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FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER %le-TOWNSHIP, 171,PZ-.:5oj
SECTION Z9 TAN-R_ZF 'j
ADDRESS eoxZQ Z ST. CROIX COUNTY, WISCONSIN
,W e-e 4 c n Gt/Z
SUBDIVISION /ova- ffLOT 3s' LOT SIZE 2°~~ /9~Q S
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
syst~►~, E IV. = 93.20,
sc- /O,
I% t, M Top o4 +~ow4 r .
d~ 5.E lo-Y ~o~pwr ~k.= I00.0 I I
1
U0~ I , I !gs
{ t-~ioc,s e
D
7s R
j B M-Top V
Va.A aY 5 E Cdn..i E ~
Y _ INDICATE NORTH ARROW
4~ssia, s•~d
BENCHMARK: Elevation and des,,cnription :T.~o4 "~ow.c-.A 4 sLl t<o,, nc.r
Alternate benchmark lh.ean'/~i aI
SEPTIC TANK: Manufacturer: Liquid Cap. lo01-
Rings used: C) Manhole cover elev: Final grade elev: '
Tank inlet elev.: Tank outlet elev.: '",OS
No. of feet from nearest road:Front , Side X , Rear Ft.lo(o-
From nearest prop. line:Front , Side k Rear Ft.
No. of feet from: Well ~R/ , Building: Zla'
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
f
I
PUMP CHAMBER
Manufacturer: /4/X 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:/ n V=►+f 'oh Al -Trench: Seepage Pit:
Width: Length 3&' Number of Lines: 73 Area Built 6V e ziV'
Exist. Grade Elev. -Proposed Final Grade Elev. e,JS
Fill depth to top of pipe: `f0
No. feet from nearest prop. line:Front , SidekRear Ft.1~
No. feet from well: 9Z~ No. feet from building 5"9
~
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:
DATE: PLUMBER ON JOB: lop r4 4 LICENSE NUMBER: z
6/90:cj
JA_ I gJ10 c ~
DEMRTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HOMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
A[~ISON Vyl 53707 State Plan I.D. Number:
5E 4 , N$4 ,Sec . 2 0 , T 2 9 - R19 ❑/ONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Hudson, LoL 35
P • 1 Holding Tank ❑ In-Ground Pressure ❑ Mound
Lane
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Sam iller on, WT -7111)
BENCH MARK Permanent reference point) DESCRIBE IF DIFFERENT FRO PLAN: REF. PT. /V.: ST REF. PT. EL /
/ ~p 7Sl
a o ~X i~rvl¢r)f~ r~ Cs~ (J = 97,5/ GdD, D/
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Doug S r b d c6'1~
SEPTIC TANK/HOLDING : 2. c = d 8
MANUFACTURER: - LIQUID CAPACITY: TANK INLET ELEV.: TANK OU WARNING LABEL LOCKING COVER
PROVIDED' PROVIDED:
-A LL
o ,a S ❑ 'NO ❑ YES U~M
BEDDING: V~DIA.: Vyfqt~MATL.. HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T F ESH
C . 0,, I 11 ALARM: 4O4FEET FROM LINE:, I i I AIR INLE
❑ YES 0 `~t ❑ YES NEAREST Uo GJ, S~ oZ~
DOSING CHAMBER:
MANUFACTURER: BEDDING:. LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CON ERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
__-1 EST
PUMP ON AND OFF El YES E] NO
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolle ire, construction shall cease until MAIN
the soil is dry enough to contin
CONVENTIONAL SYST WIDTH: -LENGTH: NO. OF DIS . PIPES ACING: COVER INSIDE DIA.: LIQUID
BED/TRENCH / 3( t TRENCHES: / MATERIAL: PIT
DIMENSIONS D
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. P PE DI TR. PIPE TERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPE ABOVE COVER: ELEV. INLET: ELEV. END: o PIPES: LINE: AIR INLET:
g
~ -30 STIV1- - ~7Z/ FEET FROM
I /i 9. I . ~Q / , NEAREST
MOUND, SYSTE
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
eta' in county file for audit.
Sketch System on
Reverse Side. SIGMA RE: TIT
SBD-6710 (R. 06/88) '
TU DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY ,
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / Ni
8% x 11 inches in size. check if UsZtvious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER Inv j ] PROPERTY LOCATION
/ Sk Y4 a Y4, Ste? T-%'9/, N, R E (or W
PROPERTY OWNER'S MAILING ADDRESS LOT # TBLOCK #
o B 'r -1a it Z_ 3 S"
CITY, STAB ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
3 g~ a-7(o P: no- 6i u F; -Z
a r1" o SHt~ A, 1 14
11. TYPE OF BUILDING: (Check one CITY NEAREST ROAD
❑ State Owned VILLAGE
❑ Public M 1 or 2 Fam. Dwelling-#of bedrooms -3 AR EL AX N BER )
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
20 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 120 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. ~A New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. tt.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
4~~v s (r ly 3. 30 Feet 70.7 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank / ( W m- S e,✓
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): PI ber's Signature: (No mps) MP/MPRSW No.: Business Phone Number:
o k 'Ste o h b a.. K 2-1/1 3 2- 3 3
Plumbe Address (Street, City, State, Zip Code):
R Q- a.tv Wc.t- n+on s v/
IX. COUNTY/DEPARTMENT USE ONLY
Groun) dwater ate Issued Issuing A ent Signature (No Stem )
❑ Disapproved Sani ry Permit Fee (Includes Surcharge Fee
Approved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
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 Ste.-rye r-
Location of Property S fit, Section Z O , T 2 N-R
Township 4 a/S e n
nailing Address ,6o jr - z S 7-
4, A, wL syQc L, .
Address of Site
14ic; /Q,,
Subdivision Name
Lot Number 'S S
Previous Owner of Property; e ~.a~d S7o
Total Size of Parcel 7- 0 c~~ ~4~ Qr S
Date Parcel was Created l --if- 9 D
Are all corners and lot lines identifiable? x/ Yes No
Is this property being developed for resale (spec house) ? X Yes No
Volume -10 9c> and Page Number -;7-3_ 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
I We) ceAti.6y that att Atatement6 on .this 6okm an.e tAue to the beAt o6 my (ouh)
hnowtedge; that I (we) am (cute) the owneA(.s) o6 the pnopWy dmcAibed in -this
in6onma.ti.on 6o4m, by vixtue o6 a waAAanty deed neconded in the 066ice o6 the
County Register o6 Deeds as Document No. ; and that I (we) pheb en.tey
own the pnopod ed date bon the a swage d ispos .6yes em (oh I (we) have obtained an
eabement, to nun with the above debchibed pnopenty, bon the cond.tAuction o6 said
dyetem, and the name has been duty neconded in the 066.ice o6 the County RegiAteA o6
Deeds, Document No. y~19 / y 1.
SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
77 IR
r c
ooCUMP4T NO BTdT>4SDa- f)Y ~8IKc7Oli~[ l1~ ts1~ '
me as
WKMBX
AN rs AMCiD Ar•o rrl f
S I R M
- i., AC'r TRA11sAdTrO71a)- 1
fir
VoIItTBCtq by aaA bed►aa w
,Janet.w}!t $}4j~~l1..111E..ill..!!4l?41..~..~ftllLa..A..B~Ai~l1.. f 1
' Mr,11911...« w. w CIVO r FV'M.
• w..
4 wbethW OVA W. MM)•.end..l M 1s. ~',If1xA !iwli
(NPurcheeer~, wbetber one or arose)..
Vendor sells and agrees to convey to Purchaser, upon the prompt and l1tU Per►
I~ forowes of "contract b; Purchaser, the following property, together with Mite
~I rents profits, fixturso and o,her appurtenant interests (all called the "Property"
ia..S Csoix County, state of wiscoasinr astwui To
Lots 28, 29, 30, 31, 32, 33, 35, 36 Pinegrove Heights P. 0., W-$Zp :8tu41pa, ii
3ocond Addition to the Town of Hudson.
Tax Parcel No. •
~ F
s ho
K s~;
This ..Aj1..Wt.............. homestc..d proPesty
(64 (is not)
*a paseltsee the property and to pay to Vendor
i, aguest to
.Q~.» . in the follow manned (a?_ 7 -~-*-+"'7•
an e[ 12A;00
empodko ofthin Contract; and (b) the balance of i.1 a
at the 13
e _ bkW aw the balance outstanding from time to time at the rate o1 i"
_ eatifr paii,ia-:114 on,fOllowa: 1 peyeant of $18,000.00.befaee Dsoesbfl=r • ;
t3 payments of $18,000.00 each during 1991, .
bet
2 Payments of $18,000.00 esch during 1992; all of esfi j to
alrpi ,pa°p ipal, 1 payment of $100.00 dnriag 1992..
Asd~srr till oresD err
Mu" to the foc+ego3sl~~ pgents on Principal ft
3µ
on mpaidd be3asoes at 102 pee mum Us First payment to be make as f9»',1~t drys: o[ 0t~obst,
be in die aotet.,of ~ A .013tVA X 108't ,12). 9uIbsequ ut intevest.Psy~:absl~ ~b caSa~1 ~ a
q ~R,pi p tpa3 oaf foc me pc'e°eding month, incbuding adjuabli t foc pepls we3~ll
how~, the attire Outstanding balance shall be Paid in full on or befors:tbe.•• SAC z s o!&
( the maturity date). z
~gPiollpwies any default in payment, interest shall accrue at the rate of % per annular an 00
111 rot
I t kiwbidt abdi include, without limitation, delinquent interest end, upon acceleration os~.matatritoq
roes Laser, snares excused by Vendor. agrees to per monthly to Vendor amounts sufficient to Pei etasosabl~`aedc~ .
• pared that 1 ta>w, speeW asseseuento, fire and required ins urance Premiums when due. To the extent received bir.V~rtd4r•
Vawda 14'issa de">tp* payments to thong obligations when due. SucW amounts received by the Vendor for paya/not„gt
gear,. awprMats and`insursace will be deposited into an escrow fund or trustee account, but shall not beer lnL r . r
union ed mewiae required by law.
.Any
OPP"
apptagt.>♦lyp ye powd without premium or fee upon principal at any time •w•••••,
~Y
.L~"i MesOefalyr prepsymMt..tbb aaAtrad shall not be treated all in default with respect to Payment so long L.
>ri ¢e espaid babrna oipeineiDel and interest (and in such ease accruing intercit from month to month shall be treated s,~
as-unp" p ladpnl) is lea than the amount that said indebtedness would have been had the monthly payments been
.r, Mob.a• bet >~AW above; provided that monthly Payments shall be continued in the event of credit of any Proeesde :
a~ eaaR ear# _Condemnation. the coademaed promises being thereafter excluded herefrom. t.
-Pglsvl ie atateethat Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
none , ~ - r:.
esaatbsstles is ooaeideratiat of file down payment specified above, one of the above Lots
~d They further agree that I
' ' . xLll b to the is part performeoce of this fbntsaca.
on Ui-vill be,=]SOW epos receipt of each of the $18,000.00 Payment on principal specified above
and 1 Ills. last Lot will be oarveyed on reosipt as the final payment of -the $5,124-00.
Perdmar agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained b)r Vendor, until the full purchase price 4 paid.
the date hereof
Pa+~er 9W be entitled to take possession of the Property on 11.........
•Ow.• ~ ~ 11
e ~A
K ~;J
j bAln~ ! eats sTATe SAN o/ WISCONSIN iVf.eo~f ,I W w l Blank Cq Lt. t , , ;
SYN. vo. V
-yY
1
j'
orupon VeailOdM►
tar t sad' assessments levied oa tM Property
py' isbea des all tasel
Pnsebsasr
in it FViidoe,411 dlws - receipts abowins sash psyassnt. ;
10
• so to w T ti !s~.e~
116
r
PYrehassr covenants not to Commit waste nor allow waste to f becommitted
1ienittesdupeiioieto theelisn~ ofthisCon `o"
to keeP the Property
to imply w%b in laws, Wdinstslees and regulations affecting the Property.
Vendor agrees that in case the purchase price with laterest and other moneys shall be SoU , paid and all e°aditioas execute
and sbail be tally patormed at the times and in the manner above specif i gad cloy wili all ddeman encumbrances. eaapt ;
the ParsYriser. s Warranty Dead, in too simple, of the PropartY, free ,
Ulna or ~brauces created by the act or dafpult of P rc)taser, and except:
Vans, easements. for public util~ties
rr
.
F
""pp sErw that time is of the essence and (a) is the event of a default in the payment of any Principal or
Interest wbkb continues for a period of ..90..• days following the specified due date or (b) in the event of a default In
performance of anT+ other obligation of Purchaser which continues for a period of -.9Q---• days following written notice
tltaeof by Vgtdor idelivered personally or mailed by certified mail), then the entire outstanding balance under this contract notic
ser waives), become immediately des and the full, at s doremedies (subj ct htouany limitat nshprov dedaby lads
sad Vendor shill also have
addition on ~ to these provided by law or in equity: (i) Vendor may, at his option, terminatt this Contract and Purchaser's
r[ghts, title and interest in the Property and recover the Property back through strict foreclosure with any equity of
redemption to be conditioned u n Purchaser's full payment of the entire outstanding balance, with interestthereonfrom
the data of default at the rate in effect on such dateandotheramountsduehereunder (in which event all amounts previously
void by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the
the rate in effect Contract to
the dottePof
Property it purchaser fails to the en . ouyid ng bale may sue wihf interest f thereon perform~jice
Immediate and lull mpayment ounts ~y
default and other amounts due hereunder, is which event the Property shall be suctioned 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 (h) 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 apppointed to collect any rents, issues or profits during the pendency of any action
under (1), (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 biding upon Vendor if and when pursued in litigation and all costs and expenses bated or including reasonable attorneys fees of Vendor ititle
evidence shall be added hereunder
pal(andtpaidaby Purchaser, as then-
extent not prohibited by law and expenses '
currd, said shall m Included is any lodgment of any action of foreclosure of this Contract, Purchaser consaft
Upon the comnseacement or daring the pendency hom
the Property estead interest, to collect the rents, issues, and P~seeWats
to the cep dusIni of s r .nam of the Property. In ndina
during the y of snob action, and such rents, issues, and profits when so collected shall be end _ ,
applied as the coast shall direct.
itable interest in the Property (by assignment of any
, Poseb"W shall not transfer, sell or convey any legsl or w
of Purchaser's ri'hte 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 rst paid in full or the Interest
conveyed is a pledge or assignment of Purchaser's interest under this Contract solely security for an indebtedness at
Purehassr. In the event of any such transfer, sale or conveyance without Vendor's w, ' ^n consent, the entire oust-
-A&--balance shall become immediately due and payable in full, Vendor's option without notice.
Vendor shall make all payments wbeti 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 a
makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to
the Mortgages If Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Conrnsf'
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
of this Contract shall be binding upon and, Inure to the benefits of the heirs, legal representatives,
AU terms
succwor$ t nil assigns of Vendor and Purchaser. (If sat-an owner of the Propea gthees Louse in Vethe ndor lu the join dood to be consideration ade in fulfillment Mreof.l
b in
f QQ
D~.,.....
Dated this ~ day of . . .
d H. toe by
P A
0,. ( iihratt..... i
~ :...C ..............(SEAL) .0• (SEAL)
+
(SEAL)...... (SEAL)
.Janet P. .Stout • ..-SAM. E...-Mil.let.
AUTRZNTICATION ACHNOW LBDGMBNT
c
Signature (s) STATE OF WISCONSIN
1~ ....Q71 . . County. ss. 1~1~ tM
3 t.
z
authenticated this (lay of 19..-... Personal came before me this .......day of
. . 18....... the above n end
.......t._
TITLE: MEMBER STATE BAR OF WISCONSIN -
If not,
authorized by 4 706.0A, Wis. F+nts.) to me known to be the person...._ who executed the
f dial; lust nt and acl~n wledge the same.
THIS INSTRUMENT WAS DRAFTED BY _
?yyigQS)•.CB;i,..B'!.D.•Eieywod............. 711\
P..O...~Sis4. ~ 16..-. Notary Public . County, W„iNor.
(Signatures may be uutheuticuted or acknowledged. Both My Commission is permanent. (If not, state exp ra
are not necessary.) date: , 19.........)x i
T .Names of Verwns sirninr n, any capacity should be typed or printed b-lcw their ,.:&rtw :res. ,i
t t%n rnvTRACT- 11n41•141asi and t'srpWab-State ass of wlarsala. rerw No. 11 - 1962
K~l
b
SEPTIC TANK MAINTENANCE AGREEMENT w
St. Croix County
m
n
OWNER/BUYER.- o
• ~
ROUTE/BOX NUMBER * fn: Z e 7 Fire dumber
m
CITY/STATES wZ ZIP~syO/(v _
PROPERTY LOCATION: ' Section , - T~N, RJJJ JW
Town of /~c~diso-• St. Croix County,
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Subdivision?-,,., 6iou~~ s~ Lot number
Improper use and maintenance of your epticosystem could r esult in
its premature failure to handle wastes.-
of pumping out the septic tank every three years or sooner,
if needed, by a licens'ed' 's'ept'ic tank pumper. What you put into
the system can a ect the function o= the-septic tank as a treat-
ment-stage in the waste disposal system.
St. Croix Count residents•MEy be eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
whi.c 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 'sys't'ems agree to keep their system properly
maintained.
The property owner agrees to. submit to St. Croix County Zoning a
certification form, signed by the owner and by a mater 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), less than 1/3
Certification
three year expiration. y
o
I/WE, the undersigned have read the above requirements and agree 0
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as.set by the Wisconsin Depart-
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. r
SIGNED c
DATE - `7 - `T l
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016.
386-4680
Sign, date and return to the above address.
.DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
-INDUSTRY, DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISON WI 3707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SE TION: TOWNSHIP/ LOTNO.:BLK.NO.:SDIVISIONNAME-
SE_1/ N LC~/ 7-8 /Tz9 NAM E (or) W Nj sori 9S 1-rN G I~GTs
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
SP Cho 1, SAM MtL
USE DATES OBSERVATIONS MADE
NO. BE RMS.: COMMERCIAL DESCRIPTION: IPRQ ~FIL D IP pNS: 1 TESTS:
Residence UIV K New ❑Replace rl b N s 7) M / _/Ake-M 9/
Soacs Se Says " /A° Ptor
~►cdl~ttbT
RATING: S- Site suitable for system U= Site unsuitable for system R ^ O STOUND: ou IN-GR___11S PElu RE: SI~I J -IN~-FILLH~ SG : RECOMONvAENT ON AL tion~~
IGNRATE:
If Percolation Tests are NOT required DESC/_~ If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: 1415 Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- I4oNE
> 6,17 kd&L S 21'&,"L 748 NFS 4 a$ay Asi( 4P
q 8.
35 > 7S "&-crs 7C8e, r4S 3"BQN a N A614Q
B_ Z
> ''BLL.TS A"goui to "$e„ FS 7 " ASi `P_
B- .Q .C>
N o N~
9,0S /A
B- , -6 91.7% NawjE > l~.SV LS &'e8 4,4AiS _ 16 B- AZ 96, I / NoN~ > 9.4 Z z " Lss 3 " Is~401sAA 919#a P;
B- qi^,erv ~c PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAT ES
PER INCH
NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1PERIOD P
P.' I S,00 4014> Z. > Z 1
P_ i 3.46 96.70 > > a > Z
P_ p 7.70 3 > 'L > 2 >
P_
P_ L I oN
P- _
PLOT PLAN: Show Mc t ons o percolatio~ tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. ascribe what are the hori-
zontal and verticgVelevation~s points Ad show their location on the plot plan. Show the surface elevation at all borings an the direction and percent
of land slo e{ } \ Q 4
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print : TESTS WERE COMPLETED ON:
EY JoNNSaN ~aN>usaN ING ~rvC M/a11~N 6 /99/
aa-V
oonal):
ADDRESS: C~ ~ CERTI VI'TIONUMBER: IPHONENUYBER(opti
CST SI ATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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