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HomeMy WebLinkAbout008-1038-10-000 -0 0 Q o ° I 0 03 0 o C c O 0. 0 w ,°n o m U x 0 o c ~ c ~v ° w c o +J Q~LL O s ma>m LL C ~ a -60.2 CA (D C) o °v 0 °o. °64 N= N o-a m °1 0 O CL 2:L U C N 7 •p1 E :3 O C z y V O O LL C M N ~OJN-Y O O C U L d w E Q EwCLW m I M N E ° z O z E ° co a 0 w N O Z a a w ~ r m ~ in H ~~ww E ° `t • N O L_ ~ N Q ° z z O N I ~ I f0 E E > CL O 0 y m `m ~ 0 o a - m 3: 0) CO) U) E z m a • ~aaa 0 N ° 0 0 J U U rn rn } ti Mi:o a m p rn o O E Jo m m w c LL o cc 'o Q cn m S' y y 0 +r 3 O c c E V U n a c a°°° w M ° A? ~ In E E (D n n ° \ o o ° 06 U) r- l' MCI CO N 7 a0.+ C ~ ~ C,,. W m C-i m 42 CO O w LL O Z N 15i rL'. fn U ~ ~ y s I 3#6 EL as • a m .V 4) tw o ; R 0 t A vat 0 U) Gbh'-/03F- L- FORM - STC - 104 AS BUILT' SANITARY SYSTEM REPORT OWNER / TOWNSHIP Ca Ile SECTION__,Z.~.LT 0? N-R'1~ W ADDRESS fJt~K ST. CROIX COUNTY, WISCONSIN l U SUBDIVISION LOT -LOT SIZE al'' PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ v 0 w lao D Drive avo a fu#1 l) w Jo`~(So' Be~ 70INDICATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer: 4lue5terA lre(GTtLiquid Cap. Rings used:j_Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front>, Side, Rear~<-Ft.~~a0 From nearest prop. line:Front-A-1 Side, Rear__)( Ft. No. of feet from: Well/d0 , Building: J3 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE w~ PUMP CHAMBER Manufacturer: &'djJ(f5r r1'P&5 f Liquid capacity: 1'w Pump Model: D lZ Pump/Siphon Man fact.: o& Pump Size Elevation of inlet: ' Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: 1L°U 4k1 Switch Ty e: 0d'C1j Location Distance from nearest prop. line: Front , Side, Reark Ft.1~15-06 Distance from: Well B ilding r SOIL ABSORPTION SYSTEM Bed• Trench: Seepage Pit: Width: lL Length ~D Number of Lines: _2_Area Built s60 Exist. Grade Elev. Propose Final Grade Elev. Fill depth to top of pipe: (F No. feet from nearest prop. line:Fro tom, Side, Rear_j r , a~9 No. feet from well: ~O No. feet from building ~Q HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Fro t , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: /f DATE: PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj DEPARTMENT OF INDUSTRY, SAFETY & BUILDING LABOR & HUMAN RELATIONS INSPECTION REPORT FOR DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION 'Number: MADISON, WI 53707 e Plan SE 4 , NW 4 ,See .13 , T 2 8 -R16 (If assigned) Town of Eau Galle D CONVENTIONAL ❑ ALTERATIV E1 7 l Holding Tank El In-Ground Pressure Mound r.n O MIT LDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: NAME HO wT 54028 B H (ermanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. P LEV. r ' Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Thomas Wang 3231 St. Croix 128776 SEPTIC TANK/ / MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUT- 9TIEEEV.: WARNING LABEL LOCKING COVER P / PROVIDED, PROVIDED: ~i OEM- 20D 972,5-1 ES ❑ NO ❑ YES BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO F ESH ,4 ALARM: FEET FROM LINE: / AIR INL T: ❑ YES O - ❑ YES NEAREST---* DOSING CHAMBER:= =9_-),/* { b = r MANUFACTURER: BEDDING: LID CAPACITY: PUMP MODEL: PUMP/ MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ED YES O i~ LJC~J? L- C~d~ C ❑ NO LS E__1 NO GALLONS PER CYCLE: PUMP AND CONTROLS ,ERATIONAL: NUMBER OF PROPERTY WELL: BJJILDING: VENT TO FRESH (DIFFERENCE BETWEEN I! ti { S FEET FROM LINE: r ( i ~s~ / AIR INLET: PUMP ON AND OFF C~ - 0 3 0 ES ❑ NO NEAREST ~~(J d } 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 the soil is dry enough to continue.) MAIN 3 / CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DE DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DIS NUMBEEL-OF PROPERTY WELL VENT LE FRESH BELOW ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM AIR INLET: NEAREST OUND SYSTEM: fZ Z/ 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; (ID 6- ever 5 ( ES ED NO 0-YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVERT ENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: l CENTER: EDGES: it r r ,f- - E:1 YES LINO S ❑ NO ❑ NO 12 Ir 4P I PRESSU IZED DISTRIBUTION SYSTEM: , WIDTH: LENGTH: NO OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: ILL DEPTH ABOVE COVER: BED/TRENCH / TRENCHES: DIMENSIONS -0 1 MANIFOLD PUMP 011= r MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING: ELEVATION AND EL V.: ELEV.: DIA.: I! E E / Z PIPES DIA.: DISTRIBUTIONr '5 HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO I S,1 INFORMATION / APPROVED PLANS ✓ YET 2-YES ❑ NO 1(~ ❑ YES LINO PERMANENT MARK OBSERVATZES LS: NUMBER OF PROPERTY WELL: BUILDMG: COMMENTS: FEET FROM LINE: { ❑ NO ❑ NO NEAREST----* G~ 7 / c - -i . ~ c /rte f - ' / 9. z5 '0 ~U lJ ~ ~ , ~ ^J~~~,L..k.. { ~.I.,CX . / ~I /~.Q~~ ~.r Y i~ . ~ ✓4~--(~•-tp~/ _ ~/'~'ij~ Ct ''I U ! e in in county file for audit. i .41 S e yste on Reverse Side. SIGNAT E: TITLE: y,SBD1,-67100 (R. 06/88) ~F SANITARY PERMIT APPLICATION 10ILHR In accord with ILHR 83.05, Wis. Adm. Code couNT STATE SANITARY PERMIT # ~`7 -Attach complete plans (to the county copy only) for the system, on paper not less than L 8/s x 11 inches in size. E:] ~ f rbvn top revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUUMB R 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Y C' Id h- rCL L0 / t'0 k 7 F % a /4, S 1 T,-) , N, R E (or PROP TY OWNER'S MAILING ADDRESS LOT # BLOCK # , zjdb? A I CITY, STAT ' ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER El ITY II. TYPE OF BUILDING: (Check One) ❑ State Owned VILLAGE 1 NEAREST 0 El Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms j jQ4JN OF: APARCEL TAX NU R ) III. BUILDING USE: (If building type is public, check all that apply) ~Q~ 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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. VJ 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 El Holding Tank 12 Seepage Trench 2; ❑ 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.) (Min./inch) p9 ELEVATION o ~0(j 11 <Z6 9 J Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New F-xisting Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank S f Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name (Print): Plum is gnature: (No Stam MP Business sPPhonnejNumber: 1AA4 'S / ~),2 ~v I L11. Plumb r Add!ws (Street, city, State /Zip Code): ` IX. C TY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includesg round water J'ate Issued Issuing A nt Signature (No Stam Approved F1 Owner Given Initial _ Adverse Det rmin tion .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 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 administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f 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) 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 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. PROPE~TY OWNER PROPERTY LOCATION c~ p, ~ fr ell e C [Ltd f' + /'v Y. t~ Y., S T i 0, N, R E (o W PROPERTY OWNE 'S M ILIN ADDRESSS LOT # BLOCK=# CITY, TAT ZIP COD PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned E3 VILLAGE : f NEAR i A ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms I PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 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. ❑ New 2. [S Replacement 3. ❑ Replacement of 4.0 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 (sq. ft.) (Gals/da /sq. ft) (Min./inch) ELEVATION 6~9 v 6 " 7- Feet W, Feet VII. TANK CAPACITY Site INFORMATION in gallons Total of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 0 tun7 i7" Q S M _TT_ F1 1 11 F] 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 Name (Print): P MbeSignature: o mps) MP Business Phone Number: C d Plum r' dress (S eet, City, State, Zip Code 7 c-) t e IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Ag t Signatu Approved ❑ Owner Given Initial Surcharge Fee) T /(J Adverse Determination X. C DITIONS OF AP RQVAL/REASON R ISAP, "VAL: SW S rmprly P 7 R. 188) DIST '1 I in C On Cppy To: Sa ty & ui s Division,C 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 administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use.. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainslwater 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) -Violation Number Form - S T C - 101 PRE SANITARY PERMIT ISSUANCE PROCEDURE Location Section Township/Municipality Lot No. Blk. No. Subdivision p~ I 1 r I t~ti I l i IT ol~ N/ R 1 W I fro Q n~s~ y Procedure prior to sanitary permit issuance where a septic tank must be replaced during winter weather or other health emergency and soil evaluation or other sys- tem evaluation cannot be conducted. 1. Obtain assurance that the property owner is aware of further requirements for a system evaluation. 2. Obtain assurance that owner is aware that if system is found to be failing, it will be their responsibility to replace it with a code complying system. AFFIDAVIT TO BE SIGNED BY PERSON REQUESTING THE SANITARY TERMIT: I, the undersigned do hereby acknowledge that I am receiving a sanitary permit to SY4 m" n. 4S k nr% without a soil and system evaluation due to inclement weather or health emergency. Furthermore, I acknowledge that a soil and system evaluation will be conducted as weather permits and that if the system is then found to be failing as defined in Section I L H R 83.02 (18), Wisconsin Administrative Code, it will be replaced with one that complies with Chapter I L H R 83 of the Wisconsin Administrative Code. If temporary pumping is to be utilized for maintaining a newly installed septic tank, due to failure of the system, the tank shall be maintained by a licensed pumper in accordance with N R 113, Wisconsin Administrative Code. SIGNE DATE` A copy of an affidavit in lieu of EH 115 along with the PLB 67 must be submitted to the Plumbing Bureau for purposes of fee reimbursement. ffif!!F. t!5 Si nature of Applicant Date Subscribed and sworn to'before me STATE OF WISCONSIN This L~/ day of 19 . SS. COUNTY OF nau Nota y P blic, State of Wisconsin My Commission Expires:' 1~ 1J .r'. S~. YK Doi SAS CU I W& far Rowd day of _ °t 2400 7 e~ . In and Iii =04 mow til ltiteassa. a tha pe paM` ewe. titre Iiwi*Mapely. tegetisr Wilk the ale wlestmt l lewb Nr esYsd tie "Prapety1. Glumly. old* at Wimmummisc t Quarter (SW 1/4) of the aefue"rO tM l/+1) lying 1Msterly of the !hM Half (S 1/2) of the 1/4) iECIZPT Lot 1 of MV tiled August 11, 1982, in t, AL60 that part of the ,I,u, Of the Southwest Quarter (SW 1/4) Ne' ehL~ :qty Trunk "N" .except co m ncing at a point where the i ftmak *N' intercepts the East side of County Trunk '"sot s'+ t Thence East 19 rods; thence South to the north side l:aLong the North side to the Point of Beginning. 13 j "Temp Asip 2Af, Rice 161x. $WdKt A. agreed that if the Eross milk check recei••ed by the tjhWesW~.er, 1982 through March, 1103, is less than $3,000.00 ' "laount owing hereunder shall equal the gross receipt and 1111 be paid by the Purcha-er in equal installments in JUM, 1983, but in no e;cnt .hall the ieficiency exceed month, a Mb fife Alheperty. and to ply v odor at See Ex h i h i t A in the following maTmK: i Wong dk. baisaoa of i together with istarast tram date beentime to time uspsid. at the rata of per cent per asrmm. osll paid Bee Exhibit A d'i > ~sslwmssf'`lifAierrs/eeebPsressk+cMlso viniorpaynemle amdeilsrefhs P1W- equked, i~asiM'r% nder~esM'to aiue~8rcifaeewwes•rseeirrd•bq go Vemolem to eEMwsk MMHW whsll s ll A ly imtersst on the unpaid balance at the rate specified and then to principal. A" amkemimit mmmy ar tea upon principal at any time after d e c Exhibit A X ft der IIKX~Ot.• 4 ► tde eostrsct shall not be treated as in default with respect to payment so long as do us"" nd 11 a r" hmd in such case acwing interest from month to month shall be traatad as unpaid peigeipW is ut dimrtasid WWWadseee would have been had the monthly payments been made as first speeNbd abausc Aim to sW be continued in the avant of credit of any proceeds of insurance or condemnebw the elm- " beiss veetiafter amohWed busham. 41101064 Pochsaer is madefied with the title as shown by the title evidence submitted to Pkuehaeer for anamium- Umm, except there i.^ outstan6l rag a mertga4e in favor cf the State Bank, Wcodville, Wtscorcln, w__ich tie Vc-ldors agree to holdicg the Purchaser harmless- t.nerc,rcr:. HoV:ever, in the event of a dk ftul on the part c_" the Vendor, `h:, Purchacer -!,all have the right tt! nag said mortgage in accordance vt"-, +he terms t^erec. Any su-h q shall be credited as having "c -i paid pursuant to the terms of'this uhM% t *__1 M ► West at future tide evidence. If tide evidence is in the fam of an abefteL it aW be tatailei ilor d Yw tr Pile is l date of closing :+sfm*sUeptsseeeismetthaPrepertym i6 .3eptember:l, 198?. i'l'°BaUeadiaNw~onwrmerAetAamepetfes~► t _ wsN, na u - keg! + t r. r *~e to pay whM dM all trM ri aammaansata h>~Isd ett w ara~lllh T dltilrar•. Yattdor r ~w■i t"ealpis iowiKi wi pa0►tai1R, _ ~ ~ ~ , NpiMf~pwemandanwPronfyi rd=l== Q eld am# v nay ngrir, is*vftWJifallits~nra`fa value , bogv ed *A .caa~i"•r~ ` ani aar.this Omateaet. Purchaser mess pay w Neaaoo pe sahiaaes wlMa ie,. ii " la laws d w Wader's i~Mast asd. miw Vadsf awwisa Arta h~~eMM~„ Mr~~it ilt ~~i~r ahaf M rrRh VMder. Ptlrehassr shat peaatpl~ dr sdfeiti[Mirlsi~rro~eiN~~11 ~ ' am Vftdw apw is WM;L Nero psi i/ is Is ~wls*Ills ~e dans/~d. im, the Vendor dmmm. w:..taatia. w,. N «osi dN 11l& Anehusr amomm s we is eenaok wamte mer allow waft to be coat td an ft . M e~sY.itit eaditim and somir. to hump w flees Ar War wpsrisr 1rw Wa at t aR ~ ` b~ ahia~aear end raguiseiom ssiYietirtg . fkaas ' .3 Vander apses that fe ease w peetwse p~ TAO hutmnht and osier neamiraatiai N 4t4 paid ntlt )d pwftr.ad at w w and iw w enemas show apeddsd, Wtlsr wi all ds~ri~ wse■N /Mr ` j NEr Dosd. Is W dbpbr of dw Pt+spety. fkw and char d all Was and wsobness, rest~lira~ Mt e gby w apt or d*ok d Pwchae mW =espt: ■ n a Pumchaser apws that time is of the essence and in can of default in the payment of any principal or inter" whlnl^,4 ht y the of any of the conditions. covenants. or promises of Purchaser. and such default shall omuthns hr a 10 lama Vendor may. at Vendor's option, declare the contract at an end, all rights of the 9990,., aoset eanesilad, sad w amounts paid by Purchaser hereunder forfeited, the same to remain Venderpma obwo W as liquidated damages for the failure completely to fulfill this agn~ent: and Vendor nabs haw w right of r►sntry: or, at the option of Vendor and without notice to Purchaser. no' dw whole amount of mpaid principal shall be deemed to have.become due and payable: in p1 tiwd, w aapaid principal and interest together with all sums which may be or have been paid by Vendor ei awls . west bd~ an such dbbnrsements at the rate aforesaid shall be collectable in a suit at law, or by foreckwoss of this aaollrlEht the J!kw norhr as U the whole of unpaid principal had been due at the time when any such defadt oocnnd, end i~ fW ri i~IfioM shall embrace, with unpaid principal and interest, all the sums so disbursed with interest u atae@WL In bHnL to ad wee any remedy hereunder. whether abated or not. all expenses. including reasonable ststme 0.4 wr► shah o w principal, became due as incurred, and in pee of judgment shall be inchtded tbwahe. Upon w asameucemmnt or during the pendency of any action of foreclosure of this Contract. Purchaser commute to As all pofa Y i riehiisls dpw Pr artyineludlnj homestesd!Merest, to c6le6 the rents. issues. and profits d the Prouty. krbg w pendency of such action, and such rents, issues, and profits when so collected shall be held and appisd u w aeart `A. 81111111 41169L 4' - AN' of nethis Contract shall be binding upon and insure to the benefits of the heirs, legal representatives, successors and aasiiph of Vendor and Purchaser. (I f not an owner of the Property the spouse of Vendor for a valuable consww joins lumb to hiMSh homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulBNowut . hanaLl st DMd&b 30th day of August - - - - 19 _82 Zt- LI ISBAU e Virgi Helgeson Clarence Frederick a s . , / (SEAL) lCl_ +tt ,1 ~ w IUAIJ F7 a sine Helgeson . Barbara Frederick g ~ - AUTHENTICATION ACKNOWLEDGMENT authenticated this 30th day of STATE, OF WISCONSIN 18 82 of the above named ss XiMil Het eson H lain Hel eson, qty, Clarence Frederick and Barbara Personally -ame before me. this d~ of Fr isle 19 w above named • Robert G. Walter - to me known to be the person . who executed w fengoins TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledged the same. (If not. - authorised by 4706.06. Wis. Scats.) ' - _ k This instrument was drafted by Notary Public County. Wis. ROBERT G. WALTER My Commission is permanent. (If not, state expiration date: Attorney at Law (Signatures may be authenticated or acknowledged. Both are not necessary.) The use of witnesses is optional. ONAmme#41 persons signing in any capacity should be typed or printed below their signatures. ham-- _ . iaoget)rr with 'the . aE~i~lt#a fra■~ tise !,o tip ti; " ~ ft~ ad~msbd, u;tet31 paid no oy' $3 , 0011.00 OW its weddiwg A=th uatil paid in #6s Purchaser shall pay aot !t specitid. bereft of "tip 1, 190:9.' and sach 36 MOMM,'" s to bf interist being pa#Q 111, on tbelx _ OWdalent loan provided tb*. Y'r t. price is allocated as foes $199,000.00 ' Beal Estod a , ' $ 70,OOO.00 Cats and ~a S 10,468.20 Feed and 41 t t is allocated as follows S10,0Oa 00 Tbv&xds tAO"0"0 arm $ 6, 360.09 Tow=s tho t,, dabs h~ -with the Purchaser eseo t3,t t the Vendor, the tm9M' a+I, . } P, abd ,any default therein shall A respect to the personal pztY N'th• , it is mutually agreed that the _ . : ottiiertl3 a dispose of such items, provided that be in the ordinary course of the Owt: the value of the remaining persoftal mss' than the debt, there an . A W aKlditionaI security for the anomt to be. , a 11"# the Purchaser has assigned their inba#eet a adY4bring real estate located in the State of ' therein shall constitute a default ber"U'l. . 7 That monthly payments shall be alb . prlnoiW. and interest to real esEaba ds l sf ana`interest towards personal property which time all of the payment shall be aid to indebtedness. Any prepayment shall be personal property at the option of the P1ufl+a be no prepayment greater than $10,000.00, ia, . for herein ih any one calendar-year. 41 8. This contract shall be fully paid-withim lk 9. This contract may not be sold, assigned equitable interest of the Purchaser. trls consent of the Vendor. 'Y 4. 10. It is mutually agreed that the " Oar residence to and through September 3r :a~ ~Y it polo- *had for keeping young stock ' ©hesr and agreed all manure in tt* K iutat therefore the 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 pttmlt Issuance. -should this development be intended lot resale by sold second should this office retained with the completed trwhen r#thaeCproperty house)# Is then appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - w - - - - - - - - - - - Owner of property C ~(ire,wc,le_ \d nr10 &rA VV eAQ k- L Pc`aotloS of proga t 5IZ 114 1G 1/-4, Section T_1_V-R- Township ono - \ \ C Melling address ~~J` COUrJT~Q Wnnc\~~~ ~Ic ~S a0 Address of site Cots •abdlvlslon name Lot number Ptsvious owner of property ^1~„~ e` Sa N Total size of parcel Data parcel was created Acs all cornets and lot lines identifiable? as _ No Is this property being developed for resale (,spec house)? as Volume and Page Number as recorded with the Register of Deeds. ft INCLUD--------------- E WITH THIS APPLICATION T119 FOLLOWING: A WARRANTY DRNO which Includes a DOCUMENT NUMBRRO VOLUME AND PADS NUmaltit, and the ORAL OF THS RROISTRR OF DRRDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. it the deed description teferences to a Ceitifled Survey Map, the Cattltled Survey Map shall also be required. T PROPERTY OWNER CERTIFICATION i(We) cettl[y that all statements on this form are true to the best of my (oucl knowledge) that [ (we) am (ate) the owner(s) of the property described In this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 2n °l5 j and that I (we) Presently own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, tot the construction at said system, and ame has been duly recorded in the office 701~a ynty Regiatec o[ boa as ument No. 1. Signature of owner 8l nature of Co-Owner (It Applicable) Data of Signaturs Date of Signature l • SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ro c.c~{ `t I~~b v n f.. OWNER/ BUYER k App.;,...- n O ROUTE /BOX NUMBER Fire Humber d \ • r CITY/ STATE \VJ pp ZIP rt PROPERTY LOCATION: Section T N, RW, Town of St. Croix County, Subdivision Lot number______• Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a l'ic'en's'ed' •s'ept'ic_ tank pumper. What you put into the system can a'f'fect th-e-- uncC on o, the septic.tank as a treat- ment-stage in the waste disposal system. • St. Croix County residents-may 'be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, wh 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'tems_ 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), 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. H 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- W ment of Natural Resources. Certification form must be completed •d and returned to the St. Croix County Zon Office within 330 days of the three year expiration date. SIGNED - 1404- DATE'' St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. a avetice FreJeri~-k l st SeC13 7"2 $ N I b t,J F u Ga lle . pt4VITE So1Ar~ SYSTEth 903122, :t l i N f 4 r I uuu. SL t IA't FlkA j s" s l`er~ C01x i~~ e I Sarg4Ge U ~e Shed ioI ahartder~ec~ .t+_.{2 8i.o:icZ) 'Ce 'a' ,tot n z ..3u ctt)t~~ tk e area a~ I~Aoo ga~ , 1 Sepfi~taak/e' d5 B e 1 ew ncdun v WwiSf ° ~ewta.iK u,ndisturloe~ J bl Prvt e►►yyt a h to bt rervIIIJ C-arM Pow 3a+ ~U p Rome Gc,nage - I n,,N 1J000--- po0 lal pu~,pJ _,__~,~►aw►ber due Foam C - ~r. .~t_t+cZ ~:3• Zi (i)(F,~ Z• T1-tt Mtur~cl N A ghl W-6 Gra tj ~ CCrrter S~ai~ ina ~er~anclicu~c:i ~ r11c Stoy~ No L~s r ti . bore Nei les a p - wets 3a3 . _ ' 831 90 Page _ Of _ Straw, Marsh Hay, Or ( ~g c~ Synthetic Covering Distribution Pipe Medium Sand ` Topsoil I F 3 p E x stops Bed Of 2'- 21. (Force Main Plowed Aggregate From Pump Layer p /.04i. Cross Section Of A Mound System Using E A Bed For The Absorption Area F X75 F i G /,0 F ; Signed: / 111"Lel A /o Ft. H B SU Ft. License Number: I /:y Ft. Date: Y/ J Ft. K /D Ft. Alternate Position L 70 Ft. of Force Main W 32 Ft. L 1 Observation Pipe` ~ - 8 - \ K r - - A - W I~-----j---------------J---------------------- Force Main From Pump ONSITE SEWAGE YSTEM ~,Distributlpp Bed 0 f %2 2 Pipeu ga~,' ~ ~r Aggregate 2 t Y-7mr P7 ~ „ r I Observe to , E ° P p,titnent Markers I s , ~i hh~~••❑❑ AV's DEFAR l t1Ei 1 f:;r f~i ~ . y t t i.. t,!c~ 4'~.Lr11101W 1 V1l.~iy l:i ter: Plan View Of Mound USui9' W6'i*d* -Y-61'qCbsorplion Area Page _ Of _ Perforated Pipe Detail End View )Perforated End Cap) \c;t~ PVC Pipe o s (~•°`~e~o°c Holes Located On Bottom. ~v s Are Equally Spaced S Q PVC Force Main .7 PVC Manifold Pipe Alternate Position Of Distribution Force Main pipe P Lost Hole Should Be Next To End Cop End Cap Distribution Pipe Layout P q Ft. R ~q FT " S 3(." X 3 6 Inches Y lq Inches Signed: AL 4, Hole Diameter Inch Lateral Inch(es) License Number: .30 31-1 M Manifold 2 Inches Date: NV Force Main 3 Inches # of holes/pipe _3 ~L i A ~ ~w t Invert Elevation of Laterals&t_ Ft. 1 DEPSiIT" "„i. ;;,r[ TIONS t " U, G PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' :3 1 ` n 4"C.1, VENT PIPC VENT CAP WEATHER PROOF APPROVED LOCKING JUWCTION BOX MAWHOLE COVER WI FN 2s' FROM DOOR, 1 wINDOW OR FRESH AIR 11JTAKE GRADE I I `i" MIN, fG..~ F.-T Ilk 19"MIU. ' L . COAIDUIT - ~ I \ i p~4StTE SE ACSTEM IAJI..I:I VI E I ~ AIRTIC.~f SEAL I III ~ -7 APPROVED .JOINT A rr l is° 7 a I III APPROVED JOIWTS I W/C.Z. PIPE. a yam` ; I u I III W/C.I. PIPE " a >J I I ALARM EXTEWDIW6 3r EXT T ENOIIIC 3 .r OIJTO 501.10 SC::. ONTO SOLID SOIL Rte. I DEI'AfiTP,•rt: v, ~ _Lr :d;aa _ -i3 ~ I ON • I OFF D COWCKETE BLOCK C.1 S 3 ~ _ RISER EXIT PERMITTED OIJLy IF TANK MAWUFACTURE:R HAS SUCH APPROVAL SPECIFICATIONS SEPTIC AND DOSE TAA1K5 MA►JUFACTURE:R: MI tQI.J¢,S1Ccn IJUMBER OF DOSES: 3 P E P. DAy TANK bAZC : 0 no GALLOUS, DOSE VOLUME f 200 ALARM MANUFACTURER: TQc~k ABU INCLUDING BACKFLOW: GALLONS MODEL NUMBER: N A CAPACITIES: A=~INCIIES OR .4`411_ GALLONS SWITCH TYPE: ~'~a+ B = 2 INCHES OR 1-_ GALLONS II (j D PUMP MAWUFACTURER: V O V J C='10 IIJCHES OR I3 GALLONS MODEL NUMBER: W f, 3 L Do I'Ll, INCHES OR 701 ~z. GALLONS SWITCH TYPE: Ha NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHAR`E RATE ,0111 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE Bj"?WECN PUMP OFF AIJO DISTRIBUTION PIPE.. 10'0 FEET I1 n + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . 2.5 FCET + -FEET OF FORCE MAIN X '&Lk F/ ~ Loo ([FRICTION FACTOR.. F FEET TOTAL OtiWAMIC HEAD =12• tO FEET INTERIJAL WSIOIJC Of TANK: LENGTH ;WIDTH I~ ;LIQUID DEPTH SIGUEO: LICEMSE DUMBER: ~2 DATE:o -117- V.6. DERARTM4N'T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION IN LABOR DUSTRY, C P.O. BOX 76 HUMAN NDATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090) & Chapter 145.045) LOCATI N: SECTION: T UN CIPAL TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: a Ta~N/R/6E (o COUNTY: ~ ER' UYER'S NAME: ~ MAILING ADDRESS: "4 kc ' ~ Qop C~ c USE DATES OBSERVATIONS MADE SPA Sy NO. BE RMS.: 1COMMERCIAL DESCRIPTION: PROFI E DES 3 ONS: ER A!!I TESTS: $aResidence ❑New ®'Replace ~b 90 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM-IN-FILLHOLDING TANK: IR ECOMM EN ED SYSTEM: (optional) CIS ®u ®S ❑U as ]U os ou os ®U )6 If Percolation Tests are NOT required DESIGN RATE: \ I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: * Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) S' o 6 s' X-0 ( Nk s iC l I 'a P i C a "r ; l B- rm P 'S rQt;' h, C 6" &'l s ~y _04,te 4J LJ1, B- s o ~ t' I ,ao G Ik s' a ~ e>~B~ S B- ho (~Z~ 6~kk C4 S W/ B- w a. 1? r'es~wh~ti1A ndg ya PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P OD3 PER INCH P- 30 C2 30 P- 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 19. 1 t t I`Q ti d _ /b I I i E ! 3 F i 3 itN 7 -4 t` oQ I e► E r t i~ l i i ~GS~K~' t i 3 i } Jpwla a 3 ~ra P ` , . 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 ( rint): A TESTS WERE C~ P ETED ON: Q ap 6 ' AD CERTIFIC Tlp MBEP: PHONE NUMj3~EFji,optional►: CST SIG Q}~ E(//~ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate said test, your report must include; I Complete legal description; 2- Tl-rn must clearly whetli2r, this is a Aesir commercial project; 1 MA}a -i,er of bedroor or commercial use planner'; 4. Is ,is -nient' A"'; 5. Comb y rating oxes. A SITE IS SUITABLE 7 ! A HOLDING TANK ONLY IF ALL OTHE RULED OUT BASED ON SOIL If '~'S; 6. PLEASE eviat.ions shown here for writing profit ;criptions and completing the plot plan; 7. MAKE diagram accurately locating your test ~ms. Drawing to scale is preferred. A sel _.r. { used if desired; 3. Make SLAB :'imark and vertical elevation referen e, clearly shown, e permanent; 9. Corn PI a;,e boxes as to dates, narnes, ad(! good plain data, p st exemp- tic 10. If h fio(,rl ain, elevation) does nr lace N.A. in the appropriate box; 11. Sid, tl ,,our ; r r address and your c r, n number; 12. Make i 7:1 distrih as required. ALL SC :L TESTS MUST BE FILED WITH THE LOCAL A, (WITHIN YS OF COMPLETION. EVIATIOF FJR CERTIF L TESTERS 3s and Textures Other Symbols (over 10") BR Bedrock cob able (3 - 10") SS - Sand, e, gr - Gravel (under 3") L5 - Lin 4 -High a, Sand c Perc hurt Sand F Sand Bldq B. Is - L ;s.rny Sand j c sl - c -'y Loam < I. i .11, Bin - C ,a . sil - it Loarn BI Black si - Silt Gy - G: x.cl - C I y- Y scI - r~ •~y Loam R - R sicl - ' gay Loam mot - IV, Sc Clay VV/ - v.r sic - ay fff - f C- r c C Coll pt - i m - Mar rn d - dis`"ra p pron - HWL - Nigh six f-xtures disposal BM - BE, VRP Verb ! t n san ,ary r - ~ C ~r• quest private Omer to do 1, ST. CROIX COUNTY r, WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Sept. 4, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Clarence Frederick property located at the SW 1/4 of the NE 1/4 of Sec. 13, T28N- R16W, Town of Eau Galle, St. Croix County revealed suitable soils at a depth of 24 inches below which seasonable high ground water was noted. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely, Ar cJames K. Thompson Assistant Zoning Administrator cj