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FORM - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Saoh OAt~keo' TOWNSHIP W y.J a,*~
i
SECTION IQ T aa_N-R I4 ~-2 S C~ l V ~-W
ADDRESS Roy*- aat Z ST. CROIX COUNTY, WISCONSIN
---9kP.Mey" 0.1-~ t"d/A/G
SUBDIVISION LOT Z 7- LOT SIZE 2-11 Ace.✓S
PLAN VIEW Imo- I D : OZ0 - iL(o~- ~ U-aoa
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
C.arag2. Nou~a~.~
2yKty' 28 xSo
wLl~
N (e
D ,
R ~ bq
z -
v a
w
y . - - -
7D ~
3S Sc~.1<4~"= to~.~.r«;ota~or..,~ t tea.,,
B.M. gtv. s load'
w..s't 61 ("144a- S M. Tc o~ f l t ~s,l
INDICATE NORTH ARROW
BENCHMARK: Elevation and description:14 d Tm.1cL--Pa. e $,~,Co~Wm✓fit.=loo.o
Alternate benchmark1VA 9E
SEPTIC TANK:Manufacturer:_Wa:,sm,r Liquid Cap. J606
Rings used: 0 manhole cover elev:/,(~ Final grade elev:
Tank inlet elev.:a~Z" Tank outlet elev.: I-$$
No. of feet from nearest road:Front , Side , Rear XFt._86~
From nearest prop. line:Front , Side , Rear X Ft.--740
No. of feet from: Well Coop , Building: 'i(a
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
• r
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: M!'a Trench Seepage Pit: -
Width: Length 36' Number of Lines: Area Built_&q?,
Exist. Grade Elev. Proposed Final Grade Elev. q.-611
Fill depth to top of'pipe: 4/O
No. feet from nearest prop. line:Front , Side, RearVFt..38/
No. feet from well: 8 S" No. feet from building_ 6~
HOLDING TANK
Manufacturer:_All# 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: 00 o-7-~ _
LICENSE NUMBER: , 5r 2 Z
6/90:cj
f
INSPECTION REPORT FOR SAFETY & BUILDING
~ DEPARTMENT OF INDUSTRY, DIVISION
LABOR & HUMAN AELATIOJIS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
P.O. BOX 7969
MADISON, WI 53707 State Plan I.D. Number:
NW 4 , NV,-, Sec. 19, T29 -R19 (If assigned)
❑ CONVENTIONAL ❑ ALTERATIVE
Town of Hudson ❑ H ing Tank ❑ In-Ground Pressure ❑ Mound
IT ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Sam Miller Box 282
REF. PT. EL V.: CS E . P . E
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:
Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number:
Doug Strohbeen 5432 St Croix 135484
SEPTIC TANK/ of e Go-- = Z 2,
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV. TANK OUTLET ELEV.: WARNING LOCKING OV R~
tj YES ❑ NO ❑ YES NO Ile BEDDING: VEfdT DIA.: V~EPA MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T RESH
~ ~ AIR INLET:
G.a. C-10- ALARM: FEET FROM LINE:
❑ YES NO S ❑ YES NO NEAREST ~a
DOSING CHAMBER: ARNINU MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: PROVID DLABEL PROVIDED:OVER
YES ❑ NO ❑ YES [:1 NO ❑ YES ❑ NO
PUMP AND OLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT ET RESH
GALLONS PER CYCLE: FEET FROM LINE:
(DIFFERENCE BETWEEN ❑ YES NEAREST
PUMP ON AND OFF TER: MATERIAL AND MARKING:
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: INSIDE DIA.: # PITS LIQUID
WIDTH: L N0. OF DISTR. PIPE SPACING: COVER PTH:
BED/TRENCH I TRENCHES: t M RIAL: PIT
DIMENSIONS
(0 UID ..2-7' NUMBER OF PROPERTY WELL: BUILDING: VENTTOFRESH
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. IPE DISTR. PIPE ATERIAL: NO. I TR . LINE: AIR INLET:
BELOW PIPES, ABOVE COVER: ELEV. INLET: ELEV. END: •~~L ~,r C'./'CS~ine PIPES. FEET FROM ! r 4'O
17 oo •i5~ ✓c. 2-72-9 3 NEAREST~♦ -3 J U
MOUND SYSTEM: 7.l? '
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows slope: mound systems to make certain that it ON REVERSE SIDE. SHOW
YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL VER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
MULCHED:'
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH F TOPSOIL: SODDED: SEEDED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ Y ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH: TRENCHES: LATERAL SPACI GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COV
BED/TRENCH DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATER PO. DISTR. DISTR. PIPE DISTRIB PE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.'
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:
n ❑ YES ❑ NO E] YES ❑ NO NEAREST-~
~l Z„ i„ t-f' 1,' el, gel - cz/I.LF% i~ 4r' `4Q
~Vl' ~ ~ /c2.1~"~_~~ Cf_;~..C,A 4-~ ~',k'~.S S .~L"J /~tA►m~i'd~''"~Cl~4~i7-`ct;v.,.
R in in county file for audit.
Sketch System on SIGNA RE: TITLE:
Reverse Side.
SBD-6710 (R. 06/88)
17DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code cou
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than El 1.2 S'~~
8% x 11 inches in size. C eo d revision to pr vious 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
07 AdzW (4) 1/4 E'/a, S 9 T L9, N, R 9 E (o
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
S / 1(321- 7-*7 Co rX : dw
II. TYPE OF BUILDING: (Check one) F-1 State Owned VILLLLAGE U NEAREST ROAD
(T ~ S O Y~ C.ok,,1'r Yi i.W
❑ Public 121 or 2 Fam. Dwellin" of bedrooms PARCEL M
III. BUILDING USE: (If building type is public, check all that apply) Z <1 Q
1 ❑ Apt/Condo 0 /
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. N New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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/day/sq. ft.) (Min./inch) ELEVATION
ySb (P I J (0cfs Q- 7Z G 3 /00- 70 Feet /0y0 0 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 Holding Tank X 000 Wm~ P~
Lift Pump Tank/Si hon Chamber, El 171
Vlll. 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) MP/MPRSW No.: Business Phone Number:
Plumbs s Ad ss rest, C'ry State,yZip Code):/ 5 G C/ W/ 7 0/7
2P NTYIDEPARTMVENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a e Issued issuing gent Signature No S ps
proved ❑ owner Given Initial Surcharge Fee) ~Q
Adverse Determination C CJ
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
r
t
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) so 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.
11. 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 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) doss section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - - - - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
APPLICATION FOR SANITARY PERMIT
STC-100
This application form 1s to be completed in full and signed by the oWnet(s) of
the property being developed. Any inadequacies will only result In delays of
the permit Issuance. Should this development be intended got tesale by
owner/contractoc,(spec house), then a second form should be retained and
completed when the property Is sold and submitted to this office with the
appropriate deed recording.
Owner of property 5QSoowi AjF% /
Locatlon of property N&.Z i/4 NE 1/4, Section
Township Aik.efson -
•
Mailing address &x 4*z -y7-
_r
Address of site , Goa wr y l~a-•~
Subdivision name ass n, Cou+►'t~c,~ Uiat"J
Lot number
Previous owner of pcopetty ,~ei~ `st ~~~ss%KO
Total size of parcel -7- -
Date parcel was created 6 -2
Ace all corners and lot lines Identifiable?
is this property being developed for resale ('spec house)? XX Yes
Volume -74 7 and Page Number Y'l_ as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION TITS FOLLOWINGI
A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PUCE NUMBER, and
the SEAL OF THE REGISTER OF DEEDS. In addition, a cettilled survey, If
available, would be helpful so as to avoid delays of the reviewing process. it
the deed description tolerances to a Ceitifled survey Map, the CettIlled Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (out)
knowledge] that I (we) am (ate) the ownet(s) of the property described In
thls Intotmstlon totm, by virtue of a warranty deed recorded in the office of
the County Reglotet of Deeds as Document No. 4/3 z z 3 c. / and that t (We)
presently own the proposed site for the sewage disposal system (at t (we) have
obtained an easement, to tun with the above described property, tot the
conettuctlon of said oystem, and the same has been duly recorded in the office
of a County Reglste of Deeds, as Document No. el3 P-2-:3 0
Signature of Owner Signature of Co-owner (11 Applicable)
Date of Signature Data of Signature
DOCUMENT NO. K pAJt 49 STATE BAR OF WISCONSIN FORM 11-11988 THIS SPACE RESERVED FOR RECORDINO DATA
_ LAND CONTRACT
Individual and Cer,wnt„
=h(• M-` (TO BY USED FOR AIJ. TRANSACTIONS WHERE OVER
4V1I1,7/YL V e+R 000 is FINANCED AND IN OTHER NON-CONSUMER ST. C-Roix Co., W1
ACT TRANSACTIONS) n i for A:icord
Contract, by and between . Novenb¢r_.11s 1987
...RUhy..R9jlNya. a single woman at 1:25 P M
("Vendor",
whether one or more) and..SaM..E....Klifex Register of Deods
("Purchaser", whether one or more). ola?wN~
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser, the following property, together with the
rents, profits, fixtures atld other appurtenant interests (all called the "Property"),
in...... St.%..G7CQAX County, State of Wisconsin: RaruaN .o
West one-half of Northeast Quarter (ViNE%)
except the east 8 rods, and the Northwest
Quarter of Southeast Quarter (NASE1,0, except Tax Parcel No
the south 6 rods, all in Section 29, T29N, 19W.
MWSF
FEE
This is--not..._ homestead property.
( (is not)
Purchaser a6-sees to purchase the Property and to pay to Vendor at . 208 8th S..t....., Hudson, WI
the sum of =.256,_150!00 in the following manner: (a) $.Qs000.•QO.............................
at the execution of this Contract; and (b) the balance of $ 236,.15Q.QQ together with interest from date
hereof on the balance outstanding from time to time at the rate of.nine..49X1 per cent per annum
until paid in full, as follows: Interest to January 11, 1988 shall be limited to $1,320.29.
$80,000.00 plus interest on the unpaid balance on January 11, 1988.
III
$50,000.00 plus interest on the unpnid balance on January 11, 1989.
$50,000.00 plus interest on the unpaid balance on January 11, 1990.
$56,150.00 plus interest on the unpaid balance on January 11, 1991.
The above payments shall be made in addition to any payments made for the conveyance of
lots until the total price is paid in full.
All payments shall be by 2 checks, one to each Vendor for 11 of the full amount.
A )pot tedlehase Ageemefnt h adlsgo been sildpol tli datey 11th y
rove a ow'ever, a en ire ou s an In ba ance 9F al In u on or afore the da of
....January 19..91.. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of 10....... % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal, balance).
Purchaser, unless excused by Vendor, agrees Ao pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, apaoWi aswv*menta, fire anA required insaraaee premiums when due. To the extent received by Vendor,
Vendor- agrees to-apply payAwnts to these ebligatious when due.- Such amounts received by the Vendor for payment of
taxes, "wgamenta and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law. Any amount may be prepaid on principal at any time.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Ana
-Amount may be prepaid without premium or fee upon prineipal at any time after 19....... (OR)
there may -be no prepayment of principal without permission of Vendor. 'P 11 11 e
In ;he event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall he 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 continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purcha<er is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
Purchaser agrees to pay the coat of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Vendor until th- full purchase price is paid.
Purchaser shall beent:tledto take possession of the Property on the date hereof 10
•Cn,.. Ou; Or.
LAND CONTRACT- Indlv4dual and ST %IC PAR OF' WIS( ONSIN w'-., - n 1.•ae1 Hunk Po, Ins
Corporate FORM No. 11•-IYtl: SIu.•n...... Rya.
PA,E 50 r pr•,nus- , u, p:.) when due all taxes and a •->>n.- rtv Irvied on the 11ruprrty or upon 1'• adnr's interest
lit ,r ;,rJ b., d,•I`••r L,r 1'ewlor .it dernand ruc'elpts show'ulg !`urh payment.
rla,l keep it r• rtnprov-•m.:nts on the I'n,pcII. tn,'•rr•d rel•ain't loss or damage occasioned by fir ,ex-
.-.:-.r.t>• l••►tl!- sad suet ntl.cr imzards as 1'cndur oia) n•tlu.rc, wvthuut co-wiurance, through insurers apprved
r,: 1 t, .r t•.. s :h, t , !,lit Ver,•I.,r shall not require Coverage in nn Antn:rtit more
t) .st. ! -A vt, 1Pr tI ;s I onlract. 1'urcliasrr si,al! ,,:,y Me w-irarive pr,•Tni ems when due. Tr,c p--Lacs shall
t ,.r.•Lu•! '!e l . al I:rvur if tLe Cendor'.4 11 turret awl, urlPes 1'eador ou.crwtse agrees in writing. the original
:-'I l ru,t• the 1'r„pert, =I:WI he del it4 d will, Vendor. PurcLaser shall promptly g-ve nutl: a of 10-15 to
+n(:-ns•:! :st.d 1•end6r. ll--1s 1'urcna. er ar.d Vendor •,t I.vrwiNe agree in writing, insurance proceeds shall
i. r►sr"::.ten or repair of- tim Property damaged, pr,.cided till- Vendor deems the restoration or repair to be
r nut a;l w;,<te n,,r a to t" r"r• • •1 t'.e Property, to keep the !'r~l•c:
1 n;.• ,::du.a,o w1ri r ; air, tit keep the I'1";,ert: tr.l 'ram her.- x,perior to the lien of this Contract. and
.i. .%I'll all Iowa, ordinance. and rc;rulatalrecun;; tl•e I'ropert~.
\y'.•h ! a.IC•7 t'.at tit rase the purchase price with Int."est :still otl-•r nionv3s sl,all he fully paid and all ennditions
Ile r fully t ri• n':ed ,it u.(! t.l is :.red in the rntumcr alines specAn d, l-:r. r V. ::1 on di-man,'. execute and deliver to
t•L;t,i u
ti -o- I'rt:• r~ . %k arrant) Iretd, to lee simple, of the 1'rop.rty, tree and clear o.r all liens and encumbrances, except
ah.- lien, , r.. rem ,raricea created I,y the act or defnvlt of P;jr. ! a-er, and ex(-, I t: exist ing highway. 1 f_. East
or West fences encroach oil this. or. adjoining land, warranty wjll f):Ot app1J' to land..
between such fences and true description lines.
in Ill , t "f a de fl. jn the payoivnt of ui.} principal or
t'. a that htnP is of the 1 --rare :still 4;11
'.roues for h ri"d of 6 i1... d;t's fell.,, ;n,; ti.. •i'. i!ied w;v d:-!r .r rill in the eyrnt of a default in
I'urrh. ,->.r l , „1 ...df1}'s ''ll/rw'Iili• wr lt,n tretire
. e ,.tl . r ohll~;tti,.n ui «I i, e, nt r i - ''•r _ ..•utr'.CL
t:. u,!:n{, ha•:u,t,• 'tea, r -
• \ , : . rr,l p. r.,m:tl;; .•r niailvd I,•, c,-rt:`,- I ma :iI lit. I, y„•
a! ti•..t n"tic. 1%%1X!1 Purcl.a cr }:-rely
•i - • r uatvl} d'a• ao•1 p:r.ahle in t'.tll, :,t 1'-•.,I'-r~ "I'. ,
11 Il L:nr ti. tcln: t• .,Li h, Inut!:,t: lit-xide,1 h•. la•.-1 in
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t t .f Pill, \ ,t,-n r ! I.r. r ;inn
„ 1' , 1'1 :-tr t tree:\ t illy,- •t ,I t" , r• r ,t , ! r , l„
r t 1i.t al•y:,N,t•, tl•t ! rlt C.•.l r u .I f
n11
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) i' laic .t,d r \pr !I ! i ;,,.-1 . 1 1 . ' l'ire t-..r. in.
:t i. :n ,V-i , li i iurludr d in act- in•icn ' ut.
e of tl:r O,nt:art. Pure~aser consents
l'ne,n tee .nn.ntenccmtnt or during tFc .•nrtt•nc: of stay :r l,rnfits of
t• t t n an tit' lit of a receiver of ti-e 1't, pt n ciu,!:r.t r' ! t r. r-' t
the 1'r"pett d taxi,- tl e pendency of such art and rnlltrted xha'I t'e Leld and
al•t,!te,l it1 -'.all -!:r„:.
t r _i li .,,nc- . :r.': I• _ a! nr , I, • n ~t it,, U e Pr,•I,- I, 11,. a~- rnnta: of any
t.r ;11 of 1'nrch.a•' iiv-it= uwler this (l.ntr:,ct or 1 t ,east„n, lnr.t••h•rm le . nttu•r \ca. I tc,th"•It •he pr-,r
a-lice etil•.t•r tic ut<tan,I: ! •irr ..,ir -1 , •,tr:i,.t i< fn' T,:,r! to f'tt{ -•r t1.. ,:•.•.-rxt
nr a r,nient of I'':r- - r' r , , }l r :t. it t .Ire _
I'rn--^ a4t r --1)* r ..n} •,1-', tr,t r.. f t -:.i t r' t t , - t'> wri:!- - tl~c tnt' r rt-tar lie C
hal:tttr•• pa. .I le .c,!e r tl, (''ultrart all h. ,.n1 :r . I : ~I - I } r in f :11. at V4.1 ' r'- "I It', it wit.. 't• t,"•t P
1 ••n i - 1 make all r Trento NA i d-. t'• I.' ::•t' "rt tt :-nd'r': :-_•a e t l - I' tty nn tle da•e of
it i• r'•,r•t a' \ r r•t tar a c m"rt: ace -ranted Ly Purchaser 1 ' r w I t' , r,' f rncnl.•d P :rot:- e•
a6, = t !t t,r -Lent n' tie a11:"alitc ,t n 1 •'-,t' ,r•1 t a r,trt I 'v to
'f 1•r ndur rails to .I" .u ! a!l t' I t: 1' 1. _ 11•: rose t- sends n•:
:i,!, . •:-t. walt'r• :rly default ah„at v: ..i•.c: :..!i.. , t. -.,11,., r:,t. !,..::t f 1•~,-.t,:t-, r
• ••na ne this Cnntrni t x! a'! he F-i•v'inu up-in and i^orr to the h- nefitc of the heirs, legal rfirrerPntatirra.
uc r• :,~d n=sir-ns of fender and P•n^hase. Ilf not an owner n! t1,P Prn;,erty the srru-P'•r Vendor for a cah;ahle
ton\id r t n , line hPrein to -Plen•e I,nni-trad nict•ts in the a'tb)PC+. Property and atrrPes to ?n!r in the execution of the
decd t,• rr„lr in fulfillment her•nf.I
1,.:'.., 16th November l:r 87
C -rl
,4 / 1...1
C~• ri [ - • / , c , - - , { = J,.i,l kJ L ..::11.,
orres~ L. Kossin~; / Sa 'liner
t'"T,/ 1.LA1.r
Ruby U`ailey
AUTHENTICATION ACKNOWLEDG!IIRV i
all parties rFATE it!' Wl (I,\
r
r rat.•.P h,. r'
1611i: ..avc:t^l,~tr In K. I'. P.
John rb. Hi-vwOod
-jj•111 t'-'.t1:~ is <'I'\it I!\1!•,p\1'I:1'rr\~I\
W . .
John 1). Ilcvw,'.'•.l, H. w,'-•-!, taxi -.tutI.r
Hudsilo, Wi-,conc;itl r,•+t)Ih tt
O.
,`fr
1 'It 1 1 ,.,,~,1 w•.1 . rnr wlr .Iw,• Itwr R'.•.n ,..n. Iwr.n 11 ,
STC-105 H
SEPTIC TANK MAINTENANCE AGREEMENT 'Y
St. Croix County
r
w
OWNER/ BUYER cr
ROUTE/BOX NUMBER god -f-# Fire Number
CITY/ STATEu~~mr. r
M
PROPERTY LOCATION: wly X/ Section.. 117 TAN, R /9 61,
Town of u St. Croix County,
Subdivision L"T":4,V;tA) 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 licensed"se t'ic tank pumper. What you put into
the system can a ect the function o the-septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to recieve a grant for
a maximum of 60% of the cost of replacement of a failing system,
whicNi 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 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 o
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart- a'
ment of Natural Resources, Certification form must be completed .L'
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED
DATE 5 -1
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016,
386-4680
Sign, date and return to the above address.
RY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
.DEPARTMENT INDUSTRY, DIVISION
'LABOR AND PERCOLATION JESTS (115) MADISP.O. BOX 7969
ON WI 3707
HUMAN RELATIONS
1\/ Chapter 145) .Z 2
p1Q l (o (ILHR 83.09(1) &
LOCATION: T/ Nr SECTION: 19 /T24 N/R TOWNSHIP/ AcC . LOT NO. LK ~ NO.: S NAME:
NW 'tkyyl Lr
C9 U Y: OWNER'S f~RSNABMAILIN ADDR ~rQto) h 54M ILIA ; $QpOK 1CoyQ0 KV~Sr~~/
USE DATES OBSERVATIONS MADE
NO.B DR : COMMERCIAL DESCRIPTION: PERCOKATPN TESTS:
Residence u~y ZNiw ❑Replace 2 C~l~ Z 9d
'1 So►~ ~ y 66 Sa►c~ $kD~ - ~,~ru~RcT
RATING: S= Site suitable for system U- Site unsuitable for system SYST CONY NTIElNAL: JMOLINCY:__ [:]U IN-GRO ND -PRESSURE: S STS IaULHOEILDING A SOff/ EL:(opt'
nal)
IGRATE:
If Percolation Tests are NOT required DES J If any portion of the tested area is in the
under s. I LHR 83.09(5)(b), indicate: ~L 4S5 ` Floodplain, indicate Floodplain elevation: /VA
PROFILE DESCRIPTIONS
1. _r BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGRYS TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 3 63 0 N 6 •~$3 z~ 'iQc ~Ys 2 S $a~Cs~c G►e b 37 "$aN rvis
B- Z sg /6Z.63 NoaC Q.sB cc s a.~ cs~°Qe~ A75
B= 33 > $.33 /3 scTS "Q $oNCS~~~cob 33 BeNeS~fG 1 ~~Berr~Is
B-4 g S' / .e3 d ~ > 9 ccYS Z4"Beal '"Q C*&R- '66 44h $o,,,j d x
B- 'S /U.Og 116.9 ! > /0.0% /4`' N L46,t II"Ra$ CS16Q CSi
6-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER II AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D 2 PER PER INCH
P_ I c~ 0 /6q.7o 3 ? Z > >
P_ Z ~;oa N'Ne 6Z-70 > 2 > > 2 <
P- 14.Lo r~asd Lug ~u 2- >Z
P-
p_ 4 I 6N AT TUC_
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
0-r 140 Lk'
I 'S~ c
48 j I
I
-SCA 4C
IL -
.7 tN
1
_ 1. I
P
ttNt Ay'
- -
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,( int : TESTS WERE COMP T ON:
N+~2v~ JOUwso~ JoNNs'*N Sueydy///G V, 96
ADDRESS: CERTIFICATION NUMBER: ZONE NI~M ERO( optional):
4v7 SEcoN4 l~+Clds~, N s f~1 d 3
Aa4
CST SIGNA E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHRSBD-6395 (R. 10/83) - OVER -
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