HomeMy WebLinkAbout032-1063-90-100
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DEPARTMErjT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
i S Is Plan 1.
MADISO WI 53707gQ~
(If assigned) 'Number:
gk, SEA, Sec. 23 , T31-Rl9 CONVENTIONAL ❑ ALTERATIVE
Town of Somerset ❑ nd
❑ H ding Tank El in-Ground Pressure Mou
OF FERMI HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ol0 -
1st. Nat'l Bank 109 E 2nd St.,New Richmond, WI --e Z -o
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Calvin Powers Jr. 1553 St. Croix 128832
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO
BEDDING: VENT DIA. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
DOSING CHAMBER: ' = P3, G/ ' = D . $Z
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIF4fWMANUFACTURER: WARNING LABEL LOCKING COVER
~ / PROVIDED: PROVIDED:
❑ YES ❑ NO l JCU L Cls d S 19-YES E:1 NO Eg- 5 ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ' oY' 6 lf~'YtJ ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.) /
CONVENTIONAL SYSTEM: Pte; 6f//4A ~Z = ~31,
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: 44 PITQ.
BED/TRENCH / TRENCHES: i MA AL: DEPTH:
DIMENSIONS "IX C•
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. IPE DISTR. PIPE MATERIAL: NO. I TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PrES: ABOVk COVER: ELEV INLET: ELEV. END: ` / PIPES: LINE: AIR INLET:
EARESTT Boo, >
(z X - / r 9 V031 JC.~. 4 6 Pic, 3NFEET FROM
>60 2 -lq / 7 /L8
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
0, b
7, 13
n
;T: 12.
Retain in county file for audit.
Sketch System on
Reverse Side. SIGNAT E: TITLE:
SBD-6710 (R. 06/88) `~~J c r~
oqz
SANITARY PERMIT APPLICATION
ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
s STATE SANITARY PERMIT #
:Attach complete plans (to the county copy only) for the system, on paper not less than ❑ , -6
8% x 11 inches in size. if 11 In,e-v2-u-sapplication
-See reverse side for instructions for completing this application. STATEELM I.q.14UMBE R~
1. APPLICANT INF RMATION - PLEASE PRINT ALL INFORMATION. YO w ~C
PROPERTY OWNER PROPERTY LOCATION
'/a S S T , N, R or
Z S,.e_
S~tr PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
Zf-
STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR C NUMBER
i
_0 P
II. TYPE OF BUILDING: (Check one CITY NEARE T ROAD
❑ State Owned ❑ VILLAGE
N Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms - P ETA Nu B O l _ f0 Q~
111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. El 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 [9 Seepage Bed 21 ❑ Mound 30 ❑ SpecityType 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. ABSORP. AREA 3. 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
.t . 33(~, _ez 9- Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank
Lift Pump Tank/Si hon Chamber -
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of ,04onsil:R sewage system shown on the attached plans.
Plumber's Name int): Plu is Signat e: ( Sta s) MP/MPRSW No.: Business Phone Number:
3 S_
um is Address (Street, City, State, Zip ode):
W. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued issuing gent Signature (No Stamps)
.Approved El owner Given Initial Surcharge Fee)
Adverse Determination Y~.)
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 y
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 orisite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitarypermit 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 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; (Jose 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)
.
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'~/~7 ~~✓o~SJ~ Fr46A Ali Intalb And ODeuralion Plpo
7Ir~.//s.O'JO "J ' 45 /7 i.. Approrld Venl Cap
Mlnlmun 12' A0o•e
Final Grade
20• 42° Apon Plpr _41,C461 Iron
VNSTo Final Grade Venl Pipe
~ Wren Noy Or SimMlk Co.erlny
2• Ayyreydle
Ore( Plpd
Ola(rlDrllo-
-Plpe 0 0 0 --Tee
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Ala b Aypre ole 0
,r Beneelp Pipe Perlordred PIP, hot*.
f , V l1JuJ o -CO Wlnp Terminallnp At
Bottom Of Syelem
u '~1w rw wLt,eG
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SOIL FILL
DISTRI13LITIOVI PIPE
APPROVED SI JPETIC COVER
""'MATERIN. OR V OF STRAW
2" OF AGG9EGAlE ay- OR MARSH HAj
tFl2-21/2 AGGREGATE ep X
ELEV. OFEET--_
3' r
DIS'1-11I51JTIOU PIPE To BE AT LEAST C:2~ WCHES BELOW ORIGIIJAL GRADE
AQU AT LEASTZO INCHES BUT KIO MORE THAI) 4Z IMCHES BELOW FILIAL GRADE
MAXV'IUM D rVi OF EXCAVAT100 FROM OKI&WA . 69ADF- WILL BE !i22_ IIJCHES
nNIMUM 9EFrH OF EXCA\1ATI0N H\OM. C~14INAL GRADE W1LL BE 2-2_ INCHES
t'~.,.
590 -405 2
sI~►JEO: ~ ~ I~
LICEIJSE AIUMBER:.~
DATE: _,9a
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7F) PUMP SELECTION
1) Pump selected will discharge GPM at ft.
total dynamic head.
2) Pump model and manufacturer
7G) DOSE VOLUME
1) 10 times void volume of distribution lines gal./cycle
2) Daily wastew ter olume : 4 doses/24 hrs. _ gal./cycle
3) Minimum d6se volume gal./cycle
1H) DOSE CHAMBER
1) Minimum capacity required gal.
Licunoc "U:~ \
Date:_..
PAGE -Jff-/Or
~
/,/oq r,?NoS PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
Nl~J 7/lewl* edjo /j, 7
VENT CAP
4"C.I. VENT PIPE
T WEATHER PROOF APPROVED LOCKING
25' FROM DOOR, JUNCTION BOX MAWHOLE COVER
WIIJDOW OR FRESH 12"MIU.
AIR INTAKE
~ I
GRADE
I "
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M
CONDUIT L- IB"MIN.
-
IA11..E1' (~NS1TE~ rv yl,i` - OVIDE I - _
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j P.IFCTIGHT SEAL ~ ( I
III
APPROVED JOINT A F ' S-" I ((I
W/C.I. PIPE. APPROVED JOIAITS
I ( W/ C.1. PIPE
EXTENDIM& 3'
ONTO SOLID SC:,, f i'~;Qjua I II ALARM ONTO O SOLID S
O SOIL
v I I ON
I I
1 $ I~"' PUMP
-
OFF
0
CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SPECIFIGATIOMS
SEPTIC AND
DOSE TANK MANUFACTURER: -h- NUMBER OF DOSES'
PER pAy
TANK :,IZE:GALLONS DOSE VOLUME
ALARM MANUFACTURER' .,~o INCLUO!!:;, ;,AC! PLOW: -32-L 9 GALLONS
MODEL NUMBER: /1~iJ CAPACITIES: A=. 3INCHES OR /I&2GALLOU5
SWITCH TYPE: X " B n 2 INCHES OR GALLONS -9,5' ZX PUMP MANUFACTURER: QQ
C IWCHES OR 3A.If/ GALLOIJS
MODEL NUMBER:~~
D INCHES OR 1-&.-['w10 ALL0 NS
SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE
PUMP DISCHARGE RATES-=--GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE et'?? /EEN PUMP OFF AND DISTRIBUTION PIPE.. _ - FEET
+ MIAIIMUM NETWORK SUPPLY PRESSURE . FEET~*'' -405 '
+ FEET OF FORGE MAIM X _ 5 F oiT.FRICT1o11 FACTOR. FEET O ~
_ TOTAL OJUAMIC HEAD = C EET
INTERNAL RIMENSIONS OF UK: L GTH
,WIDTH ;LIQUID DEPTH
SIGNED: LICEMSE HUMBER: ,JS'L3 DATE:
-117-
~Y-"\1 h 7 /CyrCIe-
• R i n5e CY c~ ~ I
Ho 6 0\ r~ May', M~A so
S 2ria1 M) / 3 7
l .eAsf ~,4oa JENT /
' /~xru~C Qort~'S
~v
f ~c'a✓
-ZAUEr P/
3
LLzr
-7 50051-1
~PAge a5y ~
l ~45(k rPY-, S ft~c I-,
r Ca /v, h
hl
L r~-,~q- 9 a
GOULDS SUBMERSIBLE
' SEWAGE AND EFFLUENT PUMPS _
. F ~ EP0311 sy0
Me i,. y
LIST DISC.
OOUPEP0311 142 EP0311 1/3 HP 115 V Effluent Pump 1/2" solids
EP0011 256 80 172 10
Submersible
Effluent Pump MODEL EP0311 '
METERS FEET SIZE 3I8 SOLIDS
25
g .20
15
= 4
0 10
H
2
5
0 00 4 8 12 16 20 24 28 32 36 40
L GPM
0 205 5.0 7.5 m'/h
CAPACITY
~ r
Performance
Curve 3885
METERS FEET c
yc • ~
2e MODEL 3885
801-1 SIZE 3/4" Solids
70
20
7 ao
WIE
15 so
WEOSM
p
10 30 WE
20 WE071
5
,0 p >0 40 so 60 ,0 eo 90 100 110 120 GPM S 9 0' 40 5 2 8
0 10 20 00 mYh
CARAWY
LIST DISC.
aX WE0311L 142 WE0311L 1/3 HP 115 V Low H 3/4' solids 491.55 329.35
OJUPWEO311M 142 WE0311M 1/3 HP 115 V Nod H 3/4" solids 491.55 329.35
GOUPKE0511H 142 WE0511H 1/2 HP 115 V High H 3/4" solids 704.25 471.85
GOUPWE0712H 142 WE0712H 3/4 HP 230 V High H3. .3/4" solids 843.65 565.25
*****SEE FULLOWI,% PAGE FM PERFORMANCE AND SPECIFICATIONS.
DATE 13/88 DEPT 30
PAGE 07u
Pub. # 60 '
1/78 '
PROJECT DETAIL DATA SHEET
'NAME OF BUSINESS
LEGAL DESCRIPTION _~/y ~~c ~y.~, Tom,,,/Q~~ ~~`~„~S`.•
OWNER
MAILING ADDRESS
,G~rx,roh/ZZIP fir?/7
ARCHITECT, ENGINEER, ADDRESS ? /9
PLUMBER OR DESIGNER JJ
TELEPHONE NUMBER
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building k/ New building Addition
( ) Apartments and condominiums . . . . Number of bedrooms
( ) Assembly hall . . . . . . . . . . . Seating capacity
~C) Bar . . . . . . Seating capacity_ # of meals served
( ) Bowling alley . . . . . . . . . . . Number of lanes ( ) With bar
( ) Campground and camping resorts Number of sewered sites
Number of unsewered sites
( ) Total number of sites
Camps
• ( ) Day use only Number of persons
( ) Catchbasin ( ) Day and night Number of persons
( ) Number
Church
. . . ( ) No kitchen Number of persons
( ) Dance hall ( ) With kitchen Number of persons
( ) Dining hall Number of persons
9 . . . Number of meals served daily
( ) Dog kennels . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity-
Car-service Number of car spaces
( ) Dump station . . . . . . . . . . Number of dump stations
Employees ( total of all shifts) Number of employees
( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit
Number of units with 4 persons per unit
( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff
Number of office personnel
Number of patients
( ) Mobile home parks . . . . . . . Number of sites
( ) Nursing homes . . . . . . . . . Number of beds
( ) Parks . . . . . . . . . . . . . . Number of persons
( ) Toilets ( ) Showers
(X) Restaurant . . . . . . . . . . . . . Seating capacity ;?o
( ) Dishwasher and/or disposal?
( ) Retail store ( ) 24-Hour service
. Total number of customers
( ) Schools . . . . . . . Number of classrooms Meals ( ) AdMers
( ) Self service laundry Total number of machines
( ) Service station . . . Number of cars served daily
( ) Swimming pool bathhouse . . . . . . Number of persons
( ) OTHER . . . (Specify) . . . . . . . -
COMPLETE OTHER SIDE
il~
2. Indicate whether the following facilities are present. t.` Cam,. e4ims
Floor drain yes no _~C Number of drains L_
Food waste grinder yes no K
Dishwasher yes no x
Automatic clothes washer yes no = Number of clothes washers
3. Septic tank capacity D /
Holding tank capacity
Septic or holding tank manufacturer
4. SEEPAGE TRENCHES: total square feet width of trenches
length of trenches depth
number of trenches
/p-5/ ,lam
SEEPAGE BEDS: total square feet width
length of beds depth
SEEPAGE PITS: total square feet outside diameter
depth below inlet
total depth from top to bottom of pit
Signature of son completing form: FOR DEPARTMENTAL USE ONLY
e
& Y x
Address
AL .~,✓i>>~,,% 1l,1- Z i p
Telephone Number
Date 29- 9~
2
444719 pon, 832
STATE OF WISCONSIN CIR(.'UIT COURT ST. CROIX COUNTY
FIRST NATIONAL BANK
109 East Second Street
New Riclunond, Wisconsin 54011
Plaintiffs SHERIFF1S DEED
VS.
GASPER A. CAMPEAU
and DORIS M. CAMPEAU Case No. 87 CV 434
Route 1
Somerset, Wisconsin 54025
and
DALE E. CAMPEAU < t\
Route 1 r r ` ; 1\~
Star Prairie, Wisconsin 54026 ; T. 19E3
and
41Frk v1 G;.:u;
L'rt. f~4U 0e _ANDRLW J. CAMPEAU
Somerset, Wisconsin 54025`1
and
GASPER'S OF SC)MERSET, INC.
Route i
Somerset, Wisconsin 5401'/
and
REGISTER'S OFFICE
ROBED J. CAMPEAU $T. CRO1X CO., WI
Somerset, Wisconsin 54025 Rec'd for Record
and 'AN 181989
at 4:00 P M
MARY E. C:AMPEAU ~i
Scxnerset, Wisconsin 54625 Register of Deeds
and
ALLEN CAIJPEAU
Route 2, Box 193
Somerset, Wisconsin 54025 w
and
:a:.
CYNTHIA J. CAMPEAU
Route 2, Box 193
Somerset, Wisconsin 54025
@OCK 832 PA,'E 43
anci
NANCY CA EAU
Somerset, Wisconsin 54025
and
mAra & L'UDVIGSON
Attorneys at Law
208 Cascade Street
P. O. Box 337
Osceola, Wisconsin 54020
Defendants.
This indenture, maue the 21st day of November, 1988, between ttalph
E. Bader, Sheriff of tic County u SL. Croix Cowity, party of tiie first
part, and First National Bann o New Rictunond, party of the second part.
Witnesseth, that whereas, at a Term OL tiie Circuit Court, held in
and for the County oz St. Croix County, State of Wisconsin, at the
Courthouse in Hudson, in said County, on the 13tH day of May, 1988, it
was among other things ordered and adjudged by the said court, in
certain action then pending in said court, between the plaintiff, First
National Bank, and cietendants;
That all and singular the mortgaged premises mentioned in the
complaint in said action, and in said judgment described or so much
thereof as might be sufficient to raise the amount due to the plaintiff
for principal, interest ana costs in said action and which might not be
sold separately without material injury to the parties interestea, be
sold at public auction by or under the direction o tide sheriff of the
County of St. Croix, at any tirre, after six months from the date of said
judgment, unless, previous to such sale said premises and said judghreent
shall be redeem in the hranner provided by law; that the said sale be
SOON 8 2 PA E 44
made in the County of St. Croix where the premises are situated;
That the said sherif give public notice of the time and place of
such sale, in the maruier provided by law, that any of the parties in
said action might purchase at such sale; that ti►e said sheriff upon
compliance by the purchaser with the tetras of such sale, execute and
deliver to tree Clerk of Court, a decd to the purchaser of such premises,
so sold, setting iorth each tract or parcel so sold and the sum paid
therefor; that the Clerk of Court, upon compliance of the party of the
second part with ali the requirements of Section 846.17 Wis. Stats., as
amended, deliver to the purchaser, or purchasers, said deed.
AND WhEREAS, the said sheriff, in pursuance of the said judgment of
the said court, did on the 15th day of November, 1988, sell at public
auction, at the front steps of the St. Croix County Courthouse in the
City of Hudson, St. Croix County, Wisconsin, at the hour of 10:00
o'clock a.m. of that day, ali the premises in the said judgment
mentioned, due notice of the time and place of such sale being first
given, agreeable to the said judgment at whicii sale the premises
hereinafter described were struck oif to tine said party of tY►e second
part for the suiri of of One Hundred Ninety Five Thousand ($195,000.00)
Dollars, said party of tide second part being the highest and best bidder
therefor, and that being the highest sum bid for the same;
Now, this indenture witnesseth, that the said sheriff, by virtue of
the said judgment, and of the statute in such case made and provided,
and in consideration for tiie said sua of money, so bid as aforesaid,
being first cuiy paid by the saki party of the second part, the receipt
whereof is hereby acknowledged, has granted, bargained, sold, aliened
and conveyed, and by these presents does grant, bargain, sell, alien and
convey unto the said party of the second part, and to his heirs and
BOOK 832
assigns forever all the following described land situated in the County
of St. Croix in the State of Wisconsin, to-wit:
Tile South Half of the Southeast Quarter of the Southeast
Quarter (Sj of SE$ of SE$) of Section Twenty-Three (23),
Township Thirty-One (31) North, of Range Nineteen (19) West,
EXCEPEING that certain parcel of land located in the Northeast
corner of said South Half of the Southeast Quarter of the
Southeast Quarter (Sj of SEJ of SEJ) sold to L. J. Beauvais,
containing one-half acre, more or less, St. Croix County,
Wisconsin.
To have and to hold all and singular the premises above mentioneu
and described, and hereby conveyed or intended so to be unto tie said
party of the second part, its successors and assigns, to its only proper
use, benefit and behold, forever.
In Witness Whereof, the said party of the first part, Ralph E.
Bader, Sheriff as aforesaid, hath hereunto set his hand and seal the day
and year first above written.
Ral 11 der, Sheriff
St. Croix County, Wisconsin
STATE OF WISCONSIN )
) ss.
COUNTY OF ST. CROIX)
Personally came before me this Y." day of 't e-L` , 1988, the
above named, Ralph E. Bader, Sheriff of St. Croix County, Wisconsin, to
me known to be the person and offer described in, and who executed the
above conveyance as such officer, and acknoyaed ed the same.
No ary Publ c :
County.of S . Croix, Wisconsin
Nly Cam ssion .L%pires:
NDUSDUSI:.Icy. TOF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS
I NR,Y DIVISION
ISION.
LAU013 ANb PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS MADISON, WI 53707
~r (ILHR 83.09(1) & Chapter 145)
O 10 N: SECTION: WNS NICIPALITY: OT NO.:BLK NO.: SUBDIVISION NAME:
fry/ ~Qor Y4 /T N/ E Io o/~~r3 -
MAILING ADDRESS:
000NTY: .~t g/1/)/~
D'~
.Gl1e7/~ t r / tx/liL~ D 14!/Cr~f110h- ~~J~o/
USE C DATES OBSERVATIONS MADE 90
NO.BEDRMS.: COMMERCIAL D S IPTIO [ROFILEDE SCWrMONS: PERCOLATION TEST
❑Residence /L40 ❑New Replace ~yS:
~ ~ TA
RATING: S- Site suitable for system U- Site unsuitable for system
rONVENTIONAL: MOUND: IN-GROUNDESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional)
rV, Vill sau osr2u sou as u os ZU -7,
If Percolation Tests are NOT required DESIGN RATE: iQ
If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: Floodolain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS _
BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AN.D DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
Ozi-
BJ m 310, "s/8r ; S/I V~' 0~
B_ p.t.~ 22 s"'$ '2~ S/~ y dais S
B-
B-
y~ PERCOLATION TESTS
TEST DEPTH , WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES
NUMBER AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI P PER INCH
P. ~ aZ L ~
P- .r
P_ prt AF _ - - L
l
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 7<? Z O O ' 40
~I I
4,6
i j ~ I app
,
/10
~L, Sao/
3
-c
az;, o F,? 74
I, 111, 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 Wis nsin
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:
ADDR SS: CERTIFICATION NUMBER: PHONE NUMBER(optionall:
lzze- 011 -72
1-1' CST SIGN E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. t.,.
'LHR-SOD-6395,1R. 10/83)
- - ~ OVER -
SEPTIC TANK MAINTENANCE AGREEPIENT w
St. Croix County
w
OWNER/BUYER o
ROUTE /BOX NUMBE Fire Number o
Z4 d
w
CITY/ STATE ZIP
PROPERTY LOCATION:*.'S~ SectiorLZ?. , T, _N, R _W,
Town of _St. Croix Coun y,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed 's*e t'ic tank pumper. What you put into
the system can affect tthe :unct on o. t e 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,
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 .sys't'ems agree to keep their system properly
maintained.
The property owner agrees to.submit to St. Croix County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or.a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2).after inspection and pumping (if nec-
essary), 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-
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED 7154el~'E_z V
DATE
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
APPLICATION FOR SANITARY PSRMIT
9TC-100
This application form Is to be conplatod in full and signed by the owner(s) of
the property being developed. Any lnadaquacles will only result In delays of
the patm)t Issuance. -Should this development be intended lot resale by
ownet/conttectot,(spec house), then a second form should be retained and
completed when the property Is mold and submitted to this office with the
appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of property
Location of property 1/4 x/4, Section c;?_ . T_,jL_-R.L9-V
Township s~7 '~fl
Malting address
77) /
Adatess of alto 1
lvbdtvlslon name
Lot number
Previous owner of property ~i9rne~su
Total 5120 of parcel
Data parcel was created
Are all corners and lot lines Identifiable? >Z an _ 110
Is this property being developed for resale Capes house)?______,Yes - No
Volume , and Page Number as recorded with the Register of Deeds.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - •
INCLUDE WITH THIS APPLICATION T112 FOLLOWING:
A VARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMItR, and
the 89AL OF THE R8018TER OF DEEDS. In addition, a certified survey, It
4vallable, would be helpful so as to avoid delays of the reviewing process. It
the deed description references to a Ceitifled Survey Map, the Cartifled Survey
Map shall also be required.
---------------------------------------------------------7---------------------
PROPERTY OWNER CERTIFICATION
I(Vs) certify that all statements on this form are true to the best of my (our)
knovledge; that I (we) am (ate) the owner(s) of the property described In
this Information form, by virtue of a warrantcorded in the Office of
the County Register of Deeds as Document No. and that f two)
Presently own the proposed alto for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
constru ton of sold system, and the same has been duly recorded In the office
of th oynty Regis? r of Deeds, as Document No.
l gn tute of owner Signature of Co-owner (If Applicable)
Date of Signature Date of Signature
i
F,
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ~ TOWNSHIP z1 SEC. j _ T Z~N-R~_W
ADDRESS! ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT / LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i i
3 a3 ~ jy,
IND CATE NORTH ARROW
t
BENCHMARK: Describe the vertical. reference point used
rG~ r
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANF,: Manufacturer:
squid Capacity:
-j e'
Number of rings used: ---I- Tank manhole cover elevation: 9 -~7
7_
Tank I41 et Elevation: 7 Tank Outlet Elevation:
Number of feet from nearest Road:
Front, Side,O Rear, O feet
.From nearest property line Front, Side,0 Rear, 0 Z go feet
Number of feet from: well, building: _
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE STDF.
f `
4
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft, _
Number of feet from well:
Number of feet from building:
f.Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
2
T
Width: Length:_ Number of Lines: 04 Area Built:
Fill depth to top of pipe: c2_-Z'
Number of feet from nearest property line: Front, O Side, ( Rear,O Ft
Number of feet from well:
`po V/
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm ranufacturer:
Inspector:
Dated:x Plumber on job:
License Number: ~s
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
:
W(CONVENTIONAL ❑ALTERNATIVE IS,,,,., Planl.D.Number
r ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound (ltassigned) ` Z
o3-1y
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Gab eAl s TaveAn R. R. 1, Some/Ue>1`, W1 ",For ,v D O
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.'.
S€ SE, Section 23, T31N-R19G1, Town of SomeAze
Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number
Cad Power 1563 St. cAoiX 54908
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.'. TANK OUTLET ELEV.: WARNING LABEL LOCK' G RNO'
P EPROV ED
YES ❑NO BEDDING: JVVHIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM IFEET FROM E. AIR IN LET
❑YES NO ( ❑YES ❑NO NEAREST 1000 ~ !V U ~O~ /
DOSING CHAMBER:
MANUFACTURER. BEDDING'. LIQUID CAPACITY JPUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL JLOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. BUILDING. IVENTTOFRE5H
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LLr1c;u DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
I,( I
LENGTH NO.OF DISTR. PIPE SPACING COVER NSIUE DIA #PITS LIQUID
BED/TRENCH WIDTH:
DIMENSIONS 12 7 TRENCHES M PIT DEPTH.
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR PIPE DISTR. PIPE MATERIAL: NO. D 'PIR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIP S` ABOVE COV E EV IN/LET. ELE V( / PIPES' FEET FROM LINE'. AIR INLET:
S.10 9
I Z 7 Z-` Z NEAREST-------o- 2ZS Zap SS
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
❑YES ❑ meets the criteria for medium sand. TIONS MEASURED.
NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
YjF' S ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED 71EPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SO DED SEEDED. MULCHED:
CENTER. DGES'.
YES /JNO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH: NO. OF LATERAL SPACING. A L DEPT BE W PE. PILL DEPTH ABOVE COVER'.
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE ANIF LD ATERIAL. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEVATION AND ELEV.: ELEV.'. DIA.: ELEV.: IPES: DIA.:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS:
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE PROP: ERTY WELL: BUILDING:
L12 FEE
❑YES ❑NO ❑YES ❑NO T FROM NEAREST-
tj\ArL
9,C)
D L
C,
Sketch System on Ret in in county file for audit.
Reverse Side.
SIGNATURE: / TITLE:
'0l 01'
DILHR SBD 6710 (R. 01/82) `tom
Department of Industry, Labor and Human Relations
~~.w«,~^ Division of Safety & Buildings
L DILHR Bureau of Plumbing
P.O. Box 7969
MlOUSTRV, LRBOR 6 NURYif1 RELATIOr15 Madison, WI 53707
Tel. (608) 266-3815
LU IN ALL CORRESPONDENCE
REFER TO PLAN
IDENTIFICATION NO.
i Q 7Y6/7 NAME ~t PROJECT
&~-15 P L oL4
ft Aq)
E NL - q
❑ GENERAL PLUMBING PLANS Q Fee Received:
Priority Plan Review n y
LOCATION 1
sf--- f 23 V
CITY OR TOWN COUNT
Examination of plumbing plans and specifications for this project has been
completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin
Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the stipulations shown on the plans. Please
review your code for the requirements of each code section noted.
The licensed plumber responsible for this installation shall keep at the
construction site one set of plans bearing the department's stamp of approval.
The installer shall also notify the appropriate inspector of wher required
inspections are to be made.
In granting this approval, the Division of Safety and Buildings does not hold
itself liable for any defects in plans or specifications, plan omissions or
examination oversight, and reserves the right to order changes or additions if
necessary.
This approval is based on Wisconsin Administrative Code requirements. It
shall be necessary to obtain and fulfill the permit requirements of the city,
village, township or county in which this installation is to be made. Failure
to obtain local permits will automatically void this approval.
Sincerely, For Private Sewage Systems Only:
This approval is valid for two
years or it will be valid until
James Sarg t the expiration date of the initial
Bureau Dire or sanitary permit.
AN REVIEWED BY: DATE: Q
cc: DP' - OW Owner H & R & Rec- San. Section
Plumber Bur. of Health Fac. & Services
County Other
DILHR SBD-6099 (R. 05/82)
STATE OF WISCONSIN DILHR
ING BUILDINGS
DILHR PRIVATE SEWAGE SYSTEMS BUREA 1"OOFF SAFETY &
201 E. Washington Avenue, Rm 17
PLAN APPROVAL APPLICATION P.O. Box 7969, Madison. WI 53707
608.2663815
INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received.
The bark side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration,
Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358.
1. PROJECT INFORMATION Type or print clearly) Revision To Plan Number:
Name of S-ibmitting Party (Pla eturned to same) Project N a
L) 1 f.A)O 175 Z_ r S 70 ilk rY% AR
Street & No. or Rural Route Project Location - S reet & No. or Legal Description
3 t /J LA '-,C-
City or Village State zip city County
ALJRIC'hyrta~ WI. SG 1910/7 Village ❑ OF:
Town
Telephone No. (Include area code)
S - 6 - 5/.3,5
Designer Telephone No. (include area code) Owners Name„ Telephone No. (Include area code)
44 Street & No.
iv-A- Street & No K No.
City or Village ~ State Zip City or Village State Zip
.So c .s
2. APPLICATION R:
K Conventional System - Public Building (1) ❑ New Mound System (3a) ❑ Holding Tank (2)
❑ Replacement Pressurized System (4b) ❑ Replacement Mound (4a) ❑ Petition For Modification (6)
❑ New Pressurized System (3b) ❑ System in Fill (1) ❑ Other Alternatives (5)
❑ System in Flood Fringe (1)
❑ Groundwater Monitoring (7)
3. FEE COMPUTATIONS (Include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE
MAKE ALL CHECKS PAYABLE TO DILHR
3a. 750. 1,500 gallon septic tank -30.00 4a.
3b. 1,501 - 2,500 gallon septic tank -40.00 4b.
3c. 2,501 - 4,000 gallon septic tank -55.00 4c.
3d. 4,001 - 8,000 gallon septic tank -70.00 4d.
3e. 8,001 -12,000 gallon septic tank -85.00 4e.
3f. Over 12,000 gallon septic tank _100.00 4f.
3g. 500 - 1,000 gallon dose chamber -30.00 4g. RECEIVED
3h. 1,001 - 2,000 gallon dose chamber -35.00 4h. _
3i. 2,001 - 4,000 gallon dose chamber -50.00 4i. UN 181984
3j. 4,001 - 8,000 gallon dose chamber -65.00 4j.
3k.~ 8,001 -12,000 gallon dose chamber -80.00 4k. PLUMBING BUREAU
31. Over 12,000 gallon dose chamber -95.00 41.
3m. 500 5,000 gallon holding tank -30.00 4m.
3n. 5,001 - 10,000 gallon holding tank -40.00 4n.
t 3o. Over 10,000 gallon holding tank -50.00 4o.
3p. Groundwater Monitoring Per Lot -32.00 4p.
(other than a proposed subdivision) Subtotal
3q. Priority plan review: (walk through) 4q.
Submittal of plans in person,
by appointment, with double fee * • O
3r. Petition for Modification 4 4 n
setback -20.00 4r. o
Site evaluation -50.00
Total Fee
DILHRSBD-6748 IR. 02/83) _ NOTE: Fees subject to change on July 1, annually. -OVER
mmnnw~ APPLICATION FOR SANITARY PERMIT
'~)DILHR nOUNTY
ems) oEVSwTment of
(PLB 67) UNIFORM SANITARY PERMIT #
- M1dUST9%V,LRIBOi'16 04I.lIT1A1'1 iiELFlT10r15
-_.-y 909
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PRO E ,,,,Y OWNER MAI ING ADDRES
P ERTY LOCATI N CITY: Nd~j,~ '
VILLAGE-
1/ 1/4, , N. R (or TOWN OF:
OT N MBER
J'Y BLOCK UMBER SUBDIVISIO NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
❑ 1 or 2 Family Number of Bedrooms: Public (Specify):
THIS PERMIT IS FOR A:
V New System ❑ Tank Replacement ❑ Repair
E) Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepage Bed ❑ Seepage Trench U Seepage P?. ❑ Holding Tank
r- System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued -
El An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: r
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total *of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch)- REQUIRED (Square Feet): PROPOSED( Square Feet):
Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installati f the private sewage system shown on the attached plans.
Narttq of lumber( 1 t): / Si to MP/MPRSW No.: Phone Number:
✓ ~ ' - ~ 3S
Plu is Addres : Name of Designer:
j 41 )J- 761 ec J1 I
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: ~~,~~1 Date: ❑ Disapproved
6 0-0 / ❑ Owner Given Initial _2~i csi o / Approved Adverse Determination -
Reason for Disapproval:
84,-0 e~ ! RECEIVED
Alternate course(s) of Action Available: Q
JUN Q B
PLUMBING BUREAU
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (1151 P.O. BOX 7969
HUMAN RELATIONS \ / MADISON, WI 53707
,(H63.09(1) & Chapter 145.045)
L CATI N: SECTION: d TOE Nr, / UNICIPALITY: OT O.:BLK O.: SUBDIV SION NAME:
11 1/4 /T N/R L (or) W A. ,Tr
C NT W ER'S BUYER'S NAME: An" :r
ILI ADDRESS:
i
USE
NO. BE MS : COMMER IAL E DATES OBSERVATIONS MADE
❑Residence New ❑Replace 1 DESCRIP;PIS: O STS:
1.44 V
RATING: S- Site suitable for system U- Site unsuitable for system r
ONVENTI NAIL: M( tLl1 ODUN ( D: IN-GROUND-PR
'f _ : SYST~` -IN-FILL OLDIcNG TANK: RECOMMENDED -SYSTEM: loptional►
HIS c ❑V J J ❑V ❑J ®U ❑J ®u 1S
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: 7 Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPT++N. ELEVATION OBSERVED EST, HIGH TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B-
-7- a
B- y
1) R. R11,_ S 7--2 Sol
s
B-s- _ -
B-
PERCOLATION TESTS
TEST -DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P ql PER I 2 PER INCH
i
P- Y9 A&A),r
P- - / 13 V/Z A<
P- ? p r 3 /t
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. ~2 -14u
ill
SYSTEM ELEVATION
rl1r1 I
tc.►1 i ~t~Jls i t ED
owl
t5un
Su%tsB%.✓t° ( -_T- ctrl- j
! !
ISO 4f.
i :
~ t ` ! I V .i I~ r ,
I
I
~r
-
\3 4
I I
1.
OF—
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 ,
i
NAM (print : T S W RE M ETEID ON:
f#44L
AD JrQ ~I
ERTIFICATION NUMB PHONE NUMBER(o tionaq:
r
CS
TUR
I and one copy to Local Authority, Property Owner and Soil Tester. /
OVFR - j/.
P
P1 b. 60
1/78
PROJECT DETAIL DATA SHEET
. f
, NAME Of BUSINESS 61~Pr'.P,S
LEGAL DESCRIPTION LSD ,Sf►~~/, SF3 T3/~t//~ -
10,
OWNEREgU MAILING ADDRESS
y ,ecEr kA ZIP y~/~
ARCHITECT, ENGINEER, ~~11h~ ,~J,P ADDRESS
PLUMBER OR DESIGNER
ZIP .s2
84'03446 TELEPHONE NUMBER
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building New building Addition
( ) Apartments and condominiums . . . . Number of bedrooms
( ) Assembly hall . . . . . . . . . . . Seating capacity
( ) Bar . . . . . . . . . . . Seating capacity # of meals served
( ) Bowling alley . . . Number of lanes ( ) With bar
(~Q Campground and camping resorts . . . Number of sewered sites
Number of unsewered sites ; T
Total number of sites zT
( ) Camps . . . . . . . . . . . • . . ( ) Day use only Number of persons
( ) Day and night Number of persons
( ) Catchbasin . . . . . . . . . . . Number
( ) Church . . . . . . . . . . . . . . ( ) No kitchen Number of persons
( ) With kitchen Number of persons
( ) Dance hall Number of persons
( ) Dining hall . . . . . . . . . . . . Number of meals served daily
( ) Dog kennels . . . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity
Car-service Number of car spaces
( ) Dump station . . . . . . . . Number of dump stations
) Employees ( total of all shifts) . . Number of employees
( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with 2 persons per unit
Number of units with 4 persons per unit
( ) Medical and dental office bldgs. Number of doctors, nurses, medical staff
Number of office personnel
Number of patients
( ) Mobile home parks . . . . . . . Number of sites
( ) Nursing homes . . . . . . . . . . . Number of beds
( ) Parks . . . . . . . . . . . . . . . Number of persons ( ) Toilets ( ) Showers
( ) Restaurant . . . . . . . . . . . . Seating capacity
( ) Dishwasher and/or disposal?
( ) 24-Hour service
( ) Retail store . . . . . . . . . . . . Total number of customers
( ) Schools . . . . . . . . . . . . Number of classrooms __C7 Meals ( ) Showers
( ) Self service laundry . . . . . . . Total number of machines
( ) Service station . . . . . . . . . . Number of cars served daily
( ) Swimming pool bathhouse . . . . . . Number of persons RECEIVED
( ) OTHER (Specify) . . . . . . .
Ca
COMPLETE OTHER SIDE
PLUMBING BUREA'1
to
30N3(3N0dS3 a43 39S
S9 IQlif19 CAN A13 30 NOISIA10
SNOlIV13U NbWf1H OHOG 1 AH1Sf1QNl 3 1N
a3AkO
~ftn rv
aleQ
S - AagwnN auo4d9lal
LZ t
ssajppv
V 7
AINO 3sn IVIN3Wladd3a HOJ :waO.4 6u Lla ldw os.Aad jo ain4eu6LS
ltd jo wolloq of dol wojj 44dap M04
4OLUL Molaq 44dap
aalaweLp app4no pal aaenbs Lep4 :Slid 39Vd33S
i~ 41dap , paq ,}o 446ua L
44pim + laaj aaenbs M04 :S039 39Vd33S
s843uaa4 10 aagwnu
44dap sa4Ouaa4 10 446u8l
saWuaal 10 44KM laaj aaenbs P104 :S3HON3Hi 39Vd33S -V
f - G aaa oelnuew fuel 6uLpL04 ao OL4daS
k4pede:) fuel 6uLploH
V6 IC, 17 k4 pedeJ fuel o ildaS *E
saa4seM sa44OLD 10 AagwnN Y- ou SOX a84seM sa440L3 OLlewojny
ou SOR aa4semO EO
ou sax
aapuL.a6 alseM pooj
suLe.Ap 10 ' AagwnN X ou 'sac ULP.Ap .10013
• luasaid a.1e sa L4 Moe4 6U LMO1101 a44 Ja44a4M aleO Lpu I -Z
•
~ ---/'fir : _ L7C~•~~c..~,S.tr . ' -
l'-,Ogg
99
-9Y7
i
IS
-lo
y.; .ti - - NuM N i
p~l►Mgi
T
1 Cam,
PAGE OF
'O S tL c~ 1 O r"1 O t' A~ r 17 S S~ e n'~
. Cr SS y ~
Fresh Air InIsIS And Obsofwallon Pips
C )1 Approved Vaal Cap
Minimum 12" Abovo
Final Grode '
20- 42" Abova Plpa _ 4° Cost lion
~~NQ To final Grode Veal Pipe 84-03446
pW
Or S ntbal verin
I gal
rip n VXN - Tee
on a : r Partorolod Pipe 66lor
-Coupling Tuminaling Al
boltorn Of System
OEp ~ N 0 v~~'1~N 0~ S n~OENCp'
ESP
Ec
u oseD ~1~~1 9rHd<
flu PP
~LICJw7 ton ~ ~ .
SOIL FILL
DISTRIBUTIOIJ PIPE APPROVED S4MPETIC COVER
° MATFIiIAI OR q, OF STRAW
OF MOR EWE OR MARSH HAy
° fv 0F;~2 AGvt,ATE o8
t,LEv OFqA21FEET_~
DIS'1-11I5UTIOAI PIPE TO BE AT LEAST I►~-!C.HES BELOW ORIGIKJAL GRADE
AWU AT LEAST20 INCHES BUT KIO MORE THAI) 42 IAICNES BLOW FINAL GRADE
MAXIMUM DEPTH OF EXt/IVAT1d)0 FKOM clWw a ORAtiF- WILL BE 76 FICHES
MOMUM Wrki OF E'XCAVATIOM fKOM 0~161bqL C3RAQE WILL 'BE 1-2 INCHES
I
t
SIG►.IEO: RECEIVED ,
JUN 181984
LIGEAISE 1.JUMBER: 45 3
pLUMBING BUREAU
DATE:Z
::f3
MA.
' - _tl_1~~t~t , ~ F:>t L~ _•rs-z~rsrs::ssssis. •
1 t~~l
1'`J~•~~I~I Tom) `.Jt t v ~
Ecc
P. Tz-
GURnTjQ-4 OF' %
• FIVE
~5 AS CONCi=2~1`~ htqC
LuQ5
C~.a
}
it-
84.
CEIV D`
JUN 18 984
PLUMBING UREAU i
LUGS a!-Z 5 2 .
. ~ DiESIRtO - Ste! '
- EXTEN Slo;.t W.64-410L-El AVAtlA3LE ON 1^~oT tx~. o
DRAWN APPX*vC0
'
F FtGAi DR~,4N riot-E. CCNIF-
A
turo.~o ro~~~,►res_ sc,LcO.T[_ - _
At v Vo C"'
A:rus s Subsidiary of'Nticrodot Inc. a-1 O ( l /v"~~
-
, : • • fir,
fc) 0
•r ~
• . V
• ~ • • • • • • • - ' • try
y,.yy •
- - - - - - - - - - - - - -
4pp
-r
tam Vft" ~
4 3.4.4 6'
VIEWA
~ - _ , • aid..
ti • . = . RECEIVED ~
v • . ' j uN• 1 198 • IV
pL1IMBMB BUREAU:. s a
Q ' •
• ~,r~;r i . is
46
95
.z~ • • • wow...«•..S•r.~.•••.•...w rw•.......~••w ~r ~w•~• •
41, -A
1 TRAM RS NOTICE
•r. ' 110101u; IANvm DISPOSAL iHls WATER FOR
y \ INSI RUC IONS ,
FLUSHING AND
' sow NECT Toua wY.t TO
MOtolwc 1".,••'Acc ENO
STt.Y•t t: l L~•+••. o.(N• CLEANING FVAPOSE •
aNf. r"IL( wJ, .INi tO V(R vacuum
I OP(w wit. (G7T Mt•ago ONLY •
• O•tn Tga.lta TI,..a ORA.N- -
VALVE.
•
PLUS" A..Ar I'.• S►.L,LAc(
1 coace IC it. 081A.".
~aTtRTOw(t10•T.ONaL{YATst, •
1 • ft►LaCto tr OTw(R LOCALLT
I PTT.Cw ).cN TO
{
SIGN SIGN
A 8
ON 11-cl
atcaNos ILIIWITNJYT .
VALVE 1
_ SHUT-001 VALVE
T(E a IWO
a' twos P.PE SLIIVc
i I --a -
,i -
1 1 watGr.~
ar COCA •.r"
1 1 t.Q"N tc\ .•'1N LL
•'t-•OR VnRinEf LfVPLa /tar(..S,Oh -ANZ)LE
-N
i VIEW A ; RECEIVED
A X JUN 181984
• PLUMBING BUREAU
\w f cO•:~tctTOn
f cold•"tssco
1 VIEW 8 • Host
t
ION
sr viti.Nl
. J.
tr -C 0"m r_►IRIV
{ R-i
fat vs-owasm
- hA
&IN
A 1Rsi' M T - ff.«-)tfnct tot
1 _ •
• V1A ECt •r 01I.FL 111 F0iI 'fRA11.1:1l SArI1'i AP.Y 'A r ION
ioniturV Stutlons provide for 1woper dis-
• posal of•,liquid wastes (rota sevve a
Vacuum Bre,oker holding funks of travel trailers or other
!recreational velsicler. Each Sanitary
Station has a WATER TOWCR to pcanN ~ -
- periodic washdown of the drain inlet
area c,nd to identify its location. Separ-
fi awd from this inlet by a few car longlhs
y is a WATERING STATION with another
viater lower to fill water storage tanks t
io travel trailers.
Flexiblo Nose 1 ID - T Braid 9' long
with reach of approx. IS'.
Extra heavy spring. S" In diameter, ter
;r taus Its resiliency and returns the arm
o to Its normal vertical position.
Ibs.
Weight - A;+r+roxim,2t~Ty 100
WoK-4* .14
'84'70344-6
" Z Galvanized steel pipo painted red.
shut-oil valve.
i RECEIVED
,1UN 191984
Oren water PLU~ABING B~iiEAU
nozzle -Brass ,
Water connection bushing Ski'" pipe.
Bast, is 9%- round steel casting with
foundation bolt holes for Y:" bolts fi'r' r
spaced V ccntc:3 for 10" square or
- round eoikcretc base. •
RC,M0 i Ll1 C+. CCU., OilItficlu, Wiscon ;11 530,L
• Phone: Arco Code 414 50 3151
~P-s~`~° ~la n u c.~vJ P
FP1 {
84-03446
a PLukwlNQ
C~► onaI4
IONS =
R P T OF NDUST RY, R VE AN R
DIVISION OF SAFE ANU UI DINGS
SEE CO PONDENCE
i
~ p a7.2
g
RECEIVED j
JUN 181984
PLUMBING BUREAU t. _
D artment of Industr Labor and Human Relations
UXSCCWVM All i; n of Safety & Buildings
Bureau of Plumbing
D' ~c9 P.O. Box 7969
oil ~ oeoRRTrr~enT of
- InOUSTRV, LRBOR 6MUFTRfIRELRT10P15
Madison, WI 53707
l~ 2 FO Tel. (608) 266-3815
a iy~ 98
C-ALV't Vre i ALL CORRESPONDENCE
REFER TO PLAN
Zti IDENTIFICATION NO.
Z~S
NAMOE PROJECT E ,
S i3k, -e- 5
ONL - t
❑ GENERAL PLUMBING PLANS 7Feo eceived:
LOCATION ity P lan Rev ew n y
"IT iff Z f
CITY OR OWN C NTY_
Examination of plumbing plans and peci is project has been
completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin
Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the stipulations shown on the plans. Please
review your code for the requirements of each code section noted.
The licensed plumber responsible for this installation shall keep at the
construction site one set of plans bearing the department's stamp of approval.
The installer shall also notify the appropriate inspector of wher required
inspections are to be made.
In granting this approval, the Division of Safety and Buildings does not hold
itself liable for any defects in plans or specifications, plan omissions or
examination oversight, and reserves the right to order changes or additions if
necessary.
This approval is based on Wisconsin Administrative Code requirements. It
shall be necessary to obtain and fulfill the permit requirements of the city,
village, township or county in which this installation is to be made. Failure
to obtain local permits will automatically void this approval.
Sincerely, For Private Sewage Systems Only:
This approval is valid for two
years or It will be valid until
James ~Sarg t the expiration date of the initial
Bureau Dire or = sanitary permit.
09
DATE:
AN REVIEW-ED BY:
T\a- - 12 4 ZI
Cc: DP - WS Owner (E! & R & Rec. San. 4ection
Plumber Bur. of Health Fac. & Services
County Other
DILHR SBD-6099 (R. 05/82)
N
y
y
r
ST C- 105 r
r y
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County
0
O W N E R / B U Y E R L4 Q 0-cA W
ROUTE/BOX NUMBER _13OX- SO Q. Fire Number
CITY/STATE d A-ygLz I P 0
PROPERTY LOCATION: ~Oi~ Section, T~ N, R_Z)'_W,
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. Proper maintenance con-
sists 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 treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July`l, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agre:_e.-eorkeap their systems properly
maintained.
_r
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by'the owner and by a master plumber}
journeyman plumber, restricted plumber or a licensed pumper,veri-
fying that (1) the on-site wastewater disposal system is ia~`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. y
0
E
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 Depart- Fv
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three year expiration date.
SIGNED OQQAA 46,
DATE k LL~..Q ?44
St. Croix County Zoning Office
P.O. Box 98•
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
APPLICATION FOR SANITARY PE:MIT
S T C - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor,("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property EQ AAA N AAA K,116_11% 9 C~`d~l'ar-~ ACS
Location of Property 5 ~4 .5/-" 34, Section C T N- R W
Township Q W► "
Mailing Address ~k~Q ► a 7
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel ,~litnr.
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume l 7~ and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Othe -recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
4orcm ahe tAue to the but o .
nts on thi/s ~i my (oul)
I (We) eet~te.4y that a,Qt .6tateme
knowted9e; that I (we) am ( cute) the owne~c (b) , o g the prco petety de/scAibed in thus
in4otrmati..on 4on.m, by viAtue o~ a wcmanty deed tecon d in the O44.c.ce o6 the
County Reg~teA o~ Deeds as Document No. ,350 / 8 ; and that I (we)
pnesen ty own the pnapoAed 6 to Cott the sewage dcspoAat 6y6tem (on I (we) have
obtained an easement, to stun with the above dmcAi.bed pttopehty, Gott the
eonsthuct i.on o6 said system, and the same h" been duty Aeeonded in the O ~ 6ice
og the County Regi6tett o6 Deeds, as Document No. ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)`
(n-!~ O- '
DATE SIGNED DATE SIGNED
r
DOGUMENT NO. STATE IIAII OF WISCONSIN--FORM 11
A E 4 4 7 LAND CONTRACT-Individual and
VAI Corporate
577 THIS SPACE RESERVED FOR RECORDING DATA
3~7_.UI38
` R~G:STcRS OfFlCE
Contract, by and between ?-PCT-.A...-Cawcau__and..._.__.._ ST. .,STE SO., WIS.
D------- Doris.- M.-- ---Campeau, nd yidua_l]y_-- and_as_Joint..tenants
(..Vendor", Recd. for Record INs- 1hth
whether one or more) and-----Da~ _ V_Q_aU._Md..Andrew_.J..-_------- day of_.7,li A.D. 1938
- - ------Campeau~_ aS . tenMtS UL_ r_ aMlan------------ at i K~ 1a
("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per` I.
formance of this contract by Purchaser, the following property, together with the Rsp4t of Q ,
rents, profits, fixtures and other appurtenant interests (all called the "Property"),
in---------------------_St..__.CMiX--------- County, State of Wisconsin :
RETURN TO
Alex S. Kosa
A parcel of land in St. Croix Colmty, Wisconsin
described as follows:
Tax Key No.
South One-half of the Southeast Quarter of the
Southeast Quarter (S% of SE4 of SE',) of Section 23,
T31N, R191V, excepting that certain parcel of land
located in the Northeast corner of the South one-half
of the Southeast Quarter of the! Southeast Quarter (S':
of SE'-; of SE'-;) sold to L. J. Beauvais, containing one-
half acre, more or less.
Included herein all fixtures and equipment as part of the premises.
Seller to pay one-half of 1978 real estate taxes.
Purchaser agrees to purchase the Property, and to pay to Vendor at ? rset,.Wj,$~QI1S~Il
the sum of $100,000-00 in the following manner: $--10Q_00........................................
at the execution of this Contract, and the balance of $..994900-00 together with interest from date
hereof on such portions as remain from time to time unpaid, at the rate of.... eight.- j8)........ per cent per annum,
until paid in full, as follows:
$1,000.00 per month, including interest.
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor payments sufficient reasonably to anticipate
the payment of taxes, special assessments, fire and required insurance premiums. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law. ] 00 , 00
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal.
2L,=em.
y be prepaid without premium or fee upon principal at any time after....... JanuaLy...1-..., 19.79--- (eR)
t}(ri~ p b!t ~rtb*~ 1}>~~1~ ~ *po't>~it ~atb'°Azs r~laa # sis a lluE f~Vetdi to ~
In the 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 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 continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded berefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
Purchaser agrees to pay the eost of future title evidence. It title evidence is in the form of an abstract, it shaD
be retained by Vendor until the full purchase price is paid.
Purchaser sball be entitle to take possession of the Property on...._..._. J> X. 1 Ip»Z
6creas ORt ON& (TO 3M tMZD IN MM-CONSUMM ACT TAANSAMIONS) ~
AIvjA,ut 6114 *TAT1 "AR nF WICCANRrN M'+•~ t.+~1 R•►.1, r. 1Re
* Pu rhaser. promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest
in it,,and deliver to Vendor on demand receipts showing such payment.
Purchaser shall, keep the improvements on the Property insured against loss or damage occasioned by fire, ex-
tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved
by Vendor, in the sum of s_fu11_Jr suIab1e__ua1Ue_.., but Vendor shall not require coverage in an amount more
than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall
contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original
of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to
insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
be applied to restoration or repair of the Property damaged, provided the Vendor deems. the restoration or repair to be
economically feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property
in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and
to comply with all laws, ordinances and regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions
shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to
the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except
any liens or encumbrances created by the act or default of Purchaser, and except-
- -
Purchaser agrees that time is of the essence and in case of default in the payment of any principal or interest
when due, or in the performance of any of the conditions, covenants, or promises of Purchaser, and such default shall
continue for n period of 0......... days, then Vendor may, at Vendor's option, declare the contract at an end, all
rights of the Purchaser under this agreement cancelled, and the amounts paid by Purchaser hereunder forfeited, the
same to remain Vendor's pro, cr ty as rental of said premises and as liquidated damc,Rca for the failure completely to
fulfill this agreement; and Vendor shall fo-thwith and without notice have-the ris-ht of re-entry; or, nt the option of
Vendor and without notice to Purchaser, notice being hereby expressly waived, the whole amount of unpaid principal shall
be deemed to have become due and payable, in case such option shall be exercised, the unpaid principal and interest
to;'ether with all sums which may be or have been paid by Vender as herein authorized with interest on sucl, dishurap-
menta at tie rate aforesaid sl!all be collectible in a suit of lav., or by foreclosure of this contrnct in the same manner
s if tl•e whole of unpaid principal had been due at the time when any such default occurred. an,l the indcl-tedness shall
ewl,race, with unpaid principal and interest, all the sums so disbursed with interest as aforeaid. In case of legal pro-
ceedin,,s to enforce any remedy hereunder, whether abated or no?, all expenses, including reasonn`-le attorney's fees, shall
b:- added to the principal, become dale as incurred, and in case of Judgment shall be included therein.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents
to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of
the Property, durin- the pendency of such action, and such rents, issues, and profits when so collected shall be held and
applied as the court shall direct.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives,
successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable
consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the
deed to be made in fulfillment hereof.)
Dated this 3.0-th day of ---------•---------.June......-----------------............._.., 1s--•--78
1
\ v
k._~-• --------(SEAL) •..nrA. (SEAL)
Dale E Campeau Gasp Campeau
(SEAL) ........-.(SEAL)
Andrew J. Campeau Doris M. Campeau
•
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this ---30th------- day of STATE OF WISCONSIN
.tee 19.... 7.8. as.
;oe ---------------------------------------County.
Personally came before me, this -----------------day of
Ale X S. KOSa the above named
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, - -
authorized by § 706.03, Wis. Stats.)
THIS INSTRUMENT WAS DRA/TED BY to me known to be the person who executed the
ALEX S. KOSA foregoing instrument and acknowledge the same.
(fiifrnatures may be authenticated or acknowledged. Both Notary Public County. Wis.
are not necessary.) My Commission is permanent. (It not, state expiration
The use of witnesses is optional. date: 1>P.........)
'Names of persons signing in any capacity should be typed or printed below their signatures.
LAND CONTRACT--Individual and Corporate --111a w Par at Wtorwnwln. Worst No. It r
a ~ l
REINSTRA, VAN DYK & NEEDHAM, S. C.
ATTORNEYS AT LAW
201 S. KNOWLES AVENUE
P. O. BOX 127
NEW RICHMOND, WI 54017-0127
L R. R6IN0TRA May 17, 1984 TLLtrMONC
HEWOR" W. VAN DYK
(TIf) 111-SSOS
SCOTT R. NffDMAM
W. W. WARD (Dw COUNSEL)
First National Bank
109 East Second Street
New Richmond, Wisconsin 54017
Re: Abstract No. 6252, Campeau
Gentlemen:
Pursuant to your request, we have examined Abstract No. 6253, covering
the following described property located in St. Croix County, Wisconsin;
The South Half of the Southwest Quarter of the Southeast Quarter
(S]-, of SA of SE;) and the South Half of the Southeast Quarter of
the Southeast Quarter (S'11 of SE; of SF1%), EXCEPT the East Eight (8)
rods of the North Twelve (12) rods thereof, Section Twenty-three
(23), Township Thirty-one (31) North, Range Nineteen (19).
This abstract consists of 77 entries and has been continued to April 30,
1984, at 8:00 a.m., by the St. Croix County Abstract Company.
Based upon the abstract, we are of the opinion that title to the above
described property is in Gasper A. Campeau and Doris M. Campeau, aka
Gasper Amable Campeau and Doris Marion Campeau, husband and wife.
The above described property is subject to a conveyance to St. Croix
County for highway purposes, dated August 7, 1956, recorded August 16,
1956, in Volume "309", page 416, as shown at entry no. 61 of this
abstract.
The above described property is also subject to a Mortgage to the Bank
of New Richmond dated March 7, 1977, recorded March 11, 1977, at 9:30
a.m., in Volume "550", page 176, as Document No. 338534, as shown at
entry number 67 of this abstract.
The above described property is also subject to a Land Contract from the
titleholders to Dale E. Campeau and Andrew J. Campeau, as tenants in
common, as Purchasers, dated June 30, 1978, recorded July 14, 1978, in
Volume "577", page 445, as Document No. 350128, as shown at entry no. 70
.
Y ~
' First National Bank
Abstract No. 6252, Campeau
May 17, 1984
Page 2
of this abstract. Said Purchasers interest being subsequently assigned
to Gasper's of Somerset, Inc., a Wisconsin Corporation by Assignment of
Land Contract dated Novenber 30, 1981, recorded Decenber 2, 1981, in
Volume "638", page 487, as Document No. 374700, as shown at entry no. 74
of this abstract. Said Assinee's interest being subsequently assigned
to the Bank of Somerset by Assignment of Land Contract dated December 1,
1981, recorded March 9, 1982, inVolimie "642", page 351, as Document No.
376090, as shown at entry no. 75 of this abstract.
The above described property is also subject to the terms and conditions
contained in that certain Purchase Agreement between Gasper A. Campeau
and Doris M. Campeau and Dale E. Campeau and Andrew J. Campeau, dated
April 12, 1978, recorded September 29, 1980, in Volume "618", page 209,
as Doucment No. 366674, as shown at entry no. 73 of this abstract
A Judgment in the amount of $213.00 was taken by Maki & Ludvigson
against Andrew J. Campeau and was Docketed March 8, 1983, in "6" of
Small Claims, page 245, as shown at entry no. 76 of this abstract.
However, it appears that said Andrew J. Campeau no longer has an inter-
est in the above described property, as evidenced by that certain quit
claim deed dated January 9, 1979, recorded May 16, 1980, in Volume
"611", page 625, as Document No. 364221, as shown at entry no. 71 of
this abstract. Therefore, the above described Judgment would not be a
lien against the above described property.
Real estate taxes which accrued for the year 1983 are delinquent in the
amount of $2,042.33, plus interest and penalties, as shown at entry no.
77 of this abstract.
This opinion is based solely upon the abstract of title, and, therefore,
inquiry should be made into the following matters which do not appear of
record:
1. The right and interest of any persons presently in possession
or occupancy of the premises.
2. Claims for mechanics' liens not yet filed. Any materials
furnished or labor performed upon the premises within the past
six months may begone the subject of a claim for lien.
Conditional sale contracts, if any, pertaining to personalty
upon the premises or affecting the title to the premises.
3. Any dispute as to the boundaries of the premises.
Investigation should be made to ascertain whether there is any
dispute with the reference to the boundaries and whether
improvements, if any, are located wholly within the
boundaries.
r
First National Bank
Abstract No. 6252, Campeau
May 17, 1984
Page 3
4. Applicable municipal zoning ordinances which may affect the
type of structure that may be constructed on the premises and
any additions to present structures.
Very yours,
DYK & NE DRAM, S.C.
Scott R.
Slit/tg \
Enclosure: Abstract No. 6252
REPORT OF INSPTTTICN--•-INDIWAL S3kTAGE-DISPOSAL SYSTal
PRIItR.Y TREATMENT consists of Septic Tank% Other (Describe)
SEPTIC TANK: Distance from: Well~ft., Lot Line ft. Buildingl,Vft.
High watermark ft. 12% or greater slope ft. Wetland ft.
Cistern ~ft. No. compartments_j_. Liquid capacity 1agal.
EFFLUENT DISPOSAL SYST'M consists of ,Tile field. / Seepage pit (s).
Seepage Pit or Tle Field: Distance from: Well Z- ft. Buildi4,75ft. .
Lot Line ft. Cistern ft. High`Watermark of water course ft.
Slone 12-7 -®r greater ft. Wetland ft.
Total length of tile lines~ft. N ber of lines .7 Length of each 10-6
line ft. Distance between lines ft. Width of treneh_r.'
/ Total effective absorption area of trench bottomdoa. ft.
Depth of filter material below tile in. Depth of filter material
over tile in. Cover over filter material
Depth of tile below finished grade in. Slope of trench bottom in.
per 100 ft. Depth of bedrock ft. Depth to ground. water ft.c~-~
Number of Pits Outside diameter ft. Depth below inlet ~7 ft.
X Lining material Gravel around pit:-Ayes.
No. Total absorption area sa_. ft. g
Square feet of seepage trench bottom area requi ed
Square feet of seepa pit area required
Inspected by. . ~Wl J, 1A11
Title:
Approved Dat e t~ ~_,19 Z~
Rejected , Date ,19
County, Town of
1 Owner CL
D/ Sanitary Permit No.Z[~Property Address
Septic Tank Permit No. 3 Subdivision
Plb'? 7/71 Wisconsin Department of Health and Social Servioes
Division of Health
SEPTIC TANK PERMIT APPLICATION
I
TYPE OR USE BLACK INK - PLEASE PRINT
i
A. OWNER OF'PROPERTY
Nauae Address (Street, City, Zip Code)
B, LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY
Check Ones
CITY VILLAGE LEGAL DESCRIPTION'
TOWNSHIP (Block, Lot, Sec.) < %.4 y
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? ~ YES No PERMIT NUMBER
D, SEPTIC TANK CAPACITY GALLONS NEW INSTALLATION REPLACEMENT ADDITION
MATERIALSs PREFAB CONCRETE POURED IN PLACE STEEL OTHER
NUMBER OF TANKS TO BE INSTALLED:
E. TYPE OF OCCUPANCY
Check Ones One or Two Family Residence Commercial Industrial Other (Speoify)
Number of persons to be Accommodated Number of Bedrooms
F. APPLICANCES, ETCs Food Waste Grinder YES NO Automatic Clother Washer YES NO
Dishwasher YES NO Automatic Potato Peeler YES NO
OTHER (specify) YES NO
G. MASTER PLUMBER MAKING INSTALLATION
r
Names Address:
SIGNATURE OF APPLICANTS
License Numbers MP
L MP RSW
ADDRESS:
H. (TO BE COMPLETED BY ISSUING AGENT)
Date of Applioation Fee: Paid ~i
Permit Issued (da a Permit Number
Agent (name) Fors
tam, village, oityy„ooussty,, sto, speoify)
NOTES The Application cannot be considered for filing until all of the above questions are answered
and the fee paid. Agents will forward application, the fee of $1.00 for each septic tank and,
the third copy of the permit (canary) to the Division of Health. Checks and money orders should
be made payable to the Division of Health.
COMPLETE OTHER SIDE
,
NAME s V ` a A f
COUNTY:
..tom
SEPTIC TANK PERMIT NUMB13tr
REPORT ON SOIL PERCOLATION TEST
AND SOIL BORINGS
TO
DIVISION OF HEALTH - PLUMBING SECTION
P.O.BOX 309, Madison, Wis. 53701 _ L .
Pursuant to H 62.20, Wis. Administrative Code
P E R C O L A T I ON TEST
TEST DEPTH CHARACTER OF SOIL HOURS WATER TEST TIME DROP IN WATER LEVEL INCHES MINUTES
NUMBER INCHES THICKNESS IN INCHES SINCE HOLE IN HOLE INTERVAL SECOND To EXT TO LAST TO FALL
let WETTED OVERNIGHT IN MINUTES LAST PERIOD LAST PERIOD PERIOD ONE INCH
EXAMPLE
P - 0 36" TOP SOIL loss, CLAY 26" 25 YES OR NO 30 60
1
2
3
RECORD DATA FROM MLO MIM OF 3 TEST HOLES
COMPUTE SIZE OF ABSORPTION AREA IN ACCORD WITH H 62.20 WIS., ADMINISTRATION CODE.
S O I L B 0 R I N G S- MINIMUM 36" BELOW PROPOSED ABSORPTION SYSTEM
BORING TOTAL DEPTH DEPTH TO GROUND WATER DEPTH TO BEDROCK
NUMBER INCHES OBSERVED ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL WITH THICKNESS IN INCHES
EXAMPLE
B•0 72-01 " BLACK 0 I „ CLAY III". SM- 1811, GRAVEL 2411
1
2'
3
RECORD DATA FROM IN7NIIR Of- 3-BORE HOLE.0-
TYPE OF OCCUPANCY:
RESIDENCE: NUMBER OF BEDROOMS OTHER: (SPECIFY) NUMBER Of PERSONS
FOOD WASTE GRINDER: YES NO DISHWASHER: YES NO AUTOMATIC CLOTHES WASHERS YES NO
EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION: REPLACEMENT
TILE SIZE NO. LIN. FEET TRENCH WIDTH DEPTH NUMBER OF LINES
SEEPAGE BED: LENGTH- WIDTH DEPTH TILE SIZE NO. LINES SEEPAGE PIT= INSIDE DIAMETER LIQUID DEPTH
Is the undersigned, hereby certify that the percolation tests reported on this form were made by me or under W1 super-
vision in accord with the procedures and method specified in Chapter H 62.20 (3 Wisconsin Administrative Code, and
that the data recorded and location of test holes are correct to the best,-of my lniowledge and bel;ef.
NAME TITLE
TYPE or PRINT
REGISTRATION NO. OR MASTER PLUMBER LICENSE NO.
ADDRESS
DATE SIGNATURE
DO NOT WRITE IN SPACE BELDW - FOR DEPARTMENT USE ONLY
DATE ;RECEIVED ACCEPTED BY RETURNED
FEE RECEIVED VALID NO. PERMIT N0.
REVIEWED BY APPROVED DATE
INITIALS YES OR NO
2Iq
wPlb: V60
3/70 PROJECT DETAIL DATA SHEET
NAME OF BUS I NESS-
LOCATION l .`•S dit`f T'''~ /'''C
street or highway -044poor township county
LEGAL DESCRIPTION ~,,XZ. S.
R_e!eg All
Mailing address l `
ZIPj- .r
ARCHITECT OR ENGINEER Address
ZIP
PLUMBER Address A,4.
ZIP
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed:
Existing building New building Addition
If addition to existing building attach detailed memo for each.
( ) Drive in restaurant Car spaces
( ) Restaurant Seating capacity (10 sq. ft./person)
( ) Dining hall Per meal served Toilet waste Yes No
( ) Motel ( ) Hotel ( ) Cottages Number of units: 2 persons/unit
4 persons/unit TOTAL NUMBER OF UNITS
( ) Churches Number of persons Kitchen Yes No
Bar or cocktail lounge Seating capacity (10 sq. ft./person)
( Nursing or rest home Number of beds
( ) Mobile home park Number of units - dependent (camper trailer)
- nondependent (mobile home)
( ) Retail store Number of employees
Number of customers 70 s_q. ft./person)
( ) Service station Number of cars served (daily)
( ) School Number of classrooms Meals served Yes
No
Showers provided Yes No
( ) Factory or office building Number of persons (total all shifts
Apartments Number of bedrooms_
( ) Other Specify
2. Indicate whether or not the following facilities are connected:
Food waste grinder Yes _ No Dishwasher Yes No
Automatic clothes washer Yes No _ Automatic potato peeler Yes °vw°
Other . . . (Specify) No :KV
3. Fill in the appropriate information for the following as indicated:
Septic tank capacity planned b
Percolation test results - ATTACH PER LATION _TEST AND SOIL BORINGS REPORT SHEET
COMPLETE OTHER SIDE
Seepage trench bottom area planned width
linear fSyet ~ depth
Seepage bed area planned width
linear feet depth _ -~•~J
Seepage pit planned outside diameter
depth below inlet depth""
4. See approved plan for specifications and details.
Signature of person completing form: STATE DIVISION OF HEALTH, PLUMBING SECTION
P. 0. Box 309, Madison, Wisconsin 5370.1
Approved:
i6
d A,~ ~
Address: CO t~r6 44.4f ~ Date: ~z Y~
N4f 4~' ; ,L/ Z I pd" n THIS APPROVAL IS BASED ON STATE PLUMBING
M - CODE REQUIREMENTS AND DOES NOT EXEMPT THE
Date: - - INSTALLATION FROM CITY VILLAGE, TOWNSHIP
OR COUNTY M.0.00w PERMIT REQUIRE-
MENTS AND SHALL BE VOID IF REVISED WITHOUT
THE WRITTEN APPROVAL OF THE DIVISION OF
HEALTH.
DEPARTMENTAL USE ONLY TTs V F
F
2 3
lZil
AUG 192003 -7 1 6
VOL17 PAGE 4491
ST. CROIX COUNTY KAT9= H. NALSH-
SURVEYOR'S RECORD REGISTER OF DEEDS
ST. CROIX CO. NI
04/04/2003 01:55PH
SSPM
C E R T I F I E D S U R V E Y M A P RECEIVED FOR Et
Located in part of the Southeast Quarter of the Southeast Quarter of Section 23;ERTIFIED SURVEY MAP
Township 31 North, Range 19 West, Town of Somerset, St. Croix County, WisconoirrRREC FEE: 15.00
COPY FEE:
Prepared for and at the request of D.O.T N0.85 + I PAGEli 3 1 y
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Prepj. I ~N N w
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z
. Consu/ting Group, Inc
F0- . i `0~`a~~~gCt~NSjk~ z - z
Phone No. (715) 246-4319 * NR• Itf; .%SEO :3 - ZI - °3
Fax No. (715) 246-3830 _ DODGE MEnstc 4 - I - '
P.O. Box 325 ; S-2484
CLEAR LAKE:: t BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE
New Richmond, WI 54017 WI SE 1/4 OF SECTION 23, TOWNSHIP 31 N., RANGE 19 W.~
Sheet 1 of 3 WHICH IS ASSUMED TO BEAR S88'3327 W.
~~~~~~►upmmmu~►~a~~~ Vol.17 Page 4491