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HomeMy WebLinkAbout016-1064-95-000f Wisconsin Department of Commerce Safety and Buildings Division GENERAL INFORMATION Persona(Intormanon you provlce may oe usea ror seconoary purposes [Privacy Law, s.1~5(.04 (i)(m)]. Permit Holder's Name: ^ City ^ penwo^odol ownshi Jbermueller, Robert ~1 p CST BM Elev.: Insp. BM Elev.: BM Description: p ~ Ua • r7 j ~s~ l~ PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ ~~m j cTDO 6S'o Dosing ~~~ ~ ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~ 1~' ' ---- NA Dosing ~' ,~ u a'~-' NA Aeration NA Holding PUMP / SIPHdN INFORMATION Manufacturer Demand Model Number ~`~~ TDH Lift ~9~~ Lriction ~3 System TDH ~' Forcemain Length p~r Dia. Fi `'` Dist. To Well SOIL AB~~RPTION SYSTEIVrI 21c.,Q.,r,,,,,, ~3 G ELEVATION DATA Count~~ CTO1X Sanitdr~P~P~r.~t No.: State Plan ID No.: ParcelOla~ ~`~164-95-000 STATION BS HI FS ELEV. Benchmark G1,~ ~.~ ~ D Alt. BM d • ~ O ~o. ~o Bldg. Sewer 12- 48 ~ ~o - ~ fo St/ Ht Inlet C'4 13 Z~ ~'(~ ~ ~ ~ St/Ht Outlet 'A Dt Inlet ~ Dt Bottom 6.96 Header /Man. - Dist. Pipe '~ ~ ~ 3.~ Bot. System ' sZ .s o,2_ j8` Final Grade 3. (o p S ~' St cover / o~ ~ ~ . 0 TRENCH Width r Length N O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME ~ ~ DIMEN 1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufa rer~ ~ ~ s SETBACK ~ c~ INFORMATION Type O "' r ~ ~ ~' CHAMBER del Num er: System: ' (~ OR UNIT - tc.c DISTRIBUTION SYSTEM ~ - k ~ ~ C1 Header /Manifold ~~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Len th ~ g ~f.Pi Dia. Len Dia._ Spacing Or- ~ ~ o.~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No ~2 COMMENTS: (Include code discrepancies, person~s~present etc. Inspection eta,: S/ s'i~ Inspection try: ,-~~ Location: 2711 County Road G, Glenwoo City W1 5401 (I~W 1/4 NW 1/4 30 T3 1 - 1.) Alt BM Description =~ ~ P Z 2.) Bldg sewer length = 16' w ~ 5 z Z Ip$ ~ 1 v`f • q -amount of cover > `FZ . e~ ~~ d) ~$ 3 - -~' ~~~~~ , S ~ is ~ ~,,Q,~S,w~c,.) ~ ~ -L ~`~ csr g f s~ ~ ~f ~~ ~ ~ a .le.~.~i-~ ~ c~-.e.~.~~ue~~ u/~P~,vr..~i a.u;c:.~~.o~ Pla r I Ion require ^ Yes (~ No Use other side for additional information. D D BD SBD-6710 (R.3/97) ~a ~ cj y Date Inspector's Signature Cer* ADDITIONAL COMMENTS AND SKETCH NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 0 ~~ 3` 3~~M ~~ ~s~ INDICATE NORTH ARROW ST. CROIX COUNTY ZONING DE T L~;F;~. _~_,~w r_ ~~. AS BUILT SA1vITARY REP l ` :~ \~ Owner r,.- Property Address ~ rf // , 7'`" ~ ~_-.~ ~~ ~~,P, ~, ~ ~?~~(# ~- City/State ~~ 2~.~ iia._~ ~' ~ ~,,~~U ~~ / yo/3 ~ 1 sr t~c~lx ~'~ rte, Legal Description: ~~'f ..-~~~~ Lot `- Block ~' Subdivision/CSM # `--~ ~'-~~ f~G '/4 .~e~/., Sec.,~~, T,~N-RAW, Town of ~- ~o o' ~3 yh~O~p SEPTIC TANK -DOSE CHAMBER -HOLDING TANK INFORMATION: Tank manufacturer ]Y(~ lv~ ~'fe~H Size STlPC~°O~ /~ Setback from: House ~ Well ~' P/L ~ E~/ Pump manufacturer ~G u ~. d Model ~~v U Alarm location ,f~ t'P ~~ek ~' O ~ fi~i' u.S~ (HOLDING TANKS ONLY) Setbacks: Service-rva~ Meter location Alarm ion air intake Water Line SOIL ABSORPTION SYSTEM: ~ ~ ~ Type of system: ~RG'NGY Width ~_ Length ~ Number of Trenches Setback from: House ~_ Well P2 l ~ O ,Vent to fresh air intake .~' 7. ~ ~ ELEVATIONS: Description of benchmark ~ ~' © ~~ G' s~e e ~ '-e NGl e ~.51`Elevation ~~ ~ Description of alternate benchmark J B d Elevation , o ,~, ~6 ~r© L/ ~l s~ ~/D Building Sewer gb ~ STINT Inlet ~ ~ ST Outlet ~-~' PC Inlet ~- PC Bottom q~., 9~ Header/Manifold ~~ ~-~•~Top of ST/PC Manhole Cover f4 Distribution Lines (1) I ~!1 ~ 3 S (2) ~4 ~~ ~~ Bottom of System () ~d ~' / g (~) !~~' 9~ ( ) Final Grade () ~f> Jr~ ~~ (~ ~O,S, ~~ ( ) Date of installation :~/ 6 /~~ Permit number ~ 3 ~ State plan number Plumber's signature~iu'~ ~~f .~%ti~/ License number a~~-~' ~ Dat /~/ ~ ~ ~~-~ Inspector Complete plot plan ~ ~~ISC0/1S%n SANITARY PERMIT APPLICATION Department of Commerce In accord with ILHR 83.05, Wis: Adrrf. 46d,~ ~ ~_ : ~~ • Attach complete plans (to the county copy only) for the system, on~ape not than 8 ii2 x 11 inches in size. ,;~~ • See reverse side for instructions for completing this ap~kic~4.ion~ty°`'`~ Personal information you provide may be used for secondary purposes ~ -..) r^ '+ ,rye,. [Privacy Law, s. 15.04 (1) (m)]. ~ ~r- ~ ~ -~~ ~ ``s,~ ~" ~,~+.,1 ~~, Safety and Buildings Division 207 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 to Sanitary Permit Number heck if revision t'-~s~li n I.D. Num I. APPLICATI N INF RMATION -PLEASE PRINT A RM .1~ Property O ner Nam ! ~ 6~ /LJG1eLL~ ``~/ l operty t ,S T~~ ,N,R~~r>W Property Owner's Mailing Address t be -- Block Number - ~- d o v e r-- City, State / Zip Code Phone Number Subdivision Name or CSM Number II. TYPE B LDI (check one) ^ State Owned ity Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ J ~ Town OF~~~IS~~OO(6 ~o d ~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)~~ . ~~ . `S• 4`' a O / V /d / f qJT"'~ e~DO 1 ^ Apartment /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 box on line A. Check box on line B, if applicable) A) 1. ~( New 2. ^ Replacement 3_ ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an ______System __System _____________TankOnly________ __ Existing System ________ ExistfnQSystem B) ^ A Sanitary Permit was previously issued. Permit Number 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 Tan)C 12 ~ Seepage Trench 22 ^ In-Ground Pressure 42 ^ Pit Privy ' 13 ^ Seepage Pit ,, 43 ^ Vault Privy 14 ^ System-In-Fill a y Leo s vo~~ VI. ABSORPTION Y TE NFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation o ' ~ ,, ~ ~p O Feet /D6.,3 Feet VII. TANK INFORMATION Ca aat in gallo s Total # of Manufacturer s Name Prefab: Site con- l Fiber- Plastic Exper. N E i i Gallons Tanks Concrete stee glass App ew x n st strutted T nks Tank Septic Tank or Holding Tank ~ 2 ~ ^• ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ~ p ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (P rint ) Plumber's Signature: (No Stamps) MP/AI~I~No.: Business Phone Nu mber: / , ~r G!J ~ ^ / oZ sZ l 7 ~ ~ v ~~ Plumber's Address (Street, City, State, Zip Code): w o ~ wooo/ c ~7`~ ~' ~ i - IX. COUNTY/ D PARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (~ndudes Groundwater ate ssue . Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) -s, ~aa~ ~ r"' `~~~~2[~J Adverse Determination JC. LVIVUIlIVN~ UtAI'YKUVAL/ KtP1~VNS tV/KrUI~AI'I'KV ~~ ~ ~~ SBD- 6398 (R.11I97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation :,: 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. 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 on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending.an system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete forall 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 81/2 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 bakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. "~~~'ROUNDWATER 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 contamination investigations and establishment of standards. i ~ ~JI J_ ~/j ---- ---_ -- -__- - -- _- __. _. ..~ v- ~ r DI l~'I ~ ~ i -- - - - - - - i - - - ~ ~ - -- - ~ - - - - - --__ - - - , ~ 0 ~ J ' ~ ~ I, - - - - - ~ ~ __ -- _ ~ - -I ~ ~~ I ~ ~ _ __ _- i i -- i - -~ ~ -- -- ~ -- - - - ~ - -- I - -- - - - - ~ ~ li L ~ - ~ i ~ - - _ - _ __. -- __ ___ . __ ___ ~ _ __ _ I ~ ' I / ' ~ B ~ ~ -- _- II - ---I-- I ~ ~i ~ ---~ - - ~ ----- -- - - - -~ 1 - - . -- __~ . _ .__ __-_J .~ ___.... f __ ~ ._. ~ __. _. ___. ___. __._.. . _-_. _. _. I _+ _.__.__ -__ .____- _ ___. ~ __.- _ ~_ l - .v- -__._. __ ~ _' -- _ ~ I _ ~ - ~ __-_ i j ~_ ' _-. -_ -I I __. ~ ___.._ 3- --{ .- ~ -- ___. - -.__ ._ -- -- - - - _-_ _- -- - -_ ' -- t - - - I ---_ L ~ --~ -- h -- - __ - -_ _- - - y - --- -- - -- -- ~ - --- ~---{ - - - I t- -. - - ~ - p - -- -- - L ' - ~ _--- - -- -- ~ - -- - - ~ -- ~ _ -I -- - -- 1! -- i-~ ~ ~ ' - -- ~ -- ~ _ _ ~ ; ~ ~ - - - - - - - _ -- - -/ ~ o __ ~- __ ~ ---- --- - o to -- __ _ _ - _ - __ -- - -- -- - --- - . _ - -- _ ' ~ 1 -- - --- -- -_ _ _ -- ~-- _- '- _ -- -- -- } 1 ~ - - -- -- ~ s ~ ,, ~~ © 'e ~ ~ ~ -- -- -, _ -- - - --- I - - - -- ; ~ , - ---- - - -- - -: - __ ___ _ --- ; - - -- --- - _ ___ _ - - -- ~ ! i - e - i~~ -.-- t 'I __ ~_ - - - _- ~_ -- _1 i ~-- - ~ - - ~ ~~ ~1 -~ - _ - - - i _ __ -- - -- - - - __ ~ ~ - - - , -- --- _- I _ j -- _ _ - - __ -- _ __ ~ ___ __ _ ___ - .___ ._~ _ . __ _~ _ _ 1 --~-- - _- ~ ~- ~ i _ Page„a2 Of~ COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) 4" CI Vent Pipe with Approved Locking Manhole Cover Approved Cap, +25~ From Buildings With Warning Label Attached ~ Weatherproof Approved _ Warning Label Junction Box Yent Cap --~ 12" Minimum 5" Mi nl~mum i "" '~ Final Grade i 4 Minimum 6 Maximum ,~ ~ Quick 18" Minimum ~ Insp.CPipe ~___ ~ Disconnect ~ 1/4" Weep ' Hole Baffles n ~ L1 ~ ~ ~ • i ~ A Alarm ~ B On ~ C i *APPROVED Off ~ JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: ,~ Per Day ' Gallons Per Day/ ofi -Doses: /,S'G Gallons '; Volume of Backflow:...... ~ Gallons .+ l Tank Manufacturer: /o~Gv eG'f1 Total Dose Volume:....... ~ .°L~ 3 Gallons Tank Size-Septic/Pump: -- Ga lons Alarm Manufacturer: ~'`T ~~e~ ~'`. Model Number: / p j ~ ~ Qo Capacities: A~~inches or 3 ~y Gallons Switch Type: M ~ ~ ~! y ~ ~/ + B ~. inches or ,~ Gallons Pump Manufacturer: G o y ~ d - + C inches ~~ oGallons ~~ Model Number: // + D inches Gallons or Minimum Discharge ate: Tota1....._ inches or~~~Gallons Vertical Difference Between Pump Off and Distribut ion Pipe: , o Feet Minimum Required Supply Pressure :... .......... ......+ -- Feet ~ ,mod Feet of Force Main x /~~d Frict ion Factor/100 Feet: +~ eet .~ Inch Diameter Force Main Total Dynamic Feet Head:...=~ Internal Tank Dimensions: Length -- • ;Width, Li ui d De th3~" ~ ~~`~'C' ~~°'~ /NC~ q p Signature_~ Lic ense Number~aa~-~ Date ~~~ op r 12 DUSYRIAL RD. Goulds /~•f~e ,~o~",~ o", WI s4°'~ Submersible - Effluent Pump ~~ . C~7 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability '/a"maximum. • Capacities: up to ~~ GPM. • Total heads: up to 21 feet. • Discharge size: 1 ,~" NPT. • Mechanical seal: carboir rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104 'F (40'C) cor.linuous 140°F (60''C) intermittent. • Fasteners' 300 series stainless steel. • Capable of runnirg dry without datnaga to components. Pump; EP05 • Solids handling capability: ~/~" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: l %i NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40"C) continuous 140"F (60^C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. f/lotor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP. 115 V, 60 llz, 1550 RPM, Guilt in overload with automatic reset. • Power cord: 10 foot standard Irrlgth, 16/3 SJTO r;ith three prong grounding plug. Optional 20 foot I?ngth, 16/3 SJTW with three prong grounding plug (standard on EP05). A1ETERS 10 0 a w U a z 0 J H 0 ®1995 Goulds Pumps. fnc. FEE T I 3871 EP05 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES o EP041mpeller: Thermo- plastic Semi-open design . with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP Canadian Standards Association (CSA listed model numbers end in "F" or "AC".) CAPACRY EBegive Mar. 1995 89871 ,: 0 2 4 6 8 10 12 m~~ f ~~ v!-isconsin~Department of Commerce SOIL AND SITE E1[~,LUATION Division of Safety and Buildings .,.---~~, --•. Page ~ of Bureau of Integrated Services in accordance with~,t4F~R,i~3oe,~wis Adm. Code '~~ ,.- , Attach complete site plan on paper not less than 8 1/2 x 11 inches in s' e:,F~fan m `~' ~ Countq include, but not limited to: vertical and horizontal reference point (B ,;direiction a~ ~ ~,"' C percent slope, scale or dimensions, north arrow, and location and di ce to nearest road. Parcel I:C1. # APPLICANT INFORMATION -Please printa/l information. Re~Bw v Date ,~,; Personal information you provide may be used for secondary purposes (Pnvacy LBw, S 15.04 ft~: C~~FiCE 4l J ~+ ~~~~, ~ ~ • - -- ~'" 7~'~ Property Owner /'~ / Property Location " ~ ~~~ 1~~ v ~P~ /~ yCh L u Govt. lot, . `" 1 4 ~ 1/4,S~O T~O 'N'R ~ ~ W Property Owner's Mailing Address Lot # lock# Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road New Construction use: ~ Residential / Number of bedrooms ~ Addition to existing building Replacement ^ Public or commercial -Describe: Code derived daily flow ~~ gpd Recommended design loading rate ~ r bed, gpd/fl2~Ltrench, gpd/ft2 Absorption area required ~Q`~bed, tt2.~trench, ftC2 - ~ Maximum design loading rate t.Lbed, gpd/ft2~_trench, gpd/ft2 Recommended infiltration surface elevation(s) 1 D 3i J ft (as referred to site plan benchmark) Additional design/site considerat/ions Parent material ~ic /% C/ ~ ~ ~~ ~ ~ Flood plain elevation, if applicable ~ ~ tt S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = unsuitable for system s ^ u ®s ^ u ®s ^ u ®S ^ u ^ S ®u ^ s [~ u SOIL DESCRIPTION REPORT Boring # G_ro~un~d lelObi /f~ Depth to limiting factor ~~in. Boring # ~- Ground 1el y.,~ Depth to limiting factor ;ST Name (Please Print) Signature Telephone No. 4ddress Date CST Number / w d 7` ~ - d- 5'' Horizon Depth Dominant Color Mottles Structure i t C B d Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons s ence oun ary Bed ,Trench / o-// ay "- S~,L M S ~ .d o3.S /0~.0 . ~~ ~ ~ ' Remarks: o- 0 3 ~. S6 r S M .• 0 10 ~ ~ ~-- Gw vF .S' ~ - 0 6 ~ - ~ ~ ~. 33.gY ~R. ~ ~,M. 3~.g .8~ , PROPERTY OWNER /~d1J6 f/~6G RMl1 CAL ~~ CRIPTION REPORT PARCEL I.D.# O~~" /~ O y ~ ~' rO 0 O Boring # Ground f elev. _a ~• ~R Depth to limiting fact r ~~in. Boring # Ground ele Depth to limiting factor 7~in. Boring # Ground la~fP Depth to limiting factor >~in. Boring # Ground elev. ft. Depth to limiting. factor in Page ~ i of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench ~ f - .s ---- s ~ ~ a ~M ~ ~ G G*~ dr ; . ~ o -- s ~ ~- ~-' ~' ~, ~ d ~"3 -~ c..f /© ,zq • e8/ ~~ $ $ 35.8+ 88 Remarks: ~. 9-/d - SL 2~ k - G w v~ ~ .6 ~ --- s S ~- - ~ , 6' Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench l~- e --- s M G Gv ~ v~ , ~d _~- ~ .r .~ ~ Remarks: Remarks: SBD-8330 (R. 07/96) e ~ e u e ~ ~- 3 - o -- ~~ - - - _ - ~ __ ~ - _~ I - --- - -_ - _,- - ~ - _ - -- _ - - - ~ - --- _ _ _ e o °~ - ~ ___ ~ - - -- -- -- ~ _ -- -- -- - -- _- - -- - - -- -- _ -- - --- -- -- _~ i - --- - -- -~ _~ ' ~ _' 1 ~ m - - - - --i -- -- -~ ----~- -- - -_ --- - -- -- ---i -- -- -- rt _ _- _ - -l -- - __ -- - --, - -~- - i -- -- --- , - - -- ~ -- ---~ -~ -~ _ _ - -, - ____ - ~ __ ~ _ L ` _ , ~ ~ - -- ___ - - - ~ --- , I _- -- ~ ~ _ - ~ -- - -- - - i -- - -- - -- -- - -~ - -- - - -- - - - ~ _ _ f-- -- I ! I : - - ~ - - -- - --~ I - --- - -- ~ -- - -- --- II I - -- - -- -- - -- - - ~ --- -- - - -- - -- ; - , -- -- ~ --- ~- - - 1 - -- - - -- v - --- - - , - __~ __ _ , J ~ ___ __~ _ _ E _~ __ = --- I -- -- t-- ! - -~ ~ - - -- ~ _ --- ~ ~ -- - ~ , -- - - ~ ___ - . - _- -- -- __ - - -- r-- - ~ ~ -- , --- -- __ - -- _ -- --- ~ a ~ -- -- - - -- - ~ - - - -- --- __- __ --- -- -- __- -- ~ _ __ ' k - -- ~ -_ _ _-__ --_ f - - ___ ~ Y --- - -- - - - --- _ ~~ _-. . ' w ~. __O. ____ _ _ _ _ _. ___._. ._._ _. I .._ _.. ___--~ ~~~ O - _ o ! C~ R f _ - -- - - o ~ ! ! a ~ --- --- ~ - -- __ -- ~ --- - ,- -- - -_ __ -- i -- 1 -- !- ~ --- -- - ----- - --- ,_-- - 1- __ -- -- - - ; -- _._ - - ,_ i -- - ___ -- _ - -- --- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ /~d ~~~ ~ ~ ~O PJ ,~ /4iI L/ ~° ~ ~ G ~ Mailing Address ~ ~ ~ ~~- ~ 0 0 ~LJ /~ U~ Property Address ~ ~ ~ ~ (Verification required from Planning Department for new construction)_~-~4" ~,,~.~-ya~3 City/State ~~~ iKl ~ O !' of ~/,,,~ Parcel Identification Number D ~~- ~O c`!,/ - ~-do0 LEGAL DESCRIPTION Property Location ~ '/4, ~ %,, Sec. ~~ T,~N-R `~ W, Town of ~~G /V ~OOc~ Subdivision ~- ,Lot # Certified Survey Map # Volume ~- ,Page # Warranty Deed # ~ ~~ ~.~ ,Volume ~ Page # ~ Spec house ^ yes J~ no Lot lines identifiable ^ yes ,~ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT ~/07~ aDOU DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~~.~ Si ~i~2 SIGNATURE OF APPLICANT ~/ ~/x000 DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ^~'CJMEyT ~O J"~ ST.ATE HAR OF R'ISCO?1;1N--FORM 11 • ~ `f;.. ~.d r) ~ ~"t~~~ LAND CONTRACT-Individual and Corporate ~~~ ~~ ~ ~ ~ trri5 s~aCE nE3ERVfD FOR REC ORDiNG DAT4 i i tr~rliv r t,~ an~1 t,et~r+-r•n ~!arvin H. Cas:-ellius a.nd REGISTERS OFFICE !I ~`~~: 1:"~ `"•. C:~ssellius,_ husband and wife as ST. CROIX O0., W$. ,I ;i •~ in : _ ~ nan'_ s _ ~ Rec'd. for Rea°rd Ms 8th bream called Vendor, whether ~•r ^~ r ',f .,n a ~cbert L. Ober*nueller, and The ' ~rn~e~ l~r d°y of-]day A. D, 19~ ~I ..s:;..3:,.1 ~~:::.i.e, ~ ;4in: tenants- _ _ °t----2z3 . AA. ' ;~ __ __ hereto called Purchaser, whether.,nr ur m.,re, ~ [' 41TYEtitiE,~r}{; Thrt [hr Vendor, in ,~onstderahon of the ;•:ryments to t.e made and the ' i Rayi~ K td OMd `.- ::cn.+nt; ar.d e,;reement.. by the Purchaser to be performed, as hereinafter set forth, ; ^...~retW ~e;!c and at7eer, to convey unto the Purchaser, upon the: prompt and full pert orm- RETURN TO .+~...~ t~v the P•.arhaser of the c~.nenants and .+greements of this contract to be by the • !i P u :baser rix^..rd, the following described real estate in _ St . Cr01X - - Chard p .~Va ' ~~enwood Ci~ •_L~~. ,~ C. -nri', State of Wisconsin: --~- - ----- -.---~-- ;, Tax Key = _-----_-_-- -['his isnQt.- homestead property. South ,dest Quarter (SW~;) of South G'est Quarter (S;d~) of .Section 19, and SJest Half (W'2) of North West Quarter (NWT) lying [ti'est of Railroad in Section 30 ALL in Town 30, North Range 15 West. '.his Oontract is subject to a mortgage to the ran^lers ~c~e ^c'~nistration, dated October 6, 190, and recorded with the Register of Deeds for St. Croix County, `,~~]isconsin in "cl. ~'65, Pale µ58. ,ether wr;h alt hur2drngs, improvements. (ixt•:rrs and appurtenance., now or hereafter erected thereon, including all screen and storm • . ~~-r; .,rid w;rn.±,.cs, aeached mirrors, frxtLres, shades, attached floor covering, hot water heater, furnace, oil tank and light fixtures ..~;-. h .hell tk~ a part ~~( the real estate. , Thr Purchaser, m c.;r.sidera[ion of the covenants arc: agreements hereto made by the Vendor, agrees to purchase the above • !. ,!e;crihed premises, and ?o pay ?herefiir to the Vendor at ___._GlAnW4od__Clt~. ~..____._______.__. the s,.m .f Thirty-S_ix_Thousand._, Nin•~_Hundred__and Sixty___C~3.6,~~~i0_Il_d1- - --Douars, rn c:~ann •r fu!'.,,winK; 5 _. 1-~ 11~-Q-. QQ._- __,__ at the execution hereof, the receipt whereof is hereby acknowledged, and the balance >f S =' S s 3 b ~ ~ ~ . , together with interest on such p.,c'ians thereof as shalt remain from time to time unpaid, at the rate J ,f _. .per cent per annum, until paid to full, as follows: Said principal and interest shall be payable in one -f i i installments •rf rnt•Fersst}ran$------------------~7['T f3F1._J3Illl32:)(_.Js--1~[~---_,'ffegm?f rrgvrt~tre._--- ;~ k.y-atG------------------_--_-------r~2--------Pr:nidnE-tir-~rrYire~t•eh+rTr-renmry-un~ inters-aYshail-be~et}q-peid within -'I _ - _ -. _._____-_-_.. __ _ _ - ___ __ j'E'~fS ~R1Rr ?;rC ~a{C hc'n'e f' ~ ~~ Purchaser further agrees, unless excused by Vendor, to pay monthly payments sufficient n•asonably to anticipate the payment of taxes, :pedal assessments, fire and extended coverage premiums and such other insurance ptemrums as Vendor may require, and Pur- cha;er agrees to make such payments to the Vendor and hereby authorizes Vendor to apply the same in payment o[ such items- ': Said payments shall be applied first to interest on the unpaid balance at the rate herein specaied and then to principal. Any a^:ount may be orepaid with~~a premium or fee upon principal at any time, and interest shalt be calculated at all times on the unpaid balms .ce on the daily rate basis at I'350 0( lire annual rate. In the event of any prepayment, this contract shall not by treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruin Merest from month to month shall be treated as unpaid principal) is less bran the amount that :aid indebtedness would have been had ,.ie monthly payments been made as fvst specified above; provided that monthly payments shall be continued in the event o[ credit of any proceeds of insurance ur condemnation, the condemned premises heir.;, thereaRer excluded here from. The Purchaser hereby states that he is satisfied with the ~i~rle as shown by the abstract-title insurance commitment submitted to ni^ for examination; the Vendor agrees to deliver the abstract-lice insurance policy ro ;he Purchaser when the full purchase price here~~n.:er shall have been paid. The Purchaser agrees to pay the cost of later continuations of abstract-title insurance. -t,R?he Vend>r shall furnish the Purchaser thirty days prior to the Gate .[ ultimate closing, and the Purchaser shall accept as a stiff e:. rent showing of title, either (() a title insurance commitment f~*r an n~xner's policy of title insurance in the sum of the purchase pace, the Furchaser to be named as the assured, to be written by a ttlle insurance company, and guaranteeing the Vendor's title in ?h~ ,- m~irtr:n called G,r }, ~ -this agrremeni, nr /2) a mercnanG+hle abstract showing the Vendor's title in the conc`~tion called for by this ac7rer.r-at. if an abstract is furnished, the Purchaser shat: no!ifv the- Verut~r, in write n;, o[ .:ny objections to title within ten (10) d'eys after receipt ~f such ahstrac!, amt the Vend~,r ,hall then have a re.+=',nabl•~ time within which tc rectiiythe title or furnish a title pelrcy as above c!~.;eribed. The Pur<.hatier shall be entitled to take passe c;,ion of said pro rntsac cn -.-.?-ItSt aStt _. d3tL.. :le i;'eQf .~1~-~~. In case p~.s;es~t~^. is to br• obtained by the Vend•.;r, he shy:1 ha•: ~ a rv-r-;,~na,1~• time after such dale in which to remove any occupant. The Pia. baser shall be enti;ied to remain in p.,s;essi^.a as luny as he rice"nrmc all ~n.~nantc and avrvemenis herein mrnlinnvd nn his nart .. ,~~ 57'3 ~~~~ ~4~.8 The purchaser covenants and agrees as follows: 1. To pay before they become delinquent all taxis and assessrt.ents, now or herrafrer a:;sensed or levied aKalnst and ~:n the real estate described in this contract and to deliver to the Vendor receipts _•videncing due payment thereof. 2. Tu keep said premises insured for fire and extended coverage fur at least tFe sum of S __ _ -___.___ _ __ to paY the premiums thereon when due, and to comply with coinsurance pmvisi~ms, if any, in insurance companies apprnced by the Vendor with loss payable to the Vendor as interest may appear, and all policies covering said premises shall be deposited with and held by the Vendor. 3. To keep the premises in good condition and repair. 4. To keep the premises free (rum liens S+Jper lJi to the lien of this contract, or the rights of the Vendor In the premise s. 5. ?Ict to commit waste nor suffer waste to be committed. 6. Yot to do any art which shall irnpair the value thereof. In case any such taxes or assessments remain unpaid after they become delinquent, or in rase of (allure to keep the premises so insured, the approved policies deposited, or the insurance premiums paid, or to keep the same in good condition and repair, free from liens and waste, the Vendor may cure such defaults, and all sums so paid shall immediately be repaid to the Vendor and shall, unless so repaid, be added to and deemed part of the purchase price, and bear interest at the rate aforesaid. The Vendor hereby agrees that in case the aforesaid purchase price with the interest end other moneys shall br fully paid and all fire conditions herein provided shall be fully performed at the times and in the manner above specified, he will on demand, thereafter cause to be executed and delivered to the Purchaser, a good and sufficient Warranty Deed, in fee simple, of the premises above de- scribed, free and clear ~f all legal liens and encumbrancer, except any liens or encumbrances created by the act or default of the pur- chaser, and except: ----- ------------- ------ -- - ------- -- - -- - --- ---_ _ __ _ _ -- _ ----_ _ The Purchaser hereby covenants and agrees that time shall be deemed to be of the essence of this contract and in case of default in the payment of any principal or interest when the same shall become due, or in the performance of any of the conditions, covenants. or promises by the Purchaser herein to be kept or performed, and such default shall continue for a period of _._ __ _ days, they. the Vendor may, at his option, declare the contract at an end, alt rights of the Purchaser under thie agreement cancelled, and the am punts paid by the Purchaser hereunder forfeited, the same to remain the Vendor's property as rental of said premises and as Liquidated dam- ages for the failure comNeetely to fulfill this agreement; and the Vendor shall forthwuh and without notice have the right of re-ante or, at the option of the Vendor and without notice to the Purchaser, notice being herehy expressly wRlvPd, the whole amount of unpaid principal shall be deemed to have become due and payable; in case such option shall tie exrrcis_d. the unpaid principal and interest together with all sums which may be or have been paid by the Vendor as herein auth~;; Ized with Interest un such disbursement< at the rate aforesaid shall be collectible in a suit at law, or by foreclosure of this contract in the same rcanner as if the whole of said ^npald principal had been due at the time when any such default occurred, and the indebted,^,ess shall embrace, with said unpaid principal and interest, all the sums so disbursed with interest as aforesaid. In case of legal proceedings in enforcement of any remedy hereunder, whether ahatel ur nut. all expenses, includinK reasonable attorney's fees, shall be added to the principal, become due as incurred, and in case of ludKr....•nt shall be included therein. Upon the commencement or during the pendency of any action of foreclosure of this contract. the court may appoint a receiver of the premises, including homestead interest, end may empower the receiver to collect the rents, I,surs, and profits of said premises during the pendency of such action, and may c-der such rents, issues, and profits uhvn sur~'Illrc;ed, to br held and applied as the court shall, from time to time, dvect. All terms, conditions, covenants, warranties and promises hereinhall be binding upon and inure to the ben^f it of the heirs, legal representatives, successors and assigns of the vendor and the purchaser: U not an ~~:cner of the property the spouse of the vendor for a valuable consideration joins herein to release homestead rights in the subject property ano agrees to join in the execution of the deed to be made in fulfillment hereof. ~ler(wot,~d Cifi Wiscons_in_____..._ -- chic -29th---- aay ~r _ ;4arch-- __----- _-_ , f9 Z8 • Executed at __-______-__-__ 1fi__._-. __ j ~ i / SIGNED AND SEALED IN PRESEtiCE OF ~ ~• ~l! fr•~- /V r ~ fZ ~Ii2J-( '~ ~-. -_.e/ -(SEAL) AUTHF.NTICAT~ON signatures of __1'~rVin..H_--Cassell-iu~.-.dI1G~--~li>^le passe --_-. Rnhar~t_ L_ Cberrueller,~--2heresa_A._-~ez~luepy~ authenticated this___Zgttl_ -_ .. __..- day of ____,~}_ ~__-__~~. ._ _~ ST OF WISCONSIN l1 1 SS. _.__.__.__.----_.-.- -_ ~:ounty. Personally came be tore me, -__ ___- ~_ the above named_____.____ ___._--"y.._.-._-_ to me known to be the person_____ who executed the forego -.Marvin H. Cassellius _- ---------- --- t (SEA[.) S}n r 31-~:8.SS2111US ----- ----- - -- ---- _ _K9bert- L__ ~bernltaeller-- - ~ C/.Y'i:~[~C~-~, (SEAL) Theresa A.. Ol~rlhueller __ __ _ _ his wi>Le, .and. _ - --- - c. r.ti C~ ~1 ----.R1Ctldt'rj.P.-_R1VdI"~ ___-._._- - ---_.__-- Title: Member Mate Bar of Wisconsin or Other Party Authorized under Sec. '06.06 viz. ___...__.___._.___-_-..__._ -- day of ---- --- ---_ _---- -- ---- • 19 -- rument and acknowledged the same. ;j Ttris instrument was drafted by -.-__. ______..__.. R1C1'l3ZYj-~.._~V3L'G~--- 7hr use of witnesses is uohune i. Notary Public -_-. -_ \1~. My Commission (Expires) 1Is)-_. County. Wis. -- .i FROM =WICK SLICES 1 715 387 2931 2000.02-b'L le ~ y. ~-~~~ • _ _. .. HK 1 l.-KAI' 1 Product{on No. 28269 A Product of Y~Ick 6ullding Systems, Inc. last Page P.O. Box 530 - Marshfield. WI 544,19 •{715)-387.2551 Attach Print on this Page: 021022000 3 Z a ~-C ,v O ......- 'c,~ ~ /~ G ~ p~ ~' ~~lio 3>oo/Z ~~ a~'-u^ ~.- .- ~n ~ ..~-_ . ~~"~ Modei AM-481 Reversed Floor P . 7oP F~k? "~' ~,.a,~ tz,-u.. r~,~ . ~E- ~-00 T ~ij. ~ : ?2 Pb' 1 i 1 ~ 38? 2931 ?. 6 OPTIONAL pOtfBLE DORMER OVER DOOR ,