 1 085 AC. 3q1 8 14 ~F !"55.00' N 86 21'40"W S 80.17'07"E 120 213.34' 63498 S0. FT. ~ m m 1 . 458 AC. / o 112 3 G~ 119 N / 45699 SQ. FT. a 66739 SO. FT. t,~~• 1.049 AC. T.° Z 1. 53 2 AC. - - - - L---- _ _ o S 89° 09-` 27 'W ^ v qQj J`, 2662.34'..- ' ° SOUTH LINE OF THE- SE 1/4 OF 3 sS3 Z S E C. 17. O O o //'J 13/ ,j aoD / 113 v ~ 16 56076 S0 FT. ~ I. 287 AC. '701L SANITARY PERMIT APPLICATION NR In accord with ILHR 83.05, Wis. Adm. Code counl ....,..,~.,,e. ®T " STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ©1 Sid x 11 inches in size. Check if revis en top vious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION '/a ,/a, S T_ , N, R E (or. W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ' ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ~ f ) ❑ State Owned VILLAGE =N OF: ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms P u O W Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo l 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 100 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. 0 New 2.E] Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repalt of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill a VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~ ELEVATION ` Feet , Feet CAPACITY VII. TANK Site INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank r "-_ff I El El Lift Pump Tank/Siphon Chamber Fj r7 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A ant Sighatu}re (No Stah,ps) Surcharge Fee) - ` Approved ❑ Owner Given initial - - s . Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber _INSTRUCTIONS s., ,,4 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 arty 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 bg,; j submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pun ped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concgrning your onsitesewage system, contact your local-,code administrator or-the State of Wisconsin, Safety A Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include' ` I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) t# 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 #T-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 numberwith appropriate prefix (q.g.- - MP, etc.), address and phone number. Plumber mustJsign 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) eross-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: t ; SBD-6398 (R.11/88) S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _ ADDRESS_ FIRE NUMBER CITY/STATE iC,',*_d S'o,t_~ ZIP_S`~G l G PROPERTY LOCATION O~k/1/4 ,5,1/4 , SECTION,/ Y N-R_W TOWN OF St. Croix County, i SUBDIVISION LOT NUMBER_ 2 / . Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into 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/Ile, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result yin delays of the permit issuance. ,Should this development be intended for resale by owner/cohtractor,(spec house), thenla 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 Location of property5;vl/4 ~1/4, Section T_2~N-R_ Township Lv_ Mailing address Z~y Address of site sb Subdivision name-- j~J./ 1,6-Al 1~2°d2 __69 Lot no. other homes on property? -yes No Previous owner of property e7=.-:ek rgl-~ Total size of parcel Date parcel -was created 2L !'Are all corners and lot lines identifiable? Yes No is this property being developed for (spec house)? Yes L_No Volume4~2f and.Page Number y.~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEhD which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description .references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register *of Deeds as Document No.p , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. ee" i Signature of applicant Co-applicant s' Date of Signature Date of Signature t kULX Lt)., WIS. VOL U na 40 Nee... ot Remr lhh rd 82 dOY LAID CONTRACT Contract, b) and between Arnold R. Bertelsen a/k/a At R. rtelsen Virginia A. Bertelsen, husband and 41, , ~/endor, and B. i H. vea aunt, Inc., a Wisconsin corporation, Purchaser, : Vendor sells and agrees to convey to Purchaser, upon the pruispt and full perfcrmanue of this Contract by Purchaser, the following property, together with the rents, profits and other appurtenant interest (all called the "Property"), in St. Croix County, State of Wisconsin: South 53 1/3 rode of South Half of sdonthwest Quarter (Si8Wi) and South 53 1/3 rods of Southwpgt Quarter of southeast Quarter (SWWU of Section 17, T29N, R19W. That part of Northwest Quarter of Northeast Quarter (NWk NEB) and of Northeast Quarter of Northwest Quarter (NE% NWk) of Section 20, T29X, R19W, lying Northerly of the centerline of St. Croix County Trunk Highway "A" (formerly known as Hudson-New Richmond Highway), EXCEPT the following parts of the above described tracts: All land included within the Plat of Willow Ridge Second s s O Addition to the Town of Hudson as described in Vol. 4 of Plats, page 25; Parcel deeded to Harlin 0. Amdahl and Ruth L. Amdahl as described in Vol. 517, page 26, Document No. 324368; Parcel deeded to Roger E. Hatchler as described in Vol. 517, page 114, Document Number 324430. TOGETHER with an easement for street purposes over the Easterly 33 feet of said parcel deeded to Roger E. Hetchler as described in Vol. 517, Page 114, Document Number 324430. SUBJRCT TO the right-of-way of said St. Croix County Trunk Highway "A" and to telephone easement adjacent to said highway as recorded in the office of said Register of Deeds. Purchaser agrees to purchase the Property and to pay to Vendor at: St. Croix Heights, Hudson, Wisconsin, the Base Purchase Price of $100,000.00, together with additional payments per lot, as follows: 1. Base Purchase Price. The base purchase pr'ce of $100,000.00 shall be pa in the following manner: $15,000.00 at the execution of this Contract, and the balance of $85,000.00 together with interest on such portions thereof as shall remain from time to time unpaid, at the rate of lOX per annum, until paid in full, as follows: (a) For each individual lot developed and sold by the Purchaser, Purchaser shall pay to Vendor a $2,000.00 principal payment, to be applied to the $85,000.00 base contract balance outstanding. (b) A minims annual payment of $15,000.00 principal shall be paid each year, excluding the year of sale. Each per lot principal payment required above, shall be :redited toward this $15,000.00 annual payment. (c) On December 1, 1985, and on December 1st of each year thereafter, Purchaser shall pay to Vendor the differential between the required minimum principal payment of $15,000.00 and the total $2,000.00 per lot payments made during the preceding twelve (12) months, until the Base Purchase Price has been paid in full. (d) Interest on the principal balance of $85,000.00 shall accrue from the date of closing, with annual payments of interest due on the 1st day of December, each year, commencing December 1, 1984. 2. Additional Per Lot Payments. In addition to the foregoing Base Purchase Price payments, Purchaser shall pay to Vendor additional per lot payments totaling not less than $;30,000.00, as follows: (a) No interest shall accrue on the principal sums paid to Vendor under the terns of this Paragraph. sc y f . ~ VOL (b) Purchaser shall pay to Vendor the sus of $3,000.00 per lot on all residential lots developed and sold by Purchaser, subject to the condition that the minimum amount of payments to be made to Bertelsen under this Paragraph shall total at least $150,000.00. (c) During each year of this Contract that there is an outstanding contract balance of the Base Purchase Price (Paragraph I(a)) there shall be no minimum annual principal payments under this paragraph. Commencing with the year following completion of payment of the Base Purchase Price, Purchaser shall pay to Vendor a minimum annual sum of $15,000.00 per year. (d) On the ]at day of December of each year, Purchaser shall pay to Vendor the differential between the minimum annual payment of $15,000.00 as provided in this Paragraph, and the total $3,000.00 per lot payments made during the preceding twelve months, until the entire $150,000.00 minimum sum has been paid. Thereafter, if Purchaser sells any lots in excess of 50 lots, Purchaser shall pay to Vendor the sum of $3,000.00 for any such additional lot sold, up to a total of 53 lots. ($159,000.00 total hereunder) Purchaser shall not be required to pay monthly payments to Vendor sufficient to pay reasonably anticipated annual taxes and special assessments. Any amount may be prepaid without premium or fee upon principal at any time. In the event of any prepayment, this Contract shall not be treated as in default with respect to payment so long as the entire balance of principal, and interest where required, is less than the amount that said indebtedness would have been had the monthly payments been made as set forth above. Purchaser states that Purchaser is satisfied with the title as shown by the Abstract of Title submitted to Purchaser for examination, except: Real estate mortgage to Sam E. Hiller, dated February 1, 1980, recorded in Volume "608", Page 152, Document Number 362685. This mortgage shall remain the obligation of Vendor, who shall keep said mortgage current and in good standing. In the event Vendor fails to pay any required mortgage payment, Purchaser shall have the right to make such payment, and to deduct any payment so made from the sums due under the terms of this Contract. Purchaser agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the property on Closing. Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances a,Ld regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditins shall be full performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except, subject to utility easements and covenants and restrictions of record. Bertelsen shall have the right to purchase one (1) lot from B b H for the sum of '45,000.00. Bertelsen may select his lot after B & H picks its first five lots. -2- . 00 riodoY I ,eoasent to the platting of the premises into trsmont at ± IMivisiaau 1►y►''1urCbeser =W.TaWolr shall be under an obligation to appcov4 i'igoaa~,~1Nviaioie platd ptep~acsd wad submitted by purchaser. 3y " I>aj additi+0a to the Warranty Deed which Vendor shall deliver at time of t ultimate al, riwviius shall execute and deliver to Purchaser, indi.vidual 4 'At+a=+e~ JOW +Nw4rieg `rtlii .separate residential lots which Purchaser may sell, upon peymsnt of the per lot payments set forth above. All costs of platting and eats iswarsyd in preparation of individual deeds shall be Purchaser's ex 4 ,~.rs.> Pease. Purchases at-eas that time is of the essence and (a) in the event of a default any principal period of 60 days in the payment of at or interest which continues for a following the specified, due data or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 60 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), :,then the entire outstanding balance under this contract shall become immediately due and payable in full at Vendor's option and without notice (wbicb Purcbasts b6iteby waives). OW Vendor shall also bays the following rights and remedies (subject to merry limitations provided by law) in addition to those provided by law or in,. equity; M Vendor my, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back rthroagh 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 affect on such date and other amounts duo hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as * ligttidaj:ed 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 s. peformance of this Contract to compel immediate and full payment of the entire '.r 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 and and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of `~rebaser is insignificant; and (v) Vendor may have Purchaser ejected from possession ppointed to collect any rents, issues or profits `tbe Proparty and have a receiver a Aiag the pendency of any action under (i), 6.i) or (iv) above. llotwitbstaoding Vr i ► oral or writts'm statements or actions of Vendor, an election of say of tai 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 probibited '.,1~► law and expenses of title evidence shall be added to principal and paid by Owchaser, as incurred, and shall be included in any judgment. ~•a Upon the commencement or during the pendency of any action of foreclosure of tl}is Contract. Purchaser consents to the appointment of a receiver of the ;Y Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and ptpfits when so collected shall be bald and applied as the Court shall direct. •..r Purchaser shall not transfer, well or convey any legal or equitable interest is the Property (by assignment of any of Purchaser's rights under this Contract or :n. 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. h the event of any such transfer, sale or conveyance without vendor's written lf' consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Yfr~4 Vendor may waive any default without waiving any other subsequent o: prior default of Purchaser. L V3 ! sAp C 17 l i r •~~,y; 82; Continued. ;ro t r i. ♦ll fast of, this contract shall be biadias upob a" ~wAM>~ of the heirs, leial representatives, successors and aasirm of of not as ow"s of the Property the spouse of Veadar for a Valuable sins heroiq to release howestead r~yts: the subject Property and a i i* the elk stios of the deed to b! to fulfillaent hereof.) Raced this 29th day of May, 1984. C VMIDOt: PURCHASER: g" t•i , INC. ` AV BY: C Arnold R. Bertelsen a/k/a A.R. Bertelsen Donald E. Bjornst . President ATTEST: r,.. a A. Bsstelese ~riR.wrw~ C• Willies+ C. Harwell, Secretary ~ to s~ Authentication: w o- C, v Signatare(s) of Ar no1d g- Bartelsan, O Virginity A_ Rarteltyen, his pnnld E_ Bjorn tad and Willian C. X11. President and Secretary gent . -Lpc • . authentic day of May, 1pf. William J. Radosevich Member State Bar of Wisconsin. This instrument drafted by: William J. Radosevich Attorney at Law Hudson, Wisconsin 54016. -4- Wisconsin 'Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of Labor and Human Relations _ Division of Safety Buildings in accord with ILHR 83.05, Wis. Adm. Code • COU TY . 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.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE P,aOPERTI' OWNER: PROPERTY LOCATION b4 w &-)(C GOVT. LOT 'SW 1/4'5r. 1/4,S T 19 N,R it 9 E (or) W PROPERTY 0 NER':S MAILIN ADDRESS LOT # BLOCK # SUB . NAME OR C # _ is 1+2'iC jz tuilL(~fl.J C1 -4-sl CI STATE ZIP CODE PHONE NUMBER ❑CITY ❑Vl" OOW`N NEARRESST_f NAD .a P( New Construction Use K Residential / Number of bedrooms [ J Addition to existing building [ J Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maxim design loading rate 0-7 bed, gpd/ft2 6 1 trench, gpd/ft2 Recommended infiltration surface elevation(s) aq hV > ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CO VENTIONAL OUND U ROUND ROUND PRESSURE AT-GRADE STEM IN FILL HOLDING ZANK U= Unsuitable fors stem S❑ U S❑ U IS ❑ U S❑ U S❑ U ❑ S 9rU 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 Tmr& 0, 410:5' Ground 6,7-44 L Z y'l ~raa 1yj r I ,`j elev. 44 -1/8 4- 1 r- 07 6 Depth to limiting f~ts(.~ Remarks: Boring # k 2d /d`/ Ground L S L / rs. S r / iCa elev. 6 x.13 r 0,,140 4 3 S f r rs, r o U r 1 Depth to C- limiting 19< G.10 /ewe, -S S Remarks.: CST Name:-Please Print I rA k vL o NN Sd Phone: 4016 Address: 0, L~ t) Signature: ~J Date: r2 r 3 CST Number G~_ PROPERTY OWNER _ SOIL DESCRIPTION REPORT Page Z of 3 PARCELI.D.# L- 2.1 "uj?q-w,, Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed nnch rb Z (3, d. Ground g a=7d FOR 17 OS elev. Depth to limiting factor 7 id,0~ Remarks: Boring # $z _!Z 4 - S ',z, Ground r rh elev. f0~ S Z ft. Depth to limiting factor > Remarks: Boring # /Ove 3 J L j qb r O.S 116 /3~ 640 l ~a Ground 0- , Q g elev. Depth to limiting factor 7 ~3 Remarks: Boring # 13 Ground elev. it Depth to limiting factor E Remarks: SBD-8330(R.05/92) k s ~~Z~ , 3 a~ 3 r r: . t W ~d V -Z /Oa,00 U s \ g 04 I V ' r 5 c~ 0 r r s~pr.~G r d a 3171 Parcel 020-1284-20-000 10/25/2007 08:10 AM PAGE 1 OF 1 Alt. Parcel 17.29.19.1374 020 - TOWN OF HUDSON 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 - KAPPLER, BENJAMIN L & MARYANN M BENJAMIN L & MARYANN M KAPPLER 450 VIRTUE DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary 7i 0 Type Dist # Description * 450 VIRTUE DR C. SC 2611 HUDSON SP 1700 WITC C, (YL x tj rv~ f Legal Description: Acres: 1.165 Plat: 05-080-WILLOW RIDGE EAST II SEC 17 T29N R19W PT SW SE LOT 121 WILLOW Block/Condo Bldg: LOT 121 RIDGE EAST II 1.165 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1069/387 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.165 57,000 220,000 277,000 NO I Totals for 2007: General Property 1.165 57,000 220,000 277,000 Woodland 0.000 0 0 Totals for 2006: General Property 1.165 57,000 220,000 277,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 107 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00