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020-1178-20-000
0 2 0 > > tn 0 0 -500 c (D 2 (D %LL co C,:2 0 w c Q) 'D CD a) C_ z 0 z 0 cu LL c '0 LL c 0 a) 2 a) Z 9 = 2 « ® 0 CD 4) z z w z E E i 4j 0 0 CN CID IN (L co z IL M 0 0 z I—V 2 c cc :3 CD z E '2 '0 '0 Cl) N .1 N :3 M CD cn a) (DI c U) 0 g z c Ion-0 c 0 0 (D < 0 < < z z z z E z 04 LU m CL CL M C CD•cc MO) CD L �(D 0 .8 E C=) m CL CID j CD E E (D w U) 0 (D W 0 FL M - 0 0 0 0 0 0 z 0 [L IL 0. IL IL CL IL & \k 0 0 (0 0) r-- r-- 0 00 0 00 00 0 z CD In 0 \ § � E C —i c c 0- c co 0 0) V < .0 2 1 Q) < z iT) 2 z CID m _j k 2 co 11 U) 0 ED C, IZ 2 E 'D *0 cli 0 ID 4, E CIS 9 (D Q) .9 S / § / /C� oi m Fn UO) ID 0 (D C -5 Oi 0 04 0 4) 2 -0 Q) CO C (D to Cq —2 0 U) 0 N CID m co m 0 0 -5 -5 z m z 2 00 U) UU) 0 0 CN 0 z z z CIS Cc 2 CL EL L: 0 CL L: CL 4, C c c E 0 cc 0 0 U) 0 0 U) L) 0 PUMP CHAMBER i 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: x Trench: Width: 1 Z Length: SZ Number of Lines: Z Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 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, 0 Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: 7 Plumber on job: �-r License Number: 7 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER r ,q��/� pG�£/� TOWNSHIP �/<< sc-✓ SEC. =� T Z"7' N-R I W ADDRESS Hsi Z/ ST. CROIX COUNTY, WISCONSIN C v /�' ✓.GG S �. Ti)7Z SUBDIVISION AIZZ 5- LOT LOT SIZE T PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Toys o� A.oc I W A t,C.. 10-0 i FC,otj INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 70e OF ?_aLoc.k;. WAt..L Elevation of vertical reference point: 10c) Proposed slope at site: /d SEPTIC TANK: Manufacturer: KbVW u-7 AoQt6�:::"$.iquid Capacity: 1000 �� L a Number of rings used: Z Tank manhole cover elevation: 01(" 10 Tank Inlet Elevation: C14Z11 Tank Outlet Elevation: q31 11 11 Number of feet from nearest Road: Front,Side,o Rear, 0 13S feet From nearest property line Front,®Side,ORear,O N0�"*� - �Og feet Number of feet from: well — N IA , building: (Include this information of the above plot plan)( 2 reference dimensions to sgptic tank) SEE REVERSE SIDE dip DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION PA.BOX 7969 MADISON,WI 53707 BUREAU OF PLUMBING CONVENTIONAL EJ ALTERNATIVE IState Plan I.D.Number: llf ❑Holding Tank ❑In-Ground Pressure El Mound assigned) NAME OF DER: INSPECTION DATE: Wayne Moze)t 2012 Esmond Lane Eau Mite, W1 54701 15-1 10,4& BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: NW NE, Section 28, T29N-R19W, Town o4 Hudson, Lot #21 Cedar. H" ,St. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: L yte Petke 5517 St. cuix 88464 SEPTIC TANK/HOLDING TANK: MANUFACTURER: (� 1 LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL ILOCKING COVER PROVIDED: PROVIDED: ) 0 0 0 7 OYES ONO ❑YES ❑NO BEDDING: VENT DIA.: I VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM 9 LINE: /� AIR 1=.LET. DYES ❑NO DYES 1-1 NO NEAREST �J � �v DOSING CHAMBER: MANUFACTURER: JBEDDING: LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MA NUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: — ❑YES ONO 10YES ❑NO 1:1 YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER O OPERTY WELL BUILDING.JVENTTOFRESH (DIFFERENCE BETWEEN FEET FR N AIR INLET PUMP ON AND OFF) ❑YES NO NEARES SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing FORCE LENGTH D METER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: O.OSPACING COVER INSIDE CIA *PITS LIQUID DIMENSIONS Ia S� IN TRENCHES r "TERIAL: PIT DEPTH GRAVEL H FILL DEPTH UISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO. R. NUMBER OF PROPERTY WELL'. BUILDING'. VENT TO FRESH BELOW PIPES; ABUVE COVER'. ELEV INLET.ELEV.END: PIPES: AIR INLET I : � Z7Z FEET // `I I NEAREST---► N 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- ❑YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PERMANENT MARKERS OBSEH VA TION WELLS 1:1 YES ❑NO ❑YES NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL'. IS CENTER: EDGES ODDED SEEDED MULCHED : [—]YES ONO OYES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL'. NO.DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV.: CIA.: ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORK ECTLV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES NO 1:1 YES ONO COMMENTS: I PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE: DYES ONO DYES ON( NEAREST A I C)U I Sketch Syster41n I _ �( Retain in county file for audit. Reverse Side; IJ I (/ / SIGNATUR - TITLE. DILHR SBD 6710(R.01/82) �� I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT - APPLICATION TO THE APPLICANT: • 1. This sanitar y p ermit is valid for two (2) years; r c 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 owners name and mailing address. Provide the legal description where the system is to be installed; If. 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'Y2 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. -----------------------------------------------------------------------------I----------------------------------------------------------------------------- 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 ate[- . included the creation of surcharges (fees) for a number of regulated practices which Wisco !n'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that burred 185Ure, 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. a The monies collected through these surcharges are cred!ted to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- 1 water, groundwater contamination investigations and establishment of standards. Groundwater, LJ it's worth protecting. SR D-F398(R.C3/86) III SANITARY PERMIT APPLICATION COU Y DILHF� 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 PLAN I.D.NUMBER 8%x 11 inches in size. -t',e trerse side.for instructions foScompleting this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES ❑ NO PROPERTY OWNER P O E TY L CATION Wok Z NOS % F—%, S 2,p Tof N, R/ E (or ow PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME CITY,STATE C/ZIP ODE' PHONE NUMBER Y NEAREST ROAD,L 'OR LANDMARK /--a,/C& ,�- Wirt. S Jf70/ P33 /.3 El LNO : /�w� lA II. TYPE OF BU LDING 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. New b. 1:1 Replacement c. ❑ Replacement of d. El 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 O�TEM: (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. ABSORPT PH SYSTEM INFORMATION: (Check one) 1. a. RI-seepage 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): Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in Ilons Total #of Prefab. Fiber- Expp. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank �0v0 / /y i'D wry} Lift Pump Tank/Siphon Chamber A'' �a! '� ❑ 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 Sig ture:(NM_Ups) MP/MPRSW No.: Busine Phone Number:_j 3_Z 4 4. Plumb 's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State, p Code) Phone Number: d S .rmry �i,' SS�o/ 3 D AD IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Iss ing Agent Signature(No Stamps) 12" Approved ❑ Owner Given Initial T Syrcharge Fee /3 Adverse Determination V cjY " 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 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 Wq y yV-(_ Location of Property /�/� k /V 14, Section a , T _N-R Z_� W Township /7 d So e"l Hailing Address £ , Address of Site a k ,S d v\I Subdivision Name C A A& ¢e j . Lot Number 1 Previous Owner of Property Total Size of Parcel GC Yt 3 Date Parcel was Created 2 Are all corners and lot lines identifiable? Yes No Is this property being developed for resal (spec hous ? Z,----'yes No volume !�_ and Page Number 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 (We) CeAti..6y that att 6tatement6 on this 604m cute true to the beat o6 my (oun) knowledge; that I (we) am (ane) the owneh(6) o6 the ptopenty descAi.bed in th.i,d .in6oAmati.on 6oi►m, by vi tue o6 a waAAanty qeed uconded in the 066.ice 06 the County Regi,6ten o6 Ueed6 a,a Document No. and that I (we) pneaentty own the pnoposed 6-cte bon the sewage didpo6 .ayzs em (on I (we) have obtained an easement, to nun with the above de.aehibed ptopehty, bon the conetnuction o6 said 6y4tem, and the Game has been duty %eco&ded in the 066.ice o6 the County Reg.iaten o6 Veed6, a6 Voe ment No. ) . SIGNATURE OP OWNER $IGNAT OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. II STATE BAR OF WISCONSIN FORM 1-19821ii THIS SPACE RESERVED FOR RECORDING DATA j WARRANTY DEED ------a__W s1 nnnsenaCQZgoratian__.___C�dax__Hz�J.s__A��re�.4l�m�nt-,--Ix�cl Rac'd. for Record this 6th ------------------------------------ ------------------------------------ ----------------------------- day of Jan A.D. 19 87 ------ ------------------------------ --------- ---------------------------------------- ---------- Grantor, j' f 1 :30 P and----Layne__Maser.---------------------- ------------- ------- --------- ---------------------------------------------------------------------------------- -------------"---------------------------•------------------------------------------------•-----•-------------- ---------------------- Grantee, Witnesseth, That the said Grantor, for a valuable consideration_._._. !' _ -- - II. RETURN TO conveys to Grantee the following described real estate in ______________ ,I County, State of Wisconsin: jl Lot 21, Plat of Cedar Hills Estates in the Town of Hudson. Tag Parcel No: ----------------------------------- r FED • This ....is_not.------------ homestead property. (T-Z (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And...gran-t_o_r_,--Gedar__Ri-Ll_s--_Dave_1_oFment,.__Inc_.---a--Wi.sconai.n_0orp9xat ign.......................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record and will warrant and defend the same. .�'•'� ""r.,, Dated this ........................Sth------------------ day of -------------January.--- --- k97:c: Cedar Hills Development, 13iX-:' �N- U (SEAL) By.: L�e�--/4 °' ( A Dean R. Larson, President -. * ---(SEAL) GC Je�l�,_ * (SEA L) ---"--°---------"- lYiain--C:--HaSecretary""""'" AUTHENTICATION ACKNOWLEDGMENT Signature(s) ------------------------------------------------------------ STATE OF WISCONSIN ss. ----------------------------------•-------------------------------------------- 8•t•---Craix-------------------_Count Y. authenticated this --------day of--------------------------- 19------ Personally came before me ti,Is --- __.___day of January 19 86 the abo a named -_-------•--------------•-----------------------------------•------------------- Dean R. Larson, 'President a 0 * --------------- --- m - -•_'Harwell,--Secretary of Wiliam C. --------------- TITLE: MEMBER STATE BAR OF WISCONSIN said -corporation to me known to. be ----- - . I (If not_ ------------------------------------------ such off icers and the persons who.... -----------••--- - - ---- --------------------•---•---------- •--- authorized by § 706.06,Wis. Stats.) executed the fre oin instrument and acknowledge the same as the deed of THIS INSTRUMENT WAS DRAFTED BY said rporat ' b i s authority.. HEYWOOD, CARL, HURRAY & SHERBURNE ------- ------- -- by Samuel R. �Cari---------- --------------------------------- PAP/10 1 "9`vo �GZS'o— - -- ---------- ----------------------•---- ...... 4016______________ Notary Public --__St.---Croce---------------- County, Wis. (Signatures may be authenticated or acknowledged. Bath My Commission is permanent. ([f not, state expiration are not necessary.) �c date- ---------------------"-----''I L��'Ll"'�----------- � -Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. POP 11 Nn. I—1982 `.Tllwwikee, Wis. • H • x • cn . H • a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT c St . Croix County z W ry� a OWNER/BUYER Q / ' 0 S Q M X0 on 4&vv ROUTE/BOX NUMBER Fire Number ., .CITY/STATE 6�a%4 �rni(tr' LVisc . __ZIP Sy 70/ PROPERTY LOCATION:L� � � 9 Section TAN, R , W, Town of 1140s0.v , St . Croix County, Subdivision CQD,*jg a j'/j_j �l 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 ' E I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- o ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Offkre within 30 days of the three year expiration date. SIGNED 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 . r T .aa-7 sn c7 1 a` f 1 Q N1 VtA M t � N � N J {? j d .�z U DEPS!"RY �f OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS i;l1JUiJ tRY,. DIVISION t.�,i:()R Ait;D P.O. BOX 7969 i./%8,OR RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.09(1)&Chapter 146.046) I.O AT NSHIP MUNICIPALITY: OT NO.. L NO.: SU OIV Sly�g►�NAME: 1/4N1� z8 Z9N/R19�to w �bSoN Z/ — �Il1d� /+FILLS >�S7ATES courorv: ,,// .4-romv.4 W 1 Cf41n A Q -,ME�. 6Z7 F.1iRF�XAv� USE r _ IDAM OBSERVATIONS cMADE Q p IrEFICOLATION TEST 10FIesidence uN K O .,...•� 1 New ❑Replace L�$E R A, /'8o .FAN ( r98' So lus 906y, 'jOf G.5 �k$ RATING:S-Site suitable for system U-Sib unsuitable for system ONV A U L O TA K: ECOMMENDED SYSTEM:I tional) S ❑U S ❑U S ❑U S U ❑S c4,1vENr16NA Wi t:4 1f Percolation Tests are NOT required DESIGN RATE: {f any portion of the tested area is in the ,t under s.H63.09(5)(b),indicate: Cass �Floodplain,indicate Fioodplain elevation: ,Y � PROFILE DESCRIPTIONS BORING TOTAL O SOIL WITH KN SS,COLOR,TEXTURE,AND DEPTH 131 NUMBER DEPTH 1$. ELEVATION V TO BEDROCK IF OBSERVED I§LE ABBRV.ON BACK.) 8"&LYS g"BlitgSC w wt 1rdkN s e Zfi'teeq M B- /OZ.&C> pig > ,%a ZI''$RNGR 35'4Rry MS C /� 79" 9 e _ BalefAt GR 27"UrgGS*41? CC66 I B- 2 983 /03 33 NaNg > g 83 4 s`w ms f 1"s,tk It rt?o,% i s%73 lr&Ln 111*4 L 1S"6QNSL'Kk 49"60w f' S &61Z B- 7.3:3 97.45 No ry t: > 7. 33 C f ''s I 64,A 131=- " R"&C.TS It. SL 41"Beni MS ZO"KRet C.S 1` K B- 1B"$LLT� 13" NSLtbR 3a"Bt�ty MS 6 2! $auGS•ELI R � ' "y3 �Od,97 >�.33 3o'BQN MS a 1"S 4kA,,.d re&m A�oFT PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME RATE MINUTES NUMBER tf5 AFTERSWEL.LIN INTERVAL-MIN. PER INCh1 �.- 3 z U �JbntG _ 3 > 1 < Z P- 4 4 z y N L' q-1.zz 3 11% 2. i P- C� r=or o G WEI � <� P-1 i 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 hors zontai 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 94,aO e i -r Nl4"C 1.� S�IS'r lh 1&L VitfC'iON �Lcxrart>otrl I qty lei Lana. d�a. Syird r� J�1bv�Qd►'`1. , t� p� . 1 �:EJ1SC � .r«r eb Arlo, i fie• /J ...is s � I i R1Ct.iI ,44T Jl s c P�6,rf.6 aft . . mss. r1c AI-TcRNMTk_. � P�IT�hlQ1e10 'a`�/tS�,Y►'1S! L: i�"ra= G� .�. , � -,4 'OLArf ! 4 Pal! ...A.00� 1 � � i i � 1 ♦. F I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and mathods 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 pri t : TESTS WERE COMPLETED ON: 1�deJ Y AtNI4N`&04 AAM04k, 9 /9e7 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional) 4a-7 -5Ec.&Nf, -Sr /lug -wri W1 •54016 CST SI ATURE: YIA DISTRIBUTION:Original and one copy to Local Authority,Property Owner snd Soil Tester.. 0!Llita.5BD-6395(H.02182) -OVER - � � I OEM MOM mom No ENO No mom ■ ■iii iii mom ��� � '' 1 ■ No No MEMO -.ON HE ON 0 ON HEM ON No so ONO 0 No mom ME Immmom ON AN M No mmommomi mom on mommons ON mom miiiiiiim ■ mom NONE KNOMM No No No No 0 ONO No No ON ON ON No MI 0 mom ■ C � A mom 0 MEN MMA ON ME r 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (lf assigned) El Holding Tank r-1 In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: William Harwell Rt. 1111 Hudson, WI 54016 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. NE SE, Section 28, T29N-R19W, Town of Hudson, Lot 21. Cedar Hills Est. Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: William Schumaker I 6382 St. Croix 88452 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB LOCKING COVER PROVIDED: PROVIDED: OYES ONO [—]YES ONO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: r—DI—N—G—TV—ENT TO FRESH ALARM: FEET FROM LINE: AIR INLET. DYES ONO DYES 1:1 NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ONO DYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH (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 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: COVER BED/TRENCH WIDTH: LENGTH TRENCHES: DISTR PIPE SPACING MATERIAL: PIT INSIDE CIA tt PITS DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES: ABOVE CO VER. 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. OYES ONO OIL COVER ITEXTURE: PERMANENT MARKERS: OBSERVATION WELLS OYES ONO DYES ❑NO DEPTH OVER TRENCH/BED JOEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER. EDGES. OYES ONO DYES ONO OYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV.: DIA.. ELE V.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. DYES ONO I OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: — YES ❑NO OYES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. 7 TITLE. DILHR SBD 6710(R.01/82) SIGNATURE: i 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; Il. 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'Y2 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 salter included the creation of surcharges (fees) for a number of regulated practices which Wisco )ID'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re.asure 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. a The monies colle•;ted through these surcharges are credited to the groundwater fund adminis- ° tere by the :-Department of Natural Resources. These funds are used for monitoring ground- T water. grour:dwal:er contamination investigations and establishment of standards. Groundwater, s wort'.; Protecting. _,'u-3398 c;= 03i46) =51L SANITARY PERMIT APPLICATION couNT In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT## 1�l�,Z —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 ❑ NO PROPERTY OWNER PROPERTY LOCATION '/4 ,o '/4, S.2 r Taq , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 7 / ' -41 W" CG Yl«S Lis? CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK fit. �- ❑ VILLAGE. II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 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## 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. l.See a e 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): Q-'3 6/S— G / s Z Ss f ro ad Feet Private ❑Joint El Public VI. TANK CAPACITY Site in ga ons 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 QGG ,ate�� ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the private sewage system howp on the attached plans. Plum/tier's Name(Print): Plumber's Signature:(No Stamps) IYP MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: Y ale VIII. SOIL TEST INFORMATION Certified Soil Tester ST)Name CST## el! 3-g' CST's AD SS( reet,City,State,Zip Code)'" Phone Number: %9:7 �-o IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Is uing ent Signature(No Stam pw IN Approved ❑ Owner Given Initial Surcharge Fee 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 Pte'" 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/contract,Qr, ("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 a Location of Property 5L It, Section _� R, T 2t N - R W r Township 1A Mailing Address �` A O Subdivision Name L r r Lot Number v1 Previous .Owner of Property Q,( may,, �Q�tr- Total Size of Parcel fi Ccv^.v Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number A7 -7 as.-:recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 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) eeAti jy that att .6tatement4 on thiA Jonm are true to the befit of my (OLA) , knowledge; that I (we) am (are) the owner(4) o6 the ptope ty de4cAibed in VUA .injonmati,on Sonm, by viAtue ob a wa uLnty deed neeoAded in the 066ice o f the County Reg"tteA of Deed4 ab Document No. /-//.5- /� , and that I (we) p4.e4entey own the p op xied site JO& the 4rage. AotefiL 10A I _.(w2l,...haVe obtained an eaeement, to nun 94ith the above duc4 bed pnopehty, bon the eonbtnuction o f acid ay4tem, "d the flame hab been duty %eco44ed in the Oj6i,ce of the County Regi6t. en o6 Deeds, ab Document No. ::2`1&_479' ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) /? Z Le DATE SIGNED DATE SIGNED Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's in Crest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex- •lerded coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of $........... _n/a.......................... but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to in:;llrati a companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be ,Iumically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Propert - in irood tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case 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 urchaser a 3ftX e d in fee simple, of the Property, free and clear of all liens and encumbrances, except �ersona'1 Repress n a�ivQ S any lens or encum ances created by the'act or default of Purchaser, and except: ....easements,._R>rotective_. ._cov .nants..o.f._record,__if._any,-.and--zaning..a.rdinanae..require-meuta�...................................... ................ -••--••-----••---••---•--••--.....•----•-•----•--......•-----........•... •----•••-- ................. ................................................. -_....-.-................. ................................................................ ... .......................................................••---------.--•-• ---•- --•----•-•--••--•-•-••-•-••-•-----•----••--•-....... ---- -......•------•-----I'll-------••-----------•---------------------------------- Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of ---60...days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of Ag--•_ 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 to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property hack through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder(in which event all amounts previously pail by Purchaser shall be forefeited as liquidated chuna-res for failure to fulfill this Contract and as rental for the 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 thorcof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action ii the equitable 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 0), 00 or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, 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 solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediatelydue 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 such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on 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, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this -11th•-----•... -•............. June 19 19_---•-... day of - 86 (SEAL) ---- -------- AL) ._parr. J.....Stewart......................... Vy ----------------------- ------------•-- . --------..(SEAL) ---/?�"/( a►�2G_. .... ... William C. Harwell :"�� 1Q J . ..._-_-....-......... ......... _.. ............................._... ........ _...._. . AUTHENTICATION ACKNOWLEDGMENT"O,7r.�,, Si natures STATE OF WISCONSIN 'U � C- ss. authenticated this ........day of........................... 19.... Personally came before me this .11th......day of --_---June........................ 19.86._ the above named -------------•--•-----------•----------------------•-------------------•--•----- Harr J _-_•_•••_-y___-.__Stewart__and_•Willi•am,C,__Harwell * ................................ -------------------- .................... --•-----------•.......----.....--•---------•----•.................--•-------•--- TITLE: ATEMBER STATE BAR OF WISCONSIN ---•--..-•-•-------------••--••-------....-•--•--•-...-----•••••-•--•---•.••-_.. (If not, .-•-................................... authorized by § 706.06, Wis. Stats.) to me known to be the person .s .._..._.... who executed the foregoiinEp-instrument and acknowledge a'''cknowledge the.same. THIS INSTRUMENT WAS DRAFTED BY L ...._.v°L.1.........�................. ................. o..s--A.__Murray,_•HEYWOOD,_-CARL_ HURRAY ------ (f rt/ �ZS�!✓ & SHERBURNE, P.O. BOX 229, * �� f. 4A..... - 'S40itr••---•----•----••--- •----••----••--•-------- Notary Public _--_St, Croix-----_-__ County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is per anent.JIf no state expiration are not necessary.) date:1_i • ••---.•--•-• --........ , 19-..•--7) 4. ;, `Names of persons signing in any capacity should be types! or printed bet - signatures. • (NT NO. STATE BAR OF.WISCONSIN i'FIM 11—1982 THIS $PACE RESERVED FOR RECORDING DATA LAND CONTRACT �k . p �y Individual and Corporate R"SMS 0FF'V •� .• 1 (TO BE USED FOR ALI. TRANSACTION$ WHERE OVER v•�.a`v C +`-% l i$2fi,000 IS FINANCED AACT TRANSACTIONS)NON-CONSUMER ST. CROIX CO., wis. Rec'd, for Record this 11th •ontract, by and between .._Harry J Stewart, as Personal day of June _q�p, 19 86 esentative of the Estate of Aldro Larsen a/k/a John pf 11 .45 A ,NA. - Aldrg__Larsen__a/kJ a_ John_Aldro__Myren Larsen,__at- (+Vendor+', Jame s�O�rConne11 whether one or-.more) and—William C. Harwell y„ some" Dow *single man ----- ("Purchaser", whether one or more). JS Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- deputy formance of this contract by Purchaser,the following property, together with the rents,profits,fixtures and other appurtenant interests (all called the"Property"), In--------------St. Croix ----------- ______________ County, State of Wisconsin: RETURN TO - See legal Description on Addendum Tax Parcel No. ................................... 3�b _ g2,3 s FFF This .__._.i s--not-._---_--• homestead property. i!c$ (is not) Purchaser agrees to purchase the Property and to pay to Vendor at .such place as he shall name 192 500 00 -------•----------------- the sum of $_.------x-•--•-•'----------------------------------------- in the following manner: (a) $ 60•,t]�JO.e00.._..----•_.........--•---. at the execution of this Contract; and (b) the balance of ----------------- together with interest from date hereof on the balance outstanding from time to time at the rate of..............ten..CJ.gl)........... per cent per annum until paid in full, as follows: See Payment Terms on Addendum Provided, however, the entire outstanding balance shall be paid in full on or before the........11th day of ---------JUMP,________________________ 19---9.Q_ ( 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). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due.To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. 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.lG$fik�SXxXxxx�cXXx7ccgXxXx]g7 tkeaxxri:g.�xx�c�x�co�txodxisai>�aip�txv��>st��cmis>zaon�ufx�eils6a>tifC 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 iagrij&payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds 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 Purchaser for examination except: 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. Purchaser shall beentitledto take possession of the Property on.......the__due._hereof....................11&X •Cross Out One. LAND CONTRACT—Individual and STATF. BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. Corporate I- FORM No. 11—1982 Milwaukee. Wis. y .vii 1743PAGEl 8 7 LAND CONTRACT ADDENDUM Legal Description The NJ of the NJ of the SEj 'of Section 28-29-19 , except the South 100 feet of the East 565 feet thereof , and except a parcel of land located in the NEI of the SEJ of Section 28 , T29N, R19W, Town of Hudson , St . Croix County , Wisconsin, described as follows : Commencing at the Ej Corner of said Section 28 ; thence S89 037146 11W ( assumed bearing referenced to the monumented East-West I Section line of said Section 28 , bearing assumed S89 037146 11W) 23 . 78 ' along said East-West line to the point of beginning; thence continuing S89 037146 11W 1301 . 48 ' along said line to the West line of said NEI of the SEJ ; thence S 0 003144 11W 661 . 63 ' along said West line; thence N89 034148 11E 761 . 971 ; thence N 0 005112 11W 100 . 001 ; thence N89 034148 11E 535 . 401 ; thence N 0 030138 11E 560 . 56 ' along the Westerly right-of-way line of U. S. Highway 1112" to the point of beginning. NEI of Section 28-29-19 , except that parcel described as Lot 1 of a C. S.M. recorded in Vol . 3 of C. S.M. ' s , page 862 as Doc. No. 359579 and except that parcel described in Vol . 583 , page 527 as conveyed to the State of Wisconsin. Payment Terms $35 , 000 . 00 on June 11 , 1987 and $35 , 000 . 00 on each anniversary date of this Contract thereafter ; provided, however , that if the unpaid principal balance on the Contract is greater than $85 , 000 . 00 on July 1 , 1988 , Purchaser shall make monthly payments of $3 , 500 . 00 commencing on July 1 , 1988 and on the first day of each month thereafter . Also provided that on the first day of the fourth month following Purchaser ' s death or permanent disability , monthly payments of $3 , 500 . 00 shall commence hereunder and shall be paid on the first day of each month thereafter . Vendor shall release Lots of not more than 31 acres in size at any time during the Contract upon payment by Purchaser to Vendor of $5 , 500 . 00 per Lot . Each $5 , 500 . 00 payment and each $3 , 500 . 00 monthly payment shall be applied to reduce the next $35 , 000. 00 required annual payment . Also provided that for each $5 , 500 . 00 paid by Purchaser in total monthly payments , Vendor shall release one additional Lot of not more than 31 acres , upon request of Purchaser . Purchaser shall pay the cost of drafting Partial Releases. Vendor shall convey to Purchaser one parcel of land around farm buildings upon recording of C. S.M. without further payment . Parcel not to exceed 6 acres . AL 1743PAGE 18? LAND CONTRACT ADDENDUM Legal Description The N} of the N} of the SEJ .Of Section 28-29-19 , except the South 100 feet of the East 565 feet thereof, and except a parcel of land located in the NEI of the SEI of Section 28, T29N, R19W, Town of Hudson, St . Croix County, Wisconsin, described as follows: Commencing at the Ej Corner of said Section 28 ; thence S89 037146 11W (assumed bearing referenced to the monumented East-West } Section line of said Section 28 , bearing assumed S89 037146"W) 23. 78 ' along said East-West line to the point of beginning; thence continuing S89037146 11W 1301 . 481 along said line to the West line of said NEI of the SE} ; thence S 0'003144"W 661 . 63 ' along said West line; thence 934 ' 48"E� 761 . 97 ' ; thence N 000511211W 100. 00 ' ; thence ° 48"6 535 -401 ; thence N 0 030138"E 560. 56 ,line of U. S. Highway "12" to the point along the Westerly point of beginning. 8EC. StMSereeorded-�n Vo1 . e3cottCtSaM parcel described as Lot 1 of 359579 and except that parcel described � inaVol . 583 , pace 527 as conveyed to the State of Wisconsin. g . cn - y r STC - 105 r" a- SEPTIC TANK MAINTENANCE AGREEMENT .o St . Croix County d ' y OWNER/BUYER --- ROUTE/BOX NUMBER y' / _ Q _ _Fire Number CITY/ STATE_,A"'44S'eAl !✓r _,� _ —ZIP PROPERTY LUCATION : /og `4, Section_ Z_ _, T_ 0f N , R—/-Z--W , Town of /S _e s St . Croix County , Subdivision t»aa., -ev *���+% , Lot n-umber 141 _ 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 , if needed , by a licensed septic tank pumper . What you puk into the system can affect the function of tike septic tank as a treat- ment stage in the waste disposal system . St . • Croix County residents maw be eligible to receivu 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 kelp 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 . O I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with 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 . SIGNED. DATE St . Croix County ZonLng 'Office P.O . oox 9k, Nammo'�d , WI 54015 715-7 16-2239 or 715-425-8363 Sign , date and return to above address . A . r LAN C '� r" N ,� Z it pi In It it 8 1 B P - - � 1 � C7 I m P Z w IP1 a I r �' I r- (1 m I (D (nr z I [N IN I_ (Lp � I CJuYt�T � f1EPAFiTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS -tnlf)USTRY, DIVISION I ABOR P.O. BOX 7969 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 IH63.090)&Chapter 145.045► LOCATION- SECTrOWN. NSHIP UNICIPALITY: OT NQ: SUBDIVI I NAME: V '146i'1/4 Z$ /TZbN/R/04(o /,,/4j 1LZj — r6jj,4k qILLS CS'TJ177,e$ COUNTY: NE 'S MAI LINU ALIORE 5: STCe0lX SILL. ell(,0WELL RT I UQSON / TA(316 USE DATES ObSERVATHM MADE Residence QN k 81NOW ❑Replace oc-rroupl/4 /9 x ©cro$mk 5ot�s $ao� A46 G6 Soles $k - $UQoo wr RATING:S-She suitable for system U-Site unm tabu for system N L: U D: S ❑U - - LL D A K: ECOMMENDED SYSTEM:(optional)❑ttS U S❑ S D K�I CONVENTI A et& If Percolation Tests are NOT required DESRIN RAT • If any portion of the tested area is in the - r under s.HB3.09(5)(b),indicate: CcaSS Floodplain,indicate Floodpiain elevation: VA c, PROFILE DESCRIPTIONS BORINRG Ajg, ELEVATION 1 A THICKNESS, L TEXTURE,AND DEPTH TO BEDROCK F OBSERVED EE ABBRY.ON BACK.) B- 9.�o roz.6a N , W'iCiLC T 5 9'�61w5L w bt /3 k'st * Z& tN M t i" S.19AtA 04 17._' & Z �s3 /03.33 > 83 9"BLL� 1.1" tvM`r 41L 27"Bier,CSrb CAC 9 /01-94U Rao , „ 17 4-5 i3",&L-rs /I"dawL /s"8ani 'CAA 4 d+I;M3�G2 g- x,58 QC.�9 rz'BL�TS /6 8 HSL 41' Ms zo IBQN CS. R v")C > 9.58 2 p � M M II S r 9 33 BRMSLt4R 30'vogMS 41t zI"B�,C%f6R pp i/ w "' p p Zry P- v PERCOLATION TESTS TEST DEPTH WATER IN HOLE TIM DROP NUMBER ACMES AFTER SWELLING INTERVAL-MIN. R PER INCH S 340 14ONE /t)z.60 t Z P. Z C- bq3JtS 3 >71 42 P- s ? Z z P- ,,tlL�hlo lL �.d2 F- P- PLOT PLAN: Show locations of percolation tats, soil boring* and the dimensions of suitable soil areas. Indicate sale 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 boring*and the direction and percent of land slope. SYSTEM ELEVATION 9g.20 Cfle rw Aey � 1 'S f'1'L ac. TI j t � r t � f j i t kA 14 F j � .... ; � cTats M13►Af K.tww. i J - � � t ' loft ,+ ` e ' ' I i , I s i t tt i t .�. 1 a.. � �� r Ow�k•� C,oASe .e , I,the undersigned,hereby certify that the soil tests reported on this form wen misde 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): —TE-M WERE COMPLETED ON: ��it y Joel Oc.-roB lk /S /9�s6 ADD CERTIFICATION NUMBER: PHONE NUMBER(optional): 4o-7 u it S-- S s40/16 I% 40%d i A UR i DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-S813-6395(R,02/82) -OVER- i(�l�RAvL A ye-/e� ��9/ o� C .�G�Gtr (V! MY J� t v ' I ac, � � D o7— Ora T�fbs" a