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HomeMy WebLinkAbout038-1128-50-200 r FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT rAp TOWNSHIP ) OWNER SECTION__.~: 1_T_Z_L_N-R W ST. CROIX COUNTY, WISCONSIN ADDRESS LOT 3 LOT SIZE SUBDIVISION PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM wfl~ `st I 4 g' t ,A)/L INDICATE NORTH ARROW ~ ~ ~ `--~~~•6 BENCHMARK:Elevation and description: Alternate benchmark / . SE :Manufacturer: Liquid Cap PTIC TANK ~Final grade elev:_1~~ Rings used:`- Manhole cover elev: ~ ~ Tank inlet elev.: Tank outlet elev.: 1 r No . of feet from nearest road :Front Side 2r Rear Ft. Side., Rear _Ft ?ref; From nearest prop. l ine :Front , and Building: No. of feet from: Well (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE nal a 7/8: + Wis4ov(sin D,:4partment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT St. Croix ,Safety and Buildings Division (ATTACH TO PERMIT) Lot 3 Sanitary Permit No.: GENERAL INFORMATION SE'-~,NW',Sec. 31,T31-R18,Co.Rd. C 149203 Permit Holder's Name: ❑ City ❑ Village ❑;Town of: State Plan ID No.: Robert Thell Star Prairie CST BM Elev.: Insp. BM Elev.: Description: Parcel Tax No.: 6D /6Z,0 BM 7 't 038-1128-50-200 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI ELEV. Septic n Benchmark j4 3~~ < •°C L~ S k~C, A&d, z~ o ,9 ~z. o~ Do Aeration Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/ Fit Outlet 5,'7 Vent TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic NA Dt Bottom NA HeaderLUaa. p g 0 G 9 Aeration NA Dist. Pipe r Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Moln-u'facturer Demand ~./3 0116 Model Number GPM TDH Lift Friction S stem TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width , I Lengt i No. Of Trenches PIT o. f Pits Inside Dia. Liquid Depth S (P I ~~O DI N I N DIMENSION LEACHI Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM a Num er: INFORMATION Type O CHAMBER System: Gv1(r, to>/ >60/ OR UNIT . DISTRIBUTION SYSTEM Header A Ma-p field i< Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 1 Dia- 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 I COMMENTS: (Include code discrepancies, persons present, etc.) 7- CO 12 /x ~ f n revision requ ed. Ye Yes 0 o Use other side for additional information. SBD-6710(R 05/91) Date I ns pector's Signature Cert. No. o SANITARY PERMIT APPLICATION - j4qoodf ILHR In accord with ILHR 83.05, Wis. Adm. Code COUN -.,,,.v.....,..,, STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ Q~ 8% x 11 inches in size. c eck revis on to prewous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE W ER PROPERTY LOCATION ~c2 '/a, S / T,~ , N, R E (or)(0 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 3 CITY STATE ZIP CODE PHONE NUMBE SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST fiOAD ❑ State Owned VILLAGE j PW I= I . _V4 e Public PA EL A Nu R( ) ® 1 or 2 Fam. Dwelling-# of bedrooms ❑ III. BUILDING USE: (If building type is public, check all that apply) f/~8_~ds 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) 1.9New 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (s g. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ,1 s~' ss / V.( Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the un ersigned, assume responsibility for installation o e onsite sewage system shown on the attached plans. Plum er' Name (Print): ) Plumber's Si at :(N Stam~}s) MP/MPRSW No.: Business Phone Number: ~s2 ` 00- f~ P umber's Address (Street, City, State, Zip Cod : ~ J IX. CO TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing ent Signat (No Sta ps) Surcharge Fee) Approved ❑ Owner Given Initial q L~Q~ _ _ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: J-M8 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber f 1 t~tk~l 2q I r ~ r Dt ARTIVCENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (1-163.0911) & Chapter 145.045) LOCATION: O : k('41 TOWNSHIP Y: OT NO.: BLK. NO.: SUBDI VISION NAME: SE VW~/4 31 /T31 N/1118 Star Prarie 3 n/a n/a COUNTY: OWNE S M . St. Croix James F. Plourde ~8098 Ttaly Dr.. Takt-ville. Minn. 55044 USE DATES OBSERVATIONS MADE NO. : CO O ~I LE DESCRIPTIONS: PERCOLATION TESTS: F Residence 3 n/a ®New OReplace ( 8-28-87 n/a RATING: S= Site suitable for system Ua Site unsuitable for system ONVENT L: MOUND: IN-GROUND : S Y,ST EM-1 -FILL OLD ING TANK: RECOMMENDED SYSTEM:loptional) ©S OU E]S OU ES OU S ElU ros ®U conventional If Percolation Tests are NOT required DESIGN RATE: if any portion of the tested area is in the under s.H63.09(5)(b), indicate: Class 1 Fioodplain, indicate Floodplain elevation: n/a t PROFILE DESCRIPTIONS BORING TOTA H T R UNDW TER-INCHES CHARACTER IT THICKNESS. OL R, XTUR , AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.Hl E TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B. 1 6.58 100.21 none 5.58 .75bl.s.1. 4.83bn.c.s.&gr. 1.00 bn.gy.mot.sil. B- 2 5.91 100.26 none 5.16 .58bl.1. 4.58bn.c.s.&gr. .75bn.gy.mot.sil. B- 3 6.09 100.13 none 5.09 .67bl.s.1. 4.42 bn.c.s.&gr. .75bn.gy.mot.sil. B- 4 6.08 99.97 none 4.83 .75bl.1. 4.08bn.c.s.&gr. 1.25bn.gy.mot.sil. B. 5 6.33 99.88 none 4.83 .58bl.1. 4.25bn.c.s.&gr. 1.50bn.gy.mot.sil. I B. i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER INCH P- P. P seee esign r8 e 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 98.04 ~ 1 v' l _ . ill', ~AKF lco' _ NTH SEA-` I # i I : I. I, the undersigned, hereby certify that the sod; 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: Ga ' L. Steel 8-28-87 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN NAII DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02182) - OVER - 4sU202 CERTIFIED SURVEY MAP t \ , MARY P. PICLAGEN, RITA M. PLOURDE AND JAMES F. PLOURDE NORTH 114 COR. SEC. ,3/, T31N,R/8W, (COUNTY SURVEYOR'S MON.) Part of the Southeast 1/4 of the Northwest 1/4 of Section 31, Township 31 North, Range 18 West, Town 0 Indicates 1/2" iron pipe of Star Prairie, St. Croix County, Wisconsin. a w found. ? OIndicates 1" x 24" iron o M pipe weighing 1.13 lbs./lin. \ ft. set. tUNPL A T TED LANDS ° '``,`,{~/{111111/yAN \1 S 86.33 ' 0611E ' 2 No \SG O NS 200,00 / ♦ / /77,99 ' O4 ~2.o y~ - - - - - - - - 1ARSH LINES M b a"W 47. OB' R N L 5') LAURE C t f 114 NW //4 b . M o ' Cb W M Y• S , w ry ER FALLS,..-' 11 LOT C~',, ' Q . W N I Q n 'SC ` ° Vj 1, I /9 ACRES r 0 48,726 so. Fr. LOT / C. S. M. VOL . 6, LAN NET =•-•1..000 CRES /1111{1x/, , 43, 367`S *D. PAGE 1535 Murphy ° - RegisteredeLand MSurveyo 3-0 N Surveyor's Note: w ri :`ORA/NF/ELO ml o Lot 3 of this certified survey Ma AREA h y map does not meet county or Dated: August 2, 1987 S Be• /s' /3 200.00' °I e township area requirements. Revised: Sept. 10, 198 /B' so' Acquisition,currently being • )7B2r sought for new R.O. W. for C.T.H. "C" has made it % (1) N I I_ impossible to meet these area 2 Q I ° requ3remerLts and create 3 lots . ,y R 4:_O T 2_ I A variance will be sought. ■ ■~a~D I m o0 1.093 ACRES W 7 h , J O O 47,690 SO. FT. `t 33 h vt O N NE T = 000 ACRES NI M I SEP 1 1981 al ~ 43,367 SO. FT. ~ N VAR JV!= a - v M W/OT I Cb I O q O O° h ~ q abb Qow% I~ I K ~ FUTURE NEW c R. 0. W. h t = W I S BB• /5'/3 "E 200.00 O ,I30' Q = h W O tu I h vl JI p a /83.24 ' 16.76' o b j} h Q 3 N `r1 N •I I. OWNERS ADDRESS : ° 0 7U \ e ° ~ ~ ° ~ 18088 Italy Ave. N° h y ° I ~I Q W 2 T3 'I Q Lakeville, MN LO l v ° 55044 y ` 1. 03/ ACRES I I ~I 44, 9/T S0. FT. , 3 - N NET 0.944 A N O ^ ~I Q M N 4/, /01 SO.FT, I ` I tv (i APPRON/M - m y J a o q , SCALE /00' I 20.0 0 50' /00' /50' 200' 250' 37 179. 9/' ~1 "'0, I N8810010W 200,00 UNPLA TTED LANDS ~UMP3cti cld5l~ti Pr.;:;<~ , .•i.iiN!1`f(i _ AND ZONING COMMITiEi 31/4 COR. SEC. 3/,T3/N,R/8 W, /COUNrY SURVEYOR'S MON.) CURVE DATA CURVE CHORD BEARING CHORD ARC CENTRAL ANGLE RADIUS /ST TAN. BEARING 2N0 rAH.BEAR/NG 1-2 N04.00'45.5"£ 109.33' /09.36' 04.3/'57 /382.39' N06.16'44E NO/•44'47"E 3-4 N0S-42'32"E 173.86' 174.08' 09.55'30" 1004.93' N0/144'47"E N40'17"£ Vol. 7 Page 1884 Certified Survey Maps St. Croix County, Wisconsin SHEET/ OF2 ' FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP 'ei SECTION T~N-RIF W ADDRESS ~ Cp VC4- (2-1 :SriWI ST . CROIX COUNTY, WISCONSIN SUBDIVISION(?Zd 1W Z 00. ST LOT 3 LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Writ Cs l r- sa ' INDICATE NORTH ARROW BENCHMARK:Elevation and description: Z/ =:i Alternate benchmark SEPTIC TANK:Manufacturer: lb 'G KS Liquid Cap. Rings used: - Manhole cover elev:"'Final grade elev: , Tank inlet elev.: Tank outlet elev.: 9/s No. of feet from nearest road:Front , Side Rear Ft. /7- / From nearest prop. line:Front , Side, Rear Ft. 7.~ No. of feet from: Well -S hg , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE s 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: Seepage Pit: Width: _Length ~ -Number of Lines:,,.2_Area Builts~ Exist. Grade Elev. Proposed Final Grade Elev. /PxJ 6 Fill depth to top-of pipe: QUO No. feet from nearest prop. line:Front , Side , Rear_L_Ft.4? No. feet from well:_g,-,:~_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: DATE: - = PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj 'Wiseonsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT St. Croix Safety and Buildings Division Lot 3 (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATIONSElk,NW,,Sec. 31,T31-R18,Co. Rd. C 149101 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: Bob The11 Star Prairie CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 45 W_ 038-1128-50-200 TANK INFORMATION ELEVATION DATA Yl--22/9/ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark y v / Do5in9-_„ / C-0 S SL OK Aeration Bldg. Sewer Holding - ` St/ I4t Inlet G L ' 9 ~S TANK SETBACK INFORMATION St/ Ist Outlet Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD 'O.-'PIet- Air Septic NA -DAEgattorn mg NA Header- Aeration NA Dist. Pipe c/0" Holding Bot. System iV 9,37/ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Mo Number GPM T H Lift Friction S em TDH Ft Loss Forcemain Length Dia. Dist.To SOIL ABSORPTION SYSTEM BED /TRENCH Width i I Length N. Of Tr nches PI No. f Pits Inside Dia. Liquid Depth DIMENSIONS ~ MEN 1 N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA NG Manufacturer: SETBACK CHAMB l Num er INFORMATION Type O r Mode System: ~__c-ntr , ~oJ5 1, OR UNIT DISTRIBUTION SYSTEM Header/Manifold v Distribution Pipe(s) „ x Hole Size x Hole Spacing Vent To Air Intake Length _ZC_L' Dia Length '!50 Dia. Spacing iP SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of T xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) ll Plan revision required? ❑ Yes No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 71 DILHR SANITARY PERMIT APPLICATION COU 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 /4 q1o of 8% x 11 inches in size. ❑ Check 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. PROP TY WNER PROPERTY LOCATION '/4 '/a,S T N,R E or 1 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CI TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY : NEAREST ROAD ❑ State Owned ❑ VILLAGE ❑ Public ~ 1 or 2 Fam. Dwelling- # of bedrooms -PARCEL T NU E ( ) III. BUILDING USE: (If building type is public, check all that apply) ~Rev, 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. 9 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 X] 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. ft.) (Gals/day/sq. ft.) (M' ./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete structed Con- Steel glass Plastic App Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installati of the onsite sewage system shown on the attached plans. Pl u mbe s Name (Print):, Plumber' si ature: No Stamp~►~ MP/MPRSW No.: Business Phone Number: yr 19-41 r.291 la yAddress; Street, City, State, Zip Code)- mIX. . COUNTY/DEPARTMENT USE ONLY ❑ Disapproved gbtary Permit Fee (Includes Groundwater 10 a e slue Issuing gent Sig Approved ❑ Owner Given Initial Surcharge Fee) -2lol:A Advers 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 APPLICATIO11 FOR GANITART i'CRKIT ETC-100 This application form is to bs conplnted In full and signed by the otrntt(s) of the property being developed,' luny Inadoquacies will only result In delays of Lite pit ralt Issuance, -Should thin development be lntended for resell by ovnet/contractoc,(spec house), thcn a second fore should be retained and campieted when Lite property Is sold and submitted to t h I a of lice with the apptopcl+te deed recording. law&Y.-.---------------------- Owner of property Location of property .114 Gt~ 1/1t gectlon T o vn s h l p_ Halling addttss Address of site subdlvislon nawq • Lot number pttrlous owner of propstty ' Total size of parcel r Date parcel war Created All ■ll cornets and lot lines Identlfisblst Yts }to Is this pro patty btln9 developed for rteala (spec houst)T-Lxo Yolnr+e and p491 (lumber _ _ as recorded with the 11e918tet of Deeds. - INCLUD9 WITH Tllld APPLICATION THE FOLLOVINCs A VkA;IKXTr D¢tD which Includes a DOCUHYHT NUNneR, VOLUX2 l.ND pAot NVKllj;t, and the 91KL or TIIL RBOI©TRR OF DERDn. In addition, a cettitled survey, it available, would be helpful so as to avold delays of the tavlewlnq ptoetsa, it the deed descrlptlon teterencas to a Cettifltd survey Map, the Csttllled survey Hap shall also be required, • - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r - - • - - - - - - - - - - - - - - . - - - - - - - PROPERTY o nril CEATIrICATION 1(v•) certlty that all statements on this form are trutr to the best of sty lour) knovltdgtj that I (we) am (ace) the owner(s) of the ptopetty described In this Intntmatlon form, by virtue of at warranty deed tecorded In the ottice of Lhe County Register of Deeds as Document No. PtesentIy own the proposed alto for rho newage disposal system (otdItIva)I haw, obtalntd an easement, to run with Lite above described property, I a r t.he' construction of Sold n gtem, and the same has been duly tacorded In the olllce of e ° R `y t soda, as Document No. e19nature at owner 8Lynatuce oL Co-Ovntr (lt Applicable) Date of e19natute Dats of 919natura naaniitun111lI r -M - 111M a ~AiAIICf~NOMOhIMNOIeOOMK ~ j „ OMCE gilt b.-._ A Y-1 ~w~w *1 r fl flll/'de VRWr VNrf♦ ~ Reed for 2800F efttfeetlre«t JUN 2 41991 t L. The11 find Sharon .1n Thal 1= - at JIM rat %i . whether one or moral. IJ . (yam vela Per- ' tt1>l stltni grow to convey to Punheser, upon 00 Prompt and full prx- contract by Purchaser, tN foNOWWQ Property. kg" with the of 0" and o1 Mr appurtenant interests (all called the "property"), a h+ 'tro ounty county, state of Wisconsin: e""n's 21 Somerset Box Somerset, WI 54025 Tax Parcel P& - { _ fY s Part of the Southeast Quarter of the Northwest Quarter (SE} of NW}) of Section Thirty-one (31), Township Thirty-one (31) North, of Range Eighteen (18) West, described as follows: Lots 1, 2 and 3 of Certified Survey Mop filed September 15, 1987 in Volume "7" of Certified Survey Maps, ; page 1884, as Document No. 430202. is not homestead property • ~ Ir nOq pun* ha~~a~~s hale the Property and to pay to Vendor at 18088 Italy Ave. , Lakeyi 11 e, MN 19 5UU.00 in the following manner: (a) $ 3 000.00 the sum of s 16 500.00 together with irhterem from dab g at the execution of this contract and (b) the balance d S en per cent par annum from time to time at the rate of hsreol on to balance outstanding uW paid in hint, as follows: There shall be monthly payments of principal and interest in the amount ^ of $100.00 per month, commencing on July 21, 1991. Balance to be paid in Ml by June 1, 1993 or paid in toll when a new home built on one of the 3 lots is sold. day of Provided, however, #0 erh4re offing balance shall be paid in full on or before the 1 '19 Q1 (the maturity dsta). 3une interest shall accrue at the rate of 1 % per annum on the er*o amount F any default in payment, in default (which hlCh shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire ` Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably onfici- Purchaser, unless excused by tad annual taxes special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor sprees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of testes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest WOM Otherwise required by low. Paynmm% shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any antotrd may be p►eP~ woW pr n or fee upon principal at any time after C I D s i n a 19 (OR) two may be no prepayment of principal without permission of Vendor.' to ` In the event of any prepayment, this contract shall not be treated as in default with respect to payment so ag 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 continue d 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 wArninadon except: tea ti agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall ai " r+rMldbl~`hnda+rnrlthehNl pcrchsse price is paid. June 21 t9 91 Putidyesr. III MtMtlep to take poasssaior► of the Property or . M WMI STATff t11W OF WdKXW BW WI9cONSN REAl1Gi~RA , ~ r f~Q1ttAMatt t f ~.".1 ..M1. owom r a0 wAft na a aNm a waste nor aNew woo d be aommNftd an so Proparq. fat. ~~~to~r►oowi~sj~ilbiilar~ii iMaal~r«om Nnr orpafa a M» Mn d . MIf1110f apaao 10 in aria ft purdMr pme wo IftlnMt and other nanaya shot be bhf Ned «f i _cost Vendor wN1 on Osnw~ « (Ao.a: , bas f~Illy #arfetnnad r hhnaa and in dla SNOW show ape PwdwAm it . a wain q Rood. in loo dmpor d 11a r+r, aw and doer d d IMno «d «i &V liens or Own, bravoes created dh►thha act d dobydld Ptrdhaasr, and enaspt i , w PudwW agnass so Pima is of the essence and (a) in he avert of a dal" in the payment d ftmd W*h continues for a period of 30 days laiowirhg Me specftd due daft or MI in the aemt dates' a d any oMiW ob~ps~on of Purchaser which continues for a e!r of 30 days tONOwing vlll l Vendor (dNiverod or mailed by cwliRed MON), then Mice entire aremixtbp balsrwe under unto @W become Mlnr~ payable in fut. at Vendor's option and without notice (which x waives), and Vendor also haw the nights and remedies (subject to any wMttions Orate p! 1 4 addition to vim provided by law or in eZt 1n1 Vendor may. at his option, ft►minate It" Mm- and rf(!lMa, We and interest in the P~ rroowr the Property back through strict foreclosure wO r ndararAion to be conditioned upon s kd payment of he entire ouMlsndin0 balance. w1w Ytlohot ltoNOn p fit did dd&A M the raft in coact on such dale and char amounts due hereunder (in which ewnt all amoulft t Purchaser ahaN be breleMad as d damages for fa*jm to UM Oft Contract and as eaalr r- b ~ Properly if purchaser fails to redeem : or (R) Vendor may sue for specft perbnnanae of Mnis Comm wdisls and full pi no d tit e aAelrhdMng belerdw wih ktsrest hereon at he raft in efbct on 10c~1e raohNlW =`a 4111111111110 and oMnr amounts dw hherehrhder, in which event ft Property shah be auctioned at Judicial sets ON any y del be table for any dslic*W. or (ik) Venndw may an d law for the enth unpaid purchase price or ( ttereok or (M Vendor may, ceders his Contract at an and and ronave This Contract as a aloud on Oft In a adon.M tin egllNble it Is I of Purchaser is lrhsignificarhk and (v) Vendor may haw PurcfwW ejacftd of # and have a reoeiwr appointed to collect Why rent, ieness or profs durino Mn panOMtay d allp fad. . K tNMtM h or (M above. any CAN a wrNftn staftmenft or actiae d Vendor. an elacron Ali d the remadias daft ony be binhdhrg upon Vendor H and when pursued in and ant ooeft andw attorneys lees of Vendor incurred to anforce any rennedv hereunder (wharar abaatd or 0 enaert as pdnibwd by law and of We evidence shelf to added principal and paid by Punahaaar, M A canna, and del be included in any Upon tin oonummeawnt or during the pendency, of any action of bre closure of ihle Contract, Ptsdow 40 } loft appoiwnart d a neosivera ris Pro ' homssftad inbrost to ooMsct tit rerMs, issues. «+d 1iM p~pp dueiw tlha pendency of such apertyction,, rents, issuss, and profit when so coNacled diet to VM ' r aR~Md ae in oohrT shah direct Pundnser shall not ImWm set or convey any kpel or *quit" interest in the =Irty Dy aesialleNit d Purdtaser's rights under this 6; race or by option, long-term leas. or in any other way) w 1♦nt. piton concern of Wrda unless ether he outstanding balerce payable under Oft Contract is first paid in tuft a tuts tam*W is a =event aasignnhenI of Phrd+rar's interest under this Contract solely as security for an Purchaser. In tin event of any such Vander, sale or conveyance without Vendor's "No Ooneer I ha erMMa hrtlarhoa payable under this Contract $W' eoomn inrmedialety due and payable in full, at vendor's option without rAgm Vendor shall make aN pernerht when due under any mortgage outstanding againe the PropgA► on i1M this Comm (except for any mortgage granted by Purchaser) or under any note secured spy, paideq; such payrasnts makes Wn* payinent of the arnounis then due under On Contract. Purchaser may make any lAorlpegaf if Vendor fats to do so and all payr ants so made by Purchaser shall be caneidered Payments . Vendor m" waive any defeat without waiving any other subsequent or prior default of Purchaser. AN ftroe of this Contract shall be binding upon and inure to the benefits of the heirs. legal successors and assigne of Vendor and Purchaser. (H not an owner of on Property the spouse of Venda a y consideration joins herein to release hornestead right in the subject Property and agrees to join m the eMecdlott:' deed to be made in k0knent hereof.) Dated tuft 21 day of , Ila -91 (SEAL) 1. r • Mar McLa a Robert L. T hell (SEAL) rim -Rjaa M. Plourde Sharon Jo Thell 2 (SEAL) u ACKNOWLEDGMENT ` re(s) STATE OF WISCONSIN St. Croix County. aut henticaled this day of i c Personally came before me this 1 dsyd 1 June 19-9 _1 the abom a of Mary P. McLagan. Rita M. Plourde. TITLE-. MEMBER STATE BAR OF WISCONSIN James F. P1 urde . Robert L. Thel l Nett . pf not. Sharon o e auMwrized by §706.06, Wis. Stats.) to me known to be the person who K. IS 1 S~MENT WAS DRAFTED BY foregoing instrument and acknowledge>he =ann.:.: GaryT . alllargeon Box 416. Somerset, WI 54025 (Signatures may be authenticated or acknowledged. Both Nobly are not necessary.) My Conurnh is permanent a11i „t dale; 9-t-94 +M.M.awNa..ivws~rw.av.riwe.~.ea.vr+~rw~ratr.ww.. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 2!?0.z / ADDRESS: Z9Z3 _ ea,_, ~,d,~_~,,,E FIRE NO: LOCATION: ~S~ _1/4, ~1/4, SEC. S~I TZ_I_N-R_,Z& W, TOWN OF: ST. CROIX COUNTY SUBDIVISION: LOT NO. 3 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. ell i SIGNE DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 DE AR'TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS PJ,DUSTAY," DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069 HUMAN RELATIONS (H63.0911) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP Y: OT NO.:BLK. NO.: SUBDIVISION NAME: SE 'CW~/4 31 /T31 N/1118 Eor) W Star Prarie 3 n/a n/a COUNTY: OWNER'S ME: MAILING ADDRESS: St. Croix James F. Plourde ~8088 Tfaly Dr., Takeville, Minn. 55044 USE DATES OBSERVATIONS MADE ERICOLATIONTES NO. BEDR CO T O IONS: T ~Residence ®New ❑Replace PROFILE DESCHIPI 3 n/a 8-28-87 n/a RATING: S- Site suitable for system U- Site unsuitable for system ONVENT O L: MOUND: IN-GROUND : S -FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) ©S ❑U EIS ❑U Es 11U ❑ S DU ❑ S ®U conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.1-163.0915)(b), indicate: class 1 Floodplain, indicate Floodplain elevation: n/a r PROFILE DESCRIPTIONS page 1 A0A r1pritruil BORING TOTA D P H TO GROUNOWATER•INCHES CHARACTER OF SOIL IT THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED ST. HIGH-EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 6.58 100.21 none 5.58 .75bl.s.1. 4.83bn.c.s.&gr. 1.00 bn.gy.mot.sil. B- 2 5.91 100.26 none 5.16 .58bl.1. 4.58bn.c.s.&gr. .75bn.gy.mot.sil. B- 3 6.09 100.13 none 5.09 .67bl.s.1. 4.42 bn.c.s.&gr. .75bn.gy.mot.sil. B- 4 6.08 99.97 none 4.83 .75b1.1. 4.08bn.c.s.&gr. 1.25bn.gy.mot.sil. g- 5 6.33 99.88 none 4.83 .58bl.1. 4.25bn.c.s.&gr. 1.50bn.gy.mot.sil. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. R O 1 P RI PER INCH P- P P- seee eslgn ra e 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 98.04 I ~ II 'fit .~~>4K~ i t IN i , 11, i\ I " ku~ 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: Gat* L. Steel 8-28-87 ADORE CERTIFICATION NUMBER: PHONE NUMBER (optional): 9819 N- Shorp Dr.. Way Rinhmand, Wj- 94017 ..-2298.-.-,/,, 15-244-62QQ CST SIGN { V-7,42Lk-z" DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - - f ~~Nsr'P r` •r a sa ' ,Lof.C.i~a t p \ _ PAGE OF og /G'.flPn~iftJ~ fresh All I111al6 And Obteivallon Plp• J TL ////,1 /I J Approvid Vaal Cop Ylnlarum 12*Above final Crad• 20. 42' Above Pip' 4' Coal Ilea To flaol Oro.a VaaJ Pipe rawM ►top Or Sa USA O01.1r10vllon Plp• Tao + ~BP•Ilorolo! Pips bolo, ~Coupllny Twariaoll ny Al sallom Of S1616m ~ fD P~rJ~o~eD 9r1% Vcj la< Ian SOIL FILL DISTRIBUT101.1 PIPE APPROVED S19PETIC COVCR ' "'~rtATI:R1At- OR 40 OF STRAW 2- OF AGGREGATE-~ oRMARSH HAy 0 Flt-212 AGGRCGATE ~p OIL,, ELEV. of EET .3r A L 015~"Rlp~rJTIU1J PIPE TO BE AT LEAST -,;20_ INCHES BELOW ORIGINAL GRADE AQU AT LCASTZ0 INCHES BUT 1.10 MOR.C THAN tit IUCHES BELOW FIMAL GRADE M&MMUM DEPTH OF EXCAVATIOP FXOM OK16V AL 69ADF- WILL BE _ INCHES rJK1MVM OEf rli of EACAVATION FOP CA~I6INgL GRADE WILL BE INCHES S1GNC0: LICEIJSC IJUMBEI1: DATE: / ~ ~ saw /83 - - _ . ~ 3a