HomeMy WebLinkAbout038-1038-10-050
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER « 61 t' a r~ c'
ADDRESS
SUBDIVISION / CSM# LOT #
SECTIONTN-R,W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t
/ Dole",
X,Sf,4
I ~ y
J
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
1
t
e
l
BENCHMARK:~
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:, fi r 1( =c y Liquid Capacity: G-
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS y
Building Sewer S't ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: /sue.
LICENSE NUMBER:
INSPECTOR:
3/93:jt
1"S?;1Q*Zirt6X-ARIn1?J IRIE 9.31 AT ff SNIME SYSTFA. H County:
Lalhora In Relations INSPECTION REPORT
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermito.:
Permit Holder's Name: 16?7 /L ❑ City E] Village ~ Town of: State Plan ID No.:
Elev.: nsp. Elev.: on: /,[_~L/L_ /1i Parcel Tax No.:
B- 111119-11
TANK INFORMATION ELEVATION DATA A9300033
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / S~ Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Inlet 7
TANK SETBACK INFORMATION St/ Ht Outlet ca ~-~i-
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
Air I
Septic ® NA Dt Bottom
AA-
Dosi NA Header/Man.
Aeration NA Dist. Pipe l
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. I 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.)
LOCATION: STAR PRAIRIE 9.31.18.160 NE,NE,CO. RD. H
Plan revision required? ❑ Yes IU^"O
Use other side for additional information. 7
SBD-6710 (R 05/91) Date Inspe or's Signatu Cert No.
T
ADDITIONAL COMMENTS AND SKETCH
~ L
SANITARY PERMIT NUMBER:
EDILHR SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than El ig&~an7pr.kvus 8tf x 11 inches in size. 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 OCA ION
an e~ y t/a,S T N,R E(
PROPERTY OWNER'S MAILING ADDRESS L 6T # BLOCK #
CITY STATE - ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
)w S V y6 Sl
/'I ( _3 (171
0 71
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD
VILLAGE
( ) ❑ State Owned
R =W OF::
❑ Public If r1 or 2 Fam. Dwelling-# of bedrooms 'PARCEL AX NUMBER(b)
III. BUILDING USE: (If building type is public, check all that apply) ~J 3 l 3 f
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. Ln-Reconnection of 511 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: r
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
3o- REQUIRED s . ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
y
' ~ ,5 z 3 ,Z ~ .meet 1 l Feet
VII. TANK CAPACITY Site
INFORMATION in allons Total # of Manufacturer's Prefab. Fiber- Exper.
New lExisting Gallons Tanks Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank c.
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): Plumb s ignature: (No Sta s) MP/MPRSW No.: Business Phone Number:
l l 0?6<
Plu s Address (Street, City, State, Zip Cod :
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved San' ary Permit Fee (Includes Groundwater ate Issued Iss ing Agent Signature (No Stamps)
Approved Surcharge Fee)
❑ Owner Given Initial I-r /
Adverse Determination 1 "1 2 L'JimW& -
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
S
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your San taiy`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 revision-, 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 tc 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; close 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)
STC-loo
This application form is to be completed in full and s'
the o~~ner signed by
will
only n Ilct(Sesulttile Property being developed. Any inadequacies
delays of the permit issuance. Should this
development be intended for resale b
douse), then a second form should be retainedrand ncompleted(when
the property is sold and submitted to this office with the
appropriate deed recording.
owner of property
Location of property_ ~7 /4 1/4, Section
- 22-N-~Lw
T
Township fR
Hailing address ~ C-
V~
Address of site
subdivision name
Lot no.
Other homes on property?
yes- X_No
Previous owner of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable?
Z Yes No
Is this property being developed for (spec house)?.___Yes No
Volume%" and page Number
of Deeds. as recorded. with the Register
•
INCLUDE WITH THIS APPLICATION THE rOLLOWING:
A IIAR1U1, ITY DEED which includes a DOCUMENT NUIWER, VOLUHE AND PAGE
NUMBER & THE SEAL Or THE REGISTER of DEEDS. In addition, a
certified survey, if available*, ;would be helpful so as to avoid
delays of the reviewin
references to u certified process.
urves Ma If the deed description
shall also be required. y map, the certified survey Map
PROPERTY OWNER CERTIFICATION
I (Wc) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am
the property described in this information form, bthe y virtue sof oa
warranty deed recorded in the Of e of the county Register of
Decd, as Document No. L,/ 5/
own the proposed site ---f-o-rL_tlie sewage di psalt system or I (we)
obtained an easement, to run the above described ( ) prrty, esently
the construction of said system, and the same haso be n duly
recorded A~ n ti office of county Register of deeds as Document
No._ t
signature o ap 1 cant
Co-appl cant
Dat of ignature
Date of s gnature
VOL
1b Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's Interest
in it and to deliver to Vendor on demand receipts showing such payment.
Purchaser shall keep the Improvements on the Property Insured against loss or damage occasioned by fire, ex-
tended coverage perils and sucq other hazards as Vendor may require, without co-Insurance, through insurers approved
by Vendor, in the sum of $ n/ a but Vendor shall not require coverage In an amount more
than the balance owed under this Contract. Purchaser shall pay the Insurance premiums when due. The policies shall
contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original
of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to
insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, Insurance proceeds shall
be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
economically feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property
in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and
to comply with all laws, ordinances and regulations affecting the Property. ,
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions
shall be fully performed. at the times and in the manner above specified, Vendor will on demand, execute and deliver to
the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except
any liens or encumbrances created by the actor default of Purchaser, and except: no ne
Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or
interest which continues for a period of (,p 6days following the specified due date or (b) in the event of a default in
performance of any other obligation of Purchaser which continues for a period of~410 days following written notice
thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract
shall become immediately due and payable In full, at Vendor's option and without notice (which Purchaser hereby
waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in
addition to those provided by law or In equity: (1) Vendor may, at his option, terminate this Contract and Purchaser's
rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of
redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with Interest thereon from
the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously
paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the
Property if Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel
immediate and full payment of the entire outstandng 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 entlre unpaid purchase price or any portion
thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title Ina quiet-title
action if the equitable interest of Purchaser Is Insignificant; and (v) Vendor may have Purchaser ejected from possession
of the Property and have a receiver appointed to collect any rents, Issues or profits during the pendency of any action
under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any
of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses
including reasonable attorney's fees of Vendor Incurred to enforce any remedy hereunder (whether abated or not) to the
extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as In-
curred, and shall be included in any judgment.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents
to the appointment of a receiver of the Property, Including homestead Interest, to collect the rents, Issues, and profits of
the Property during the pendency of such action, and such rents, Issues, and profits when so collected shall be held and
applied as the court shall direct.
Purchaser shall not transfer, sell or convey any legal or equitable Interest in the Property (by assignment of any
of Purchaser's rights under this Contract or by option, long-term lease or In any other way) without the prior written
consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the Interest
conveyed Is a pledge or assignment of Purchaser's Interest under this Contract solely as security for an Indebtedness of
Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding
balance payable under this Contract shall become Immediately due and payable in full, at Vendor's option without notice.
Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of
this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to
the Mortgagee If Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Contract.
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and Inure to the benefits of the heirs, legal representatives,
successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable
consideration joins herein to release homestead rights In the subject Property and agrees to join In the execution of the
deed to be made in fulfillment hereof.)
Dated this day of 19
(SEAL) (SEAL)
Norman V. Sullivan
PAMELA K. FORD
(SEAL) S 1 NOTARY PUBLI (SEAL)
WASHINGTON COUNTY
Joan C. Sullivan MY Comm. ExAireS July 25, 1997
AUTHENTICATION SAC NK OWLEDGMENP
Signature(s) STATE OFv*9eetMN P~t1NUUt'
ss.
l~tlG ~7.J County. ~
authenticated this day of , 19 Personally came before me this Q' ? day of
0 C~7h> ~ 19-SLZ-the above named
JEROMEP.ROWE SC/9~1J C: `jcc1L/'f/~y~tJ
tea.. WASHiNc Onl
My Commission Expires Aug !5, i"
TITLE: ROF'ONS
(If not, to me known to be the person who executed the
authorized by § 706.06, Wis. Stats.) foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Susan Meeds
h~ QW
Notary ublis 1.(~1R5 County, <fYis: /tfiV
Star Prairie, Wisc. My Commission is permanent. (If not, state expiration
(Signatures may be authenticated or acknowledged. Both date: C7abF2- 9711 19~_,)
are not necessary.)
'Names of persons signing in any capacity shoud be typed or printed below their signatures. SB11 NTF 0040
State Bar of Wisconsin
LAND CONTRACT-Individual and Corporate Form No. 11-1982 Nelco Forms, P.O. Box 10208, Green Bay, WI 54307-0208
VOL 1 P E 1 1
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11 .1982 THIS SPACE RESERVED FOR RECORDING DATA
LAND CONTRACT
A Individual and Corporate
'496863 ($28 000 IS FIN NCED AND IN OTHER NON-CONSOUMER
ACT TRANSACTIONS)
OFFICE
Contract, by and between Norman V. Sullivan and Joan C. REGSTE IRS
/►ff1.tr'
Sullivan, as tenants in common ST. C}LIONCV ~
("Vendor", pc-,'d lrReCOrd
whether one or more) and Susan Jean Meeds, a single woman APR
5 1993
Purchaser", whether one or more). ?:J Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- t:n
1
formance of this contract by Purchaser, the following property, together with the ~eglKerotDeedS
rents, profits, fixtures and other appurtenant Interests (all called the "Property"),
in St Croix County, State of Wisconsin:
RETURN TO
Tax Parcel No.
The NE 14 of the NE'4 and the East 99 feet of the NW14 of NE14, Section 9,Township
31 North, Range 18 West.
This contract replaces that Land Contract dated 21 September 1987 and recorded
September 25, 1987.
This is homestead property.
(is) (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at a designated place
the sum of $ 26, 000.00 in the following manner: (a) $ 6 000.00 previously pd
at the execution of this Contract; and (b) the balance of $ 16, 229.10 ,together with interest from date
hereof on the balance outstanding from time to time at the rate of_ Seven 7) per cent per annum
until paid in full, as follows:
Monthly payments of not less than $200.00 per month to be applied first to
interest, than to principal, the entire balance due and payable 5 five years
from this extension of contract.
Provided, however, the entire outstanding balance shall be paid in full on or before the 21st day of
October , 1g 97 ( the maturity date).
Following any default in payment, interest shall accrue at the rate of 7 % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and requ(rgd'insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations 'when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited"Into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after 21 SeppPmber 19_92 (0R)
there "~'R~il~fk~YRFXx
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing Interest from month to month shall be treated
as unpaid principal) Is less than the amount that said indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except: none.
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitled to take possession of the Property on September 21 17
Cross Out One.
SB11 NTF 0039
LAND CONTRACT-Individual and STATE BAR OF WISCONSIN
Corporate FORM No. 11 - 1982 Nelco Forms, P.O. Box 10208, Green Bay, WI 54307-0208
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 4 z,k ,
ADDRESS: ~FIRE NO:
O:
LOCATION: 1/4, =1/4, SEC.
_T N-R_lW,
TOWN OF:
ST.•CROIX COUNTY X_
SUBDIVISION: LOT NO. '
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 to
help with the cost of the 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 the St. Croix County
Zoning 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 (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification from will be sent approximately
30 days prior to three year expiration.
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system-in accordance with
the standards set forth, herein, as set by the Wisconsin DNR.
Certification form must be completed and returned to the St.
Croix County Zoning officer within 30 days of the three year
expiration date.
SIGNED:
DATE:
St. Croix County Zoning office
911 4th St. -
Hudson, WI 54016
DERARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, c DIVISION
REANDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX 76
N WI 53707 HUMAN
(H63.09(1) & Chapter 145.045)
LOCATION: SECTION: TOWNS H I P/M!lM11DUW=Y: LOT NO.: BLK. NO.: SUBDIVISION NAME:
NE 14NEI/4 9 /T 31 N/R18 ko,) W Star Prarie n/a n/a n/a
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix Susan Meade 11406 S. Greely Stillwater, Minn. 55082
USE DATES OBSERVATIONS MADE
TESTS:
NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION
®Residence 3 n/a New ❑Replace I 9-3-87 9-4-87
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
®S ❑U S ❑U ®S ❑U ❑ S CCU ❑ S x❑U conventional
If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a
PROFILE DESCRIPTIONS Page 3 DU
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH]" ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-1 6.83 100.74 none >6.83 .33bl.1. 2.50bn.s.l. 4.00r-bn.s.l.
B-2 7.32 101.13 none >6.74 •58bl.1. 3.33bn.s.l. .33bn.ssil. 2.50bn.s.l.
.58r.-bn.s.l.
B-3 6.41 99.92 none >6.41 .58bl.1. 2.00bn.s.l. .58bn.s.sil. 3.25bn.s.l.
B-4 6.09 98.74 none >6.02 .42bl.1. 5.67bn.s.1. @4.42sil. lens .83dia.
B-5 6.50 98.24 none >6.50 .50bl.1. 6.00bim.s.1.
rB decimal' PERCOLATION TESTS
TEST D WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER I AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD '1_ PERIOD 3 PER INCH
P-1 3.82 none 30 2 17/8 17/8 16
P- 4.21 none 30 13/4 1% 1% 20
P-3 3.00 none 30 2 13/4 13/4 17
P
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 96.92
i
3
E _ E I I
r
r a_ . .
~ ( 3~ ~ ~ Ff CE
1A ~ _
!
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 9-4-87
ADDRESS: CERTIFICATION NUMBER: P NE NUMBER (optional):
988 N. shore Dr., New Richmond, Wi. 54017 2298 115-2,46-6200
CST SIGNA
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
l -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 395
To be a complete and accurate soil test, your report must include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4. Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
. PLEASE use t' bbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LE{ '_E diagram accurately locating your test locations. Drawing to scale is preferred. A
iarAte sheet n ry L- used if desired;
8. ke sure yon !nchmark and vertical elevation reference point are clearly shown, and are permanent;
9. - mplete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain, r' tion) does not apply, place N.A. in the appropriate box;
11 . Sign the form and place your current a+ r and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") BR - Bedrock
cot) - Cobble (3 - 10") SS - Sandstone
gr Gravel (under 3") LS - Limestone
`s - d HGW - High Groundwater
v {rse Sand Perc - Percolation Rate
r im Sand W - Well
- ? Sand Bldg - Building
Is - Loamy Sand > Greater Than
sl `?--Jy Loam < Less Than
*l L.,:.:-.m Bn - Brown
sil art BI Black
si - S;;, Gy - Gray
cl - -am Y - Yellow
scl i.,y Clay Loam R Red
sicl - Si` t Clay Loam mot - Mottles
sc Sandy Clay w1 - with
sic - Silty Clay fff few, fine, faint
"c Clay cc - common, coarse
pi - Peat tarn - Many, medium
nl - Muck d - distinct
p prominent
HWL - High water level,
Six general soil, textures surface water
for liquid waste disposal BM - Bench Mark
VRP - Vertical Reference Point
TC a
A vate
i t
J
PLOT /PLAN
PROJECT_~ y ✓,'i~ S ADDRESS_® G
~/4 ~f/1/4/S /T~~/ N/R~ W TOWN c COUNTY re
M1AS Byron Bird Jr. 3318 DATE - 5 '
BEDROOM CLASS PERC, =---CONVENTIONAI,~ IN-GR UND PR SURE
CONVENTIONAL LIFT- MOUND- HOLDING TANK
SEPTIC TANK SIZE LIFT TANK SIZE
DOSE TANK SIZE HOLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark
* H.R.P.
❑ Borehole Well Scale = Feet
0 Perc Hole System Elevation l
X
w. 7
i u~
Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~C( Sdh ~S TOWNSHIP SEC. T ZLN-R~W
ADDRESS 1~06~ Grtew ST. CROIX COUNTY, WISCONSIN
l/~~~4 ~17
SUBDIVISION - LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I•ZHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
CO
CO.
3
.s3
Uc f
G*1cJ~ >~a'
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used /0jp-G._
Elevation of vertical reference point: /DO Proposed slope at site:
SEPTIC TANK: Manufacturer: -e C / 1 Liquid Capacity:
Number of rings used: 4t' Tank manhole cover elevation: /0-0
Tank let Elevation: Tank Outlet Elevation: ~c p
Number of feet from nearest Road: Front,Q Side o Rear , feet
From nearest property line Front, 0Side, 0Rear, 0 ' feet
Number of feet from: well / building: /Y9 <1e'1' e ~d ~ ~
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
r '
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. .
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed : Trench
Width: Length: Number of Lines:~ Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, Rear, Ft.~~
Number of feet from well: D LU t
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT, y► 7 /-7
40 r
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.C. BOX 7969 BUREAU OF PLUMBING
i MADISON, WI 53707
NEi,NEi,S9,T31N-R18G1 'CJ CONVENTIONAL ❑ALTERNATIVE IIIassgned)D.Number.
Town o{ Stan Ptra vue ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DAT
Susan Mee6 1406 Sarah Gtceetey, Sti,.P& teA, MN 55082
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELE V.
Name of Plumber: MP/MPRSW No.. Cnunty. Sanitary Permit Number:
Sytcan BiAd Jk. 3318 St. cto i.x 112779
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
f/ PROVIDED. PROVIDED'.
:.,c i C~CI~ ~•tO J 4 P~ZYES ❑NO ❑YES NO
BEDDING: VENT DIA.: VENT MATT HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING. JVENT TO FRESH
:
~r ALARM LINE AIR INLET
FEET FR I :I !&B
❑YES NO ❑YES ❑NO NEARESTOM
DOSING CHAMBER:
MANUFACTURER 7ING L IQUID CAPACITY JPUMP MODEL PU MP; SIPHON MANIII ACTIIHEH WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
ES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF FBUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO -NEAREST -0
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing r 11AAMIT111 4A ING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF DISTH PIPE SPACIN(I COVER iNSIUE DIA =PITS LIQUID
BED/TRENCH ' Q .53 TREN=HES tilnrEHIAL: PIT DEPTH
DIMENSIONS D
GRAVELDEPTH FI LL DEPTH DISTH. PIPE DISTH PIPE DISTR. PIPE MATERIAL NO D H - NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER E EV Lf I ELEV IN PIPE' LINE AIR INLET.
y~ h 9I°)j FEET FROM 1q~
T Cat `J~ ( (~f NEAREST--►~7VV C~
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER TEXTURE PERMANENT MAHKEHS otsSERVATH)N WELLS
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVFH TRENCH HEO OFPTEI OE TOPSOIL SODDED SFFUFO MULCHED
CENTER EDGES
❑YES. ❑NO ❑YES ❑NO [:]YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO. OF LATEHAL SPACING [HAVE L DEPTH III LOW PIPE FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTH IDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV. DIA ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION DOLE SIZE HOLE SPACING DHILLE CORRECT LV COVER MATE HIAL VERTICAL LIFT CORRESPONDS TO APPROVED
YES ❑YES ❑NO
COMMENTS: PERMANENT MARK O R ATION WELLS. NUMBER OF PROPERTY WELL: IBUILDING:
FEET FROM LINE
73 ❑YES NO ❑YES ❑NO _ NEAREST
A1
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNAT RE'. ~ TITLE.
DILHR SBD 6710 (R. 01/82) AA~~ Zawing Admini~sncc~h
~f0~
II
SANITARY PERMIT APPLICATION COUNTY
Gr'D/
DILHR In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
mom / y7'?
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER
8% x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION (p~
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES I.L11 NO
PROPERTY OWNER PROPERTY LOCATION
u e G %/V- '/a, S T ,T/, N, R /ICE (00J52
PROPERTY OWNER'S MAILING ADDRE S LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
.t,t 11jd a t_0- '
C T , STATE ZIP ODE PHONE NUMBER CITY EAREST RO , LAKE OR LANDMARK 11 M/ ,//~Cvx
VILLAGE :
TOWN
II. TYPE OF BUILDING OR USE SERVED: 03?-Io3~;'-10-050
Number of Bedrooms if 1 or 2 Family~~ OR ❑ Public (Specify):
111. PURPOOSSjE OF APPLICATION: (Check only one in #t. Check # 2,3 or 4, if applicable)
1. a. X" New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a. Conventional b. ❑ Alternative C. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. %Seepage Bed b. ❑ seepage Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
02 0 1- 04IFeet Private ❑ Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New isting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank GG ❑
Lift Pump Tank/Si hon Chamber ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name (Print): ` Plumber's nature: (No Stamps) MP/MPRSW No.: Business Phone Number:
~ o l l g'7 l
Plumber ress (Street, ity, State, Zip Code): Name of igner:
/n J 6o QJl 2
Vlll. S611 TEST INFORM TION
Certified Soil Te ter (CST Name J~ CST
6C ~
CST's ADDRESS (Street, City, State, Zi Code) Phone Number:
94HT/V. 4&1V lee ,;2 54r 49.f &&7
IX. COUJ TY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamp )
yApproved ❑ Owner Given Initial S charge Fee
Adverse Determination S1 u' W~
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 03186) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION r
TO THE APPLICANT:
1. This 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. A new permit may be needed
if there is a change in your building plans, system,.focation, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
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. Private sewage systems must be properly maintained: The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the.
State of Wisconsin, Bureau of Plumbing, 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 where the system is to be
installed;
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system check all appropriate boxes depending on system type. Check experimental only- if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
Vl. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, litt/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8',/2 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; dosing or pumping chambers; 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 forma
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate.'The groundwater bill Groundwater
included the creation of surcharges (fees) for a number of regulated practices which Wiscor~in's
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried , easure
is used in your building is returned to the groundwater through your soil absorption o
system or the disposal site used by your holding tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398 (R.03/86)
APPLICATION FOR SANITARY PERMIT
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 in delays of
the permit issuance. Should this development be intended for resale by
owner/contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property f li t ) __J 0, Location of property 1/9 &-1/4, Section , TAN-R-L~I-W
Township
Mailing address
-Vj
Address of site
Subdivision name
Lot number
Previous owner of property ~o r 4'Y1-I) Ul YY> 1 Le i Ui~lV
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? Yes 0
Volume and Page Number J 1 as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if
available, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified Survey Map, the Certified Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No.' ,~(~~/Q• ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been duly ~ec rded in the Office
of the County Register of Deeds, as Document No. ,l
S"'ignature f Owner - Signature of Co-Owner (If Applicable)
' ✓ 7,^
Date of Signature Date of Signature
l
34
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11 -1982 THIS SPACE RESERVED FOR RECORDING DATA
LAND CONTRACT
j~ Individual and Corporate REGISTERS 4304:98 326 000tIS FINA ICED AND "N OOTHER NONWHER --CONSUMER REGISTERS OFMCO'
ACT TRANSACTIONS) ST.
CfaROenv . CO., WI&
Contract, by and between Norman V. Sullivan and Recd. `::r =11~~'_ d this 25th
Joan C. Sullivan as tenants in common day Sept. A.D. 1987
•
("Vendor", Cd 8:30 A`
whether one or more) and Susan Jean Meeds, a single
woman mes O'Con ell
('Purchaser', whether one or more). " n
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- 4CDeputy
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures and other appurtenant Interests (all called the "Property"),
in St. Croix County, State of Wisconsin:
RETURN TO
Tax Parcel No.
The NE 1/4 of the NE 1/4 and the East 99 feet of the NW 1/4 of
NE 1/4, Section 9, Township 31 North, Range 18 West.
O~ .
This i s not homestead property.
(is) (ls not)
Purchaser agrees to purchase the Property and to pay to Vendor at a designated p l a c e
the sum of $ 26 , 000 .00 in the following manner: (a) $ 6,000.00
at the execution of this Contract; and (b) the balance of $ 20,000.00
,together with interest from date
hereof on the balance outstanding from time to time at the rate of nine (9) per cent per annum
until paid in full, as follows:
Monthly payment of not less than $200.00 to be applied first to
interest, then to principal, with the entire pricipal balance
due and payable five (5) years from the date of closing. ,
i
Provided, however, the entire outstanding balance shall be paid in full on or before the 21St -day of
Spt PmhPr , 199_( the maturity date).
Following any default in payment, interest shall accrue at the rate of 9 % per annum on the entire amount
in default (which shall include, without limitation, delinquent Interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required Insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and Insurance will be deposited Into an escrow fund or trustee account, but shall not bear Interest
unless otherwise required by law.
Payments shall be applied first to Interest on the unpaid balance at the rate specified and then to
amount may be prepaid without premium or fee upon princi al. Any
principal at any time afterSentPmhPr 71 , 1987 t334i~r (~7JbOdJOXXhQXJR~X406UMX>~C{6(t4(Ofvitkot)t~ltt~llc9totf~Of~i/~1f~Ot.•
In the event of any prepayment, this contract shall not be treated as In default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing Interest from month to month shall be treated
as unpaid principal) is less than the amount that said Indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be countlnued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except: None FKptgrkaxam&xmcgy gx--a&xRtgxk tdxx
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitled to take possession of the Property on September 21 -19 87
'Cross Out One.
NTF 2278
LAND CONTRACT-Individual and STATE BAR OF WISCONSIN
Corporate FORM No. 11 - 1982 Nelco Forms, P.O. Box 1075, Green Bay, WI 54305-1075
o BOOK (y~ PAGE JJ
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's Interest-'
1 In it and to deliver to Vendor on demand receipts showing such payment.
Its
~Q
t^ Purchaser shall keep the improvements on the Property Insured against loss or damage occasioned by fire, ex-
tended coverage perils and such oz her hazards as Vendor may require, without co-insurance, through insurers approved
by Vendor, in the sum of $ n / a but Vendor shall not require coverage In an amount more
1 than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall
contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original
of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to
insurance companies and Vendor: • Unless Purchaser and Vendor otherwise agree In writing, insurance proceeds shall
be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
economically feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property
in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and
to comply with all laws, ordinances and regulations affecting the Property.
Vendor agrees that in case the purchase price with Interest and other moneys shall be fully paid and all conditions
shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to
the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except
any liens or encumbrances created by the act or default of Purchaser, and except: usuix Easements,
covenants and restrictions of record, if any,
Purchaser agrees that time is of the ~Saence and (a) in the event of a default in the payment of any principal or
interest which continues for a period of bU days following the specified due date or (b) in the event of a default in
performance of any other obligation of Purchaser which continues for a period of 60 -days following written notice
thereof by Vendor (delivered personally or mailed by certified mall), then the entire outstanding balance under this contract
shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby
waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in
addition to those provided by law or in equity: ((Vendor may, at his option, terminate this Contract and Purchaser's
rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of
redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with Interest thereon from
the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously
paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the
Property If Purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel
immediate and full payment of the entire outstandng balance, with Interest thereon at the rate in effect on the date of
default and other amounts due hereunder, In which event the Property shall be auctioned at judicial sale and Purchaser
shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion
thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title
action if the equitable interest of Purchaser Is insignificant; and (v) Vendor may have Purchaser ejected from possession
of the Property and have a receiver appointed to collect any rents, Issues or profits during the pendency of any action
under (I), (Ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any
of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses
including reasonable attorney's fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the
extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in-
curred, and shall be included in any judgment.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents
to the appointment of a receiver of the Property, including homestead Interest, to collect the rents, issues, and profits of
the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and
applied as the court shall direct.
Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any
of Purchaser's rights under this Contract or by option, long-term lease or In any other way) without the prior written
consent of Vendor unless either the outstanding balance payable under this Contract Is first paid in full or the Interest
conveyed is a pledge or assignment of Purchaser's Interest under this Contract solely as security for an indebtedness of
Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding
balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice.
Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of
this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to
the Mortgagee If Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Contract.
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and Inure to the benefits of the heirs, legal representatives,
successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable
consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the
deed to be made in fulfillment hereof.)
Dated this
21St day of September 1987
V, ~rt^ (SEAL) (SEAL)
Norman V. Sullivan Susan Jean Meeds
(SEAL) (SEAL)
Joan C. Sullivan
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Joan C. Sullivan STATE OF WISCONSIN
SS.
St. Croix County.
authenticated th' day of 119 Personally came before me this 21st day of
September 19 87 the above named
Susan Jean Meeds
Samuel Carl 4Norm V. Sullivan
ITLE: MEM R STATE BAR OF WISCONSIN
not, e the pers ons who executed the
authorized by § 706.06, Wis. Stats.)
alik
THIS INSTRUMENT WAS DRAFTED BY
ACORN REALTY, INC. Dennis Fibli'064
245 Main Street Notary Public', Skie 49 Itfia1jx3ln
County, Wis.
Somerset, WI 5 4 0 2 5 My Commission is permanent. (If not, state expiration
(Signatures may be authenticated or acknowledged. Both date: SPn t P m
'Q 19$7
are not necessary.)
'Names of persons signing in any capacity shoud be typed or printed below their signatures. NTF 2278A
State Bar of Wisconsin
LAND CONTRACT-Individual and Corporate Form No. 11-1982 Nelco Forms, P.O. Box 1075, Green Bay, WI 54305-1075
I
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER FIRE NO.
CITY/STATE, _-A I k ZIP
PROPERTY LOCATION: 1/9 /4, Section T _N, R_LW,
Town of ' idly l1 , St. Croix County,
Subdivision , Lot No.
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
$3000 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
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning 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 (2) after
inspection and pumping (if necessary), the septic tank is less than 1/3 full of
sludge and scum. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree to maintain
the private sewage disposal system in accordance with the standards set forth,
herein, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
DATE
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
' PLOT PLAN J
PROJECTS S ADDRESS / 06 J` ~~•.c.c/ f~~/w`` ~~r
114 1/4/S /T / N/R W TOWN crh OUNTY
IW~ -
MPRS Byron Bird Jr. 3318 DATE 2- z !i
BEDROOM CLASS PERC CONVENTIONAL,& IN-GROUND PRESSURE
CONVENTIONAL LIFT_ MOUND_ HOLDING TANK
SEPTIC TANK SIZE 2r-~-a IFT TANK SIZE
DOSE TANK SIZE OLDING TANK SIZE
ABSORPTION AREA PERC RATE BED SIZE 1, X i
Benchmark V.R.P. Assume Elevation 100'
Location of Benchmark a o
* H. R. P.
0 Borehole Well Scale = Feet
0 Perc Hole ~ a- System Elevation /qy
36 " TYPAR COVERING
1 2-
12" 3' 4 6' 0 3' 3' 4 3'
1 Sewer Rock 18
12'
9! L''
~O.
C.C
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