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FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER~~ t~ P 1 P_~ o,?O Ln G.tJ TOWNSHIP _WoL
ads
SECTION? O T ,2 N-R I W
ADDRESS &&_,d.e,-dN &I ST. CROIX COUNTY, WISCONSIN
SUBDIVISION I'll o.~ ~.'d~ e _tZ'_ LOT l ZLLOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
. 1k
~o `~',L ha
p
r
• ~ es°. a
• , 1~ X 5 2
INDICATE NORTH ARR W
BENCHMARK: Elevation and description: c~ hie er 45,
Alternate benchmark
SEPTIC TANK: Manufacturer:, Liquid cap. Ze-&4
Rings used:2, Manhole cover elev:_Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front~, side-,, Rear Ft.Z&,~d-'
From nearest prop. line:Front , Side
Rear Ft. Z;6_
No. of feet from: Weller ~ D , Building /6 `
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
• i
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.:
-Pump Size ~
Elevation of inlet: Bottom of tank elevation
Pum
on _
P elev..
Pum off elev.: Gallons /cycle:
Alarm: Man.: m. M
an
Switch Type: _Location
Distance from nearest prop. line: Front `
Side-, Rear Ft.
Distance from: Well
Buildin
g
SOIL ABSORPTION SYSTEM
Bed: Trenchs Seepage Pit:
Width: _4~2__Length 2 Number of Lines:
_Z,.._Area Built
Exist. Grade Elev. -proposed Final Grade Elev.
Fill depth to top of pipe: 171~
No. feet from nearest
prop. line:Front_, Side
No. feet from well: a Rear,_Ft._
feet from building- l'~
HOLDING TANK
Manufacturer:
Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest
drop, line:Front Side
No. feet from: Well Rear
building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE : l f~-
PLUMBER ON JOB:
LICENSE NUMBER:_
6/90:0
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HOMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707 State Plan I.D. Number:
NW 4 , NE%, Se c . 2 0 , T 2 9 - R19 El CONVENTIONAL El ALTERATIVE (If assigned)
Town of Hudson, Lo~1118 ❑ Mound - ~6
Holding Tank ❑ In-Ground Pressure
_Q A- NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D TE
halson St. N, T
BEN H MARK (Permanen reference point) DESCRIBE IF D FFEREN I FROM PLAN: Hudson, W 1 REF. PT. ELEV.: ST REF. PT. ELEV.:
jo,
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Wm. S h r 382 S Croix 149021
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ;ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVI PROVIDED~~,~
, 7q si YES ❑ NO ❑ YES LJ NU
BEDING: VENT A.: VENT MATL.: HIGH WATER NUMBER OF ROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑ YES JCJ NO YES ❑ NO NEAREST 6 ~~S U ~O a
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARM G LABEL L CKING OVER
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: B ILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) I ❑ YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
BED/TRENCH TRENCHES: MAT RIAL: PIT DEPTH:
DIMENSIONS `57°Z- / C
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DI TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET:
7~ 3 yN 013,d y c NEAREST 5 O C(3 MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM slope and furrows thrown unslope
: mound systems to make certain that it ON REVER❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONSOIL 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: TNO.OF RENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
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
n
/ i
r '0 (~.r
Retain in county file for audit.
Sketch System on
Reverse Side. SIGNATURE: TITLE:
SBD-6710 (R. 06/88) Jbvsco
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COON
STATE SANITARY PERMI #
-Attach complete plans (to the county copy only) for the system, on paper not less than El / 8% x 11 inches in size. 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
t d e e,,eeA1,ed1 7- AP 1/4,4/ 1/4, S r?d T , N, R l E (o W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
:`JAB - ` l Gt/ r`aC ~.K,sT
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) ❑ State Owned O VILLAGE 4' 5 aw G®
❑ Public 41 or 2 Fam. Dwelling-#of bedrooms 3 AR TAx N MB ( )
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 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. R New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSO, AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
9.o Feet der~ Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION ew istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
[Tianks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber El- n F] F] F] E1
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:
e~l:Q ry+ $'C`iGc1f~GE/~C1i' G /2 Q
Plumber's Address (Street, City, State, Zip Code):
O r
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (I8urcha yerFeej Water [Date Issued I i ature (No S mps
Approved Owner Given Initial` Adverse Determination
ll,11/ 1~_77
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
APPLICATION FOR 8ARITARY PERMIT
• 9TC-100
This application form Is to be conplotad In full and signed by the ovnerls) of
the property being developed. Any Inadequacies will only result In delays of
the pztmlt Issuanco. -Should this development be Intended for resale by
ovner/contcactot$(spec house)c thon a second form should be tataln•d and
completed vhen the property Is sold and submitted to this offlee vlth the
approprlate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ovntr •ot property Ag~~Zeo' ;&ey-CA,aiire
Location of propetty X114 4f 1/4e 8sctlon vz0 . Tex-It
T o vn s h l p_
Ka c l i n g a d d r e s s /P,r.-A,*S
Address of site _ aO c&
8ubdivlslon nas►e_f✓~`ll~4i s° QsT
Lot number
Previous ovner of Property C
Total sire of parcel /As C~c ;s
Data parcel was created _ 7i-k j
All all cornets and lot lines ldentlflableT P(f~Yes xo
Is this propetty being developed lot resale (spec house)Tas xo
VDIUN• / nd Page Number as recorded with the Pollster of Deeds.
w-------------------------------
INCLUDE WITH THIS APPLICATIOH THIC FOLLOVINCt
A VAAR"TY D¢ID which Includes a DOCUNRNT HUN88Rc VOLUHQ A)tD PAOR xU?IarR, and
the 0KkL Or Tilt RBOISTXR 0► DRKDS. In addition, a cettIIIad survey, 11
available, would be helpful so as to avoid delays of the reviewing process. It
the deed deacclptlon tolerances to a Ceitlfled 8utv8y Hap, the Certified Survey
lisp shall also be requited.
PROPERTY OWNER CERTIFICATION
I(ve) certify that all statements on this form are true to the best of my (our)
Rnovledgel that I (we) am (ate) the owner(s) of the property descclbcd In
this in[ncmatlon form, by virtu- of a warrant dead recorded In the o(t c
the I • of
County Reglatet of Deeds as Document No. ,~,~8~d . A and that I (ve)
pceaentIY ovn the proposed site
for the sewage disposal ayaten (at I (ve) have
obtained an easement, to tun with the above described property, for the
conattuctlon of sold system, and the same has been duly recorded In the olllce
of
a Covnty Register or sods, as Document No, /
z 141
signatuco of0 t
ellnatuta of Co-Owner (11 Applicable)
oat of signet • Date of Signature
CROIX Co., W4
tl►~E Ree4 for Recexd lhls 23rd
&Y of
vfl
_A.DX I I?
eo r '
: LAND CCBiTM CT
di~
Contract, by and between Arnold Y. Bertelsen a/k/a A. R. rtelaeaand--~ r
< Y % ' Virginia A. Bertelsen, husband sad rife", Vendor, and 3. i H. velopment, Inc.,
a Wisconsin corporation, '•'ir~`
Purchaser,, Vendor sells and agrees to conwy.to Purchaser, upon the pr-Wt and full .
r" performance of this Contract by Purchaser, the following property, together with
the rents, profits and ppurtanaat other a
interest (all called the "Property"),
in St. Croix County, State of Wiscooain:
South 53 1/3 rods of South Half_ot Southwest Quarter (SOS'd})
and South 53 1/3 rods of Southeapt Quarter of Southeast
Quarter (SWkSE}) of Section 17, T2911, R19W.
That part of Northwest Quarter of Northeast Quarter (NWT
NEB) and of Northeast Quarter of Northwest Quarter GlEk
NWT) of Section 20, T2911, R19W, lying Northerly of the
centerline of St. Croix County Trunk Highway "A" (formerly
kncwa as Hudson-New Richmond Highway),
EXCEPT the following parts of the above described tracts: e O
All land included witLin the Plat of Willow Ridge Second Addition to the Town of Hudson as described in Vol. 4 of FLT
Plats, p4,ge 25;
Parcel deeded to Marlin 0. Amdahl and Ruth L. Amdahl as
. described in Vol. 517, page 26, Document No. 324368;
Parcel deeded to Roger Hetchler as described in Vol. 51•/,
page 114, Document. Number 324430.
TOGETHER with an easement for street purposes over the Easterly
33 feet of said parcel deeded to Roger E. Hetchler as described
in Vol. 517, Page 114, Document Number 324430.
SUBJECT TO the right-of-way of said St. Croix County Trunk Highway
' "A" and to telephone easement adjacent to said highway as recorded
in the office of said Register of Deeds.
Purchaser agrees to purchase the Property and to pay to Vendor at:. St. Croix
Heights, Hudson, Wisconsin, the Base Purchase Price of $100,000.00, together with
additional payments per lot, as follows:
1. Base Purchase Price. The base purchase pr'ce of $100,000.00
shall be paid in the following manner: $15,000.00 at the
execution of this Contract, and the balance of $85,000.00
together with interest on such portions thereof as shall
remain from time to time unpaid, at the rate of 10% per
annum, until paid in full, as follows:
(a) For each individual lot developed and sold by the Purchaser,
Purchaser sha:l pay to Vendor a $2,000.00 principal payment, to
be applied to the $85,000.00 base contract balance outstanding.
(b) A minimum annual payment of $15,000.00 principal shall be
paid each year, excluding the year of sale. Each ver lot
principal payment required above, shall be credited toward
this $15,000.00 annual payment.
(c) On December 1, 1985, and on December 1st of each year
thereafter, Purchaser shall pay to Vendor the difFerential
between the requiced minimum principal payment of $15,000.00
and the total $2,000.00 per lot payments made during the
preceding twelve (12) months, until the Base Purchase Price bas
been paid in lull.
(d) Interest on the ;principal balance of $85,000.00 shall accrue
from the date of closing, with annual payments of interest due on
the lot day of December, each year, commencing December 1, 1984.
wo.j.agp„Wo 2. Additional Per Lot Payments. In addition to the foregoing Base Purchase
'TTV.s'" "w Price payments, Purchaser shall pay to Vendor additional per lot payments
totaling not less than $;30,000.00, as follows:
Tugren Souse
502 secom S1 (a) No interest shall accrue on the principal sums paid to Vendor
Hoeta+ wts under the terms of this Paragraph.
54016
7153868234
VOL
y:
(b) Purchaser shall
pay to Vendor the sum of $3,000.00 per
lot on all residential lots developed and sold by Purchaser,
subject to the condition that the minimum amount of payments
to be made to Bertelsen under this Paragraph shall total
at least $150,000.00.
(c) During each year of this Contract that there is an
outstanding contract balance of the Base Purchase Price
(Paragraph 1(a)) there shall be no minimum annual principal
payments under this paragraph. Commencing with the year
following completion of payment of the Base Purchase Price,
Purchaser shall pay to Vendor a minimum annual sum of
$15,000.00 per year.
(d) On the let day of December of each year, Purchaser
shall pay to Vendor the differential between the minimum
annual payment of $15,000.00 as provided in this Paragraph,
and the total $3,000.00 per lot payments made during the
preceding twelve months, until the entire $150,000.00
minimua sum has been paid. Thereafter, if Purchaser sells
any lots in excess of 50 lots, Purchaser shall pay to Vendor
the am of $3,000.00 for any such additional lot sold, up to a
total of 53 lots. ($159,000.00 total hereunder)
Purchaser shall not be required to pay monthly payments to Vendor sufficient
to pay reasonably anticipated annual taxes and special assessments.
Any amount may bq prepaid without premium or fee upon principal at any time.
In the event of any prepayment, this Contract shall not be treated as in
default with respect to payment so long as the entire balance of principal, and
interest where required, is less than the amount that said indebtedness would have
been had the monthly payments been made as set forth above.
Purchaser states that Purchaser is satisfied with the title as shown by the
Abstract of Title submitted to Purchaser for examination, except:
i
Real estate mortgage to Sam E. Miller, dated February 1,
1980, recorded in Volume "608", Page 152, Document Number
362685. This mortgage shall remain the obligation of
Vendor, who shall keep said mortgage current and in good
standing. In the event Vendor fails to pay any required
mortgage payment, Purchaser shall have the right to make
such payment, and to deduct any payment so made from the
sums due under the terms of this Contract.
Purchaser agrees to pay the cost of future title evidence.
Purchaser shall be entitled to take possession of the property on Closing.
Purchaser promises to pay when due all taxes and assessments levied on the
Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts
showing such payment.
Purchaser covenants not to commit waste nor allow waste to be committed on
the Property, to keep the Property in good tenantable condition and repair, to
keep the Property froe from liens superior to the lien of this Contract, and to
comply with all laws, ordinances a,:d regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys
shall be fully paid and all conditons shall be full performed at the times and in
the manner above specified, Vendor will on demand, execute and deliver to the
Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all
liens and encumbrances, except any liens or encumbrances created by the act or
default of Purchaser, and except, subject to utility easements and covenants and
restrictions of record.
Bertelsen shall leave the right to purchase one ( 1 ) lot from B S 11 for
the sum of 15,000.00. Bertelsen may select his lot after B b 11 picks its first
five lots.
-2-
vo. na .48
Vendor shall consent to the platting of the premises into residential
subdivisions by Purchaser and Vendor shall be under an obligation to approve
and execute subdivision plats prepared and submitted by Purchaser.
In addition to the Warranty.Deed which Vendor shall deliver at time of ultimate
closing, Vendor shall execute and deliver to Purchaser, individual
Warranty Deeds covering the separate residential lots which Purchaser may sell,
upon payment of the per lot payments set forth above. All costs of platting and
costs incurred in preparation of individual deeds shall be Purchaser's expense.
y
Purchases ae-ees 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 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 period of 60 days following
written notice thereof by Vendor (delivered personally or sailed 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 thoi6e provided by law or in
equity; (i) Vendor may, at his option, terminate this Contract and rurchaser'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 iffec: on such date and other amounts due hereunder
(in which event all amounts prev:onsly paid by Purchaser shall be forefeited 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
peformsnce of this Contract to compel immediate and full payment of the entire
outstanding balance, with interest thereon at the rate in effect on the date of
default and other amounts due hereunder, in which event the Property shall be
auctioned at judicial sale and Purchaser shall be liable for any deficiency; or j
(iii) Vendor may sue at law for the entire unpaid purchase price or any portion j
thereof; or (iv) Vendor may declare this Contract at an end and remove this i
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 pobsession
of the Property and have a receiver appointed to collect any rents, issues or profits
during the pendency of any action under (i), ED 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 attorneys 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 incurred, 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 unde:• 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 may waive any default without waiving any other subsequen~ or prior
default of Purchaser.
-3-
i
Pxx 49
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
,loins 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 29th day of May, 1984.
VENDOR: PURCHASER:
B.5 H4EVELOPt1EENNT, INC.
~i
BY:
Arnold R. Bertelsen a/k/a A.R. Bertelsen Donald E. Bjornst , President
ATTEST:
Virg a A. Bertelaen
William C. Harwell, Secretary
A_.,
Authentication:
Signature(s) of Arnold R. Bertelsen, a
Virginia A_ B rt lw n- hia wife, and S.Q w SL
1
DenAld F_ Sjo ■rad and William C.
Harwell. President and Secretary
respectively of B b H Development Inc.,
authentic day of May, 19
William J. Radosevich
Member State Bar of Wisconsin.
This instrument drafted b,:
William J. Radosevich
Attorney at Law
Hudson, Wisconsin 54016.
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/ BUYER Ae , e- A,&,-,
ROUTE/BOX NUMBER Co 7_4- /X% FIRE NO.
CITY/STATE 4L4 ~G e~,rro l✓ ZIP
PROPERTY LOCATION: Z11V 1/4 x/4, Section ® T A 9 N, R_,/ I? W,
Town of Y'Ae~9411_1 , St. Croix County,
Subdivision F~rg?,eCd ?'f.~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.
SIGNE . ~J
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
DEPARTMENT'OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
' LABOR AND P.O. BOX 7969
HUMAN RELATIONS PERCOLATION TESTS MADISON, WI 53707
(ILHR 83.09(1) & Chapter 145)
LOCATION: ' SECTION: TOWNSHI LOT NO.:BLK. NO.: SUBDIVISI NAME:
Nw /a air / 20 /Tr N/R/9R.r W S llt~ W~~caw t tr~b -T
? ~k +DDRESS: ' /
CO NTY WNER' Ir-v aioPM MAILING A
sak, <r /la2`TA 46 UASa>✓ W l
~`err M/cNgFL
USE DATES OBSERVATIONS MADE
T
NO.BEDRMS.: COMMERCIALDESCRIPTION: Foe REDE Rj~,~ NS: IPEPCOLATION
lArResidenci de'N ❑Replace 2~J/1~lJy') i"* 1z
l/r
'tea acs k G 5•~ So,L.s k $~k++K~ar
RATING: S= Site suitable for system U= Site unsuitable for system rCZ
CONVENTIO❑N~. M tQN S.G~U IN-GRO ND-P URE: SYSTEM-IN❑-FILLHO~LDINGTANK. 0 ECOMMEN optional
I ms DESI N RATE:
If Percolation Tests are NOT required I If any portion of the tested area is in the
under s. ILHR 83.09(5)-(b), indicate: 4,ASS ' Il Floodplain, indicate Floodplain elevation: NA
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTHS. ELEVATION OBSERVED EST- HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B .67 Q4 A0 > £3.6-7 76'9C.C.TS / "8eNS[ 40.8 1ASiO
B- z 7.6-7 94 NC > 7.67 /1 b-crz, "8e jSL 72"8 ihSfGr
B- 4Z q S.?Q Nm ? 4Z 711-L75 QuSc "IQd QN /h1tG+~ ~2 ~1S1fG
B4 1cm 9?.07 Note > 9-97 raLo5 -ree,451_ '2s 49,eHcsV'4Q
B- Sj1:j.Se_> 9CA2 NO N E /'S"&CIS 8"gkYSI~ -79"ISRN 'iU
B-
c PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IBS AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P RI D 3 PER INCH
P. 20 rlo4t PS .'70 3 >-Z
P_ So NoNE 7.00 2 <3
>Z > >Z <
P- 3.90 rloN Lr
P-
P_ EELEv AT dT refc_
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 surfac elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 4zR5b _
I $F~M MARK. - N E ae. ' -
4q , $4
L lea _Eav t6-j . .00
3 Z
P- sal,'
4s' 44'
'SCALE,
J
4<
1J
i
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 OMPLETED ON:
2v~ziy S~>ti 6Al >JSoN eV&y/t,4 ihfl, z3 /42/
AD ESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): I&n b
CST SIG TUBE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
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