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Parcel #: 020-1231-30-000 02/07/2005 12:13 PM
PAGE 1 OF 1
Alt.Parcel#: 29.29.19.1240 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): *=Current Owner
*
DAVID K&LISA M SPOTT SPOTT, DAVID K&LISA M
496 DEER HAVEN DR
HUDSON WI 54016
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description *496 DEER HAVEN DR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.390 Plat: 2421-ROSSING'S COUNTRY VIEW
SEC 29 T29N R19W LOT 12 ROSSING'S Block/Condo Bldg: LOT 12
COUNTRY VIEW ADDITION
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
29-29N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1056/447 WD
07/23/1997 830/368
2004 SUMMARY Bill#: Fair Market Value: Assessed with:
49280 249,400
Valuations: Last Changed: 04/29/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.390 32,000 160,900 192,900 NO
Totals for 2004:
General Property 2.390 32,000 160,900 192,900
Woodland 0.000 0 0
Totals for 2003:
General Property 2.390 32,000 160,900 192,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 111
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
COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715 - 962 - 3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
ST. CROIX COUNTY GOVERNMENT REPORT NO*' 5:3300/01 PAGE i
k' CENTER REPORT DATES 11/30/93
1101 CARMICHAEL ROAD DATE RECEIVED± 11/2:3/93
HUDSON, W1 54016
ATTN** THOMAS C. NELSON
Ik
I
OWM* Mike 6 Jennifer Eide
LOCATIONS 496 Deer Haven Rd., Hudson
COLLECTORS M. Jenkius
DATE COLLECTED! 11-22-93
TIME COLLECTED** 2**00pm
SOURCE OF SAMPLE** Kitchen faucet
DATE ANALYZED**11-23-93
TIME ANALYZED442**00pm
COLIFORM,MFCCS 0 /100 ml
INTERPRETATIONS Bacteriologically SAFE
NITF;ATE-N** 4 ppm
Abave 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, m9/'L \_..
LAB TECHNICIAN! Pam Gane
OFA VEPENp,
=c sm WI Approved Lab No. 19
O
d3 h Means "LESS THAN" Detectable Level Approved by'*
PROFESSIONAL LABORATORY SERVICES SINCE 1952
13 V - 3
�
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST.CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON,WI 54016
ELAtj
(715) 386-4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
Specify desired test(s) & remit appropriate fee with application.
Outside water lines are often turned off during winter months,
making access to the home necessary. Please make arrangements with
this office to insure a time when entry can be gained.
❑ Water (VOC's) $185. 00 )d Septic $25. 00
nj19 Water (Nitrate & Bacteria) $35. 00 (Visual inspection)
wner:MIKE tTENtiiF�R E1�pr- Requested by:ANgggA KAQ.y qo C gruK�
ddress: yq(o Q6� PA-ugm A6 . Address: -706 19tk ST.
/ City & State: ,)o nIJ , City & St. Hudsont , WZ
Zip Code: 540/i, Z ip code: 5 0 4 /b
Telephone N°: ( ) g �i�g� Telephone N4: (
Property address (Fire NQ & Street) : �9(� Deet ARUEN
C.�
Location: _;,��;, Sec. _, T N, R W, Town of uDSo
n St. Croix Co. , WI. Tax ID N4 I - Parcel ID N2
60 '.1 �.00OUT I� vi eW ~
House color: 6knaig Realty firm: G-al Lock Box Combo:
A / Water sample tap location: jAj,
✓ TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Is the dwelling currently occupied? E� Yes ❑ No
If vacant, date last occupied:
Septic system installed by: 7 Year:
Septic tank last serviced by: rt�i �lSUN)T� w. fiAT,W Date: SEhT 9 3.
Previous Owner's Name(s) :
1
Have any of the following been observed?
❑Y S low drainage from house.
❑Y Sewage Back-up into dwelling. �,�
❑Y Sewage discharge to ground surface, �� '
road ditch or body of water.
❑Y 1pq Slow drainage from the dwelling. "'.
❑Y y1 Foul odors.
Other comments relative to system operation: "
I certify that the above information is complete and true to the
best of my knowledge. ��
OWNERS SIGNATURE: ` DATE:' /
I�� < �� //ZTl �
4/93
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
t
IN
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? OYes ❑No
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: ❑Below grd OAt-Grd OMound
Approx. size ' X ❑Gravity ❑Dose OPressurized
OBed OTrench ❑Dry Well
Molding Tank OOutfall pipe
OBSERVED DEFICIENCIES ❑Other OUnknown
Septic tank
Setbacks: ❑House OWell OProp. line ❑Other
Dose tank
Setbacks: ❑House OWell OProp. line OOther
OLocking cover OWarning label ❑Pump/Floats
❑Alarm OElec. wiring
Soil Absorption System_
Setbacks: Mouse OWell OProp. line OOther.
OPonding: ❑Discharge:
General comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
e
Inspector
Title
o s
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
1 b n N p r n■ Nomai ST. CROIX COUNTY GOVERNMENT CENTER
rF. 1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
November 22 , 1993
Andrea Kary
Century 21
706 19th Street
Hudson, WI 54016
An inspection of the septic system on the property of Mike and
Jennifer Eide, located at 496 Deer Haven Rd, Hudson, was conducted
on November 22 , 1993 .
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.
Should you have any questions, please contact this office.
Sincerely,
Mary Jenkins
Assistant Zoning Administrator
mij
IS
Form - :S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER /1?'14_r TOWNSHIP SEC. _Z,�' T �' N-R�
ADDRESS oi��e # / p W 2 g ST. CROIX COUNTY, WISCONSIN
SUBDIVISION,f oSs,', v V,,c�&OT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of ILHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
� I
I
Hal,s�
X45' Ws II
X95 w4
Sc,. Ia INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used 2 4-f fe 1
Elevation of vertical reference point: 100- 0"
00- Proposed slope at site: NotA
SEPTIC TANK: Manufacturer: wa 1 s a v, Liquid Capacity: 1000 qg
'-T
Number of d:rings used:se J Tank manhole cover elevation: S.
�y
Tank Inlet Elevation: S•0 1 Tank Outlet Elevation: V 2 9
Number of feet from nearest Road: Front /'%A Sid Rear, O Z 10 '
feet
From nearest property line Front 10 Side,O Rear,Q 40 3 feet
Number of feet from: well (o S' , building: 20 4
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
_
f
PUMP CHAMBER
Manufacturer: �! Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size .
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, Ft. ?
Number of feet from well: j
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: l�H yd„"�;p,,� ! Trench:
r o �7
Width: /g Length: 3 4:;;.' Number of Lines: � Area Built:
Fill depth to top of pipe: 1- a
i
Number of feet from nearest property line: Front, O Side, O Rear,It .LS
Number of feet from well: $_7
i
Number of feet from building: y /
(Include distances on plot plan).
SEEPAGE PIT
Size: �1'7 Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: � Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, OFt.
Number of feet from well:
Number of feet from building:
` Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
te a►-!
License Number:
3/84:mj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR ,SAFETY&BUILDINGS
LA190R&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX'M69 BUREAU OF PLUMBING
MADISON,WI 53707
iA�(��i (+ i 529 T29N-R19U1. CONVENTIONAL ❑ALTERNATIVE State Plan LD.Number:
N 4 SE 4! D (If assigned)
!
Town G Hudtson ❑Holding Tank ❑ In-Ground Pressure ❑Mound sing C un�Jc. hew
ME OF PERMIT HOLD ADDRESS OF PERMIT HOLDER INSPECTION DATE:
Sam MiUen Route 1, BOX 282, Hud6an, w1 54016 /0-.2o- 9j, 9-'2U
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV..
Name of Plumber: IMP/MPRSW Nn.. Cnunly Sanitary Permit Number:
Doug StA hbeen 5432 St. CtoiX 1128d3" �� S
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL L
- P}R�O-,VIDED. PROVIDED'
I, ;. ) V:-, �(4 ,O I L]JYES ❑NO ❑YES`NO
BEDDING: VENT DIA. I VENT MATT HIGH WATER NUMBER OF'' ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
_ ALARM FEET FROM ,rf ) LIN63 ��/ LAIR INLET.
: YES— NO C--�- ❑YES��NO NEAREST V.'(J/
DOSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL PUMP:SIPHON MANI (TIIHEft WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
❑YES ❑NO I YES O ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF ;PHOPE ELL UILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES 1:1 No NEAREST-�
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of pl owl ng I E N(,TH 1111AMIT111 MATE IAL AN MAHKIN6
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 IDISTH PIPE SPA(,INi� COVER INSIDE "A 11ITS LIQUID
BED/TRENCH THE NC RES MA,TE'E AL. PIT DEPTH:
DIMENSIONS
RAVEL DEPTH FILL DEPTH DISTH.PIPE DISTH PIPE DISTR.PIPE MATERIAL NO DISTH NUMBER,OF, .PROPERTY WELL. BUILDING. VENT TO FRESH
B OW PIPES ABOVE COVER Et EV INLET ELEV.ENU PIPES ,-LINE t, AIR I
" NEAREST- s g7 q.� r
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.
DYES El NO
SOIL COVER TEXTURE PE HNIANE NT MAHKE HS OBSEHVATI(1N WE ILLS_ L-1 YES 1:1 NO ❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVER THENCH BED =TOPSOIL S(1DDEO SEEDED MULCHED
CENTER EDGES
1:1 YES. LINO ❑YES ONO DYES 1:1 NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO E O N C H E S. LATEHAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
1�IMENSIONS-;
>.MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTH DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.. ELEV. DIA. ELEV. PIPES DIA.'.
ELEVATION�yAt�Nt71'
D1STR MATION HOLE SIZE HOLE SPACING DRILLED CORRECT LV COVEN MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
1WFORMATIDNe PLANS
DYES ❑NO DYES 1-1 NO
COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF ',. '.PROPERTY WELL: BUILDING:
q -t FEET,FROM; 'LINE:
JD ❑YES 1:1 NO ❑YES 1:1 NO _ 111E+4fiEST `
\
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE. Zoning fLdmi.n"thaototl.
DILHR SBD 6710 (R.01/82)
SANITARY PERMIT APPLICATION COUNTY �•
7 DILHR In accord with ILHR 83.05,Wis.Adm.Code , v�Q
STATE SANITARY PERMIT#
i a ffle
–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 X NO
PROPERTY OWNER PROPERTY LOCATION
lz 546,% , 4, S wZ T.24 N, R If E(or)
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUIABER SUBDIVISION NAME
CITY,STATE ZIP CODE PHONE NUMBER Q CITY NEAREST R AD,LAKE OA LANDMARK AUX/ f D/ VILLAGE: !G �. ��
11. TYPE OF BUILDING OR USE SERVED: a
Number of Bedrooms if 1 or 2 Family —3 OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a.� New b.El Replacement c. El Replacement of d.❑ Reconnection of e.El 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. 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. X 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):
3 �s5 �T +!p 4/8 SZ �T �' Feet Private ❑Joint ❑ Public
V1. TANK CAPACITY Site
in g allons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank X0
Lift Pump Tank/Siphon Chamber ❑ Lj I Lj ❑ 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:
DaK ST( �bath I a •f c ��- s jr
L 3 Z
Plumbe 's Address(Street,City,State,Zip Code): Name of Designer:
IQ '1�14 W
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
a-A A ' s
P. C t h 9.r' ma,m /S9 S
CST's ADDRESS(Street,City,State,Zip Co e) Phone Number:
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps)
Approved }{� Surcharge Fee
pp ❑ Owner Given Initial v1�
Adverse Determination
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
--J
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;
11. 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;
Vlll. 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'h 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 .BtBf
included the creation of surcharges (fees) for a number of regulated practices which Wisco :In s,..
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasute a
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)
I
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 ,$ ry� j,'//a✓
Location of property S_w 1/9 1/9, Section a2 f N-R /'fZV
Township M, ✓-soh
Mailing address Ae le-W' 2-.0 2—
/Yti/-s n.2 GtJ= -s-viv/L
Address of site „l�,i
Subdivision name eO SS'-'h
Lot number Z-
�1 Previous owner of property ( r�� �5��►•N
Total size of parcel 2- , 3 ? 14cQ r 5
Date parcel was created :-
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? X Yes No
Volume �7'F '7 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 references to a Certified Survey Map, the Certified Survey
Map shall also be required.
I
-------------------------------------------------------------------------------
PROPERTY OWNER CERTIFICATION
I(We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in
this information form, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. y -5 '*:2-3V0 ; and that I (We)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has bee duly recorded in the Office
of the County Regist r of Deeds, as Document No. 3 02 g-3 O ) .
e of Owner Signature of Co-Owner (If Applicable)
D - r - 0e
Date 6 f Signature Date of Signature
- - 77t :
7 �Y4t .�,
TNIe MACK ReeeaY�son waCOA♦Nla aAf�
DOCUM04T NO. $TATS EAR OF WISCON8I FORM 11-im
" } ' REGISTER'S (DICE
�+ (To RE UERD FOR A T�A)IaA, CT101id 1r�� OVER M
O
Wt
a.Ren IS FITIANCED AND IN OTalElt NON-CONSUMER ST. CROIX W.
ACT TRAN"MONS)
Reed for 03COM
��,•. .ems► ,' �r
COIItMC)k bi and between ------•-----• 1S2'S P M
..R11l1X.-1MNX�_a single woman
-------------------------------------------------------- at
wMebae one or more) and_Sit10..T...M111CX-----------------------_.-- ~Vendor". of 0006 t
......._..................•--._......_..... ... ("Purchaser", wheaw one or more).
Veabw rift and egress to convey to Purchaser, upon the prompt and full per- `«;
*gDeeses of t>sis oontraet by Purchaser,the following property,together w"the
�t= j=j^pnats,fixtures mW other appurtenant interests (all called the"Property").
...................... county, State of Wisconsin: IWTURN To
F Y
West one-half of Northeast Quarter (WhNFh)
_ except the east 8 rods, and the Northwest rJ`
Quarter of Southeast Quarter (NW1tSF4), except Tax Pared No. .................... ...........
the south 6 rods, all in Section 29, T29N, 19W.
r�$
This ...........3s..ttOt..... homestead property.
(u not)
208 8th St., Hudson, WI
Purchaser agrees to purchase the Property and to pay to Vendor at .............................................................
..
the ease
at i-H..4:_0.................................... in the following manner: (a) =.ZQs.QQQ 2m................•---•---.....
at the eEeention of this Contract; and (b) the balance of =236,,150.OQ------------------together with interest from date
>tuaef an the balance outstanding from time to time at the rate of.nine._49X ....................... per, cent per annual_u
=0 paid in fua, 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. i
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 k of the full amount.
_ A t. ass Agee t so been d ou fa e� 11th
�giowever;the entnre oh ante vac pal in On of 'fore the day of
----,jALAtls.Ly....................... 19..521.- (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).
f in fieient iepay reseewaWy antiei-
due.Te•the extent received by Vendor,
Vsffiday' affg�� when - by the Vendor for payment of
ji he Aep"q&.A into an."eve fund or trusts* account, but shall not boar interest
rwpirsC-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. AW-
., �Iatmay be,pwpaid-withe" ism or fee apen-prioeipal*t any time-after.--- - --••;;--;i---:-....__, 19... .. (OR)
a€ prieeipel withee�per Ye lder.mission e€li-we ossy be no prepayment a
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal,and interest (and in such case accruing interest from month to month shall be treated
as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been
made as first specified above; provided that menthlp payments shall be continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
K Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
t'- for examination except:
i
r
Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
the date hereof ------
Purchaser shall be entitled to tale possession of the Property on .. .. .... ... .............
sCrwR Out One.
LARD CONTRACT—Individual and STATE. RAR OF WISCONSIN wi. ,r-.n i.nd Blank Co. 1ne-
'. FORM No. 11--11082 SAuw a�wcr, R'ss.
- CMtOfaMl ;.
M,/ASE
Purchaser promises to pay when due all taxes and assessments levied on the Property or upon _Vendods itut r w
in it and to deliver to Vendor on demand receipts showing such payment.
i shall
keep the improvements on the Property ins"red against loss or damage oaafiosled by Am.4 �
rer.ted coverage 0 ch other hazards as Vendor may require, without co-irsurance, through 1p4PS1ss app! ii
i=° by Vcn,iur, in the sum of ;. `�..::.:..�........ . . but Vendor shall not ra ptire eovera�e ils in amount MM*
than Vie balance owed under this Contract. Purcliaser*4all pa the ;asurance premr�ms when due. The policies sh
c-,main tae standard clause in favor of the Vendor's interest and, untess Vendor otierwise agrees in writing,the
of all policies covering the Property shall. be del osited with Vendor. Purchaser shall promptly give notice of Ns�to
in ur ice companies pd Vendor. Unless Purchaser and Vendor otherwise agree in writing, trrinraaor Proceeds sfmll
he ape c U w-gMf1ition or repair of the Property damaged, provided the Vendor deems the restoration or rllpltif 40u
P rebu_r r ecr,:,its not to c,rurnit waste nor a:krc waste to con:rmtt,•d on the Property, to keep the Property
in Ruud tcnantat,le condition and r pair, to keep the Prupert} Iree :rum liens superior to the lien of this Contract, a"
w c,n.:tly with all laws, ordinances and regulations affecting the Propert%.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all eonditieas
stiall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to
.yµ the Purchaser, a Warranty Deed, in fee simple, of the Propert}, free and clear of all liens and encumbrances, excWt
any lien:; o: encurnbranees created by the act or default of Purnna.ser, and exc•-pt: existing_.hlghway.......T1. i 1
or blest-.fences .encroach..on thi-s..Qr_.adJ4.lnlni; land, .wirr4ntY .will.-nv.t._aDF�Y- to. laud...
• .
between s . ces.-and_tygp .scripti�q.lines,
uch fen
.. .........................
- - --.........................
Purchaser agrees that time is of the essence and (a) in tl.e •vcrt of a default in the payment of any principal Ot
interv.<t which continues for a period of ..60..-da}s follot~ing t!.c s;:e._ified clue date or Ib) in the event of a default in }
per!c r an•-,• of ;.n-. other obligation of Purchaser which cuntn:u(, !,,r a 1.eriod of...6.0 days following written notice
ti:err•ui Vc::,t.r Ideiivered personally or mailed b; certified ma:,). t:.en ti e e:,!:re wltsanding balance under this contract
` stall tw-i t. ininx•diately due and payable in full, at Vendor , +,1'; :+ i WAi:out nuticc• (which Purchaser hereby
!. .,, to any limitatione provided by law) in i
1• wal. :.nu Vcrd�r ::tall also have the t,d]uwin> rig},ts and r, ec r - } 1
ti. u,,,-c provided by law or in equity: (i) Vo nd,r ma} 1, n, t, ri i r.atc ti is 1. nti:.••i and Purchaser's
rid} t rtcrc t in the Property and r �, r tic 1'r to r• f� r tit ogee:,•lire V:ith am equity of
, t„ t:.• t..;rn,f upon },,nc•i.a�cr :1' tr r,.,❑t •.r ,.,nl .i,: L,,1•n:cc..t'•.ti intere-1 thereon from
tt:e i.,' • ..:! r.:c• n u'. on �u� :,tcandctter nt ',oit ox•',,rc,.:.�.c• tr ��r, chevcr,.::l: untsprevioualy "•,.
paA n 1' , , r >t i!; br tore•:e•.t,.: .. lip,. 1 c ,t. I r,..!:,1 for the g i
Pro{ y t .aser fails to redeem); or i it) \ r i o r n ,n e • ti,s Contract to compel Y
unrue,ti c �
,, , A : tl pa%rnent of the entire uut,t,,r.r . • r t r:,t c,ft, )ti the date of.
do fau:t and ,Ger amounts due hereunder, in witic,, eye t tr.,• I r 1 c i I a n r, ' at i i.,tai sale and Purchaser;
shall he liable for any deficiency; or (iii) Vendor n::.:. . :.t r. itsc price or any poetics y'
tl:crr,f: or live Vendor may declare this Contract at an <•rnd .. �:.i,:e, t! �> ract.isacloud on title in a quiet-title
:tit.,.,, it tt:e ,•,,,;u,hle• interest of Puieha-er i� in>:_rn ,io t• :,n,! 4 i t r n hack. 11,..cha-er4;ectld from possession
;. of the- Property and have a receiver appointed to c„!lect :,r..: rw t r )r,:';t„l�ru. ti,• pendency of an} action
s under (i), lit) or (iv) above.Notw;thsta :,l;,it' ar,: or:d or cent,:; r,,, or ac•ticir.; Vendor, an election of any
of t}a fore;.-wn�r r,medi,s shall only be `•n.d,: u!..n Ve1011 : r w ! { ,.c d in 1;ti1:-,t c n ar.d :,r: costs and expenses
including rc:,.r c attorrn•.s fees oc V,nd,,r tr.c ,gyred to ti-Ion, n.dcr in ,ether abated or not) to the
exte•,t nu' t :jt;ted by lair and expens . .-f tit!, ,•;id(rr+ 1'!.• .... I:r.:x in.,l an,i paid b-; Purchaser. ar in-,
Purred, and shall he included in any judgnu ut.
Upon the commencement or during the pendenc} of anti action or `,rcc;n uie of this Contract, Purchaser consents b,
to the appointment of a receiver of the Property, including i,r c tt•ad L.ter,.t, tt, cuil,•ct the rents, isRues, and profits of
the Property during the pendency of such acr.�in, and satin rei:t<. -sac>. ar ti profits when so collected shall be held sad
applied its t!.c court shall direct.
Purchaser shall not transfer, sell or convey an, teal nr e-,i:t:,h!e .r!ertst in the Prnpertp (by assignment of any
of Purchaser's rights under this Contract or by (,ption, long-Terin 1,::-, t r it m,y other wa>') without the prior written,.,
w consent of Vendor unless either the nutaandin¢ l..aance pa ;d,ie .:r lc. r.tract i� fir>t paid in full or the interest' '
conveyed is a pledge or as,i nment of Purci astir :av st i `< r a, olc:: c :city for an indebtedness of
Purchaser. In the event of am such transfer, :.ilc or c im ey-,r r•, to '` •. ,end r: wri .tin c, r unt, the entire outstanding n`
balance payable under this Contract shall become immediate):,d e and r:c abie in full, at Ver.hr' option without notitie.
Vendor shall make all pr.:.-ments w-}-en due under an. ^..,+rtcai. out<!andirc aura n-t the Property on the date oL
this Contract (except for any mortgage granted by Purchaser; or :n,1er any rote sec .-c•+1 t'.erc{:,. provided Purchaser
makes timely payment of the amounts than due undo•*-t,i Corti:.,t. Pure` <c- n c,, na;r.±cots dirnctlg to
t}e Mnrt_acee if Vendor fails to do so and all r•r•r,c rut- so :t::ie i. F....” :: t, cnn , -ed payments made on
this Contract.
Vendor may waive any default %%ithout wa a
i%inir n% other -1F,-, i :,!.1 !,rior de a.rlt of Purchaser.
All terms of this Contract shall he bincine upon and inure to the hcnents 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 subiect Property and agrees to join in the execution of the
'x deed to he made in fulfillment hereof.)
(rated t:,- 16th d.,> of November 19 87 .
r SEAL)
or E. Rossin / a: '•tiller
Ruby ��
AUTHENTICATION ACKNOW LEDGMEN f
r` signature(-1 all parties STATE OF R•ISCON'�I'
ss.
;v ..•t. :. , + t'• !< 16tbda; e.
- of \ovmber- ?9 87 I et a:;a::: c a:::e i,efc:c rte a.s da of
t i:e above named
*John Ht W10-1-0d. _ -
,._°
TITLE- SIT:yiRF:fi STATE BAR OF WISCONSIN
t': nA.
nut u.•. e,l 1 WiW. Wis. Fiats.) c l r. n t n .,, ese,uteri is
%AS r.r<a F-En Pv d
John D. Heywood, Heywood, Cari S Murray
Hudson, lei scans in 54016 X ,, Coar:t_, Wig
+1. not, state a rate
xnr nn
,r ;.....•, ,.tin,... :r ., -, ., r> ':, ; '.. ...,,,I n. .., .h.,.
I.AIin C'O\T'RAC'T—rndividaat,and Verparale.–State Bar of wtae+naia,TOM NO-it—1,,e:
N
H
a
9TC - 105 a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St . Croix County z
d
a
H
OWNER/BUYER S, ,=
ROUTE/BOX NUMBER,& Fire Number
.CITY/STATE —ZIP
PROPERTY LOCATION:_,j_Wat, Section_ , T?fN, R / 9
Town of / A C" , St . Croix County,
SubdiviaionBe ci,S e,' �'�.� U'a_ccJ+ 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 pdt 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 coat 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
E
fl/WE, the undersigned , have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
rr
the standards set forth, herein, as set by the Wisconsin Depart- b
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Offkge within 30 days
of the three year expiration date .
e-D ')'�j j
SIGNED �✓
DATE 7 `
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.
INDUS TNIENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, DIVISION
LABOR-AND PERCOLATION TESTS (115) MADISON WI 53707
'HUMAN RELATIONS
(H63.09(1)&Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/Mad4�16FR,C.LL� : LOT NO.:BILK.NO.: SUBDIVISION NAME:
T� /2- �{OSS.?+�s //i�td r
SW )I4 E'/ 9 / d?N/R/9 A GGV�s epr C
COLIN/�Y: OWNER'S BUYER'S NAME: MAILING ADDRESS:
l= cilia �c / 1�'l/e Tl du J?tW 46 6AA Wt!V. !,6
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: ER AT ON TESTS:
Wesidence ,t/ A XNew ❑Replace ?—,/2. A p (7-1?0,
/`'� /7 .fold MAP 8r C Z d O C
RATING:S=Site suitable for system U=Site unsuitable for system ` L
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional)
[gs ❑U xS ❑U �S ❑U ❑S LMU DS ®U AAy k
If Percolation Tests are NOT required DESIGN RATE: If an portion of the tested area is in the
under s.H63.09(5)(b),indicate: /0(// Floodplain,indicate Floodplain elevation: A
PRR,FIV DESCRIPTIONS
BORING TOTAL• DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- ' Z A,l� / r S� ,j s it s� B CS o�. B,? CS if I
B- 2— •S' A16Me_ 7 .S' 2 10 1 Sl n git ICS. 3. 8 S
B- 3
7119, 7101 .S' l Sl o ar si, o S
B-45- 7,5" �.la,f f�- 7 �.S' ,18 s) 3 cs 3 cs
B-
PERCOLATION TESTS
TEST DEPTH.- WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER 4NQ4 &6 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D J PER INCH
P- Y.1, Ala S L 3
P- .3' A10 1 ( 6
P- Y,11 Aia ; 6 6
P-_
P-
P- _
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
_ •� -
I
� r ,. ■/ c
x
E
Ue
T N
It J =Lrel _ 01-0Sc._-.
_ _ V�
_ _.. �
L A-} S k 1,er f o
i
I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord wA the 40 ures 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 qW knowle g d belief.
NAME(print): COQMPLETED ON:
•et t s f10 /l/P 4-,
ADDRESS: CERT ICATION NUMBER: PHONE NUMBER(optional):
r� / ve, low is
CST SL TURE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
s
INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a complete and accurate soil test,your report mast include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
3. MAXIMUM number of bedrooms or commercial use planned;
4, Is this a new or replacement system;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL.
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
9. Complete all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If the information (such as flood plain,elevation)does not apply, place N.A. in the appropriate box;
1 1. Sign the form and place your current address and your certification number;
12= Make legible copies and distribute as required, ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
it - Stone (over 10") BR - Bedrock
cob Cobble (3 - 10") SS - Sandstone
gr -- Gravel (under 3") LS --- Limestone
*s - Sand HGW -- High Groundwater
cs - Coarse Sand Perc - Percolation Rate
riled s - Medium Sand W - Well
fs - Fine Sand Bldg - Building
Is Loarny Sand > -- Greater Than
"sl Sandy Loarn < - Less Than
'I - Loarn Bn - Brown
�sil Silt Loarn
BI - Buck
si -- Silt Gy -- Gray
�cl - Clay Loam Y _ Yellow
sci -- Sandy Clay Loam R Red
sicl -- Silty Clay Loarn snot Mottles
sc Sandy Clay w,' with
sic Silty Clay fff -- few, fine,faint
`c - Clay ce -- common, ct,arse
pt - Peat rn111 -- Many, rn0dis.!rn
m -- Muck d - distinct
p - prorninent
HVJL. - High water level,
Six general soil textures surface water
for liquid waste disposal BM - Bench Mark
VRP --- Vertical Reference Point
TO THE OWNER:
This soil test report is the first step in securing a sarlital'y permit, The county or the Department may request
verification of the soil test in the field prior to pt:rmit issuance, A complete set of plans for the private
ewwre system and a perrnit applicatiOn must be subMitte(9 ,() Itle appropriate local autliority in order to
ab!air) a prermit. The sanitary perr:r;t niust be obtained ant, pr,s,od l3rior to the start of any con n-IrtiOrl,
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