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AS BUILT SANITARY SYSTEM REPORT
OWNER r41 E tYavl~ G / TOWNSHIP AS o.✓
SECTION T N-R W
ADDRESS 61A-4e-9 ST. CROIX COUNTY, WISCONSIN
SUBDIVISION e da k' !f~' LOT4~LOT SIZE-2-24-4:1 PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
41 e10
`cam r
~ 5F
B
INDICATE NORTH ARR
BENCHMARK: Elevation and description: .fix t -r- el it
Alternate benchmark -ZAXI.ti/iP
SEPTIC TANK: Manufacturer: ai `oCa/-e,S7` Liquid Cap. IG~OD
Rings used:,S-Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side , Rear Ft.
i
From nearest prop. line:Front-L, Side , Rear Ft. 3 S
No. of feet from: Well u i~r~tk4; Building:_ /,P
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front_, Side-, Rear_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench:-,Z_ Seepage Pit:
Width: Length 4'c'j~ Number of Lines:__';_Z- Area BuiltG~a
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe: 0 a? F No. feet from nearest prop. line: Front , Side X, Rear Ft. 3S
No. feet from well: No. feet from building
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front Side Rear Ft.
No. feet from: Well building , nearest road
Alarm Manufacturer:
INSPECTOR: '7
DATE: e PLUMBER ON JOB:
LICENSE NUMBER
6/90:cj
LOCATION: HUDSON 28.29.19.1182,NW,NE,HARBOR CIRCLE, LOT 54
Wiscohsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
J-46or and Human Relations INSPECTION REPORT
Saf6ty"ar~d Buildings Division ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 149339
Permit Holder's Name: ❑ City ❑ Village] Town of: State Plan ID No.:
CEDAR HILLS DEV INC HUDSON
CST BM Elev.: Insp. BM Elev.: BM De option: Parcel Tax No.:
020118850000
TANK INFORMATION ELEVATION DATA A9200186 G 6z 2
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
r
Septic Benchmark Z7 0.27 160M
A0, 27' Z. 3
Dos4ag-
27
Aeration Bldg. Sewer ` D` 90, V Z-0
Holding St/ Inlet 3 B~/ T
TANK SETBACK INFORMATION St/ Outlet 9a,~$ off
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic ,`r NA Dt Bottom
Dosi NA Header FA d
Aeration NA Dist. Pipe 1 7.07'.57 • '
Holding Bot. System ' 8 y 9~• 0
PUMP/ SIPHON INFORMATION Final Grade
rer Demand 3,72
~lo•
Model Number GPM
TDH Lift Friction System H Ft
oss FHea IN
Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Length O No. OfZrenches PIT No. Of Pits Inside Dia. Liquid Depth
N
DIMENSIONS
LEACHING u acturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O C,B„0' SS CHAMBER Mo a Nu
System. OR UNIT
DISTRIBUTION SYSTEM
Header /4+arrffat&' r~ Distribution Pipe(s) ,r x Hole Size x Hole Spacing Vent To Air Intake
Dia. Spacing
Length r Dia Length 63!
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over „ a Depth Over f f r xx Depth Of xx Seeded /Sodded xx Mulched
Beds/ Trench Center ae4/Trench Edges 3Z 40 I Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
6Dp
Plan revision required? ❑ Yes a1l0
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: ,
}
i
C:7~:DILHA SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATE SANI PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ~ 9
8% x 11 inches in size. &9d if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
4'., e,101 t/a -/4,S T2¢,N,R E(Or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
e e /V
11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE ap e l~rG
NUMBER(S)
❑ Public or 2 Fam. Dwelling~# of bedrooms 2- A L RF:
III. BUILDING USE: (If building type is public, check all that apply) Q - ~~Ft7 67e
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 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. L~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 60-seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) a d ~LE SVA_TION g7". ej YSr~ rS 4J c0 (J' r 61-,3 r ~d Feet y$'i
Feet
Vll. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concret Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank _X~. I M 1 0 1:1 0 1 Lj I
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number:
W ' 11"a 1" 6' C Li Lc "14he,.01 L an~-?-- F'' 3 38G 3 t '2
Plumber's Address (Street, City, State, Zip Code):
/~Gl d l 6
eV2d
IX. OUNTY/DEPARTMENT USE ONLY
Groundwater a e su Issuing Agent Signature (No Stamps)
❑ Disapproved Sa~lnary Permit Fee (Includes Surcharge Fee)
cam
Approved ❑ Owner Given Initial ~ v
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/86) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code adm nistrator 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, r9connection, 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. Corny ete for all
septic, puma/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; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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 '11,,a ekz /x_
Location of Property Section 2 P , T__?y N-R / ,91 W
Township
Mailing Address r: a re r ec eL
Aer d.r c, Z,/ S ,`t o "4-
Address of Site ~i~-H Z.a.r c j rC:,~ e
Subdivision Name ~_~oCci N 6~ C~ r
Lot Number sz/
Previous Owner of Property aX ao r e
Total Size of Parcel "e4- Q~ rL~
Date Parcel was Created lZ l~ / F-4~
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? DC. Yes No
Volume and Page Number C ~s 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 refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
1 (We) eexU6y that a t Atatement6 on this for an.e true to the best o6 my (ouh)
knowledge; that 1 (we) am (ahe) the owner (.d the pnopen ty dens cAi.bed in thin
in6ohmati,•on 6oAm, by viAtue o6 a waAAanty deed recorded in the 066ice o6 the
County RegAAten o6 Ueed~sas Document No. 11,(gl7r ; and that I (We) p4e6entCy
own the pnopoeed bite bon the .6ewage didpoi ayss em (on I (we) have obtained an
easement, to nun with the above dedcni.bed pnopenty, bon the con.6tnucti.on o6 said
dyetem, and the same has been duty recorded in the 066ice o6 the County Rega.sten o6
Deed, ae Document No.
SIGNATURE O1 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
4..
sr,, UMENT N0. STA.TX OF 1bISCONSIN fc~•titNli *HIS s►Aes asasavsa "a McoMilis DATA
LANI/D~~G`Of1iTMCt .
44 ITO s p~~p !'oR ALL MANBA ON$ wal>Zes OVRR 3M$ OFFV
Y su,s~s 1U'*1NANCRD AND IN OTHRR No1tcoxsvstsa
ACT TPANSACTIONa1 ST. CROIX CO., WIS.
Reed for Record " 11th
Ha r JStwart ae Personal day of J~~A,eD. 19±6,
Contract, by and between r..
Re.................................. reseative of the Estate of ro arsen a/k/a,John
.("Vendor", James O'Connell
whether one or-.more) and... ..liam. 11
. s. IsOft r7,4 y
*sing]e..man-.•..... -•.--...--..-..•.-••"Purchaias"-.whether one or .more). rij
. ,
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- deputy
formance of this contract by Purchaser, the following property, together with tM
rents. profits, fixtures and other appurtenant interests (all called the "Property"). - - f
in St:.. Croix County, State of Whcon&13: RLTu11N To
See legal Description on Addendum
Tax Parcel No
38b - q~~3 r
SS
s
FEE
This lo-na.......... homestead property.
94 (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at , e A h..place .as. he shall name .
the sum of 19Za500.00.............. in the following manner: (a) $..6049.09.•9Q...........................
at the execution of this Contract;' and (b) the balance of >]AL59949 together with interest from date
hereof on the balance outstanding from time to time at the rate of t0A.11a)........... per cent per annum
until paid in full, as follows:
See Payment Terms on Addendum
Provided, however, the entire outstanding balance shall be paid in full on or before the.......llth.......... day of
.........June 19...9Q. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of ...~,Q.... % 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 principal. Any
amount may be prepaid without premium or fee upon principal at any time,
tkea:altsxibluaoc ~IOaslaie7aslbClEM1d11>R!t
In the event of any prepayment, this contract shall not be treated as in default with respect, to payment to long
as the unpaid balance of principal, and Interest (and in such case accruing Interest from month to month shall be treated
III i as unpaid principal) is less than the amount that said Indebtedness would have been had the VL"Mijkpayments 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:
i
• I
I
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 hill purchase pries is paid.
Purchaser shall be entitled to take possession of the Property on....... XhS-.dfiXi~-- RKS-?9 f--,MIX......
.Cron Out Oar
wit, tl PAGE l N7y 3 ~ ~~t,,,,
Purchaser
Promises to pay when due all taxes and assessments levied on the Property or upon Vendor's in;':rxst
it it ><nd 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-
Irrdtd coverage perils and such other hazards as Vendor may require w hout co-insurance, through insurers a
II'I by Vendor. in the sum of ' pproved
than the balance owed under this Contract. .Purchaser.shallt►i a V`he insurance not premiums when due.nThe policies shall
cuntaill the standard clause in favor of he Vendor's Interest and, unless Vendor otherwise agrees In writing, the original
of all policies covering the Property shall be deposited with Vendor.
inx,aruaaee companies and Vendor. Union Purchaser and Vendor otherwiseagre e inalwrpitin insurance tProceeefds shall
hp applied to restoration or repair of the Property duns a or ~nwnirall • gad, rovided the Vendor
y feasible. p endor deems he restoration or repair to be
Purchaser covenants not
in good tenantable condition and repair,tto k ~ allow from committed on
superioreto theelien s of his Cthe ontract and
to comply with all laws, ordinances and regula ions 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
,u rson Re res n a v
the ur hoses a hate e,16 peed, iQI simple, of the Property, free and clear of all liens and encumbrances, except
any lens or encum antes created y he act or default of Purchaser, and except:.... easemenj;a.s..protectivle..
covenaata..taf ..tecntd, ..if..any.~..and..zoning..axdiltanca..rsquiXe0lenta.
-
Purchaser agrees that time is of' the essence and •(a) in tho event of a default in the payment.of.any.principal.
. or
interest which continues for a period of ...60... 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
thereon. h,• Vendor (delivered personally or mailed by certified mail), then the period
em
out~sa nding balance under this contract
shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby
winces), and Vendor shall also have the following rights and remedies (subject to any limitations
addition to those provided by law or in equity: (1) Vendor may, at his pp provided by law) in
ril:hte, title and Interest in the Property and recover the Property hacktthrough strict eforeclosure this r w th nany uequitye of
redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from
the date of default nt tht• rate in effect on such date and other amounts due hereunder (in which event all amounts previously
pail by Purchaser shall be forcfeited as liquidated damavea for fnilure to fulfill this Contract rind as rental for the
Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel
immedinte and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of
defnuit 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 fer the entire unpaid purchase price or any portion
them ,f; 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 env rents, issues or profits during the pendency of any action
sander (i), (ii) or (iv) above.Notwithstnnding 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 rensnnnble attorneys fees of Vendor Incurred to enforceany remedy hereunder (whether alipted 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.
a y comm
durin to the ppointment ofeacr ceiver of thegProperty, Includinga homesitead Interest,to collect theorents tlasues, andrprroftsnof
the Property during the pendency of such action, and such rents. issues, and profits when so collected shall be held and
arpliet► ns the court shall direct.
Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any
of Plirchnser's rights under Olt Contract or by option, long-term lease or in any other way) -rithout the prior written
consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest
convened 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'
ranted by Purchaser) or under any note secured thereby,
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments Purchaser
the Mortgagee if Vendor fails to do no and all payments so made by Purchaser shall be considered payments directly
this Contract. paypayments made on
n
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,
sucressors 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 Pro and agrees
deed to be made in fulfillment pertY to oin in the execution hereof. j on of the
1 .
Dated this 11th '
day of June
19..86...
TF)
......(SEAL)... A. C~Rgi A L)
• Alatry~..J....S.t:ewart. i~ '
...........................................................(SEAL) ....„`,p•,~1.....`•~,rntr~ ~Qtt'.~~••~ ) /
. William C. Harwell J
v= L: c
AIITHNNTIOATION .%~~'•O v ~ `
ACKNOWLSDQMENT~'•,''1~:'•
Signature(s) 0 *
3TATE.OF-WI$CONSIN
authenticated this ........day of fi~'t..r~'4~X...............:....County.
•••••••••P 19..••-- Personally came before me this .110 ......day of
.,):Yng 19.8O... the above named
• +..Sewa~'t.•atId..Wil.ug!.:..i}1?!!ell
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not.
tuthnrised by.~.?06.08, Wis. $tate.j
to me known to be the person 5.......... who executed the
foregoinp•,)nstrument and cknowledge the. same.
THIS INSTRUMENT WAS DRAFTED BY/!(✓)
koi$.. A•.. Murray.,.. H>YWOOD, GARI HURRAY
& SHERBURNE, P.0 BOX 229 f rt/DR-S'O~✓~..........
.
u son';-Wl...5.401fr Notary Public .
St Croix
(Signatures mn be authenticated or acknowled er!pa ent • .County..Wis.
" are not necessary.) t,'ed. Both MY Commission is per anent. If no state expiration
date':1 r 19..
Notmen of Dcr.On. 61 . ; '
!RA1nR In wow - .-.r•.. .
AFFIDAVIT to cn~
O U d N
STATE OF WISCONSIN ) -V% c'?
s s
N
COUNTY OF ST. CROIX ) 3
Martin and Connie Pittmann being duly sworn depose an
follows:
1. We are husband and wife, and own Lot 54, Cedar Hills Estates,
Town of Hudson, St. Croix County, Wisconsin (the "property").
2. We have applied for a building permit to build a three bedroom
home on the property. All three of the bedrooms are located on the
upper floor of the building we wish to build.
3. On information and belief, the septic system requirements
differ depending upon whether a three or four (or more) bedroom home is
constructed on this property.
4. We covenant and agree that the home we are about to build is
and shall remain a three bedroom home. We specifically covenant and
agree that unless authorized by St. Croix County Zoning we will not
build or use said home as more than a three bedroom home. We further
covenant and agree that when and if we complete the lower level in said
home that we will include only a bathroom and a family room in the lower
level.
5. We make this affidavit with the knowledge and intent of
inducing St. Croix County Zoning office to issue a building permit for a
three bedroom home (rather than for four or more bedrooms). In
consideration thereof, we covenant and agree as herein provided.
FURTHER AFFIANTS SAYETH NOT!
Dated this day of May, 1992.
~I
Nat- M, X
Martin Pittmann Connie Pittmann
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ss.
ST. CROIX COUNTY )
r
Personally came before me this day of May, 1992 th^ above
named Martin Pittmann and Connie Pit mt ann to me known to be the persons
who executed the foregoing instrume t and ac~nowl(~dge the same.
,
Notary Public
St. Croix County, WI.
My commission expires:
This instrument drafted by Robert F. Wall.
[PITTMANN.AFF] 3WDIRFW
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ST C- 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
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[tf
OWNER/BUYER ~,'(/,•n r>a~~,y.,,r,.Q.((
ROUTE/BOX NUMBER T,i K liu Fire Number
~ ~
ZIP
CITY/STATE ~/stioCC~a✓ Al
l0l
PROPERTY LOCATION: it., Section, TN, R If, W,
Town of /,luds~.~ St. Croix County,
Subdivision Lot number.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into fi
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their 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 veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), 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.
0
F
I/WE, the undersignedA, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- "d
ment 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.
SICNED*0'7t/
DATE
Ev G t~
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-223S► or 715-425-8363
Sign, date and return to above address.
Y, T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
.-,IINtJDUSTRDUSTRY DIVISION P.O. BOX 7969
' HUMA AND PERCOLATION TESTS (115) MADISON WI 3707
HUMAN RELATIONS
ULHR 83.09(1) & Chapter 145)
LOCATION: SECTION: JTLOT NO.: BLK. NO.: sLLBI A ISI NWE: J
N 0/4 N 64 2`ts J29 N/R1 ~ E (or) W sort S4 I- I l/-•.,&AN t J
C NTxx: O ER'S BbYJER'S NAME: MAILING ADDRESS:
,C~~)A ILL fJ4~WELL
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMER IAL DESCRIZP(New I P OF LE DES RIPTIONS: ER OLA I N TESTS:
Residence ❑Replace ' MAY S") LS e-14 A r
RATING: S= Site suitable for system U= Site unsuitable for system
EM-IN❑FILLHO~LDINGT K:RE~Q~M SYSTEM:
COSTIE1U. M~1S.aU IN-GROUNDPR❑ESSUR E:SYSTJ
"S XS X
If Percolation Tests are NOT required DESI N RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: LASS ~ I Floodplain, indicate Floodplain elevation: ~a
C AZT PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TOGROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS COLOR TEXTURE, AND DEPTH
NUMBER DEPTH RV. ELEVATION OBSERVED ES HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B ) 11 17 q6,•U ~n~~ > //.17 13"Q~TS )q`'$~,~Sc~ ~9°6e,~MS I~~e ~g`'BeNMS
B- 'Z 19-A7 96.21 o > 9-43
B- 3 9.%3 9-, JV C,n c 9.$3 ►2''$~~,-s zl'~g ,,s~ ~'gQNMs ~Q~~ ~~s'eQNms
B-A l05"' 3 96, 17 40th - /6, ~•,~LLT~ fSs`'BeNL 3q~'$Q►~1►1S,~G~2 62,-,8e" As
B S p,9Z :S o /6.9Z j7''BLCM 7"&o SL ~Mr11s ,e 7!''B2u m~
B-
PERCOLATION TESTS
TEST DEP~TFf--~~~~ WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IAlOryVFi91 AFTERS ELING INTERVAL-MIN. P RI D 1 PERIOD 2 PER D PER INCH
P 5- > <
P_ 7-0 ~ r~O-OC- Ad j o 3 y~ >2. >Z
P_ p OrJt_' 2 > Z
P-
p_ PLUA-1 1 A i C (ZG
P-
PLOT PLAN: Show locations of percolation tests, soil bolings a th~irrnsions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their I ation on he p2n-plan. Show the surface elevation at all borings and the direction and percent
of land slope. 47
SYSTEM ELEVATION U {gyp e~2~ roc K - QZ.OD
TP I l 0
6
-Y r
~a
E
,
N
'SS
SySr~ MS 15 IQ~ -f
, I
t t f !
lyrn~k --Ta{'_ ~F 5r;~ t'1_c_- L ' °aQLa
0-T, -Lt
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print l: TESTS WERE COMPLETED ON:
~kvc u~SarJ JouaSc~,~~u2v ,,"C QV /99-z
ADD ESS: CERTIFICATION NUMBER: PHONE N BER(optional):
rj 4$ 13G56- Q%6
CST ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate sail tt:st, yo;.rr report must include:
1. Compute legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3. MAXIMUi.1 number of bedrooms or commercial use planned;
4. Is this a new or replacement System;
b, 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;
6. PLEASE usr:r the abbreviations shovvil here for writing profile descriptions and completing tine plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchniark and vertical elevation reference point are clearly shown, and are permanent;
9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. if the iriformation (such as flood plain, elevation) does not apply, place N.A. in the ?pro;:;; iate box;
11. Sign the form and place your current address and your certification number;
12. Make legible copies and distribute as required. ALL SOIL TESTS ILtUST 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") 8R Bedrock
cab - Cobbie 13 - '10") SS Sandstone
gr Gravel (under 3") LS - Lir'nestone
s - Sand i-IGW High Grocmdwater
Percolation
c:s Coarsr> Sarlt9 Pr,rc - ate
rned s ib"edium Sand W Well
€s F ne Sand f31£:Io Builclin£i
L.Qanny Suns: > Great{:i i han
sl Sc E ttI y t_£7alY.
p. S;:. L BI Black
C;y Gray
"c Caa; L« r.n; Y - Yellov",
sc Sandy Ci;iy Lo;wn R Red
sici - Silty Clay Loam rnot - Mottles
sc Sancly Day vv with
sic - Silty Clay fff - few, fine, faint
,c - Clay cc - common, coarse
pt Peat mm - Many, medium
in - Muck d - distinct:
p prominent
HWL High water ievi 1,
Six garler::al soil toxtul£'s surface water
for liquid vvaste disposal BM - Branch Marl,
VRP Veiticai Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must he obtained and posted prior to the start of any construction.
e l~' ~a rve ~4 W 2 ~ S~ `.D ~ ~ P.G~QV' ~ C/S 6 !Ji✓o ec t~G- G~S'a~
Y"
~ G!J
~ yb
nn6
~ ~ l6-B d ~ h
Sy`o~t un~,~d Sef/3~e~kS
2b b ~
ell,
f~d
4 G ° a f
7-1
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REPT131 HUDSON ST. CROIX COUNTY ZONING PAGE 2
06/02/92 14:21 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 2/92 AREA: JT
Activity: A9200186 6/ 2/92 Type: CONVSEPT Status: PENDING Constr:
Address: HUDSON 28.29.19.1182,NW,NE,HARBOR CIRCLE, LOT 54
Parcel: 020-1188-50-000 Occ: Use:
Description: 149339
Applicant: CEDAR HILLS DEV INC Phone:
Owner: CEDAR HILLS DEV INC Phone:
Contractor: SCHUMACHER WILLIAM C. Phone: 386-3121
Inspection Request Information.....
Requestor: BILL SHUMAKER Phone:
Req Time: 13:06 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
r MENT OF REPORT ON SOIL BORINGS AND SAFETY & BUIL
INDUSTRY, DIVI
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX
N WI 5
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOCATION: N6, SECTION: /MN/ROE(or) W TOWNSHIP/ SrTY: LOT .:BLK. NO.: SI~DAQI fy~V1lL,? 46 C NT O ER'S BgYIER'S NAME: MAILING ADDRESS: 154
~~~~.~..'G~000~~.....UU ye, N J
ir2p)x 91LL 144RyyfL1_
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: JPROF LE DESCRIPTIONS: ERCOLATI N TESTS:
N~'Residence U New ❑Replace dy ] Qz- MAY 7 9Z
U
l I~ MAY
1 K 4 SOILS - $vl R 04A
S= Site suitable for system U= Site unsuitable for system
P-UJ14S: EIU IN G~ P❑U RE: SYM-INE1FILLHODLDINGK: RE~MMEN~DE`®EM~(o`prtional)I~EI.~~I~ILS
OSTI❑U . IMO -
r 1ra;;`JT I 0' POS U I
If Percolation Tests are NOT required DES If any portion of the tested area is in the
~"Ss N RATE:
under s. ILHR 83.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH WV, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- ~j 17 96,o I~oNE > Il,j7 131IL-LTS ~q''S~,~SL39''81e~Ms>~G~ 6g''BeN~ls
f3"$LLTS ►2"BQN~L li"kdR~►.t ~'hS 76~~k,~17'IS'~G12
B- 'Z 9AT 96,22 6 E > 9-43
B- 3 9;%3 9~ ~'S z Noo c > 9.$3 !2'r$ccTS ~I'~Bltn►SL 37''$QuMS~GQ~c~I~ 4%*'8QNmS
B-A j6.%3 96,T7 r4oA > /6.r,.3 9"<S re.''BeNL M"&.NtSiGe 62''8eN AS
B-S p.9Z 3 0 } >D.qZ )9l"& .L.TS 7"&,,jSL M*'&AjfhS-~7(vre7&Puftl
B-
PERCOLATION TESTS
TEST DEP~TII-~~~ WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IJ►tOMYBg AFTERS WE LING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH
P_ )"Z > > <
P_ 2 .7 o1uC 9617-0 3 Z >Z. Z
> 7 c
P- D Ot\IL
>1 Z
P-
P- I A-7 IJC- RL-
P-
PLOT PLAN: Show locations of percolation tests, soil boyngs ^th i rrnsions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their I ation on he ply plan. Show the surface elevation at all borings and the direction and percent
of land slope. I
SYSTEM ELEVATION \ U PPE e-,...T. P'eNC-K,.. _ -97 '1
fIQb TQNCi~ r'~®.
g
a
61V Wu-tt
.
-
iST-W rJ C b er] v
E ,
E
-i I,a~>=ir_ IS r (a 4
N
SA
SySr't"s t S QI -F
I
E _
E ;
T s i p
&-.r- (Ar"AP_k Tcap,~ ov' _S&7-1 ~
i
Y,-r~0
I, the undersigned, hereby certify that the soil tests reported on o a me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the locati o e~[ a best of my knowledge and belief.
NAME (print l: TESTS WERE COMPLETED ON:
3014 U Sam ' /99Z
ONE N BER(optional):
ADD ESS: h CERTIFICATION NUMBER: N46-56%10
b I~1 + S,~ 6 4g CST TUBE:
%ejeET ODISTRIBUTION: Original and one copy to Local Authorii ster.
DILHR-SBD-6395 (R. 10/83) -OVER -
i
Gs
96g
" --'J TIONS FOR PLETINt OR 115 - S BD - 6595
To be a c«n c"urate soil t,, r, #tort mus.
1. Complete le„
2. The use section ily indicate lis is a r or commercial project;
3. MAXI UNI roc b- droorns u R al Use plant t1;
4, Is this rr new r; r(cent systern;
5, Complete the sL:: £ 1~ rating boxes. A S'TE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEM, RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the o€, € ere for writing profile rJes(-rit.)tiorls and completing the plot plan;
7. MAKE A l_ECIB,- 'y Iocatirrg your test locations. Drawing to scale is preferred. A
separate sheet n,<, '
8, ?lake sure your, .Ievation reference point are clearly shown, and are permanent;
9. Complete all ap;). i b° K s ates, names, addresses, flood plain data, percolation test exemp-
tion, if app- I
M If the inform Ictl as flood 1:0--) does not apply, plan^' the appsotsriat:e box;
11. Sign the fc. i re your cu= ent and your certification n
12. Make laced.>lc c s art(] distribute, c I. ALL SOIL TESTS _''ST BE FILED A,'ITH T14E
LOCAL AUT~ ' Y WITHIN 30 D C1MPLETIO .
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures ~ -Vnibols
st Stone fover 10"} BIR - 1edrock
;fob C: )ble (3 - 1011) SS - Sandstone
g (under 3") I . Limestone
1h Ground eater
Cs d fi~rcolnlion Rate
s It€g
I Than
x
4
R F
scl Lx;;trr~
aicl y Darr rrlct I - tiles
sc - a ;y I
sic; - Aay fff - few, fine. faint
*c y ct; co€nmor c
pt _ snrn Many, ~n
€n ck d - distinct
p prorrlinei
H,"' High v
Six general Soil Sur
for ligwd >vas!,~ - I launch
V `v`er nce Point
it
TO THE OWNER:
This soil test report is the first strap in securing a sanitary permit. The county or the Department may request
verification of this soil test: in the field prior to permit issuance. A complete set of plans for the private
sewage system and a permit application must be submitted to the appropriate local authority in order to
obtain a permit. The sanitary permit must he obtaiiaed and posted prior, to the start of any construction.