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f �o6MMERCIAL TESTING LABORATORY, INC.
f 514 Malin Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227
ST. CROIX ZONING REPORT NO.:,, 05741/01 PAGE 1
ST, CROIX COUNTY REPORT DATE: 5/30/91
COURTHOUSE DATE RECEIVED: 5/29/91
HUD80N: WI 54016
ATTN: THOMAS C. NELSON l
020 -
t
Om, Patrick & Toni Wakel i ng I r_ � �s,T/�r�q f
LOCATION: 487 Countryview Rd.r Hudson
COLLECTORS M,, Jenkins
yk{
�N
SOURCE OF SAMPLES Kitchen faucet
COLIPORM10 0 /100 ml. !
INTERPRETATIONS Bacteriologically SAFE
NITRATE-NS 4 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard,
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAB TECHNICIANS Pam Gane
WI Approved Lab No. 19
��;,: Of.yNOFPEiyp fNr
J
O wp
D
< Means "LESS THAI'!" Detectable Level Approved by+
PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY ZONING OFFICE
St . Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - ( 715) 386-4680
The St . Croix County g Zonin 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 L/
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127 . 00
(For VOC' S )
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at time of
inspection) ``ll
Property owner 's namoPAj] QCr_ .f C `� I �1 ��/�i�� L 1 &(6
Property owner 's address �N'1 CQQAJ,,7ZY V-I E W I219 MUX'SoN I'V,
Legal Description 1/4 of the 1/4 of Section , T N-R
Town of Lot Number Subdivision Name
FIRE NUMBER LOCK BOX NUMBER
Color of house Realty sign by house? If so, list firm:
�()vf� `� G o �_j C ONj;kj(z 2 f
PLEASE INCLUDE, IF AT ALL POS IBLE, 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 : li4- FW3T 1`L�= -)6 -,AL 46-
Telephone Number (,
REPORT TO BE SENT TO: N
Closing date `_1
Signature -Ct
1 rrz)L .0 A�
r
t ,
k
• ST. CROIX COUNTY
n� ter.
FY WISCONSIN
ZONING OFFICE
ST.CROIX COUNTY COURTHOUSE
911 FOURTH E HUDSON,WI 54016
715 386-4680
May 30, 1991
Lois Hinrichs
Burnet Realty
2020 Washington Ave.
Stillwater, MN 55082
Dear Ms. Henrichs:
An inspection of the septic system on the property
of Patrick & Toni Wakeling, located at 487 Countryview Rd. ,
Hudson, WI was conducted on May 28, 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.
Si cerely,
P
M n in
Assistant Zoning Administrator
cj
• Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER u��,r„/i�/•Yeti! TOWNSHIP SEC. T ZEN-R �
ADDRESS, X-_"'_2 9-2— ST. CROIX COUNTY, WISCONSIN
SUBDIVISION x_14; LOT 3 LOT SIZE A/ /Q /
PLAN VIEW
Distances and dimensions to meet requirements of I•LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
aJ
1 ,
I J Y"X24
Df,Vd
�ow Sa
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1
1 �
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1 `�-,•ice '_-.--r' 'I � C` ,'
/S1 S
s y s-l'a �. E f�, CK T.z o
t,
i t INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used � ��f jz>,'Q5` Cork"r'_
Elevation of vertical reference point: Proposed slope at site: 6- % 3E-
SEPTIC TANK: Manufacturer: Liquid Capacity: /4106
Number of rings used: �_ Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front,Side,(D Rear, O feet
i
From nearest property line Front 10 Side,Q Rear,0 feet
Number of feet from: well [o Z building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
i
PUMP CHAMBER Ilk
Manufacturer: _ Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, Ft
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: n Trench:-e� �
F
Width: Length: 3C, Number of Lines: Area Built:
Fill depth to top of pipe: Q
Number of feet from nearest property line: Front, OSide"Z Rear,0Pt !3z
Number of feet from well:
Number of feet from building: 5�'3
(Include distances on plot plan).
SEEPAGE PIT
Size: 111 Number of pits: Diameter:
5
Liquid depth: Bottom of seepage pit elevation: ` 5 ,'}
Area Built:
Has either a drop box O or distribution box been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK ,//�
Manufacturer3 /f/ 1 Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, Q Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
i Dated:- Plumber on job:
` //1
License Numbers Al -
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
.MADISON,WI 53)'07
NtV'4jSE%,S29 ,T29N-R19W CONVENTIONAL ❑ALTERNATIVE r,e Pla nl.D.Nuri
Town 0 j' Hud�s o n Holding Tank El In-Ground Pressure ❑Mound assigned)
Lot 3 Ro.6.6ing Countnyview
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE:
Sam Mitten Route 1 , Box 282 , Hudzon, W1 5401 td s uo:
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV: CST REF.PT.ELEV.
Name of Plumber: MP/MPRSW No Cnunty. Sanitary Permit Number:
Doug Sttoh.been 5432 St. Cna�,x 112826
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. UOUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO ❑YES ❑NO
BEDDING: VENT DIA.: I VENT MATT HIGH WATER NILIIUIBER OF ROAD: PROPER TV WELL: BUILDING. JVENTTOFRESEI
ALARM FEET FROM
LINE AIR INLET.
OYES ONO ❑YES 1:1 NO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP;SIPHON MANUF ACTUREH WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO EYES ❑NO DYES ONO
GALLONS PER CYCLE: [7ND CONTROLS OPERATIONAL NUMBEWOF PHOPEHTV WELL BUILDING VENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET.
PUMP ON AND OFF) ❑YES ❑NO NEAREST or
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing j1fN(,TH D TEH IIIATI THAI 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 IDIST11 PIPE Sf nCINa COVER ]lNSI OL Uln =PITS ILIQUID
BED/TRENCH THE NCHFS MATERIAL: PIT DEPTH.
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UIST R.PIPE U PIPE DISTR.PIPE MATERIAL NO UIST 19 NUMBER OF PH OPERTV WELL. BUILDING. VENT TO FRESH
BELOW PIPES ABOVE COVER EI EV.INLF 1 ELEV.ENU 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 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.
F-1 YES ONO
SOIL COVER TEXTURE PE HMANF NT MAHKF HS JOIISIFIVATION WELLS
DYES ❑NO El YES ❑N�ON DEPTH OVER TRENCH BED DEPTH OVER TRENCH HEO UE PTH OF TOPSOIL =S. SEE UED MULCHED
CENTER EDGES
1:1 NO 1:1 YES ONO ❑YES O
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO.OF LATE HAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
BEDITRENCH.. TRENCHES
D4MENSI0fgS.
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO UISTH DISTR.PIPE UISTHIBUTION PIPE MATERIAL&MARKING
�.ELEV.. ELEV. DIA. ELEV. PIPES DIA..
ELEVATtt)N;ANTS'.
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED COLLECT LV JCOVIH MATERIAL PVL ARTIICAL LIFT CORRESPONDS TO APPROVED
❑YES ❑NO ❑YES F-1 NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBR QF PRNE ERTY WELL: BUILDING:
FET,. ROM
r�
❑YES ❑NO ❑Y ES ❑NO NEARES
l
1
S
z �
ola
Sketch Sydte 0 /Retain in county file for audit.
Reverse 5Ide.
SIGNATURE TITLE.
DILHR SBD 6710 (R.01/82) Zoning AdminizttLatan
�� �� APPLICATION,. COUNTY
DILH
� R SANITARY PERMIT APPLICA O
In accord with ILHR 83.05,Wis.Adm. Code STATE SANITARY PERMIT#
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLA 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 ® NO
PROPERTY OWNER PROPERTY LOCATION
1,Y,—' %, Sc2l T 1, N, R E(o W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER S BDIVISION NAME
I Z Z_. f .dui
ITY,STAT ZIP CODE PHONE NUMBER CITY NEAREST AD,LAKE O LANDMARK
v Z 7 VILLAGE:
!� o
11. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family S OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a.X1 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. Pe rmit# 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.J2 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. aX Seepage Bed b. ❑seepage Trench c. ❑ See a e 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):
7 Y_*� 4 V 70- 11 -Z Feet Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber 1 Li I ❑ Li I ❑
VII. RESPONSIBILITY STATEMENT
I,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) MP/MPRSW No.: Business Phone Number:
St410_130 ._ M r Z 2 3 z3a
Plumbe 's Address(Street,City,State,Zip Code): Name of Designer:
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
i V. r; h 4L
ST's ADDRESS(Street,City,State,Zi Code) Phone Number:
40. u rc,) A vs,. Huss 00L Lo ' 0 1 414 S9
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial S charge Fee
Adverse Determination � 120 1,2� 1 IC,
X. COMMENTS/REASONS FOR DISAPPRO AL:
0"o re)� b y a�P 0 X4 Z61
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
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 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; 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
i
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 Atli
included the creation of surcharges (fees) for a number of regulated practices which Wisco [r `S
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried Te3StP@
is used in your building is returned to the groundwater through your soil absorption u
system or the disposal site used by your holding tank pumper.
; a
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)
ypEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DIVISION
INDUSTRY, DIUtSION
LABOR AND P.O BOX 7969
-a., PERCOLATION TESTS 115
d-1lIMAN,>'�ELATIt�NS 1 ) MADISON,WI 53707
(H63.090)& Chapter 145.045)
FN:S SECTION: TOWNS HIP/k4� TTY: LONO.:BLK.NO.: S Or�IO AM��
�� �/ ,2 /T.2 N/R/?/(or ��►-a
: OWNER'S BUYER'S NAME: MAILING ADDRESS:
7 r / SOr�; Ol
USE DATES OBSERVATidNs MADE
Residence NO.BEDRMS.: COMMERCIAL DESCRIPTION:.S'e•`/w M Replace ce g PROFILE OffL S: TESTS:
NA 9Ve 9
Q
N
RATING:S=Site suitable for system U=Site unsuitable for system
ONV QU MS lJU iN G1G]LV PE1U SF]VaLH .�iGIU COMMENDED nnali
If Percolation Tests ate NOT required DESIGN RATE: If any portion of the tested area is in the 1�+
under s.H63.09(5)(b),indicate: JC`?�J (Floodpiain,indicate Floodplain elevation:
.�._I PR FIV DESCRIPTIONS
BORING TOTALS ELEVATION P H T GROUNDWATER-algli{s6 CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH
NUMBER OEPTH4#t OBSERVED EST.Hl HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
Bi ( 4 ' t 7 Cam/ r Cs
.S- Ael fl•a /, . y/ 19n /Ci, 3. 3 AAt jirr
s- � S' .0' 7 • 78/!" /SoBn / y13h /mss, 3. 7 ,�H �.-s,
a
�
7 V /, 8 0- , "V AI IC-S, V6 eke C-S
B- .� � . o,cr� 7 /.
.8 c
PERCOLATION TESTS
TEST DEPTRT WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER QW."*& AFTERSWELLiNG INTERVAL-MIN. y PER PER INCH
P, o z, _& ..._ _ 41 3
P .
P.
P=
#+I,0T PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
Iontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borin§s and the direction and percent
of land slope.
SYSTEM ELEVATION � . /11 e_
).. ,"s. r
JA
Or
POP *t J011 Ae
As
r
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.
NAME print : TESTS WERE COMPLETED ON:
ADDRESS: Ae CERTIFICATION NUMBER: PHONE NUMBER(optiq�'
PT S TURE:
t
'Original and one copy to Local Authority,Property Owner and Soil Tester.
(R.02/82) —OVER --
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STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT Ho
St . Croix County z
t7
a
H
OWNER/BUYER
ROUTE/BOX NUMBER Q#/ `zs'Z Fire Number —
CITY/STATE , 50,01 Z I
PROPERTY LOCATION :�k, S Z, Section a j T�_N , R �,
Town of &41�2k St . Croix County,
Subdivision&ts;a4 ,/mac pfr 1 Lot number_.
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists of pumping out the septic tank every three years or sooner ,
if needed , by a licensed septic tank pumper . What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix. County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 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 . H
0
I/WE, the undersigned , have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- ro
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 C N E
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 .
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/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
Owner of Property ,�1—t 1lae-
Location of Property , Section T�N-R,�
Township � ,SOh
!tailing Address ie 0—o v( 7
-�� ,0 n j.t,Z f_—& AL
Address of Site-��,h�r t/ f/, '�.� JQg7..
Subdivision Name
Lot Number
Previous Owner of Property >,��s7`` lc?EyS i h�a
Total Size of Parcel z.
Date Parcel was Created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for resale (spec house) ? -;;- Yes No
volume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (eve) ceAti6y that att Atatement6 on this foAm au -tAue t0 the best o6 my (oun)
hnowtedge; that I (we) am (ah.e) the ownenk 06 the pnopenty deschi.bed in thiA
i"604ma.t i.on 6o4m, by viA tue o6 a waft an ty deed neconded in the 0 6 6ice o6 the
Count RegiAten o6 Deec(A" Document No. 3
_2 and that w
y o ; at I ( e) pnee en.tty
own .tJ�a pnopod ed a.i.te oh the ewa a b digs ors
6 g p 4 yes em (on I (we) have obtained an
easement, to nun with the above dedchi.bed pnopenty, bon the cond.tAucti.on o6 said
bystemp and the dame has been duty neconded in the 066ice o6 the County Reg.ieteA o6
Veedd, ae V oament No.
3 z 3D 1 .
Sa,..i --yy)11
SIGNATURE Oh OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
�0
DATE SIGNED DATE SIGNED
�9;Pma 49
DOCUMENT NO. STATE BAR OF WISCONSIN FORM I1-1M T"is " c' """re row Racollo(rre oars
LAND CONTRACT
- tadhldul aed l orpnb REGi TER'S Ural
f) ITO nE USED FOR ALI, TRANSACTIONS WHERE OVER
4304230 2-11-000 IS FINANCED AND IN OTHER NON-CONSUMER ST. rkir;lx CO., W1
s ACT TRANSACTIONSI
REC•i Irlt A:cord
Novesb¢�474 t oA
Contract, b) and between . 1QXX£&x..):....,RQa$ing-and••„•-••--_,•-
RukY...Ra),�eY.r_.a sin8le woman
.............................................................. p+} I:25 P M
................................................................................................ ("Vendor",
whether one or more) and..51110..E-...(`1 A IR.r.............................................. Re91ster of Deods
............................. ....................... .................... ......................................_
.......................................................... ("Purchaser", whether one or more).
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract b) Purchaser,the following property,together with the
rents,profits,fixtures and other appurtenant interests (all called the"Property"),
in......st....GX•QU........................................... County, State of Wisconsin: narusr,To
West one-half of Northeast Quarter 641004)
except except the east 8 rods, and the Northwest
Quarter of Southeast Quarter (NWZSE1&), except Tax Parcel No. .................
the south 6 rods, all in Section 29, T29N, 19W.
FM
I
�I
This _ 1s..nOt.. homestead property.
( (is not) ...................................
208 8th St., Hudson WI
Purchaser agrees to purchase the Property and to pay to Vendor at ..........................
the sum of$.256-150.00.................................... in the following manner: (a) $ .9...00.QQ..•_.__...•,-
at the execution of this Contract; and (b) the balance of $2317,•150.00__.•..............together with interest from date
hereof on the balance outstanding from time to time at the rate of.nine..49X1 ................... per cent per annum
until paid in full, as follows: Interest to January 11, 1988 shall be limited to $1,320.29.
$80,000.00 plus interest on the unpaid balance on January 11, 1988.
$50,000.00 plus interest on the unpaid balance on January 11, 19159.
$50,000.00 plus interest on the unpaid balance on January 11, 1990.
$56,150.00 plus interest on the unpaid balance on January 11, 1991.
The above payments shall be made in addition to any payments made for the conveyance of
lots until the total price is paid in full.
All payments shall be by 2 checks, one to each Vendor for ;I of the full amount.
A )pot.�tedluse Agmem nt hadlso been shi�tgdpolj .tqI ff dateb 11th
rovi e , owever, a ent ire outs?ant ing ba ance a e at in u on or efore the...................... ... day of
....JArLuary...................... 19.11.. ( the maturity date).
Following any default in payment, interest shall accrue at the rate of 1Q.......% per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purrbaserr, unless excused by Venderr agrees to pay monthly to Vendor amounts sufficient to pay rensonably antici-
pated annual taxcwz,Fpenial as menta,-fire and repaired insaranes premiums when due.To the extent received by Vendor,
Vender-agrees to apply pa}nwnts.te these Obligations when due. Such amounts reeeive(i by the Vendor for payment of
taxes, asr,w[aments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.Any amount may be prepaid on principal at any time.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after........ ...... .... 19....... (OR)
them-may be no prepayment of principal without permission of Vendor!` II 11 V,6 litardil"lit prom rpi-ow
rl.
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall he treated
as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been
Wade as first specified above; provided that monthly pa)-tnents shall be continued in the event of credit of any proceeds
P P
of insurance or condemnation, the condemned premiser being thereafter excluded herefrom.
Purchaser states that Purcha=er is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except:
Purchaser ar•rees to pay the cost of future title evirlencc. If title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall beenctled to take t,nsse-lion of the Property on t he date hereof IV
•Cnw. (r,; (1n,.
LAND CONTRACT—Individual and I V 14AR W, wls(ONSIN fit•^ 1.•e•I Wank C,.• In,
Corporate FUaH �o. il•—IVB: �luv n...., R,a.
r+r �n '�y /PASS W�ti,. - Purchaser promises to pay when due all taxes and asbessments levied on the Property or upon Vendor's intarec.to it,ard to deliver to Vendor on demand receipts showing such payment,` J'"V4Lnst;L al.all keep the improvements on the Property in cared against loss or damage occasioned by fire,' hazards us Vendor may require, without co-irsuranee, through insurers spprov �
"---- but Vendur shall not require coverage in an amount more
p f
by Vendor, in the rum Of :. - ...::-
than t`,,• balance ow',rd under this Contract. Purchaser• shall pa�y the ialurance premlems when due. The �Iheo�rliinall � : F
c•.nt:tiu the st,lndard Clause in favor of the Vendor's interest and unless Vendor otashalltp agrees in•ve noti a of loss to *rx�
a( all pu!icars coverin{r the Property shall be del osited with Vendor. Purchaser shall promptly gt Purchaser and c"r t •r p s otherwise d writing, insurance shall atd
he so wre ttoation or air of the Property damaged�providedtheVenor deemsthe estoratiin o +.
repaW 40 be
Oil � a
�,ic,il, 1r•:fbU,!c. �,,.
rtr `
1',;rcha.:,r rocl n:,its not to cnrnmlt waste nor aaow waste to becon,mitir•d on the Property, to keep the Prope $ ,
in 1•cmA tenantable condition and r-pair, to keep•the Property tree from liens buperior to the lien of this Contract,and
to c,.n:ply with all laws, ordinances and regulations affecting the Property.
be full aid and all conditions
mone s s}.al) Y P
� d other S
interest an
chase rice with t liver to
Vendur agrol t},at in case the par P Vendor will on demand, execute and de
nor above specified,freed
nd in the man P ex
r. t t the t:r.tea a r encumbrances, tempt
rr tad a e
h full
,err en
e}.all a fens and
S ( ear u. all 1
0
ertt free and clear
' Deed, in
fee simple,le of the I r p
the Purchaser, a Warranty P •' 1 brio I•�„�St
existing..�..g.... Y•r••••
any Ilene ur encumbrances created by the act or default of Purchaser, and except:
or West.-fences encsaach..on land...wa rant Y W11I.not..applY. to
lA .•
between .s ich. fe.Rees-.aHd..true,.description-.lines, .,..
..................... ................. .......
Purchaser at reea that time is of the essence and la) in ti,e evert of a default in the payment of ally principal or
irterf•st which continues for a period of ...60.:.daya following the specified title date or (h) in the event of a default in
pert,,r^nr: of an:, other obligation of f'ufchuser which continuer; for a l.c•riod of..b0. -- days following written notice
tic•e,+i i• \'et„h,r tdeiivervrd pemonully or mailed I certified mail),ti•,en the entlre out-tandintt balance under this contract
stall he,•,me in;medlately due and payable in full, at t'ender's option LOA without notice (which Purchaser hereby'
shall also have the fr,lluwint riyrhts and reu:c l ,- Liter to nny limitations provided by law) in
;,,!,; t;•m t:+it r•-r provided by' law or in equity: (i) Vendor may', tit h =pti,u terminate this Contt.wi and Purchaser's
ri;•i t t:t!, :u,! ;mere-t in the Property and rer.•c,r the 1'roprrri h n is through filet foreclosure with any colony of
rruc:::ptu,:; 1„ br ! tinned u�+on 1 turh:rer :11
p:. tnr;tt th interest
ul t!,• ert.rr t,tandut� balauce, ar
t oil such d;tcandrtreramo amount, tutwhichevental?amountsprevioud4.
.h,. t' •r oral n•' r,'.nta) for thr
p e t t•t 1 :, r 1.11f he ion•'e t, a:• lirlai•!:t , ! ,I:n. r orniance of 0,I4 l'unttnct to compel
1 into r t:. I t astir falls to redec•nt t: or tilt \,1,,r n ,y sue C,r :>pec,t t• pert
nnrue;? at •,:nl ::;II pa}meet of the entire out tar.d..,, 1,111. ,r. ccith ii,l t t!,n .n at the rate In rffert ,,n the date of
Jefau:t and other amounts due hereunder, in tc'hic', ascot tl:,• Property shnll lie auctioned at judicial sale and Purchaser.
),,!1 he]stile for tiny deficiency: or (iii) Cend•,r n,:r: s rr ,t ',::,, f•,r th.• entire urp:,id purv•r.ase price or any POrtion
thor,-,f; or list Vendor may declare this Contract at an end and riniove tills t'„ntract as a Cloud tin title in a quiet-title
:..,:
it the ,,tvil•,hle Interest of 1'uir•hac er i, in_ t r,t:cant; and (yt \•o nd(,r n,a}' hav,• 1'u.-chaser Cjectad from possession r
of the Property and have a receiver appoinb•d to collect any rent. L ors or profit: durintr the pendency' le any action
under tit, tilt or (iv) uh„ye.Notwith=tardintt any oral or written �tat(nr,rst,4 or actions of Vendor, an'election of any
of tt.e fore;oinp n nuvGes shall only },C h:ndintr up•,n Vendor if :111,1 Wthen p nsued in liti¢vtioa and r,r: costs and expenses '
inclu,lint.• ems,n,'le attorneys fees of Verd,,r incurred to enforce lw% nurevy hereunder t and paid abated rc not! to the
extent w !rn whited M• la-'v and expense of title evidence sl:ull hr mt,ie d to 1•r:ncipal and paid h}' Purchaser, ea in
rurre•l, and shall he included in any judgnwilt.
Upon the commencement or during the pendent' of any action of tereclosure of this Contract, Purchaser consents
to the appointment of a receive co of such Pr action,i and lueuch rents issue'tnr,!tttrofitsllwheo so collected ushallnbeph and .
the Property during the
applied as '!e r„art shall direct:
turchaser shall not transfer, sell or cony(,)' arty weal or e,,nituble !arrest in the Property tby assignment of any
of"Purchaser's rights under this Contract or by option,long-term lease or to any other way) without the Prior written
consent of Vendor unless either the outstanding, balance pays ale un;lrr this ('Detract is first Paid in full or the interest
conveyed is a pled__^e Or assignment of Purchaser's interest under t?--is Cont ract soleiy as rceurity for an indebtedness of
Purchaser. !n the event of any such transfer, sale or conveyance tc t,,:.t Vcndr,r's written con tic t,the entire outstanding
balance pa)'nt,lo under this Contract shall become immediately d!,e nod payable in full, at Vendor's option without notice.
Vendor stall mnke all pn,�:ments when du(• under am' morti:a9e out=tandir..,ccA cal therehrpery on the e date of
this Contract texecpt for any mnrtcage granted by purchaser) or under any note P to
t► lio-t�.ly,pa the lo`thc-n due
Heil alhln:�f cat QOnttta le 1F u Purlcl:,-,,r i till file rnnsidered paymentslmade on
this Cnntrne•t.
\'c:vlor may waive any default without waivinc nny other sub<e,l+,en: , r rrior default of Purchaser.
All terms of this Contract shalt he binding upon and inure to the benefits of the heirs, legal representatives,
sucept or% and assigns of Vendor and Purchaser. (if not an owner of the Property the spouse of Vendor for a valuable
consider-Wien inins herein to release homestead rights In the subject Property and agrees to join in the execution of the
deed to be made in fulfillment her!wf.)
listed ti,i,
16th day of November , 19 87 .
r���cs'L- ��C-�',�..i<>•1� t�1::\t.t � ( EAL)
or Let E. Rossin / Sam E. `tiller
(SEAL)
Ruby 1lley
AUTHENTICATION ACKNOWLEDGMENT
,icnatn.rei•1 all parties .. STATE OF N•1SCUN,1IN
Sit.
. ........ ... County.
1, ., ., •. , eta 16th,la" of November _ 1982. Personally came before me this _ _day of
10 ...... the above named
/r /A-►C�
•John H-)'wood
MIA: MI:\11tE1i �ZT.\TI•: BAR OF WISCONSIN . ....
t.:• ..... ! •,rn•;. Wis. stets.) t, ne ktucrt t , t'•e• rcr-on who cx+toted tlr
f,+n 'Dint, test,.•,;,,••t .,•.,? .,.kr:onu ire t .c sa••'c r
. .•.aS C.,,'.F-ED r
John D. Heywood, Heywood. Cari S Murray
Hudson, Wisconsin 54016
ont elf not. state CNriratien
t , , ' ,.•ntcd e r .;;,t- ,tc?,.p •I, l: ,,. -
J.1 date.
Vp
1 %Vn a e,\tR\e7— lodnidull end aerperate—state Bar of tlrlwen„ta.Fern,No It—1•>. --