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HomeMy WebLinkAbout020-1289-10-000 ~ I a o ~o o° I h a b Q5 i N a I C I C I I I I I ~ I v z C ti c I 0 3 p I Cl) Z w rn U) o Z € y N z a co I II c o I E z V c c Z I H a Cl) I 1 _ N N 7 ~^1V1 .C a ao` m t 0 Q z°mz 0 I z d N C m ~ c m 4) v a r+ Q) CL c LM co co N °33 (L CL 0 'N a a CL z a oai ornrn CD fn J V o) m 0) 0 co co m tr- 0) = E N N rn O d co N Y d Q (D 0) CD fn c0 C n y 0 0 O N C O I~ `p E 9 CO CO _ Q 0 C N c d O O co:) I 0- C '0 N N N 1, W CO C C (D o C 7 N co N 1 N 0 c U) v~ m C € ~ CL a m `Iv +r M u 'c c a r~ y c DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY; C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIPHWdftWf"rI:+`FY: P-6 T NO.: BLK_ NO.: SUBDIVISION NAME: /c3G- Nwt/4 5:5- 1/4 Vvi /T29 N/R 0 E (or) W H uPSor.) H f 6-ff At EADowS]3S- COUNTY: MAILING ADDRESS: 5+C_R0(K CLE.v 4V11)(010 7Z 6P 66 0,0 -ry `eD. )3 , ti U D So,J W I S Syo/C.- USE ^22 S DATES OBSERVATIONS MADE NO. BEDRNIS : COMM R AL DESCRIPTION: ( JPROFILE DESCRIPTION •U~E 15 I I . fU~t i S Igo TS: Residence 30 12 Z INew ❑ Replace 9 9 19 7 7 - RATING: S= Site suitable for system U= Site unsuitable for system 5C -5Coco 3 U RkhIi RDT ~ ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMM NDED SYSTEM: (optional) ®s ❑u as ❑u ❑s ©u ❑s au T~fNes- D,zoP gax ~(5TRIg0-1 ©s ❑u I1 r1 If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: CGkSS Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. I HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) o-ice" /o )13 •s j 12 "-/,p - Y.< % 5-I ,.,qw B- I 1/0 90•yS > 1/0 AM,/,, ; 18 - I1 0 • io V// 4-1G C s 2- '(0 /L1 YR 1/1 57~ Ple'WeV 70 T,?4/ji -:757 B- 12-0 /o Y,e 51q ~A 0 - /0 /0 Y,,f 3/3 S/ y0 /aw pe? j /O - " 7. S Y 4/2 S ~ B-3 11p 5.02 7 ~8 1Fµ-e, FR; 14-1.0° 7.5Y/P f-16llv-W,S, y0 "7SYf51f r 0- C, /o YR 3/3 Sl, P/ow< p-1e., /0 YR f/ f- 5~ 2 b,-, B•/{ l2- fZ 7l(2 fR> I~"-ill" /o Y2 51V cs 0-7"/oYk 3/3 5plow 7 -f4" ~o YR 5~ lfr2, 0-S 12- 12.C~ 5 > ~ z "1" fA ; / Ll 7, 5 VR % 216t,"f Y 5/ zfsh~ ,,,,f; - B- Z-1"-11.1/ YRs/~ cs . &,PC EYE1ht77o.vS PERCOLATION TESTS } TEST DEPTH . WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES AFTER WELLING INTERVAL-MIN. PERIOD I P I D 2 P PER INCH P- / 1/9 1y0- -r 2 ~ /3 P. Z V r. ~ s. Q 2 3 _ P- 93. o 2- 3 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. 14 t GNEST 7P1E o6 9', Q " 4 fDDL.E' 7_,'0,6/VGfit,. 9©- 0 SYSTEM ELEVATION. I . I i _ I 1 s&E Pl- or Pt-4,v 1 i vr-x SIF7 S, i DI t_ _4 i I II 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: HOMESITE $EPTI,Q p=8 N=. J v l1E /7 l T ) ADDRESS: 655O'NEILRD.,HUDSON, WIS. 54016 CERTIFICATION NUMBER: PHONENUMBER(o tional}; ROBERT ULBRIGHT 2 y 2 2 3 9160 1I S MS. MASTER ER LIC. NO. 3307 M.P.R.S. CST SIGNATURE: w ~ MINN. INSTALLER & DESIGNER LIC. NO. 00663 fits,. f 4 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. > f fit 0 mPy, wE 5 T- Lo T f o x w~ Nzz Z fry w w G' Z b H f i h ~-~o$m~ ~ Ul Q r r >D~v m CA n o N ` V' °O r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER A4 Ma 0 n ADDRE ' Rd SUBDIVISION / CSM# LOT SECTION T cPq N-R / / W, Town of J GG~sdr~ Ig115 ST. CROIX COUNTY, WISCONSIN PLAN VI SHOW EVERYTHING WITHIN 00 FEET 0 SYSTEM 00, i 7\ v I DICA E [FORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 4 i BENCHMARK: NW R► ^rZ•` ! k140 ALTERNATE BM: SEPTIC TANK / PUMP-CHAMBER / HOLDING ..TANK INFORMATION Manufacturer: JA J& A.o__~, Liquid Capacity: /664 s.J Setback from: Well House 5 Other Pump: Manufacturer k Model# Size Float seperation Gallons/.cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /.Z. Length S ~JIG.S Z Number o f'tTas Distance & Direction to nearest prop. line: ~S WAL, ? Setback from: well: ~ Hd'se~ Other t w O ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet. ArA PC bottom Pump Off Header/Manifold Bottom of system Existing Grade 941 Final grade 9 ~r b DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ``S ' INSPECTOR: 3/93:jt LOCATION: HU7~SOdN 26.29.19.2 Wisconsin epartmen o In ustry, 91 PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitary rflit . Permit Holder's Name: ❑ City ❑ Village Town of: State Plat KALONEY, NARK HUDSON CST BM Elev.: Insp. BM Elev./: BM Description: Parcel Tax No.: oo, ~o , ~4~,e -c-, 020-10?3 4e eOO TANK INFORMATION ELEVATION DATA A9300345 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a~ Benchmark 160, 6' Aeration Bldg. Sewer Ho ding St/ Inlet TANK SETBACK INFORMATION St/ Outlet 0 , TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic >a ' NA Dt Bottom Dosi ng- NA Headed Aeration Dist. Pipe 67 Holding- - Bot. System PUMP/ SIPHON INFORMATION Final Grade Man ~ 31 Demand --77 Model Number I Z_ GPM _ 1 TDH Lift Friction ystem t e Forcemain Length Did. Dist. To Well 7 F SOIL ABSORPTION SYSTEM BED /TRENCH Width LengtfL f No. Of Trenches No. Of Pits Inside Dia. Liquid Depth DIMENSIONS , 5 DIMEN 1 N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufactur SETBACK INFORMATION Type O i f , CHA_ Model Number: System: 6cc_ °y5 u> ^ (LO OR UNIT DISTRIBUTION SYSTEM Header/ „ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _&j~ Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Dept xx Se ed xx Mulched Bed /__q r enter Bed / Frg3rek Edges Topsoil ❑ Yes ❑ No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) ~ILOCATION: HUpS N 26.29.19.291+ 4 f' ~~7 ~.✓r,~ C Plan revision required? ❑ Yes 2'14-0- Use other side for additional information. x~ Ig? SBD-6710 (R 05191) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY / i)r STATES IT Y ER/1T -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. C ec if r i o o us a pplication -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 %L) Y4Sr=: %4,S (pT N,R JC1 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # -7'7 1 Z CITY, S ATE IP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ,~L 5 b1b 111:2A 4 55 -171 CITY - .7 II. TYPE OF BUILDING: (Check one) F1 State Owned ❑ VI LLAGE NEAREST R D R~ 40WN OF: 'GEL TAX ❑ Public ICI 1 or 2 Fam. Dwelling-# of bedrooms 3 A NUMB 111. BUILDING USE: (If building type is public, check all that apply) ©a(~ /0 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 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. V3 New 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE 4-so REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) q ELEVATION 15 air a 6.7 a l 3 / D1 Feet C~ .3 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 Holdin Tank Qty 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): PI er's Signs re: o S mps) MP/MPRSW No.: Business Phone Number: C v:r o s i sc~3 7rs a c~-s/3s Plumber's Address (Street, City, State, Zip Code): S401 IX. COUNTY/DEPARTMENT USE ONLY W❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) b Adve a 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 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 Wisuos.sin Administrative Cody, will be applicable 3. All revisions to fh,--, i,,errrit must be approvc,4 e?y.the permit issuing authority. 4. Changes in ownership or plumber require: a Sanitary Permit "!ansfer/Renewal Form (SB 3 6399:1 to be submitted to the prior to installation. 5. Onsite st,w~age sys`ems i,.ust be properiy maintained. The ti tank(s) m;-!6t I purnped ay a licensed pumRer whenever necessary, usually every 2 to 3 years. 6. If YOU Dave questions concerning your onsite sewage system, contact your local code administrator or the Sta~~pf Wisconsin, ~$afetyA, .auildings Divjt§sion, 608-266-3815. To,beyjomplpte aqd accurate this sanitary permit application must include: -14 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the sys~ is-to,,,bejnsfs11ed.•- ll. 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 an system type. Vt. Absorption system information. Provide all information requesteo in #1-7 Vii. Tack i„f;:, nlation. Fill in the capacity of C.v Y= rtew and/or exi k.. list the lo't31 gallons number of tanks anc; = ianufacturer's name. indicate- prefab or site construct~.a and tank maiet 1i,- . Comple for all septic, purr o/siphon and holding tanks for this system. Check c.- r!rimcr;tai approva'. only if laws 'eceived experinivr:tai N o duct approval from Uil_f':R Vill. Responsibility statement. installing plUrnh'r is to fill in name, li e ,se number with appropriate prefix (e.g. MP, etc , address and phone number. PIu nt < roust sign apinlit,..&on farm. IX. CountyiDepartment Use Only. X. County/ De,r.,artrnent Use Only. Ccmpie;ie plans and specification_ -%ot spialler than 81/2 x 11 ",ost be subr , Y'ed to tf c ,,ourlty. The Wars mu-11, inciuc~e t"e following: Ll.j plat 7):r m, drawn to sc.ile,.r th coiIipie e d = r,: + c ;t on of hcldiiiij ?a,i -fs}, septic tank(s) or other tre<.trnent tanks: tsu `c r w.~ veils; w-~:a4 f A,,-:ter service; streams and lakes. purr ip or siphr-in arik-~, of O'ibUtion box,,- l: --ration systEe+n~ rr Fi i;. Tai tit. system areas; ;r the location of the bui g, ei) horizotnt< tt,3 ;'fiCr vleVatiO^ 'E'f'r~ n/-Eq ~F Ft~, C) complete specifications for pumps and controls; Jose volurrre, Ri-levat!on differences; frict', ri loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system 114 - ja ct-i:,required by thetounty; E) k6il jest data on-4 fj5jorm; and,;) afl ;aiizlag information - - - - - - - - - - - - - - - - - - - - - - - - - GR0UWDA Wth `$URCHARtare 1983 Wisconsin Act 4 Wiciuded the c'recttion of sorch irge , eos) for a number of re gti:co--.U prac.f ice JAI",i0h ran effect groundwater. r 1 l f~r~ Ns collected through these surcharges are used fon rj,ifi, 2 -%Ipg-.mod taw ter, q cund- water cor?tarniration nvesfigafions and establishment of standards. f- SBD-6398 (R.11/88) ofi'Plari AW-S4~5 s~4 a a ion Q C219- 41 -7 -7a K 4 .~-t a s v~~ sue. ~t,.,l S~,roi (,0, N t53 i 1ssa~ 1 0 a o~ Aim. + sIa ~ 1 ice. /trae ;S.e~Y'~ c. AN ~c~ t 3 I Y 44 !1 lea )!M.A .J y~ , t t . ~I i . 1 r lC~r[~ ~c~\ov~ a lV LL) `4 '7 3- 1'F~dSor~ ~l,a Sc(Ot~ l7 ~t^ PAGE OF CrUSS Sec~Ion d4ep SySteen Fresh Air Inlets And Observation Pipe - Approved Vent Cap Minimum 12" Above Final Grade 20- 42" Above Pipe _ 4" Cast iron To Final Grade Vent Pipe Marsh Hoy Or Synthetic Covering i win. 2" Aggregote Over PIPe Olstrlbutlon - Pipe 0 0 0 0 Tee 6" Aggregate o Beneoln Pipe Perforated Pipe Below Coupling Terminating At Bottom Of System propo p- Pine 1gre%cl< .SOIL FILL DISTRIBUTIOVI PIPE , APPR.OVEO ~JWTNETIC COVER ° ~-MATERIAL- OR 9° OF STRAW Z" OF AGGREGAIE OF, MARSH NA1i T (e OF 12-ZI/2 AGGREGATE ELEV. O F~ FEET DI•S-rRIgUTI0W PIPE TO BE AT LEAST ICHES BELO\n/ ORIGIAIAL GRADE A►JU AT LEASTLO IA7CHES BUT KIO MORE TNAK1 H2 IUC14ES BELOW FINAL GRADE MAXMUM DEPTH OF F-XCaVATIOO FAoM aRI&v-JgL &KAoE WILL BE FICHES MIKIMUM Wr-" of EXCAVATION MOM. 01?\f(fMgL. GRADE WILL BE INCHES SIGIJED: LICEUSE UWABER: ~~D3 DATE: NCh) IS 129 i INDUSTRY, 1%9LUV1%1 VIV JVIL. U%A%111%A%J n1Miv UIVISI('v LABOR AND P.G. 80:•: 7569 HUMAN RELATIONS PERCOLATION TESTS (115) - MADISON, w153707 • (ILHR 83.09(1) & Chapter 1451 e 2, _ LCtATJON: SECTION: TOWNSHIPMAtfNieiP*t::ffY: [,OT N NO.: SU,QDI 1 I AM : PC 6- lull/ sE' y 26 A11 N/R0 E (or)W H u PSoa H e&tf COUNTY: MAILING A : S-t-CROCK GLZ.v 4wi'a(o v 7Z Co CoUA.) ?y T.D. , 1j U 0 So.] 4J 1 S SS/a/ Cy USE ^22 S DATES OBSERVATIONS MADE Na I DES PER BE 0 RGIAL ION: rsr1t DESCRIPTIONS: PROFILE" Residence 3 op 4 &New ❑Replace ~ u~ i4 ~ IS 19 9 I J'U.3, 1 S 416 ~ I , 111 RATING: S- Site suitable for system U- Site unsuitable for system U R k~ ROT s ONVENT AL: MOUND: IN-GROLt PR M•IN.FI L OLOING TANK: I RECOMMEND EDrSY S~T`EM:: optla % P X ~STRI 6~7: DS DU BS ❑U OS DU TOS U 0SpU 'DRo II Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 03,09(5)(b), indicate: cz /HsS = Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P R NDWATER•IN H CS HA A R I WITH HIC NE S, COLOR.-TEXTURE. AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED HIGHEST EST. TO BEDROCK IF OBSERVED EE ABBRV.ON BACK.) a- l i/o 9o•y5 7tv_ Ito Mtsz ; 1~ fl f~ • ,a y,~' s B• 12d 81• Soy 74v- > 1 20 ~•GyR 5 Y C/1 s , p/owfv j it • io y f 1' /o /y $ 0-/0 '1/0 yx 3/3 S/~o/nk.~aQ; /o-/¢'• AS YIC /2 sr B. 3 1I~ ~S.oZ A6 I8 IFS, A; 14-40 7.SYe f/ •.,,ss%e 5/1 z B• r'IZ yR3 3 18"/oY f 37 - 7 I 2 M'f I2 i It"- 11*1 /D YR. S/ C'S 0-71' IOYA 3/3 s) p aw ; 7-If" Io ye 4--/f 51 If > ! 2_ fmfA ; ly- ii" 7, S YR t 7A"ea 5/ i~sb~ aNf, - 2~•-Ily'r/O YASIf d.T . B- • ILexe 'e-eZ14-moms PERCOLATION TESTS TEST DEPTH , WATER IN HOLE TEST TIME DROP IN WATER RATE MINUTES NUMBER INCHES AFTER WELLING INTERVAL-MIN. PER NCH P. / y if, O_ 2. 4 P. Z its) 9V r 5.0 .s 2 3 P. 93. a - 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 Iandslope- ' 1FiGtfEST 'TI?eNG(ti-° 9/, p l~-UDDI-E- T~L°E.uc~ = SYSTEM ELEVATION /owe s r ,tom = ~'9 O ' - - I ( ESE pi- oT-' Re-4A/ _ _ I tl 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, t . NAME print : TESTTSSWERE COMPLETED ON: HOf,IESITE `f v'V E /7 I R ~ I ADDRESS: .;~P.IIS~ PL IfdBIN(; (:(1,~ 665O'NEIL AD., HUDSON, WIS. $016 CERTIFICATI0 NUMBER: PHONE NUMBERIo tional): ROBERT ULBRIGHT 2-4 8 -2-- 3 8C0 - • ? S WIS. IWASTER PLUMBER LIC. NO. 3307 M.P.R.S. C I A UR : IAINN. INSTALLER 6 DESIGNER UC. NO. 00663 F8t3'e - 9- 0 • i f1 z r Z m o m A /iPPti°oX. WEST LoT L . I - ~."~`'~A „ ,a a;!'6: 141Yay _Iti~'~sY•ib .d►kir ~tent3,. ` .k ~y, v:#. ...fiy 1. 1 ' k to } I S ~2. b rv V~' i uy}ti.~• .)'~$4X:.i'Ja~jai. '.t~'.~iit.:i+ C%p 1 Ii 1 1 1 i ' 1 FE 0 q h ' r o 0 z o- 'N T.. Z ~ : ~ N tK ~ I , w r n n rn, ,.,r•air w I M ~K M Mtrq• N, ,tnMle » ,W ~ i I ~ ••Y,rY,'r. r 1 1~ ( ~ 1 • lM~I.AI1l:D LA~lQ~ sr u•, or rw, rw• v mein" me ""00 j- - S Z IT Ir' 1 r f1- s •Pr C " ' ( 1 1 (/1 7U1 ~a0) ' XG I t V S X ls,[ 41C.114' NORTH -MEADOW - -DRIVE-_ 9 f N MIX W i v Y= 1 •3 0 •O.~ _ tl ~ it ~ry nZ " /1r,J1 R yZQ t~~1s j~~I t3 ~ ~ • I /q0.1 1! w .t5l.~5 tl,!M'.'t ',N.,•' ( I 'fl If, 03* !s $ r 1~ ~ • - rtiu j \ r \ uoo•u'I3'w 320.50' woo•IS'u•w 305.50' ! C 11 \ \ io • i 1- X 8 L= 1-i 1 I as 90 0 , gg m 11 1 1 Irz 1 I; _ z a R EIII ' 1< z' aA Mew ,`9 'O j , A 1 'J zS r 1t I 9 = ~ • 's I 8 I APPLICATION FOR SANITARY PERMIT STC - 100 Phis sppliestion form is to be completed in full and signed by the owner(s) of the iroperty 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 #old and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property _ _ I Vl r-~t-- .A N c Location of Property I4W k 5~ Is. Section 1-( , T 29 N-R•~_ W Township w(p ~Q 1.1 Mailing Address rl"1 At,-y (2cA-0 _ ~oso~~ ~4alb Address of site _ ! A M G lubdWildn rase 4LCa 4 M ~opw S Lot Number 00 Previous Owner of Property U t-G~" N \A/a,5c0 Total size of parcel Date Parcel was Created 10 - D4 -~I Are all corners And lot lines identifiable? Yes No to this property being developed for resale (spec house) ? Yes No Volume I_44 , and Page Number S6,S, as recorded with the Register of Deeds. INCLUDE WIT11 THU APPLICATION THE FOLLOWING: 'A WatEanty Deed which includes a Document number, volume and page number, and the Seal of the Register at Deeds. In addition, a certified survey,.if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Hap, the Certified Survey Hap shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r - - - - - - - - - i PROPERTY OWNER CERTIFICATION I (Wrl coJW$V that a.CC ~stdtMEnth on th1A bohm Me th.ue to the beat o6 my (owe) hncwttdgtt that I (wtl am (ahel the orune ki o6 the phopehty descAi.bed in .t1aA .tn4olmatton 60hm, by vi tut 06 a wonhanty deed keemded in the 06 ice o6 the Count RegiAteh 06 Detda ass Document No. 15e4b07-9 j and that I ~we) pheaentty awn tJtt phopoeed We 6oh the b¢:uage disPOS a yA em (oh. I (we) have obtained an tagstmtnt, to ftun with the above doffscAtbed phopehty, o,% the eormtAucLion o6 aatd eystem, and the Game hae been dut keeo)tdtd t eke ~Jtce o6 the County RegiateA o6 Veeda, a8 tloe m ant No. 5 a 4b p Z 1. s 8tCNATUR6 Of OWNER SIGNATURE or CO-OWNER (IF APPLICABLE) 11wTR uiran~. 5r.. C.o L» C~7uaC't OGiNC:tl~IC?'tTZ Iy F~"~Z-~'L- ~~.1~06.1 EtOIITIZ190° YII:'SB3:: sl-lZ AL ~7-vA.1~ 7trs lumber ~1Z CZT7! S'~.tTT v105<31q , W1 ZZ? SOro I to ?"IPSI.Tt LOCATTON:_-'~. Et Q ri, "own a PUC)5© tj St. Croix Cauae7, Subd; s-ts ion ~-k(.a" Mt5NA0wS__19_L.o c number 2-0c> . Zmproper use Xad matacanance of your sapcic syscam could rssulc L its premature failure cc handle vasces. ?Toper maincenance can- 313c3 od pumping ouc the saocic caak aver7 three years or sooner, is needed. by a Licensed secticc tunic our or. %hac you puc Lzco ehe syscam _3n agate Cho Cuncciua oc Cho septic tank as a c.eac- none wage La the 'J&3cd di300441 syscam. Sc. Croix Caunc7 residents may ba eligibla co recalve a grant Ear a max__ ud 60z ud the case ur raplaczmenc of a Eailiag syscam. which vas La ooeracian prior co July L. L473. St. Croix Caunc7 accapead :.1133 prog:aM La Ammusc of L980, wtch Cho requiramo+nc cha owners of all nova svss agree .o (coup chair syscams properly mai.aeaiaed. i%a prover=7 owner ag=_es to submic co Sc. CC,3uac7 Zaniag a car=i_icaeion Eorn, signed by Cho owner and by a mas.ear pLumber, lourne7man plumber, rest=ic=ad plumber or a Licensed pumper veri- E?:Zg that (L) Cho on-site iasc*wacar disposal syscam is-.La prove operaclaq condition and (Z) ad':ar LaspectLon• and pumpiag..'(i: aec- as3ar7) , chw septic tank is Lass Chan L!3 full of sludge and scu Car:i:icaeion form vtll be sane aporoxiaaealy 30 days prior cc three year axpiracion. I!'•~E. the undersigned, ha•re raad the above reaui.rsmoncs and agre cc mai :caim cite prtTaca savage disposal syscam n accordance wit. Cho standards sac forth, hereia. as sac by the IJLsconsta Depart- mane of Natural 3asources. Carti=icacion fora must be eomplacad and recsr:ied cc Cho Sc. Croix Caunc7 Zaniag OE_Lce Within 3'0' day od :he three rear expit--cion dace. S _ ^ 7 AT" 1- I Z q Sc. C=-:.. Count" :jn_nt~ QC::cs P.U. 30 uacsemo►+e. ~ :COL .th,~v►_ 1ctQ-?yam . c zXEMOf1J dt7OO'1 r r ~eGr x~mOrv an orr; ~ ~ hxscA MM Mc rnYMa., rn~omro ~ r-=z~' wsw-lto 'nom r"{u~Obi CW,7mp as IT10 4 ocom m ~ o~E~tor ~fZ1 Z• a0 ~ 4 ~bY1d ~s -s o ~ ~ 5 d ~n ~v~sa o co z -a C ~ am m C* x C~> o of f a N G %ob N z a to ru Ca r+1 r fJQ TU W ~ g ~r t1~ a O bi V1 -4 -4 0%:k ~ 1'IL+Dr.>U1o 2'+1 ~ 6i x r "w C+ n N co 01 0 W C ran • to ez ni orwvw m m H {w M w'•n w°o ° n o 0 ~`^M a r ~a r T -J 44 r V1 O Co [7+ 1114 W N W . Q•WA Vi-•JO.nCh ~ yC o.o Iv ~o tU -d 0 p ^i cc b m ro b ox WOW ra air, - , r J .i r1-. •-_.J -..1 i-. ._rJ f. . 1 -i r- ! T 7~4 -7 4. - 77 T - f.. 1=1 1-1 11/12/93 09:50 $ etlsr IV'i'Y CLERK 002/004 ..k r Nye M.04~~ 555 -4~~ _ . iNle ■.Uia ALeaN7J~ ~Oa 11`COaetNY DATA STATE BAS OF WISCONSIN FORK 11-im . OQCUMEN7 NO. LAND CONTRACT and NGC7 q 1'DO 9& U3S0 ybR w~~ OT1fER O!i.CQNB Q~7~,~/ 5Ov~ ~ e7L,0se Is F[NANCA 91iQ1'10NS► V R!. Co. jt<Contract, Ip_beewm Gjt N._JJ 7CQN.~A~ v •~~~i Yemdoi" • ' o(~T~i 3 M _ d 6:30. A. Qr~.A/.1~1.B...SLXCF,L~Q~~~ . • wbetber one or more) amt.- AWR a /~A •11ALOMEY_...-hu9Jaaad..and-.Yj.fEr_..._.._..._..--•• more)• IwtitOMi , («mai+'. whether Aaad fall POV_, ,'-r - the _ t" Vemdor was and ayreea to convey to pnrehasar" ttPOp the P V"' the for..ft P~ w1 t~ ntapa ) formance of this Contract by Pare- i>st~e+d Ltillts, Prva~ldi4 flrtOtrm Sad other apya t faq$. Stab at ~flsooMIS. nsn+a■ w . v: % ta•._- •-J7i~•~•_L~•-rf~_...r+•~.•-'~ ; • • , ' I ~Y "y. i.• - s Y Tax parcel No... . t • Sb. Croix County., _ . _ : t • ry - to the Tovn o son, in Lot Meadows -1-If - .~Y• t a 4" '~r r N 25, High Wisconsin- All r} I Y .'•~•"lam ~',y' • . ' t^ v•: Cts'9-:. •'.v,-{•.,.-'',,•ai - f••.•v, ..y •:'fr. y. ' ~ , ~ - ..1,• .7 •,•.T~~r,, f •~TJ.• ••..J ..1t ~ Aif ^7'' • IV 'C •L•t,V - % •'i• + - Jri 1'•, yLN T'j'~1 !•7~~ rt:t~.~y~#.. y. i ' -:ti ti,/ J' • , .~,,,C y 'S t int.{` !U'-.. .~i. xk- • ' •T •:i - •"'J•Nl.71r•` t4 K7 of _ c..-L'T „4r. ,•'~'s3-'r',i;"'.'~. \ r ~l'"Ia. .+''J ~ ~~'!~=.W r. j.~•A^•~:: {'~~S.4~q(.~ s• .•'1~f ' ~ hOSSaetsad.pz~ r;'. .•I~• ,.L°" !'~'C jj•LI a • ` ' r .f y : . c A d6r direct~e' Ti►u (a) (>aI ~r • \ egre,ea to uhsss the P=oPy'aad to day to ve"ov .::r.~• ~b purebaM iatb. Mile >aa»emt t fsois a The Seas of ..._18 ~tllbatanaa Of ;.:.'Q-.~Q...~~.r~ _tsoSa, ~*iti' ~ the ~aeation of this Coatlrecs: Sad 1_ e at t14s' rR •i.. wy,' ~r : ca onLtandiad from slice t1/ al _ z; "0 •1F, ~,c~ r daCh 8nd bmmwf an the balm 10, in fall" ee follow,: ' _ h.? tfhm Iat a Y o ~ i MM Pam encing NoVember _I 1993 aah1Q i"tallm~ntifl< o pxiac p an Comm hereafter r equal mOnt Y 'S . every >aontli'' t nt of; 1206.44.- inte _ ' `'a,; _ rest in the amvu - , ; a,.:t-••r•• 't•'%,~7,. ~,4 •r~~:•5_r}k. ti.•~r:C`'' : , ~s+M; t • , , Y,T.~ ~'a/i. •tN- ~M1.,_ n,ab b~-,j!~yf.i, ry~~, t~,y _Y• --T~'jam-sgs SIL•ur'~ ~ • t Wt Ili ful pit W ' • f , IJ~f~.rA provided, boWarorr tho ante onbsr+ndmg A. (tho matutlV date)1 P+r anpw04 on tba wt3 •mo m °ewiaR any default la Pa9>a~tt, iatareet shall' atxla b mod, noses or maturity. the T fu default (whis>s shall include; withouC Iillaitstion" delin4naa + y s ~ i sT~RA, ,..~Y. . YY 5=• principal balsaoa)• v+,.._ s~aeon~tY ant F•• b 4andor" MOM to pay monthly to Vender amooab snflla ~ipt: to p nd, Vendor"• 60 .xcumd smeath fire std required ~s araMm P~uftla when dna To tde fi ~ of specifil o s0-0 to apply 1P~+9m be epoaitad i~atw ~a dwauft aw ~fm& or b~eabstoo, amuo'S. bt>t absll pot bees intfiat - taxes. asemmeats and imurana d : • _.,~fi • • Pei. Also nnlem otherwise satiated by 159L sad fiaea tb 1 y tb a payments Shall be aPPlied. fret to interest I's the »paid bdando at 00 Kithoat premium or fee Upon principal at a»r time amount itay be Prepaid YOU MO"" s this eAOtraot e bail not be tr'osLdl at ift 4daalt with rssp~ to paymmat ao beg is the even I of sny psMlaYmeat tptsreat fron► mooch to moatb shall be treated as the unPnid balsnee of priaeipal, and iaterast ~ ttAd&WdalnweUld have beaus had tin monthly Pay pr been as. unpaid prineip") is lea then the among enb shall be oontiaaed In the event of clydit of any proeseda made ee freet spaeiW above; provided that znauth1 m~ theraattar excluded baeetrom. remim . evtdwm mAmMed to FUre>saser of insarance Or condamstiouf the 0006611=6a p • purbaeer state. that parehasae is satisfied wlth tba tttle M st vu by the ti for eaambation wept ; t13 the coat of lntOre title evideeloe. If title eaidem* 4 in the form of au abstn4 it shall purehaser a¢tem Pay .~.~x-.Qf C]=,OO~l1;(•~_.r..._._.1 lY:..._.... , b& retained by Vendor until the full Puro'" Price to P" oo,_-.... p,,th a aboR bematitlddto take possession of the p,Wt7 •fype Oat OosF Y• j ' r 1 " a oft Ice. ~ ;pl~aMla I•ttttefi,efslstL eTATa 9A0 Or wiacOrlsil+_ yyweopee, M~ lfss Cl ate TMAC3- U"noel and rORAL me. II r ' 11/12/93 09:51 $ MUNTY CLERK .003/004 - 10 556 .4 Purchaser promises to pay when date all duce and sasasmwnta levied on the Property or upon ~ina o s Interest ; in it and to deliver to VIindor on demand recdpts showing such payment. by ft% 42- tended shall ices the im rovements ou the Property insured agalnet loin or damage n h occaaic;fibtwo- ■ roved tended coverage pet uire without Wiaeuranao, g pP perils and ouch other hazards as Vendor p,ay :aq . bat Vendor shall not rNoirn cover in an amount more by Vendor, in the sum of ; n/_at...-...... . than the balance owed under thin Contract. purchaser thin pay the Insurance pramiuats when ue ~hee,P~k~ a~ eontaln the standard elsme In favor t yof the Vendor's t w t aY ~ ndo of erw a surge" i. t~ tho o of all policies covering the t'roperly shall be ~epw insurance "nipmia and Vanddc vnleea sad Vender otherwise a ~t~ tion osp repair a to be applied to restoration or repair of tba Property damaged. provided the Vendor deems economically feasible. . • . _ Posehaaar comnaata not to commit waste not allow waste to be ttediLbe rftopair hlie~i,` of kup this C atr~Oact,- apes in good tenantable condition and repair to ken the Psoperti' to comply with all laws, ordinances an- repulo,as affecting the Property. Vander agrees that in cane the purchase price with interest and other moneys shall be iu117 paid and Q conditions shell be fully palorrued at the dam and in the ma>mer above specified, V al le a~ W lime Maim dWeva i brsd. de ver to the Purchaser. a Warranty Heed, bi fee simple, of the PtoDerty, . any lima or epeumbromm created by the act of detach of Purchaser, and sae tt 4~lGQlcdt_.~j~_anY..... _ ......__....-__...w.~...___ .w.r........- • " . _ - _ default lit the Pa~-.ent of an3rpricdpaT or' 71 iPtirelfeser ~ agrees that ! tit tinhe ia•of the essence and (a) fa rho event of a - ' - ietclcet whist coadnnm for ■ period of o._ days follow lug the specified due des pr (b) In the event of a default bt yy~ or nonce of any other obligation of Purchaser which continues for a period' of fl dins fool balance pa w h~ o - re f by Vendor (delivered personally or mailed by certified mail), then the en ti on ahaU become immediately due and payable 4 full, at Vendor's option and without notice (which Purchaser hereby naives), and Vendor shall also have the following rights and remedies (subject to any Ihn'tations; btp: ~ id by addition to those provided by~w or in equity: (1) Vendor may, his o othrotsrwlniet foreclosure M►itb any char os . rights. title and interest In. a $r'o and recover the Property bs red balance. with iAtarest tbereoeifrom . empption to be conditioned upon Li-chaser's full payment of the entire outatnmdinj = tks Z of default at the Pate is effect oaf such datoautotheramountedushenuodor&M, hicbeveatall smountspreviouely p "d by Purehaaos shall be lorefeitwd as liquidated dmagea for failure to f,111111 Contract and am rout for the 'hoes psrty if purchaser fails to redeem) i or (ii) Vendor may ano for specific performanea of this contact to compel iommediab anal full ;Iayme:: of the more outstanding balance. with Interest thereon at the rate in effect on the data of default Arid other amounts duo hercupdar, in which event the Property shall be suclioued at judicial wale sad PUrahasar abed he Iiable for soy deficlancy- or (iii) Vendor may sue. at law for the entire unpaid purchase prim at any ppppsltiio thereof; or (iv) Vendor may Uaarw this Contract at an end and remove this Contractasacloud on title in a gniebtitls action if the .:meltable Internet of Purehaser (s insignificant; and (v) Vendor may have Purchases ejected from postmeioa of the Drop srA have a receiver appointed to collect any rents. twines or Profits during the pendency of say notion wider (i). ( or (iv) abwe.Notwitdstandlul any oral or v1rfttm statements or actims of Vendor an election of any of the foregoing remedies shell only be bindini upon Vendor if and when pursued in litigation and al{ costa and espeheea Inching reasonable attorneys fees, of Vendor ncurred to sdoeceany remedy hereunder (wbetheir abated as sot) to the extent not prohibited by law and expenses of title evidence stall be added to principal and paid by Punhaaee•; as In- Burred, and ebA be included in any judgment. • Upon the commencoment or duri the pendency of an awon of foreclosure of this Contract, Parehaseat memes~ to the appointment of a receiver of the ot►arty. 1nceiiading homestead Interest, to collect the rants, 34enm_ hod psOiiftB the Pro"Ay during the pendency of such action. and suck rants, 1'sause. rind pro'fts when so eollectad al~au br A,ala~ sad applied. is the court 812411 diMI6, PUrehmes when not tranater, sell or convey, any legal or ognitable interest in the Property (b' aeei t of say of Purchaser's rights under thin Contract or by optieni, loWterm 1loses or in say other way) v►ithout y~ written 4 _r consent. of Vendor emleea either the outstanding balance-payable Under this Contract is first paid is lull or the, Intsr+st conveyed is a pledge or assignment of Parchaaer'o interest under this Contract solely as, security for an ladebtadnee} of Purchases. In the event of say such trsanfer. We or conveyance without Vendor's written consent, the entire oatdhndin r balance payable under this Contract abail became immediately due and payable in lol4 at Vendor's option witlsoat notice. Vendor shall make all payments when due under env mortgage outstAnding against the Property on the dabs of thlit Contract (swept for any mortgage granted by pbrcbaser) or under any note snored thereby, provided Purchaser mattes timely peyylamt of the amounts then ¢ne under payments ado nintracL e ad by Pa ear sbaJ1 b~ ~nsidered ypamym ne bmade oa the ?along= if Vendor fails to do w and all paym thin Contract Vendor may waive any default without waiving any other wubampent or prior default of PnrOheser. tats von, AS terms of this Contract obeli bar biadin upon and litre to the benefits of the 1 ~ represm soooe.eora and assigns of Vendor and PUrebases. N not an caner of the p~y~ty the sl to in the cum" of cep f a 1! cemo !loin joins hOra'n to relee.e homntand rtghb in the sabjei Property nd airess j dead to bs made in fulfillment bmrwL) - - r•• ' Detail this day of mr.... .(gEAL) __(SEAL) Mark Maloney a DiAnn Maloney- ~••M ~ Y-....... (Sr.AL) . _ ..._(BF.AL) a V ce11a biaxoa •a/k/ ,,,_,x-„ Glenn A. Waxon af k Glenn • , Y ce11a. Waxon ajk/a Gien waxon Waxolt AUTRR,NTICATION ACaNOWLml OURNT STATE OF WISCONSIN " St. Croix_ _Conaty. anthentlcated thin --....day ot:...~-..... 39...-.. Personally came before me tbia -.....--.d4 of Q t412aF ___...140the above named ..1'ia~ ...M ?ion .7~+._Di Ann ..~loney Glenn ~1. Waxon axk Gl:e"uri• .Taxon ....r__....... °a7'ic7a c3rffi--Wxon : Xcolrai 1~•.. waxon 'I'i'LE: ld>y3dBE8 STATE BAR of WISCONSIN •a / -'Ifyce•Y"iaaxon (It not. -.~..rr.... authorized by 706.od, Wee. 13tste.) to me known to be the parspp ~~1It-_._;wbq a~eeUte$'the mg ins at and 1wkifte the some. THIS INSTRUMRNT M►Ae GRAFMD BY Krist;ina Ogland r - At Eorri ` -ate "L"d~i - .....r c..RU.L.' L P 47 R DP.~1!'r . _ Notary Pub11C ......Coont~,'9Virs. a#ate egpisttica °3 , - T pe anent< (If not, ~,it 1 n (Signatusea may be autJlcnticated or adrnowledgad. Both M9 Commission Ice / U-f are not necessary.) date: •M,~.r o! waew„ ,ienbac is ano s-e.cib aboaid.b. f~e.re1 BrIgW a~.r 1)84 01EMMm. t-A" CO-MACT,■e Coryvhu-91,4'B~ ~wls.,ere; stir! N. III -ilea