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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX,j969 ` BUREAU OF PLUMBING
MADISON,-WI 53707
SWa,SE;i,S21,T29N—R19W CONVENTIONAL ❑ALTERNATIVE State Plan 1.0,Numbet: .
III atoned)
! Town of Hudson ❑Holding Tank ❑In-Ground Pressure ❑Mound
Lot 7 Prairie Vista
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
(
B U`�'FS
ENC a l Avenue.- Hudson, WZ 4 16
MAK [ '�d
(Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT,ELEV.'
iName of Plumbec MP/MPFISW No.: County: nitary erm,t Numm:
William Schumaker 6382 St. Croix 112675
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIGUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: W,111, LA LOCKING COVER
I � d P OVI ED: PROVIDED.
W �S T� t 5 ES ❑NO ❑YES NO
BEDDING. VENT DIA.: VENT MATL.: HI NUMBER OF ROAD: ROPERTY WELL: UILDING:IVENT
MYE9 M. FEET FROM r� LINE: AIR INLET
'QYES XNO O NE AREST 1 �� 1�
DOSING CHAMBER:
MANUFACTURER. BEDDING. LIOUIO CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER: WAR ING LA L LOCKING COVER
PRO IDEO: PROVIDED:
❑YES ONO ❑ S O OYES ONO
GALLONS PER CYCLE: PUMP AN CONTROLS OPERATIONAL NUMBER OF PROPE Ll B ILDING VENT TO rAM
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) I DYES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH UTAMf TEH M O MAR G
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
YEN IONAL SYSTEM:
WIDTH. LENGTH. N DISTR,PIPE SPACING JINSIDECIA *PITS LIQUID
BED/TRENCH TRENCHES MATEHIAL: PIT DEPTH
DIMENSIONS _H ;F ILL OEPTN UI 1 I OISTR.PIPE I 1 MATERIAL NO.DIS NUMBER OF WELL BUILDING: V NI LE FRE -
El PIPE COVER ELEV.INLfI ELEV.ENU ? PIPES LINE AIR INLET.
42 q S q 101.3 NEAREST
�3 �rI
UND 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-
meets the criteria for medium sand. TIONS MEASURED.
DYES ONO
SOIL COVER TEXTURE PERMANENT MARKE Is. OBSERVATION WELLS
❑YES ONO DYES ❑NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED.
CENTER EDGES DYES ❑NO
OYES ONO ❑YES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE ILL H AB V COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUM MANIFOLD DISTR.PIPE MAN I F OLD MA EHIAL N , I DISTHIBUI ION IPE MATEHIAL&MARKING
ELEV. ELEV. DIA ELEV. PIPES DA,:
y ELEVATION AND
DISTRIBUTION HOLE SIZE HOLE SPACING HILIEU nRRECILY CUVER MATEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
�Y NO ❑YES ❑NO
ER
COMMENTS: MA—W-f-M K OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE
/1 OYES I.�NO DYES I�NO _ NEAREST
3 ,c�
0
Sketch System on Retain in county file for audit.
Reverse Side.
TITLE
3ILHRSBD6710(R.01/62) Zoning Administrator
�Lt�ll-
DILHR SANITARY PERMIT APPLICATION COUNTY /
In accord with ILHR 83.05,Wis.Adm.Code
STATE SANITARY PERMIT
//a& y6
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size.
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES Z No
PR RTY OWNER PROPERTY LOCATION
u ol tea.✓ ,(,/%_5 %, S oZ j T N, R / E (or
PROPERT OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER S IVISION NAME
aV.e� a L
CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
® ❑ VILLAGE
OWN OF
f
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
rvi
1. a. New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. A Sanitary Permit was previously issued. Permit## /U 669 Date Issued
3. An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2)
1. a. ®.Conventional b. ❑Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. AseepageBed b. ❑seepage Trench c. ❑Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
3 (t Q) rs0 Feet kcjprivate ❑Joint ❑ Public
1i CDC,
VI. TANK CAPACITY Site
in gallons I Total ##of Prefab. Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank x ❑ ❑
Lift Pump Tank/Siphon Chamber ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
[,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamps) / PRSW No.: Business Phone Number:
AA 4'a In S ,,A&I& � - nz �
Plumber's Address(Street,City,State,Zip Code): Name of Designer:
LY a
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
11111W411-1V A644-al y�
CST's ADD (SITedt,City,State,Zip Code) Phone Number:
.er 6 - c 3 Fd
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee + �
Adverse Determination '�'�� �5uu �' `"""��� re-'
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT r `
APPLICATION
TO THE APPLICANT:
1. This 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. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
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. Private sewage systems must be properly maintained.The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-381:5.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
lll. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 8'/z 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; dosing or pumping chambers; 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.
------------------------------------------------------------------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill Ground agar---
included the creation of surchai-ges (fees) for a number of regulated practices which Wisco irt'S
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Treasure e
is used in your building is returned to the groundwater through your soil absorption o
system or the disposal site used by your holding tank pumper.
o
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, C DIVISION
HUMAN ARSLATIONS PERCOLATION TESTS (115) MADISON WI 53707
79699
It (N63.08(7)dt Chapter 145.046)
L ON:
S O H UNICIPALITY: O LK.NO JS BDIVISION NAME:
�1/ 1 �2S R/ 7 AiAi4. Yrc'M
.W .
C UNTY; WNER A .
: cipaI � eQ KN or�1 //O� LmokEc. Av
U,,S,,,E{{ DATES 09SERVATION8 MADE PROFILE DESCRIPTIONS:IFERCULATION TES
NO.BEDRMS,:iL11Residence N K C DESCRIPTION: 4 rNew ❑R�;] `,• )/ /0 `� 'be c- / 1717
Sous ok A4(c 'S Solt`S _ ILL67- 7
RATING:S-Sitte�suitaW for syvwm U-Site unsuitable for system aQ
MS ❑V 101:ou S 011 S OUL ❑SG A_ . E NVv ,JT16*4AL (S06 1) TQ�'►�KN�S
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- C LKSS (Floodplain,indicate Floodplain elevation: NA
PROFILE DESCRIPTIONS
BORING A V 1 CH CHARACTER SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH ELEVATION NUMBER
TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B_ k '7,%-7 Nc > a z< S^ c Ys 31'' R z Y st c>s �3��8RN sc4�
B. Z g.3� 99.�� >�.33 4a"$tcT°�, iG"ga t, '"ga!•.ic��,SG,IQ
B. S 9. 7 Z �(��� 9"W-n re& r4L 3 Q%A- A sSMQQNhtSt
-t d I /4olNr >C). folujS f R' $ As 23�&st &t Gbh 72"$Q SqGr
B- , 33 6.49 No NN >
B-
���� PERCOLATION TESTS
TEST DEPT WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINLITES
NUMBER I S AFTERS ELLING INTERVAL-MIN. PER INCH
P- ts6 a t 49.3 3 Z >2
P-
P- .7-'7 6101AI& 19112 3 _ _��._ __ __ 1>X
P-
p. t-1 vas t U t�I T
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances.Describe what we 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 \
S
d I
AT SW L',0'f'C%#1441't i '`•� i ■' i¢- 1
L
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M
I,the undersigned,hereby certify that the soil tests reported on this form were made by me in rd 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 o knowledge and belief.
NAME(print): nn TESTS WERE COMPLETED ON:
,Oxtvso N KuSc►d 'rjuR� ty t G INS 1��cEM @�� /,S lq �
ADDRESS:
CERTIFICATION NUMBER: P ONE NUMBER(optional):
N sA'94
6-q0€b
p CST SIG URE:
DISTRIBUTION:Or iyinal and one copy to Local Authority,Property Owner end Soil Tester.
0I1-HR-SOD-8395 (R.02/82) —OVFR —
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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
,l-ABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
SW' ,SEk,S21,T29N-R19W EXCONVENTIONAL ❑ALTERNATIVE IS,,,*Plan LD.Number
(11 as
signed)Town of Hudson El Holding Tank F-1 In-Ground Pressure El Mound
Lot 7 Prairie Vista
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Gordon Knudson 1109 Laurerl Avenue, Hudson, WI 54016
BENCH MARK(Permanent reference pointl DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.
Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number:
William Schumaker 6382 St, Croix 106091
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES 1-1 NO DYES ONO
BEDDING: VENT CIA I VENT MATL. HIGH WATER NUMBER OF ROAD' PROPERTY WELL. BUILDING. JVINTTOFRESH
ALARM. FEET FROM LINE: AIR INLET
OYES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVI DED. PROVIDED:
DYES ❑NO EYES ONO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING IVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) DYES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing I LENGTH 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:
WIDTH. LENGTH. NO.OF DISTR.PIPE SPACING. COVER INSIDE CIA -1IT5 I.IOUIU
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTH.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR. NUMBER OF PROPE RTV WELL BUILDING V NT TO FRESH
BELOW PIPES ABOVE COVER. ELEV.INLET ELEV.END'. PIPES FEET FROM LINE AIR INLET
NEAREST-
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
1:1 YES ONO
SOIL COVER ITEXTURE PERMANENT MARKERS OHSEHVATION WE LLS
OYES ONO OYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES
❑YES ONO ❑YES ONO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEH
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTHIBUTION PIPE MATE HIAL&MARKING
ELEV.. ELEV. CIA.. ELEV. PIPES DIAJ
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑YES El NO 1-1 YES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELL&. NUMBER OF PROPERTY WELL: BUILDING.
FEET FROM LINE
DYES ONO OYES ONO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE. �
Zoning Administrator
DILHRSBD6710(R.01/82)
DIL HR SANITARY PERMIT APPLICATION co
In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERMIT#
ONO 106 &? /
-Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8%x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION �"
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES LL�J NO
PROPERTY OWNER PROPERTY LOCATION
oL N '/4f '/4, S ! T , N, R / E (o
PROPERTY OWNER'S MAILING ADDRESS LOT NUAQBER BLOCK NUMBER SU�VISIONAN CI TY,STATE ZIP CODE PHONE NUMBER CITY EAREST ROD,LAKE OR LANDMARK
r �ydl�. s VILLAGE : 44S
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. 9 New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a. 64Conventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. aseepage Bed b. ❑Seepage Trench c. ❑ Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): ro
3 /T xyG ��C y jt G'1 9V1 Feet tZ Private ❑Joint ❑ Public
VI. TANK CAP CITY Site Fiber- Exper.
in allons Total #of Plastic
Prefab. .
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strr cted Steel glass App
Tanks Tanks
Septic Tank or Holding Tank ❑Li
Lift Pump Tank/Siphon Chamber ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system sho n on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Sta ps) P PRSW No.: Business Phone Number:
Plumber's Address(Street,City,State,Zip Code): / Namer of Designer:
VIII. SOIL TEST INFORMATION
Certified Soil Tester CST)Name CST#
aVU S
CST's AD SS(Street,City,State,Zip Code) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater ate Iss ing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial rcharge Fee
12,, �C6 r � � �Q�
Adverse Determination �`� U✓
X. COMMENTS/REASONS FOR DISAPPROVAJ:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT
APPLICATION
r'
TO THE APPLICANT:
1. This 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. A new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years;
6. If you have questions concerning your private sewage system, contact your local code administrator or the
State of Wisconsin, Bureau of Plumbing, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat
restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling;
III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or
repair;
IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project
is in conjunction with University of Wisconsin;
V. Absorption system information: Provide all information requested in ##1-6;
VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed,
number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete
for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if
tanks received experimental product approval from DILHR;
VII. 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. Fill in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number.
IX. County/Department Use Only;
X. Comment area for use by county or resaon given when application is disapproved.
Complete plans and specifications not smaller than 81 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; dosing or pumping chambers; 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.
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more
commonly known as the groundwater protection law. This change in statutes was the
result of over 2 years of steady negotiation and public debate. The groundwater bill GroundtE
included the creation of surcharges (fees) for a number of regulated practices which Wisco
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried TeBS #'g:
is used in your building is returned to the groundwater through your soil absorption
system or the disposal site used by your holding tank pumper.
The monies collected through these surcharges are credited to the groundwater fund adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
water, groundwater contamination investigations and establishment of standards. Groundwater,
it's worth protecting.
SBD-6398(R.03/86)
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractQv, ("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.
(honer of Property d / ""
Location of Property -!�'A/ k „SL's ;y, Section v;2 , T N - R /q W
r
Township
MaIIi.ng Address ,�' ! _ O/
Subdivision Name ' 7-...-
Lot. Number
Pruvious Owner of Property
Y
Total Size of Parcel
Date Parcel was Created ,� ► �,-� /y'" ��
r
Are all corners and lot lines identifiable? No
Is this property being developed for resale (spec house) ? Yes _p `No
Volume �O and Page Number y� as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other 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
I (We) eeAti6 y that att statement-6 on .this 6onm ane Uue to the beat o 6 my (oun)
hnowtedge; that I (we) am (are) the owner(a ) o 6 the pnopeh ty des cA bed in xhi4
igonmaati.on Sonm, by ViAtue o6 a waAAanty deed recorded in the 0j jiee 06 the
County Regi.60A v6 Deeds as Document No. ; and that I (we)
pn ea entey own the pnopo, c r s4 to 6oti the a ewo.-g dL6 oa 4 yi (on I (we) have
obtained an e.aa ement, to nun with the above des ct bed pnopeAty, jon the
eon,6tAuction o6 aa.id 6ystem, a,ad the Game had been duty recorded in the 0b6.ice
o6 the County Regi6ten o6 Deeds, ab Document No. A; ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
f DATE SIGNED DATE SIGNED
L
.z 'v b4q.;fit
DOCUMENT No, STATE BAR OF WISCONSIN FOGY 11-1Wt TM's"'"�`aaeuvso ioa.ao.ouu ears
LAND CONTRACT --
43G384f 1ael.Ye.t."C«e.r.. e00K 808 ray
ro BR OBRD FOR ALL TRANBACTfON6 wARRt OVER 'E247
tttASa!6►INANCE7 TRAN1`A#OT ejB NON.CONBVYRI
REGISTER'S OFFICE
Con traat t a,,d bet e.a_ Verlyn E. Benoy and fZT.CROfX CO.,WI
t atttel'1>�te A. $enoy, fteg'd for Record
•
........................................Gordon.-S.._Knudson ._`----- (°vendor°, APR 191988
whether one or more) and.....•......._.._.•.............._.....-.R......................... 2:55 P
...................(l..Sin.Kle.2 f!rgST1..:.........._•._............_......•._...._....._... W M
.............................................•_........ ("Purchaser",whether one or more).
Vendor ae1L and agrees to convey to Purchaser,upon the prompt and full per- RepWwd[bedt
formance of this contract by Purchaser,the following property,together with the
rents,profits,fixtures and other ap urtenant interests(all called the"Property"),
St...�roix ------ - _ - -
i¢...'..°"°'...-......._.'.-_•.-'-...' --..'..°.•'_"---. cou¢ty,State of Wisconsin: azr"aa ro
Lot 7, Block 1, Prairie Vista First Addition Tat Parcel No......`
in the Town of Hudson, St. Croix Count , WIi - ---
yy ter.-.....
further described as part of the SW 1/4 of the
SE 1/4 of Section 21, T29N, R19W, Town of
Hudson, St. Croix County, Wisconsin.
l
This homestead property.
(is) (is not) -
Purchaser chase the Property and to Hudson, Wisconsin
cede,8Yf pay to Vendor at........................................................
the sum of$................................_...........--------_---in the fyy1 wyyqq ��nnnnaa���1�ee (a) 5......t ebb.06.........-....-.....-.-.
at the execution of this Contract;and b the balance of 1y,a6U.UUr. _
( ) i............................;1 together with interest from date
hereof on the balance outstanding from time to time at the rate ef...en-(i0%)" par tent per annum
until paid in full,u follows:
36 monthly payments of $150.00, first interest, then principal,
with the first payment due May 20, 1988, and succeeding payments
due on the same day each month thereafteri The balance of this
contract due and payable on April 20, 1991.
Provided,however,the entire outstanding balance shall be paid in full on or before the.......191h .....day of
t .....•... --AR>xa..........•19.91... (the maturity date).
Following any default in payment, interest shall acerue at the rate of_.10..%per aa¢nm on the entire amount
in default (which shall include,without limitation,delinquent interest and, upon acceleration or maturity, the entire
principal balance).
i
as er,used by Vendor,agrees to pay monthly to Vendor amounts sufficient to pay rcasonabl
paled annual Lazes,special assessm 'cod insurance premiums when du ccive y Vendor,
bi-1.::n ii
Vendor agrees to apply payments to these o . me-tee pa
the Vendor for payment of
i� texts,assessment an t posited into an escrow fund or trustee account,but shall
n t-bcar i+Nc•,wt
-untess"Oiticiwlse required by law. I
Payments shall be applied first to interest on the unpaid balance at the rate speed and than to p,' gpa:. Any
I' amoun cifi
t may be prepaid without premium or fce upon principal at any time after......April - 1 92523 LOR) '
. !; nNme>�5dxxuexz�lon?xx4coC5al;ia�st4sk5t�iRk�cfisvrxx>rsexsdx}�Set1�cR
��. In the event of any prepayment,this contract shall not be treated as in default with respect to p:;ymcnt so hng
I as the unpaid balance of principal,and interest(and in such case accruing interest from month to month shall b e 1,ateJ
i� 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
j� of insurance or condemnation,the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchz<cr
for examination except:
�j rurcli;t c a}-recs to pay the cost of future titre evidence. 11 title evidence is in the form of an nbatract.it
he i h;:V-dor until the full purchase price is paid.
: i.au be entitle to take possession o'the Pro Ap
P perry on................... .ril.........18...................._..79.
r mv. STATE PAR OF wl f NSIN
Fu 101 Stock No. 13011
01 N,.it IM
j
x con "•
- _ ... vr-�I'�w�'w-P•1..,. i•',x'`r ".�t }`w. fafP1
i Purchaser promises ts p y wben due all tam and aaaesMonte leveled oa the Propartp or upon Vendor's interest
is It and to deliver b Vendor oa damsnd receipt,showin '11th payment
shall k the fmyro+ements an the Property Insured ygahut loss or damage
tended coverage ve6 other haasrM as Vendor may require,without m-inurr asurm approved
=Vendor,is the sum of_................. .................. but Vend. ryeeppuu;lrree gage ts u amount more
thw the balance owed under this Contract h tnsnranee premiums when duo. The policies•hats
contain the standard clause in favor of the Yen es Vendor otherwise agrees in writinS,the original
of all policies covering the Propert eP.I=with Vendor. shah promptly give Douce of loos to
insurance companies a pleas Purehaaer and Vendor otherwise aaggree insurance proceeds shall
be applied nor repelr of the Property damaged,provided the Vandor deems the or repair W be
feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property,to keep the Propert y
in good tenantable cond)uon and repair to keep the Pro perty tree from liens superior to the lien of this Contract and
to comply with all laws,ordinances and regulations affecting the Property.
Vendor agree that in cue 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 Purebass',a Warranty Deed,in fee simple,of the Property,free and elesr of all liens and encumbrances,except
any liens or encumbrances created by the act or default of Purchaser,and except: .X'orl @._--..---.___............... ..
-------.__........................................................-..............................................................-..............
. _.._......__..
..............................._................................................................_.................---------............. ._...._ _...._.......
.............................................---..................................................................................
... .-..-......--
....-..-__.............................................................................-...................................................
.-...._.............-...
Purchaser agrees that time is of th essence and (a) in the event of a default in the payment of any principa:or
interest which continues for a period of.!9....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...60.1.days following written notice
thereof by Vendor(delivered personally or mailed by certified mail),then the entire outstanding balance under this contract
shall become immediately 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 by law) in
addition W those provided by law or in equity:(i)Vendor may,at h'a option,terminate this Contract and Purchaser i
rights,title and interest in the Property and recover the Property back through strict foreclosure with any equity of
redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance,with interest thercon from
the date of default at the rate in effect on such date and other amounts due hereunder(in which event all amount.previous:y
paid by Purchaser shall be furefeit.td as liquidated damages for failure to fulfill this Contract and as rental for Vne
Property if purchaser fails to redeem);or (ii) Vendor may sue for specific performance 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(iii)Vendor may sue at law for the entire unpaid purchase price or any Portion
thereof;or((v) Vendor may declare this Contract at an end and remove this Contraetasacloud on title in a gme4title
action if the equtiable interest of Purchaser is insignificant;and(v)Vendor may have Purchaser ejected from possession
of the Property and have a receiver appointed to collect any rents,issues or profits during the pendency of any action
under (i), (it) or Ile) 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 alt costs and expenses
including reasonable attorneys fees of Vendor incurred to erdorceany remedy hereunder (whether abated or not) to Oe
extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser,as in.
eurred,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 assignment of purchaser's interest under this Contract coley as security for an indebtedness of
Purehaxr.In the event of any such transfer,sale or convey once without Vendor's written consent,the entire outstanding
balance payable under this Contract shall become immediatly due and payable in full,at Vendor's option without notice.
Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of
this Contract(except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser
makes timely payment of the amounts then due under this Contract.Purchaser may make any me paYmmts directly to
the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be emosidered payment.made an
this Contract
Vendor may waive any default without waiving any other subsequent or prior default of Purchaser.
All terms of this Contract shall be binding upon and inure to the benefits of the heirs,legal representatives,
sum" ra and assignis of Vendor and Purchaser. (If not an owner of the Property the sparse of Vendor for a valuable
consideration joins herein to release homestead rights in the subject Property and agrees to join in the exeestioa of the
deed to be made In fulfillment hereof.)
Dated this.............•----......18 th ........day of---.........April .... 19.88...
........-.
..-. e.. ... ..................(SEAL) .:�G7! ..5 .,fa.o� .,..�.-eL. .ss.e...-...........(SEAL)
Vef lYr?.E.r..-Aeno •....Gord9??...5-:...KL1uds(zn...................
Y
_W6•Q�yGi�t.a�n"-rte.�.. ...�._ (SEAL) ....................................................
Catherine A. Beno 4qS{W
AUTHENTICATION ACSNOWLSDOM-•r TQ
d �
Signature(a) .................................... STATE OF WISCONSIN
...... county. �c
e
T l
authenticated this--------day of....... ..................19...... -----•---Personally came before me this.- ............dny cf
�'�.................19-- -.the above n—J
-_.....-- � ....--...--_-..
•_..._....................................._......-....._-..-.---...-..---. ..--- � L.y.�."..�F -t:-� ?�[3 f/....,;.._......
TITLE:MEMBER STATE BAR OF WISCONSIN G�7 P t? n
(If not............................................................. mN S' IJ-fb^i
ate- ---•------------af-'n��1,----... ..............:..•_
authorized by 1 104.00,W is.State.)
to me known to be the person.5 who....-.. ho executed t V'
foregoi instrument and acknowledge the'same: 7.
rr,is n+srnurner+r WAS DR—ED or
0•rdon S Knudson -.- .f'.._�'?--:...-...-
M
Q,gufn, IC A Er Sa
Hudson nI 51J016
....-. ................................ .. Notary Public ..-... ... .-:'U I Coentt W s_
r
(S g t. revs may be authenticated or acknowledged.Both hly Comm ass rm is rman�ln('iTf not- la'tT ra}nFa c+
.not necessary) + Q
•h•mn of nereana.t[Tn(In•nY e.0•dH•hmAJ b pares m P.intrd .. �� � ., 1• /. -
date: _. e �.)
ariov enr�r are•wrr.. ..
t � .: -:m���. �r€�,a,±� '; :1".tNw+rt. =a.•-ar,°„sra' ..r e.; -
,, s
STATEMENT FOR CLOSING REAL ESTATE TRt,' A,J10N
r V;�''.. .- ... :a O:T t;t.?z•i..t: d'„ .,;p :\.!dress
41 54oi6
.i Da[e olt [ '.:-
-s z -_ _ -.
BUYERS SETTLFMENT STATEMENT DUE ELLEa CREDIT aUYfR 1
X X X C C xIX X 0: .100�(',I)
I�i Pr V t Prnxral$ Interest$
Principal b Interns[
f, III in,ral$ Interest b T
enr ra.a 5 isi.22. t rl'Ir.-,fJ U1.4Y
r r .In ( d Ac,,men's rlf1:1111d) _.. t.. -
ur,io�e I }-
v t l imd,ht.id by
al 1"ns b :Oil gals. b
t,orJ",g Fes
!ansfer Fees
_ I
low'ances for
�rarate tLYO9 paid directly by S-311 or to ]lycr TDru 15rr'"�I n
,553.82)
LESS CREDI r TO BUYER
BALANCE Dt.'E SELLER LI (}!7
n
tl At,E Dt E SELLER AS FULLOW5:
Lax!Ctmtract \U rt•a"C executed this day to Seller.... l�r
,>rti. I
Check
Ch--k or Cash W Balance
TOTAL SETT[.FxtFNT Di 1K SELI FR_ ;j•
i1,115 STATExIE l IS At T't PTFD AS(:ORB EI T ,.r;T j.] 1[j "• 19 t3".'� '
l f�
.ON y.p wYwwOY.o..a..wtrwte.....or w.wLVOw. Rev WA S-I-rf
" DUE SELLER !
BROKER'S SETTLEMENT WITH SELLER
x X X x X x x X n -...-. 100 0o
-)own Payment Received from Buyer... -. x .x x x x x
"ash Balance Received from Buyer......_. _. _...
f-harges.Against Sc".lcr:
Ahstract Extension or Title Policy...._
Recording Fees
Attorney s Fee
Transfer Fees
Paid for Seller s Account:
__..
1h61nquent Taxes and Unpaid Special Assessments
_ o
(l &n sslon Rea-at.S t t Agency[
Settlement -Check or Cash b TOTAL PAYMENTS DUE SELLER—►
Check _. b 1 r 20Ui 00
Check _.b -
.. Total Charges Against Seller(E— n:,n,raa,,,wl r .. r 0 i
NET BALANCE TO BE PAID SELLER
BALANCE PAID SELLER.."I'S "-- - -
t9 ..
THIS STATEMENT c5 ACCEPTED AS CORBEL - � 1
.r..i/.rJRtsR
David~t. jadiitsatut
R.v1rod 111-1-411411 rw..0..wiKORMw Y.wl.EAww W..WLMw.n
VL
rim; 17M Tg qt'
rpN EfE/y�...Y MKN.WtlL WARY'N II.ALTOIt. .
t
y
I
u cu: r.T Fo STATE: DAR OF R:�Cn SIN FORM 11-1LS! •"' "
p
LAND CONTRACT
IT i!t 1_:to Ft`! AIL- `:.A, N'Ii F.1'.r.
.t
Verl n Benoy
CQlttract.by an bevwIeti...- .Y-- .r and
�at�-Fine A. Bcnoy, Join .enanfd
II ----------------------------------------. _---------------------------._-------...--------
I; wither one or more) and-..9ordon S_._ Knucsont
I - -----------------S i ngl e- P son
-_-- ---------....................................
II
(-Pureh—r",whether one or more). ,I
Vendor sells and ap-reea to convey to Purchaser,upon the prompt and full per.
l formance of this contract by P-0 -er.tl:e following property,togrther with the
rental profits,fixtures and other apkurtenant interenta(all called the"Property"), I
:a. . ...X. _-___.. Cent State of Wisconsin:
tn._--.._...................................... ........ Y.
i
Lot 7, Block 1, Frairie 'dicta First Addition
i Tn:Parcel tic.
in the Town of 'r.udson, St. Sroir_ Countyy, WI s
j further described as part of the SW 1/4 of the
SE 1/4 of Section 21, T29N, F191W. Town of
i
Hudson, St. Croix County, WI s:.,onsin.
d t•r,
This is not ho.... ,,a
(is) (is net)
Pure: ii N.< I'r. •rt;, and to p.y to V d a: Hudson. Wiscon n
the-In o!i. 1 bGG U� ,a the • ,,c 1-br�,.r: ta) i .-i 200 00
U
at the e..cut f it C. t t. t ( 1— . r of i 1),D .w;;t er s'nh: '.._ _...
h.roof pn to L:.apes
--,t n�"-.; m ..r.. to.....< at the rate of ten (10'x) _ _ per . .
ontil DaA in full,u to:l..a
36 fnonthly paymentz of .?1j0.0C, first interest, then print;;_'_.
with the first pay:-,er.t d'-je ',,,a*,, 20, 19fifi, and succeedir,A pa}-_. :S
due on the same day each ,or.ti, thereafter; The balance of t=:s
contract due and payable on Aril 20, 1991.
Provided, lips-ever,the—t—outstanding In':—,: shall bo paid in ful'on or before the__.-. 2• -+
.................Apra]..._--------to 41 (t:e matur.:.date).
Fnllo:_ing any default is pa;u:ent• --re:,t :`all ace-ur at tl.e rase of....10-.•.p<r annum
in defau ,lt (which shall include,s;tlt—t lunit t-' l. , opt into„t ar.d, up.,n acu.r
.. at.on or r.
..._ -
principal be:.mce).
Pur':i:a cr,unless ere::-.,d by Vendor. te ray m,..niy L,Vendor an.ount„ru flicunt to I” -
pa[.d annual tea,.,rl:,<i:.l :.nd n..-,.I:m arar:ee pn rniuh.s.1—doe.Tp lt:e rata!r• -
t•e„doe t.ai P I F _..s d t% at:.- s,.rr, dce. S"n a "-i by 0',,V. .. -
-t and t ..a 11. .r... ._. an .r.r ,d .o
�.,•, ,...,...,,^nyurrrdby�.. .
P- _.all be .. .. .. _. .. ..
In ,.. A. r.. ...z .
-tie . . .. .., ,!p... .. _ ... _. ., .. .• p,... _..
r.i-ell .. t •d r.... :'.I L, ,.i t�,
U ..., _r.,d pr,-- ,.e R ,•t4r .t r u .., d ...r...
rs t...,• i'..c in ....< ._r
for e..,.-%;..,•n ta.-<pt:
Punt ,,. to): t` ,. ...,. . t_. l:ttlr •... .... < i•, . .. -
,odic,.n nJ c F. r I
.... ,a..,o .-s a d r _.. - - .
..m1 at ':e-...i--i:..1 i.-..r-:. .. r �!, ::4. :. 1..i.,r 1 ...
_ .., a '•t arr,n ty Dead, in ._ a i
,
:.t.�. :•:. ,;rs..us -rcar.l h•: t'.e r[ ar d..a_.-a! ! ,.•r, d t i O!.d_.
. --•, t ..one!s,(t,.,--le. and (a) in t.,•.,,:.t If a defau_ n E`.a•;.: it ,f r.
,_ , ;vi,,l 00 ay s. , „ter.p.:<.i..1„�.• A.e .r the ..n ... _ ,.._..,
.. -' .-. •-:<.. u...-'.m.t r oar ,r which cot:....., fir s ;.._...!,:!. I%k) -day, > .:... •.•.
.,A pa-a a
a ,at V,! ,.!
r •'! ,have t, ,;`ts and r t: ,-[ pr .,( ti 1.,l'.in
- o .is
[rue-r.r a. 1 r„.,s.:r the Pr,p•r.r .. -.. t. ,;h .,r.:.., n rh an. ,.1.:-i o!
li
- i .mad upon I•u .r's f,II p t f ti. t� h t tY ..,n
( ss.t a.tie ate;n eff.at o is i..ch d and othe Iu,h,r ni rtI ii ha. !
F-1.:a:-•:r shall be forefeite<1 as li1:i i,lat.l 1 .,vv for (,:!.rr I,V:!I this G, - .,,1 .,s n..tul .or the
,n ty if r;rch,sser fails to redeem):or (iil Vendor n,ay f, -p. , performance of this C..nI,:t I p,!
:ate ami fall payment of the entire uiatst.rding balance, •a•Ith r.t�•th.rr_ at the r ton tt,-
_ ;1 and Sher amounts due hereunder,in which event the Frop•rty�ra AAI be a . n•A at hi:,l !..r and Parc • r
•~e liab'e!or any deficiency:or(iii) Vendor may sue at Iaw for the ent.rr, .:J pur<h s or a p•r
! a iv) Vendor may declare this Contract at a end and rem•::e th t.:ntractasa•!-A.r In In a n���.,:•r-tale
n if the ej.v,Jle interest of Puras,a,er is inairnih• nt,ami(v) V-1—may h :e P.rc^.. t f
,•the Pr,,i—ty and have a receiver opp.,int,d to eollc^t any rent,. or profits,tur:ng tr p , a:t.•n
�!'r Ii). In) or (is) above.Notwi[betanding any oral n ntt.n st�,temrot-a ur actions n(l'cmi:r of n.y
- oms°,�n¢remedin shall only be binding upro Vrnd,.r i(m:.(wF,n pu r:ued in Gtigst:on acd ail trod esper.:•s
...^.g r enable aitnrneps! of Vrnd"r incurred t roforre any rcnvdy hase.:ro{cr Imh..•'-,r ah:[>tnr not) to tte
- t m,t�proh.hited by law andsespnirs e(titl<evid�nre shall he added to prnnpal an.i pud by F:«ha+er, as in•
I,and shall be included in any)ad—oL
CWn the commencement or during the pendency of any action of for-lo of this Contract,Purch a_er consents -
o rant of a r<ceI...of the Property,including hon—tead int,r t,to cniloict tAe r t....+ s,and pr"fta of
rty during the pendency of Such action,and such rents.i— ,and pr,(.0 when.o_11ecte•1`shall be held and
f`os the c,,rt shall direct.
P,n�"-.-r.hall not transfer,sell or co vey any legal o e.iaitaAle tnterest in the Property (by.: rat ,f any
P.rcts-r's r -ts under this Centraet or by option,long-term lea±.or in any other say) without the Prior srittrn
unle��I either the outstanding balance Day aM1ie under this Contract is lint paid in !u 11 or this interest
..~'I oi a pkdg-or a.si.;nmentuf Purchaser's interest under this Contract ndey a u ,y or a indebt.••dn.�;o[
r.In th,tent o[any such transfer,sale or conveyance without Vendor's writ en cor.,rnt,the entire outstanding
"m1—this Contract shall barome im fatly due and pa v able in full,at Vendor's opt in without notice.
Vend^r.hail make ail p:,ymenL sh.;n due order a c mort_ag-oust-di-t against the Property on the da'e of
rpt
!or any mc,t n e- ted by Purchaser) nder ny note f thresh V, pro •d Pur,ha.
-roily Pa; nt of the amounts then due sender ttis C,o ntr.urt Pur<ha.er m make s ::h paymenr,stir• t!y to
d Venda,!ails to to m and sal pa_:ment, w made by Paroh.,e.shall be c�m_. •v1 DsY m•.nts made on
-_. otr”"
Vendor may waive .nY default with.,ut w ving any other aubse•;•sent or prior de!a"It,.f Purc ha:are
All terms of this Contract she!] he bimlinl¢ upon and inure to the bnrE�of the heirs. ! Cal repr c.tatilb-
r,ors and.11 inns of Vendor and Purchaser. (If not an owner of the Property the spowe of Vendor for a sahuabie
dn v;..°"ins herein to release homestead rights in the sabiect Property and agrees to join in the eaecut.on of the
,iced to be madi,in fulfillment hereof.)
Dattd this 18th day of April l9 88 .
(SEALI (SEALI
7,;rljn F. P--n,)y Cordon Knuricon
(SEAL.) (SEALI
3*.h.:in•. A. F �.ny .
AOTII ENTICAT[ON ACENOW LEDOMENT
<.: �• .,. .� _. __.._. .. .-..... STATE OF WI::('OYbiY
as.
__.-. .._.._ ..County.
;..•...-t .rid th,, Jay of ..- ..._._....l9 .. Personally carne before me this-... ..._ "f
_..._..._ ......---...__.... . .__..... _._..-..
...--.-..._...................._.......-, l9.-...... the above n I
....._............._ ..-__..._.._._...
• --.-TA _.. .._ _.__..............-------......---........
....._---------
TITLE. y1 c:SfRE.R STAT):BAR QP WISCOti31N
IIf not.. ... ..._ __._-_-..
autk--t by 1 70-1.0.,WSlats.) to me k..wn U be the per,on _._....who steeuted the
foregoing instrument and acknowicdge the same.
IN'S,NSIROWNT Was De•FT[D Al
;ordon S. Knudson
..............................._.-.............._ ................
... ..
Hud3onWI 4016 ...-....--°................................. ...._..-.....-......-......
.-.._...- ......L.............`L...._.--......_.........._..... ... Notary Public....................... ..............County.Wis.
/Signature.may be auth.ntkated or acknowledged.Both 1[y Commission In permanent.(If mt. state expiration
are
not neceaairy) date:
•Y.rrw of"•holes[e..r_—O, L-14 M A.�r sr Fr:wW .........................................................[9..-......)
7 777
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ST C - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
d
a
H
OWNER/BUYER
ROUTE/BOX NUMBER �VT I Fire Number
CITY/STATE �a � ,y.�/ 44J e* j �/�f ZIP
PROPERTY LOCATION : 5?,() 14, 5A-- !4, Section 6Z T 4;L`yN , R W,
Town of /5� 5 St . Croix County ,
Subdivision / -, i' i_G_ 2!S,",0,Lot' number °f
� I
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 , I
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 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained .
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 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 .
0
F.
I/WE, the undersigned,, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the standards set forth , herein , as set by the Wisconsin Depart- "a
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 .
S I G N E D
DATE
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 .
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115 P.O.BOX 7969
HUMAN RELATIONS 1 � MADISON,WI 53707
(1-163.090)&Chapter 145.045►
LOCATION: 0 HI UNICIPALITY: OT NO.:BLK.NO.: S BDIVISION NAME:
SW �� C�/4 7.1 �n R/ for � U�SON 7 A)1211� YkTn.
C UNTY: WNE NAME:
C Of II 46R NUS c n/ //OS Lmuku AV U�.So fv
USE DATES OBSERVATIONS MADE
2fResidence : CO DESCRIPTION: S:
ICIResidence / NK *rNew ❑Replace &'—.//1 IOS- . C I3 ,9�'�
VI e c •'� �Ir`S— P-14 • p )'LLOT 1
RATING:S-Site suitable for system U-Site unsuitable for system c c c.-L i4t1 R E N14-Rh T
O J �� MSS o� IN-GROUND-PRESSURE:
S ❑� el LIHOLDI
DJG Y {�d►VVeh/T fONMI tic�aII�TQM)e 'S�
If Percolation Tests are NOT r uired IGN RATE:
eQ DESn if any portion of the tested area is in the ��
under s.1-163.09115)(b),indicate: C LKSS Floodplain,indicate Floodplein elevation:
C-T- PROFILE DESCRIPTIONS
BORING TOTAL T •I CH C A A TER SOIL WITH THICKNE S,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH tltF ELEVATION
BS �(V^ TO BEDROCK IF OBSERVED(SEE ArBBRV,ON BACK.) p t
B- / 1%1-� 7,07 NC
B- Z 4.3? 99.Alf I fq0xI6 Ao"&Ln Wdiw l "'igtgC.aSt47A
B- 9.17 98.�� n(o>J�' 2 9-1 "W-n redRaL 3 cst�a�'cob SSN�4N)4St[
B=4 9,%3 9�.�O Noru� >9.$3 l t:TS '' /hs�3'&er Sett CabCar, 7). aq#4 SA(VP
B- S 1 %.131 6.49 algd 61
B- .
bLCR't PERCOLATION TESTS
TEST DEPT WATER IN HOLE TEST TIME RATE IN ES
NUMBER -1 S AFTERSWELLING INTERVAL-MIN. PER INCH
P- 1(6 146 we 3 '>Z >Z <
P- L ,39 0 9 2 �,2 <
P- 2-7 3
P-
P- EL-evnio T
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 q4:56
8 ,
vy v/
i
AT S W C or`CoR.�/�It i ■ 1 �. i I ;.. `
d d
ti
i >i
Sc_Ake
I
' 1
i r
I,the undersigned,hereby certify that the soil tests reported on this form were made by me in rd 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 o knowledge and belief.
NAME(print): n TESTS WERE COMPLETED ON:
N "J%'i Joi{NSQN pusc14 'Z)Q G IN` —1"Iamuk /3
ADDRES : CERTIFICATION NUMBER: {j��ONE NUMBER(optional):
VV7 SCC.oN4 �i i U�SvN l 3A8�F IP
CST SIG URE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR.SBD•6395 (R.02/82) —OVER -
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