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020-1173-70-000
a o ~ o N ~ O 6n N O ,y rY p C O O N I N v I Z I I I ~ I I N v z° c 7 6 U. c O Q ~ N Z y O w 4.; 0 O I-- CN rn CL m 0 o z d Z d ° o E a v M ` N N 7 y N •N d L 2 Q)l 0 O O O (D Q Z co z o ca 'D N Z LU w 4) N E R p y ` y I O L v ~ C 3 ca w y m a E O o G o a 0) N y N a 0 Z X000 O K U) 0 rn rn y co co (D ~i N O y c a co v y y p O O O H C 00 O O O E 00 LO f6 U V1 d O O c C) O 0 0 0 O y 0 N o co a) (D (D w ; O y- y E Z r *4 o N E c= oo • 7 O O Vi I6 R 0 2 m r O Z H Tr' U) O V ~ • a d .2 d a c r`I~l E c `~1 A ciao I,0U)ic°~ Parcel 020-1173-70-000 03/23/2006 11:57 AM PAGE 1 OF 1 Alt. Parcel M 17.29.19.1089 020 - TOWN OF HUDSON Current [X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - TRAYNOR, SHAWN A & MICHELLE L SHAWN A & MICHELLE L TRAYNOR 903 WERT RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 903 S WERT RD SC 2611 SCH D OF HUDSON SP 1700 WITC I Legal Description: Acres: 1.679 Plat: 2627-WILLOW RIDGE EAST SEC 17 T29N R19W LOT 90 WILLOW RIDGE Block/Condo Bldg: LOT 90 EAST Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/10/2004 771263 2635/318 WD 07/23/1997 901/69 07/23/1997 850/232 2005 SUMMARY Bill Fair Market Value: Assessed with: 92912 301,800 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.679 69,300 238,500 307,800 NO 05 Totals for 2005: General Property 1.679 69,300 238,500 307,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.679 35,800 199,200 235,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 134 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 I COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.'. 04410/01 RAGE 1 ST. CROIX COUNTY REPORT DATE'. 4/29/91 COURTHOUSE RATE: RECEIVED! 4/26/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER'. Daryl Bjurnstad LOCATION: 903 Wert Rd., Hudson COLLECTOR'. M. Jenkins SOURCE OF SAMPLE'. Kitchen faucet COLIFORM'. 0 /100 mt INTERPRETATION'. Bacteriologically SAFE NITRATE-N'. 4 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN'. Pam Gane WI Approved Lab No. 19 D4A DEPENOF,H O` ~A V D A < Means "LESS THAN" Detectable Level Approved by'. o PROFESSIONAL LABORATORY SERVICES SINCE 1952 1 04/17/91 11:25 $715 962 4050 COMM. TEST LAB S.C. CO CRTHOUSE CJ 002 i i i - j C inter alt "MRPOLL LABORATORIES. •N-- 4500 BALL ROAD N.E it1RQLf fIVES. MINNESOTA 5X44-iSiS TE1. 6+2 7996-5020 FAx• Bt? 786.765+ G o'J April 11. 19 fff j i j O Commercial Testing Laboratories, Inc. 514 Main Street PO.Box 526 Colfax, Wisconsin 54730 I Attention, Mary Jenkins LABORATORY REPORT:. N2,s1Z Sait,r,Ie fiakCn 1-27-91 PURCHASE ORDER: #0909 byl Nary J. lenkihs &&APLES RECEIVED: April 1, 1991 i Bjornstad- SaWl a Identification: Hudson Sample Type: Water Laboratory Log Number: 2612-01 Target Detection Parameter Units Limit EPA Method 601: Chloromathone ug/L 1.4 c 1.4 gromvmethane ug/L 0.23 < 0.23 Vinyl chloride ug/L 10.30 < 0.30 Dichlorodifluoromethaane ug/L 10.91 < 0.91 Chloroethane ug/L :0.26 0.26 Methylene chlorides ug/L j 3.0 < 3.0 Trichlorofluorcoethane ug/L '0.87 < 0.87 1.1-Oichloroethene ug/L 10.66 < 0.66 1.1-Dichloroethane ug/L 10.16 < 0.16 Total 1.2-dichloroethenes ug/L 10.28 c 0.28 Chloroform ug/L !0.33 c 0.33 1,2-Dichloroeth,ane ug/L 10.47 < 0.47 1.1.1-Tricihlorotthane ug/L 1.4 < 1.4 Carbon tetrachloride up/L !0.44 c 0.44 Bromodichloronerthane ug/L ; 0.56 < 0_Srs 1.2-01ehloropropane ug/L :0.35 < 0.35 Total 1,3-dichloropropene s, up/L 10.18 < 0.18 Trichloroethane ug/L !0.58 < 0.58 1,1.2-Trichloroethane u9•/L 1.0 C 1.0 Dibromochloromethane ug/L 1.1 < 1.1 I i int* rpoll Laboratories. zne, April 1!, 199: Laboratory i~eoort X7612 Page 2 of 2 Commercial Testing Laboratories. Inc. 8jornstad- Sample Identification: Mudson Sample Type: Water Laboratory Log Number: 612 2-01 i ITa rge t Detection Parameter Units ' Limit EPA Method 601 (continued): Chloroethylvinyl other u9/L 0.70 < 0.70 9romoform ug/L 0.39 c 0.39 1.1.2.2-Tetrachlorcethane ug/L 2.1 < 2.1 Tetrachloroethene uq/L 0.45 < 0,45 Chlorobenzene ug/L 0.23 < 0.23 1.3-Dichlorobenzene ug/L 0.46 < 0.46 1,2-Dichlorobenzene ug/L 0.49 c 0.49 1,4-Dichlorobenzene ug/L 0.69 < 0.E9 EPA Method 60?: Benzene u9/1. 0.47 < 0.47 Toluene ug/L 0.92 < 0.92 Ethylbenzene ug/L 0.42 < 0.4Z Total xylenes ug/L 2.2 < 2.2 i Respectfully submitted, Wayne A. Olson. Senior Scientist Organic Chemistry Department WAO/c8 i Invoice Enclosed < L less than i i I I All analyses were performed using EPA or other recognized methodologies. All units are on an •as received" basis unless otherwise indicetad. i r At J S11. CItOIX COUNTY ZONING OFFICE d' St. Croix County Courthouse 911 4th Street f Hudson, 111 54016 Telephone - (7.1 5) 386-4 680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential, so that tt~cpro~crty can be located. Please provide the following infor'niation, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form!are received. i• WATER TESTING----------------------: ----FEE: $ 25.00 (For nitrates and coliform bacteria) WATER VOC - FEE: $175.00 7S.do (_For VOC' S fl SEPTIC SYSTE14 I14SPECTIOII------ ----~-1- ---FEE: $25.00 0 (Determines if system is properly functioning at time of inspection) f 11 Property owner's name ~GryJan"aci~, Property owner's addr ss (0)(0 i j d5 { (IV: egal Descript'o T II-R Town of S lv n ILL V •~FIRE NUMBER 3 LOCK BOX NU_MI3ER Color of house Realty sign by hohse? ,C.3 If so, list firm: dye R0-d (cc, 4a60AT\C.,__~ eer PLEASE TNCLU , IF AT ALL POSSIBLE, A MAP,i.e,COPPOI )KAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. -esting of residential ,:ater requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the ~,atcr or several hours before the tes can e gQnducted. ~pu$e- 1 5 v'0.CQ r bw`~ GII~o°~I , w , Sfi w~cS dd el ~al f a~ d eh w~a:~-c~ ra v~ abe~,t- ) h o cc . WINTER TESTING: Many times .-:ater lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please male proper arrangements: with this office to ensure time when entry may be gained. Firm or individual requesting servi es: V2b'v' Telephone Number '7/5-- '483-- 911A 9 4F REPORT TO BE SENT TO: Ve r r. 4- dox /yg, p~e55er, wr Sgeb9 _ xC1osing date r _ Signature r- C(D 3 uU ev- R oac~ , SCG q~-~,~ S Gv `l *Y4 14 ~d ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street k° Hudson, WI 54016 ~U Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can---be- located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at t'me of inspection) Property owner's name ~arti ~br~ bd Property owner's address gV 3 c-j d-r+ 1 ~Soi'1 Legal Description 1/4 of the 1/4 of Section , T N-R Town of ~d5dn Lot Number ~.0 Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house a Realty sign by house?-><' If so, l;~ist firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Zecy 20 e+~(e" Telephone Number 7/ - r3g~-Br3 REPORT TO BE SENT TO: ACAC, a do 2-,j 4. 5~. 50A t S / Closing date Signature - n~ ST. CROIX COUNTY Y t~ r'V S y WISCONSIN Y` h ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 (715) 386-4680 April 18, 1991 Terry LaPlant Edina Realty 700 2nd St. Hudson, WI 54016 Dear Mr. LaPlant: An inspection of the septic system on the property of Daryl Bjornstad located at 903 Wert Rd., Hudson, WI was conducted on April 17, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. S' cerely P . Jen ins Assistant Zoning Administrator cj COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 3T. CROIX ZONING REPORT NO." 04125/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 4/23/91 COURTHOUSE DATE RECEIVED" 4/18/91 HUDSON, WI 54016 ATTN" THOMAS C. NELSON OWNER" Daryl Blornstad LOCATION" 903 Wert Rd.r Hudson COLLECTOR: M. Jenkins SOURCE OF SAMPLE: Kitchen faucet COLIFORM" 2 /100 ml INTERPRETATION: Bacteriologically UNSAFE NITRATE-N" i 1 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN" Pam Ganz Mph WI Approved Lab No. 19 u~ Via. 2 i1 0, Noix c7uPU (`y rte" f' Z0NIN(13UF"FICF OF.\NUEVENQEHT 1~ o~ SA G Z V D < Means "LESS THAN" Detectable Level Approved by: o PROFESSIONAL LABORATORY SERVICES SINCE 1952 ,q= -4 l ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at t' a of inspection) Property owner's name arti~ ab~~5d Property owner's address Legal Description 1/4 of the 1/4 of Section , T N-R Town of 1A,&A5on Lot Number ~•0 Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house (yraLtd Realty sign by house? If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. ~ Firm or individual requesting services: Z 20 ere'~~(~~ Telephone Number 71; - j&81,-gr3 REPORT TO BE SENT TO: a e- c do Z d 5 4 ,&4 ~ borl closing date mg*at- k -1 (1 g Signature i Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,~~„~~L/~Td✓i/5~ TOWNSHIP SEC. T UN-R4W ADDRESS fJ.T G1 e~so~ Si ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT SIZE r r S PLAN VIEW I Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM d a' 00 ,y INDICATE NORTH ARROW: 1 BENCHMARK: Describe the vertical reference point used SGt~C S- f-~ h i Elevation of vertical reference point: /Qd- Proposed slope at site: J I SEPTIC TANK Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,O Rear, O (3 feet .From nearest pr©perty line : Front, 0Side 10Rear, 0 /a) feet Number of feet from: well ~w^ O building: l;7' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) qFF RRVFRS&,_ STDF 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 liner Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). ` SOIL ABSORPTION SYSTEM Bed:Trench:. Width: Length: y~ Number of Lines: ~ Area Built: Fill depth to top of pipe: y~ ~Number of feet from nearest property line: Front, O Side, O Rear,O Pt.~ Number of feet from well: Number of feet from building: ~S (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 or distribution box been used on any of the above soil 0 O 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,.0 Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: c Inspector: Dated: Plumber on job: License Number: 1 3/84:mj DEPARtMENT OF INDU INSPECTION REPORT FOR SAFETY & BUILDING ' LABOR & HUMAN RE ION DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MAy~DISON, WI 5370--77 [ State Plan I.D. Number: STN yy STL' 4i 57 , N-R196J FxR CONVENTIONAL El ALTERATIVE Of assigned) Town of Hudson ❑ ❑ Holding Tank El In-Ground Pressure Mound NAME OF RMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Daryl Bj ornstad 616 Michaelson St. , Hudson, 6JI 54016 H ►w,il, BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV., I CST REF. PT. ELEV.: Name of Plumber: - MP/MPRSW No.: County: Sanitary Permit Number: illiarn Schumaker 6382 St. Croix 119515 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: [CC , 33 55,2-6 54NES ❑ NO ❑ YES NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LIN AIR INLET: ❑ YES NO + L..r.. F-1 YES 1 *4 NEAREST 13 (O 5d+ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: MP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF PU ❑ YES ❑ NO NEAREST 11111- 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: BED/TRENCH WIDTH: LEN Tjjjiii NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID ' V TRENCHES: / I MATERIA PIT DEPTH: DIMENSIONS 1- Iflo GRAVEL DEPTH FILL DEPTH DIS R. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE OW PIPES: ABOVE COVER: ~ILEV. INLET: EL V. END: PIPES G `~6 : LINE: AIR INLET: ul~ 4;4 a ^~j ary NEAREST- + / NEAREST QC~rJ 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 MBER OF PROPERTY WELL: BUILDING: PERMANENT MARKERS: OBSERVATION WELLS: 4AREST- COMMENTS: ET FROM LINE: 8 ❑ YES ❑ NO ❑ YES ❑ NO 40 ketch System on Retain in county file for audit. S Reverse Side. AruTITLE: Zoning Admininistrator SBD-6710 (R. 06/88) s;. _ e son CA#i~ SANITARY PERMIT APPLICATION LI `DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ~~S 6-- 8% X 11 inches in size. ❑ Chek if ievisior~ previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S4,A/4 s' /a, S 7 T , N, R If E (orywz PROPERTY NER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER GL o OrG dlJl ~ llC3 e✓ ea CITY II. TYPE OF BUILDING: (Check one) El State Owned O VILLAGE NEAREST ROAD ❑ Public 0 1 or 2 Fam. Dwelling-# of bedrooms PAR EL AX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) , 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 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. ® New 2. ❑ Replacement 3.E1 Replacement of 4.E1 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit _ Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE f~b REQUIRED (sq. ft.) PROPOSED (sq. tt.) (Gals/day/sq. ft.) (Min./inch) G ELEVATION ;~v si~,c yaw., -72 3 Feet l e Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank RE 1 7 F1 -TT Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Sta MP PRSW No.: Business Phone Number: W` ,'4 m r 1 3 3 SG 7C~ 1 Plumber's Address (Street, City, State, Zip Code): x'3.5-' C r~ • ~ ~ u So~ ~ ~ O IX. COUNTYIDEPARTME T USE ONLY ❑ Disapproved Sanitary Permit Fee pncludes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) , r' - Approved ❑ Owner Given Initial) I L, C 7 .G0 Adverse Determination 1 ts~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the - State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system 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. SBD4M (8.11/88) APPLICATION FOR SANITARY P$RMIT STC-100 This application form is to be completed in full and signed by the owner(s) of the pruperty being developed. Any inadequacies will only result in delays of the permit Issuance. Should thin development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is yuld and submitted to this office with the appropriate deed recording.. - - - - - - - - - - T - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner o f Property ID4e,~ / 3'd 2n/ S Ti9- s ' WcatLun of Property 5W It 5,6' It, Section T 2y N R Z W Tuw11ship /~yUtOn~ M.i I I Lnb Address Zer 1~'l1 ,if - Subdivision Name ZC ~ a! CQI-JLut Number L~ _ - - Previous Owner of Property Z_.O M na . L-C Tutal Size of Parcel la" 1 DaLe Parcel was Created .J a~ Are all corners and lot lines identifiable? Yes No 1b this property being developed for resale (spec house) ? x you No VuLLunc 93 and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING; 1. Warranty Deed 1. Land.Contract , 3. Other recordings filed with the Register of Deeds Office lit addLtion, a certified survey, if available, would be helpful so as to avoid delays ,►1 Lite reviewing process. If the deed-description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (we) een,ti.6y that a t a,taatementa on .tiUA. 6onm ane t4ue to .the beat o6 my (uuA) kiwwadge; .that I (we) am (ane) the ownen(a) o6 the phopenty deacAi.bed in VUA c n 6 ouna ti on 6 orun, by viA tue 06 a wahnan,ty deed necoaded in the O 6 6ice o6 .the CuLai ty Re9i6 ten o6 Deeda as Document No. 9S-Oa0 ; and that I (we) pneee.,tt.ty own .the, pnupoaed bite bon the sewage poe aya.tem (un I (we) have ubta.i)jed an eaaemen.t, to nun oath the above descA bed pkopeAty, bon the eakistAucti.on o6 aai,d sy,6ten, and .the came has been duty %econded in the 066-ice u6 .tile County Regih ten o6 Deeda, as Document No. 39~d I 0 SI 'NA'1•UPX F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DA E SIGNED un'1'1: S1GNL•'D * 5f. CROIX co, 1, epwd 06 23rd P ~ •.~qR LLiiyyEst ~ ~ Y. i ~ - "6'S '3'•. 'r y~ ~ y., f • Pontraat,r.i and between M •~o ; Ar` 3e9CtLae1 a~k/a R, '3t~tr~ of a r 3eztelsen, hnsbaad and it W-1 1►mdos 'NIIs and agrean >ko 7 ;0' poa=~tbe p~t~ad" hull 4 ! t 4 Ps oMemo of this Contract by Vcba&*r,:tUe lollatipg property. togatber with t4s =tab, profits and other appurtenalRj ~t aa111K1-the. "PXgWty"), t~ "in 8t. Croix county, state of,WiecoNiai" a South 53 1 /3 rods of 1iouthi~Salt, of,SontW"t, Q and South 53 ' 1/3 rods of: Southw"t Quarter of 4outheait Quarter (SWtSFA) of Section 11~ IM, R19we That part of Northwest Quarter of Northeast Quarter On* NEU and of Northeast Quarter of Northwest quarter (fist rt NWt) of Section 20, 2AN 1;19W lying Northerly of the etry~,J{' centerline of St.'Croix Conntyr'TruWNidwmy'"0, (formerly ,h knew as Hudsoa-Nav Richmond nigb"y), EXCEPT the following parts of the shams described tracts: All land included witLin the Plat of Willow Ridge Second Addition to the Town of Hudson as described in Vol. 4 of Plats, p&ge 25; Parcel deeded to Marlin 0. Amdahl and Ruth L. Amdahl as ` described in Vol. 517, page 26, Document No. 324368; Parcel deeded to Roger L Hetchler as described in Vol. 517, page 114, Document Number 324430. TOGETHER with an easement for street purposes over the Easterly 33 feet of said parcel deeded to Roger E. Hetchler as described in Vol. 517, Page 114, Document Number 324430. SUBJECT TO the right-of-way of said St. Croix County Tru.ik Highway "A" and to telephone easement adjacent to said highway as recorded in the office of said Register of Deeds. Purchaser agrees to purchase the Property and to pay to Vendor at: St. Croix f` Heights, Hudson, Wisconsin, the Base Purchase Price of $100,000.00, together with additional payments per lot, as follows: 4 f I. Base Purchase Price. The base 6'F purchase pr'ce of $100,000.00 shall be paid in the following manner: $15,000.00 at the execution of this Contract, and the balance of $85,000.00 together with interest on such portions thereof as shall C remain from time to time unpaid, at the rate of 10% per annum, until paid in full, as follows: (a) For each individual lot developed and sold by the Purchaser, Purchaser shall pay to Vendor a $2,000.00 principal payment, to be applied to the $85,000.00 base contract balance outstanding. (b) A minimum annual payment of $15,000.00 principal shall be i paid each year, excluding the year of sale. Each ver lot principal payment required above, shall be credited toward this $15,000.00 annual payment. (c) On December 1, 1985, and on December let of each year thereafter, Purchaser shall pay to Vendor the differential between the required minimum principal payment of $15,000.00 and the total $2,000.00 per lot payments made during the preceding twelve (12) months, until the Base Purc.ase Price has been pairs in lull. (d) Interest on the principal balance of $8x,000.00 shall accrue from the date of closing, with annual pa:rntents of interest due on the 1st day of December, each year, commencing December 1, 1984. WA. J,d000*6 2. Additional Per Lot Payments. In addition to the foregoing Base Purchase Price payments, Purchaser shall pay to Vendor additional per lot payments totaling not less than $6'50,000.00, as follows: Tutpen Square 502 Second St (a) No interest shall accrue on the principal sums paid to Vendor "L'40 6 SIOtb under the terms of this Paragraph. 115 3N $231 VbL Y.F.. ~ 4 <(b),,~P"r9ba"r shall pay to Vendor the sum of $3,000.00 per lot on all residential lots developed and sold by Purchaser, subject to the condition that the minimum amount of a to be made to Bertelsen under thi p payments this Paragraph shall total ti at least $150,000.00. During each year of this Contract that there is an outstanding contract balance of the Base Purchase Price (Paragraph 1(a)) there shall be no minimum annual principal 'r• payments under this paragraph. Commencing with the year following completion of payment of the Base Purchase Price, Purchaser shall pay to Vendor a minimum annual sum of $15,000.00 per year. (d) On the lot day of December of each year, Purchaser shall pay to Vendor the differential between the minimum annual payment of $15,000.00 as provided in this Paragraph, and the total $3,000.00 per lot payments made during the preceding twelve months, until the entire $150,000.00 minimma sum has been paid. Thereafter, if Purchaser sells any lots in excess of 50 lots, Purchaser shall pay to Vendor the ate of $3,000.00 for any such additional lot sold, up to a total of 53 lots. ($159,000.00 total hereunder) Purchaser shall not be required to pay monthly payments to Vendor sufficient to pay reasonably anticipated annual taxes and special assessments. Any amount may bA prepaid without premium or fee upon principal at any time. In the event of any prepayment, this Contract shall not be treated as in default with respect to payment so long as the entire balance of principal, and interest where required, is leas than the amount that said indebtedness would have been had the monthly payments been made as set forth above. Purchaser states that Purchaser is satisfied with the title as shown by the Abstract of Title submitted to Purchaser for examination, except: ' Real estate mortgage to Sam E. Miller, dated February 1, 1980, recorded in Volume "608", Page 152, Document Number 362685. This mortgage shall remain the obligation of Vendor, who shall keep said mortgage current and in good standing. In the event Vendor fails to pay any required mortgage payment, Purchaser shall have the right to make such payment, and to deduct any payment so made from the sums due under the terms of this Contract. Purchaser agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the property on Closing. Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. 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 a,:d regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditoos shall be full 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, subject to utility easements and covenants and restrictions of record. Bertelsen shall have the right to purchase one (1) lot from B S H for the sum of X5,000.00. Bertelsen may select his lot after B b H picks its first five lots. i Wra' .49 Qssulor shall consent to the platting of the premises into residential subdivisions by Purchaser and Vendor shall be under an obligation to approve and execute subdivision plats prepared and submitted by Purchaser. In addition to the Warranty Deed which Vendor shall deliver at time of ultimate closing, Vendor shall execute and deliver to Purchaser, individual Warranty Deeds covering the separate residential lots which Purchaser any sell, upon payment of the per lot pa payments set forth above. All costs of platting and costs incurred in preparation of individual deeds shall be Purchaser's expense. Purchaser ag-sea that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 60 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 60 days following written notice thereof by Vendor (delivered personally or nailed by certified mail), I then the autire outstanding balance under this contract shall become immediately { i'~~++1c~ir due and payable in full at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided b law) in addition to those by provided by law or in equity; (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any etuity•of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts prev:ov:sly paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the f Property if purchaser fails to redeem); or (ii) Vendor may sue for specific peformsnce of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or L (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this V Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from pobsession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under M, &i) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to ' enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. 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 during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the Court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or aseignment of Purchaser's interest under this Contract solely as security for an indebt3dness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor may waive any default without waiving any other subsequen- or prior default of Purchaser. -3- r -VOV 49, 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 29th day of May, 1984. VENDOR: PURCHASER: B.S H EVELOP/MENT, INC. } ` BY: Arnold R. Bertelsen ~ a/k/a A. R. Bertelsen Donald E. Bjornat President ATTEST: Virg a A. Bertelsen ` 400-~, c. William C. Harwell, Secretary •,t 1-40 Authentication: • r~~ s CO Signature(s) of Arnold R_ B rtals n, y o virainia A_ Bertala n. his wifp. and S ~S nnnald _ RiomAtad and William C. © w Harwell- President and S cretarv res2getiVely of B-6 H velopme't Inc., authentic day of May, 19 William J. Radosevich Member State Bar of Wisconsin. This instrument drafted by: William J. Radosevich Attorney at Law Hudson, Wisconsin 54016. L S T C lU C r y SEPTIC, TANK MAINTENA CE A(:KEEMEN'1' o St. Croix 9 OU0 y ` U WNEk/BUYEK 0:1j/ dtrey ILdo2 ~Q~fC + KOUTE/BOX NUMBER zd /a EV-SJ --hire Number CITY/STATE Z 1 1' /lilC/SOn~, /iVs~ l,KUPEKTY LUCATION:_~Lkjtt. section T-.If _N. Town of 5t. Croix County, Lot uutaber 9U . M. it hJ Subdivision improper use. and maintenaace of your septic bystclu could result in I Yruper ulaiutendnce cut►- its premature failure to handle wastes. bibLb ut pumping out the Ksptic tank every tlir.•e years or boun.rt•, I it needed, by a licensed se tic tank Butner. WI►at you put into the system can affect the function of- tAµ: septic tank as a tr.cac- ment stage in the waste disposal system. St. Croix County residents tnd be eligible to receive d grant for d waxiuium of 60Z of the cost of replacement of a failing systetu. Which Wdli in operation prit►i ..St. Croix Cu►tnty accepted this program in August•of 1913U, with Lite requirement that tems agree to keep their systems properly owners of all new sys - maintained. _ j The prupurty owner agrees to oubutit to St. Croix County Zoning a certification form, vigned by the owner and by At a►dmter plumber. journeyman plumber, restricted plumber or a licensed pumper veri- tying that (1) the on-site wastewater disposal sydLetn i.s in proper uperating condition and (2) after inspection and pumping (it 11tc- ebddry), cite septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior co three year expiration. ° •L I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with X the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Certification and returned to the St. of the three year expiration dAte. SICKED DATE St. Croix County Zoning Office Y.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. t3EPARTFlIE,Nl OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IfV,OxJST;~Y, DIVISION P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON WI 3707 HUMAN RELATIONS . , (1-163.090) & Chapter 145.045) SECTION: LOCATION: TOWNSHIP/ Y: T . LK. NO.: SUBDIVISION NAME: S 7 /T 24 N/R) 9 (or q0 - k/► w ►acwast COUNTY: AM ` ` f -S CQA ► Y, I>A i~ L JOIN S'rA 6 ~ 0 J 1►C /J 0LUP4 Slr AO R"'~ A /4U_A s©1N/ USE (DATES OBSERVATIONS MADE NO. BEDRMIS.: OMME L DESCRIPTION: FILE DESCRIPTIONS: JFERCOLATIOINJTESTS AResidence 144/V_ 8-New ❑Replece LNOJ Zr 9Og A/Qy 3 $q ~s ~GY AC~k S ~ 501 is - ° gx $ute~NAR~.T ,v RATING: S- Site suitable effor system U- Site unsuitable for system OC..J S ~U S ~U YGi.i S ~U „S ~U RECOMMENDED SYSTEM: (optional) 841 rAL.v'. I S ❑U 110 If Percolation Tests are NOT required DESIGN RATE: ) If any portion of the tested area is in the under s.H63.0915)Ib), indicate: C SS / Floodplain, indicate Fioodplain elevation: + PROFILE DESCRIPTIONS BORING TOTAL ugeg JRQUP AT -I H CHARACTER IL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH#&ELEVATION HIGHEST TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) B- i 9Z 100(6 oNICE ~7.qZ /9''8(_LTs I a ssT'8 cs~b~2 B- . sa ia. ~Z N.,,e > 8-s6 's«TS 9' i± 9 B- Z 1D1,3C ~.4Z tt''g« I a 5 ,E6~R N c-Lr59BR C Al 7" CSfTak B- 4 B' .67 100.43 > lb .67 20"$LLT4 C „ R C / " ,v S ► (,-7 0& „C-lhs 44It. B. . ~ PERCOLATION TESTS TEST WATER IN HOLE TEST TIME RAT MINUTES NUMBER pT AFTERS WELLIN INTERVAL-MIN, PER INCH P. i 4. (c roof, Z > <3 P_ 4 -Lb N&yqr. P- 3,4C.) a P. I 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 47.5 i 77 z ,o ,1 ► zo N Al 4 +1 ~N ,4 4 ~8 3 A ti QL ` AST@RwJ,gTLr / mss' ~ : g a 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM print TESTS WERE COMPLETED ON: 14 Nsok Allciv&Y ADDRESS: t' CERTIFICATION NUMBER: PHONE NUMBERIoptionai): 467 54K43" L 1v Ulu ► ! 1546-4010 CST S ATURE: d DISTRIBUTION: 01itimil and ono copy to Local Authority, Property Owner and Soil Tester. DILHR•SBD-6395 (R.02/82) -OVER S rt'G 0 a. ~x T T .31 "AA ell V~