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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r u n u u ■ ST. CROIX COUNTY GOVERNMENT CENTER
, 1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
July 11, 1994
FAXED TO YOU THIS DATE
Mr. David Bracht
RE/MAX
103 Main Street
Box 68
Somerset, Wisconsin 54025
RE: Victor Wilcox Sanitary System
Dear Dave:
Per your recent request, enclosed is a copy of the As Built
and the Plot Plan for Victor Wilcox's sanitary system located in
the SE'; of the SE, of Section 14, T29N-R20W, Village of North
Hudson, St. Croix County, Wisconsin. If there is anything else
that you need, please do not hesitate in contacting our office.
Very sincerely
Marilyn K Zais
Administrative Secretary
mkz
Enclosures
i
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-429784r nIq ~J ,
Afto 2 s
o 05 `g /7 = CERTIFIED SURVEY MAP $
Located in the SE 1 /4 of the SE 1 /4 of Section 14 T29N, R20W , Village of,
North Hudson St. Croix County, 'Wisconsin. Being also part of Outlots 99,
100and101 of the Village of North Hudson. ~
Surveyed for: C. C. Cudd E 1/4 COR.
Galahad RD. SECTION 14 North Hudson, Wi. r29N,R2Ow
I
yy 54016
1io
10 CO
GOI♦-4, NORTH LINE OUTLOT 99
W
WIWO, S 89° 21' 13"E 136.78' 13 22' 33.14' _
0----- o W
le (WEST) FO3 _
-Y G.
w HAP : 69
aP Om
DETAIL -TO I- °tt 0:1 *0
-
w SCALE / I o ,M 10
r : I 00) 04► 2 0
U N t / I = w o
I tQ- LEGEND POINT OF 1 J1 : 0:
BEGINNING / 1 al w o
<q isSECTION CORNER MONUMENT I 01 WW
0: Z
~I~ NU SU SE COR.
J
~ei~~et~►~~ 0 ROUND IRON PIPE FOUND SEIgTION ix
SCALE IN FEET I"=60' O I"%24"ROUND IRON PIPE WEIGHING 1.68LBS./LIN, FT. SET. acr _
I-
I WEST) PREVIOUSLY RECORDED AS mZ o I
O' 15' 30' 60, 120' U, I
NE CORNER o
OF OUTLOT O 1
NORTH LINE OF OUTLOT 99 S 890 21' 13"E 319,35' 99 2-
1
32.00•-. 150.001 Q
S89°21'13of E %136.78' Op
VOL_ 339- PAGE 499 _ ; cl 0 1 ( WEST) O-
I /
1 al ~ \M
W a = 150 02' 18" /
I 0: _ v R= 996,34'
I 0 L 2 261. 51'
I 1DI 0 to T=S43017' 09"W
_VOL. 414 PAGE 438- ( ~1 N M S 280 14:' 51 "W
I /
61 y0l
S 82° 25' 03" I z -~30'2,a O.
1 W (WEST
0q~EE 149.09' 3 ES O'
S899\21`I3"E 2 y
0
ccI ti - 15' /5' U ru O /p
I 3 L O T 2 W M ~~O P~ 1
441 _ 34155 S0. FT. (.7841 AC.) /h 3 0
.j O M /W ti
2 41 / r~
y / / ry
°
STAIRS
N N 89° 30' 4W 173.43' VOL_707_PAG~L597
82 HOUSE
v
22°01' 20"
/ R=.979.84
L --376.61'
1 GARAGE / T= S43022''47"W ,
W LOT I 20 S210 21" 27"W QI
= I
I = _ 23662 S0. F7, (.5432 AC,) I rcl
15' -S4058'02"E I 1
ry N 56.74' QI
c GUEST HOUSE I / a~ 1
C
147, 35 0
86' • N 890 40' 16"W
Note: Lot 2 is granted an easement for ingress and egress over
1 that part of Lot 1 that is one rod (16. 501 feet) wide in the
i NE corner of Lot 1.
Vol. 7 Page 1876
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 , Side, O Rear
Ft.
0
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: X Trench:
Width.
Length: 411 -A" Number of Lines: Area Built: aze):
Fill depth to top of pipe: 32_•~
Number of feet from nearest property line: Front, O Side, O Rear,O gt•
Number of feet from well: N0 VJ ELL.
Number of feet from building:
2-5!- (fl~~
(Include distances on plot plan).
SEEPAGE PIT
Y Size: /y A. 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, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector.* Dated: Plumber on job: ?License Number: J -P R5 03V6,?
C
3/84!mj
'ION
Form S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER V ?L TOIL- Vj TOWNSHIP h{~05,,,J SEC. 14 T Z~ N-R1G-!1 W
ADDRESS ST. CROIX COUNTY, WISCONSIN
ii
. Uud Sc~ ~ W CSC .
SUBDIVISION LOT LOT SIZE
PLAN VIEW
F
Distances,and dimensions to meet requirements of IIHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
\S
p Z
t
bloc,
e N
INDICATE FORTH ARROW
,~SRa~.1
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: JUU-00 Proposed slope at site: ~ o
SEPTIC TANK: Manufacturer: ~IESeYL- Liquid Capacit : 12-SO C-_;AtA_t%,j
Number of rings used: Tank manhole cover elevation: IdO.'7~
Tank Inlet Elevation: Tank Outlet Elevation: gg•S0
Number of feet from nearest Road: Front,O Side,Q Rear, ®dJE~--1Ck1 feet
From nearest-property line : Front,0Side, OC Rear,O I feet
Number of feet from: well fW WVA.-, building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
4 SEE REVERSE SIDE
DEPARTM&NT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LNBOR &f-IUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number:
SEA, SE 4, S 14 , T29N-R20W a"'9"`°'
Village of North Hudson ❑ Holding Tank ❑ In Ground Pressure El Mound
\
NAME Of PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Victor Wilcox North Hudson, WI 54016 11 -CDO
BENCH MARK (Permanent reference Pomd DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: IcST REF. PT. ELEV.
Name of Plumber: JMPIMPFISW No.: Coumy: Samtaly Permit Number:
homas H. Cody 6593 St. Croix 102852
SEPTIC TANK/HOLDING TANK:
MANUFACTURER . ILI U CAP Y. TANK INLET ELEEV TANK OUTLET ELE V.. WARNING LABEL LOCKING COVER
~n_/j /I to'o d, 0 ~ PROVIDED FIR VI
/l// DED.
/vLJ) ❑YES ❑NO ❑YES ❑NO
NUMBER OF ROAD: PROPERTY WELL BUILDING VENT TO FRESH
BEDDING. VENT DIA.. VENT MATL HIGH WATER LINE AIR INLET
. ALARM FEET FROM DYES NO ❑YES ❑NO NEAREST
DOSING C AMBER:
MANUFACTURER JBEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTUR4OFLINE WIDE O.OVER
❑YES ❑NO ES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPE RATIONAL. NUMBER OPERTY VENT TO FRESH
AIR INLET
(DIFFERENCE BETWEEN FEET FRPUMP ON AND OFF) ❑YES ❑NO NEARESSOIL ABSORPTION SYSTEM. Check thesoil moisture at the depth f lwing LENGTH TER or excavation.
(If soil can be rolled into a wire, construction s
hall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
IDTH LENGTH NO OF DISTR PIPE SPACING COVER
BED/TRENCH W INSIDE DIA -PITS ILIOUID
TRENCHES / M ERIAL: PIT DEPTH
GRAVEL DEPTH FILL DEPTH IDISTR IPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. D R. NUMBER OF PROPERTY WELL. BUILDING V NT TO FRESH
BELOW PIPES r AB E VER E/.~ INELEV. END PIPES LINE ^ AIR IN(~F.T
C ~l'~~fG~ ~7,3 I E. NEARESTOM - ! ~l J'~
MOUND SYSTEM: G
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.
❑YES ❑NO
ERMANENT MARKERS OBSERVATION W~E
S
OIL COVER TEXTURE P❑YES ❑NO ❑YES NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL JDDED OSEEDED MULCHED
CENTER EDGES.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH- LENGTH. NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DIS7H DISTR. PIPE UISTHIBUTION PIPE MATERIAL & MAHKIN
ELEV.. ELEV.. DIA.. ELEV.. PIPES DIA.'.
ELEVATION AND
DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILOI NG.
/ FEET FROM LINE
❑YES ❑NO -]YES ❑NO NEAREST
0 L)
09- 5
Sketch System on -1~ Re ain in county file for audit.
Reverse Side.,-1 I ATU TITLE.
DILHR SBD 6710 (R. 01/82) Zoning Administrator
C(.IVU V
`DILHf~ SANITARY PERMIT APPLICATION cou I . C;~2v~ ~C
In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT #
.r~,..#,.:p.....~.
2-
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 E~O
PROP RTY OWNER 1 PROPERTY LOCATION
c ar W , I ca K, Sf!_ t/4 SL '/4, S I Li Tt , N, R aO E (Or)®
PR VP RTY OWNER'S tMAILING ADDRESS LOT NUMBER "ER SUBDIVISION NAME
'79~~ CsZ~fi(,
CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK
0.
rl' 4 VILLAGE:
11. TYPE OF BUILDING OR USE SERVED: J
Number of Bedrooms if 1 or 2 Family" 7 OR ❑ Public (Specify):
111. 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. E1 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. V 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. 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):
Feet Private ❑ Joint ❑ Public
a $ q606-
VI. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank law 1a'a,7 eJ~+' ❑ ❑
Lift Pump Tank/Si hon Chamber ~ ~ w E ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name (Print): Plumb r' Signatur : (No Stamps) MPRSW No.: Business Phone Number:
4 - ce,4 4 e9j- (h g~RS ?f ) X41-33
vftco 6ty I
Plumber's Address (Street, City, St te, Zi od Name of Designer:
RA, ( q0- S~ -3
VIII. SOIL TEST INFORMATION
C r if Soil Tester CST) Name CST
.7T~r UP- tA~)e .e-^00^ 5-74
CST's ADDRESS (Street, City, State ip Code) Phone Number:
RJR. Li 8~ l s dc~ f as- c~~~
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee jGurou nd water ate Issuing Agent Signature (No Stamps)
NJ Approved ❑ Owner Given Initial rcharge Fee
Adverse Determination ~ "o i
X. COMMENTS/REASONS FOR DISAPPROVAL:
~foux 4axkoi
SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber
San. Permit No. }~A6E I of
Owner's name
H63.05 PLOT PLAN
Show:
\OOO GAL. WI ES GRI
Location of building served v 1 Dosing chamber -Z?-3CV-' QTE z~
Septic tank \Z.SO GNU I~~ESE1~ ~ Vertical/horizontal reference point
GQ+v CCt-~'TG `rYCr~A'>`~ r
Building sewer System elevation is G1~-S
E' Effluent system HA Well-~Mvl~1C~F>P.1, Wh~'R>
Replacement system area El Property lines w/in 50' of system
i
Distribution boxes F~;7-1 Scale = Ikl= L or dimensioned
-E • ~`tLJ12 S `
Pump and controls: 5 S - ~1 6 ' Z'q 4
Mfr. & Model No. Vertical Lift Size For~ Main
S-) • 9 \'72 -a W ~FL6kjeA
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
1~l IP d ►~EI'ft~- .
P6'JC-E LAC ST
L F-IE
o
~ ~ ~ ~ ~ gy !}ousE ~ ~ ~0 4 GS y"GZ
BM EEL -I
- SS " ~ S
ON 2" l}2p1.~ u
Pl Pt: W / 'tZ' of tl pvc
J MRnsS o" I ' 1, 3' r i
1 1 1 _ / 4
l6 Ib y4pvC
a ► 1 ~ Pl~E-y0'l.o~►G
L"L
-S• -
35' LOT LAMB
Va-1T
\lllP d
M'/t'1R 1.
F Cs- POST
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St. CroixCounty and theSt.Croix^ounty Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omiss' n, examination oversight, construction, or any damage that may result in or
afte nstalla on.
01-q
P um r s s gna ur icense No. Date
PUMP CHAMBEP TRUSS SECTION AA1D SPECIFICATIONS p~6~ OF y
VEIJT CAP
Li"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKMIG
JUNCTIDU BOX MANHOLE COVER LA l)-r 1
> 25' FROM DOOR, wA~ 6 LABEL.
WIIJDOW OR FRESH 121MIU'
INTAKE
GRADE I '4° MIIJ.
sLEV• kti C,
15" MiU.
CONDUIT
-
PROVIDE I
IAILET AIRTIGHT SEAL I I
I (
I I APPROVED .]O1NT5
APPROVED JOINT A I II WIC.=. PIPE
W/C.•I. PIPE I (I ( EXTENDING 3~
EXTENDING 3' ALARM ONTO SOLID SOIL
ONTO SOLID SOIL
B I I
I ON
C ~ I
ELEV. ~D 1 FT. PUMP
OFF
D
>=L gg • SO CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SPECII` I'CATIOUS
rr r~_tiS~
DOSE
TANKS ' MANUFACTURER: Pa-bW.TS NUMBER OF DOSES: ,g -PER DA-';I
TAWK SIZE: GALLONS DOSE VOLUME
1PICLUDIN6 BACKFLOW: ~ GALLONS
ALARM MANUFACTURER: S.S' El-~C'~O S''ISIS
MODEL NUMBER: lOI hhW CAPACITIES: A= IUCHESOR 01 GALLON5
SWITCH TYPE: B = Z INCHES OR S7' 7 GALLONS
C= G -INLHES OR GALLONS
PUMP MANUFACTURER: h~S~s CO.
MODEL NUMBER: SS 4 D=-Ay ?/4MCHES OR L/~6 3 GALLONS
SWITCH TYPE: ~L -\-e- NOTE: PUMP AND ALARM ARE TO BE
INSTALLED OM SEPARATE CIRCUITS
MlhIiMUM DISCHARGE RATE_ GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 6~Z'9 FEET
+ MIMIMUM NETWORK SUPPLY PRESSURE . , . . . . . . 'r FEET
a X95 FT FEET
.F ZZ FEET OF FORCE MAIN X /oFLFRICTION FACTOR__
_ TOTAL D9UA.MIC HEAD = FEET
`rlr l STSR
1DP -,WIDTH S J "T"' ;LIQUID DEPTH 1/~
IIJ7ERNAL D{MEAISIONS OF TANK: LE1.lGTH 66
, ~T ~
aor.
• FMS P ~2 J~'Pc~-►v ~C~?.~"R
A2 - 3. 14/ X ~ '
BoTTor-I ~l - _ ~ }>13_ 2,3) = Za-~ ~ - GRI,~)h•
CROSS SECTIOIJ OF A BED 5'45TV-N1
~'*~►JT T~ I (~E 1 Z a q-~Ov~
~IIJl~T1C-p G2AbE
G
=7 Al L
hGGREGATC
~S -OF
SOIL FILL
PV C
DISTRIBUTION PIPE APPROVED SSVJ-f HFTIC CO
~-eo MATI=RIAL OR 5" OF 57R
° OR MARSH VW3
!o OF %2-21/z AGGR~GAT
ELEV. OF q6•S FEET f j'ERFORAT~ pN"P-- TO
~p f1i C; BED
3Z .INCHES BOLO-V ORIGINAL GRADE
DISTRIBUTIOM PIPE TU HE AT LEAST
AND AT L> F+ST ZO 1►JCHES BUT UO MORE THALI `i2 f►JCHES B=LOW FINAL GP-ADC-
- _y~_ fNCH1 5
11AXIMUI'~ DEPTH CJF EXCAVATION FROM ORIGINAL GRADL LJILL BL L INCHES
MINIMUM DEPTH OF EXCAVATION, FROM ORIGINJAL GRAD- wlLt- BE
SIC-NED= -
L IG E SC 1JUMBE R:
S IJ 3131 9 PSI (I V 3 H 1 V.-0.L Ph6 E y o~ y
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N N N N = T- T T T
nn-1 B►ii nv.4,3u nw1 O 1
..~-1 _a -i a m I e.A m.j a I a r.a. .a.
Owner's name San. Permit No. }7A6E
H63.05 PLOT PLAN
Show:
Gcb" DOO 6t~t . W1 f:s Et2
Location of building served Dosing chamber 12-- Q-M Tft?NJ L
ED Septic tank \-LSo Cm- wlvcsElZ Q' Vertical/horizontal reference poin
F;j C oti► ca-~`T~, ~r~1-~~ ~
Building sewer System elevation is c16.S
Effluent system NA Well- (NUN 1ev;FA , WPC~-~)
Replacement system area El Property lines w/in 501 of system
Distribution boxes [-~71 Scale = 1~1=~0 , or dimensioned
F •E . 17' f L~1Z S LL~-lI `
Pump and controls: S S- V 6- 7-9 4
Mfr. & Model No. Vertical Lift Size Force Main
a.oq FT. • 6.33 F_ • 11b.(0.Gft . S-7 XS-).9 1-)2-3WIF(ZW1
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
\~l IP d HElf~l
rt'1J`E Po ST
.•25~-.. LuT Lt►•~E
)K
,i
~ 11 ~ ~ 8y 1~~sE
1 ) /O 4.1 y"Gs
a" EEL- I
oN 2~' lam) 1,
pl Pt W / -L-Ll of 4 PVC
lJ MRASr a" 1 1 1 3'
~ 1 ` 116' y yPv C ~r
~ 1 P~Fo p~'tEo
a 1 1 1 PIPff-4o'l.0~►~
'L,L a\
-S. ,'o.
V3,4 T LOT UTA1e
\lllP
F~cE P~sT
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St. CroixCounty and theSt.CroixCounty Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omiss'on, examination oversight, construction, or any damage that may result in or
afte nstalla ion.
n ea (d o'?'? -(t
P um r s signa ure icense o. a e
r
_ywiL.coX
Owner's name San. Permit No.
of Ll
H63.05 PLOT PLAN
Shoo-w: loot/ GhL WIESG2
1 t Location of building served Dosing chamber CoNeii~re TAuh'
iz.So GRL vv►ESee Vertical/horizontal reference point
Septic tank
System elevation is 96.5
1v Building sewer
F,;: ! - Effluent system Well C ""NJ t C-i.PN ; VJN'T 1t,
Replacement system area Property lines w/in 50' of system
Npt Distribution boxes scale = 1~~ =(4 01 or dimensioned
T:~E- MLlC12S
Pump and controls: gs - y 6-Z9 FT
Mfr. & Model No. Vertical Lift Size Force Main
o.u3 rr'T 6.3Z F•r• 8-6 GNP. 5-7 _ 162-5 Ci-) 2.3 w/FLOwsn-,4th
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan,below:
iRcN Pipe 9
U/J N
McThL~ vta')oe F~~r L•O'T
IS S'
1 d~
x IM
~dd zs
X45 ~ ,9'oF
® NS
3 loo.o 1411-11 , W-
oN 7- l ~ Ne 0!k- 'yMCS ~~N '
~iPE w/
$R-►~S4 cAp 313 46)
~ ~ 4~~PERFaRRTt'A
L4 CJ
J ioL ~ ~ 81 9
ei
3S VEIJT
s, DoT L..)IU~
f'if'e R N
49 r-)ETA L
F~c.~ Corr ~P~Q 1
LD gt
1'
uent
By the granting or approving of the above plan, or upon the event o Q
permit being issued, St. croixcounty and thegt.CroixCounty Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after 'nstalla ion.
P um r s signa ure License o. a e
3
WAWAqV WPW
797tk%220
L?OC JMEW NO. STATE BAR OF WISCONSIN FORM 11-IM •"'s sr"-` 24"N' Ioll NeC011pIN• DATA
LAND CONTRACT
ss turn FOR ALL TtANEACTto>KS wtsss orsit
Q,f
eas Is nXAMA6D AND IINQTT10Na11iOWCONiU1tiR
iT. am CEO., WI
CiMU1160t, by sal between .....Chatle:a-C--Cudd-and Riled for 116Cord
R.~. ....hwtt>,egad..atui..Kilt
("vendor', NOV $ 01981
.r AA ,
("Purchaser", whether on* or stet's).
Vonisr seas and agrees to esnvey to Psrehssee, upon the prompt and full per- of owns
~st.aasae of Nis outran, by Purchaser, the following property, together with the
11111111o* Ittsus and other appurttnaat iatsreeta (all called the "Property"), Lou .....................Coanty, State of wiscotuis: I
To
Past of Outlots 099", 6100" and 0101" of the Plat I - _ :7:. -
Of Beach Lots in the Village of Worth Hudson, -
desesibed as follows:
Lot 1 of Certified Survey Nap filed September 10 1987 Tax Pared No
in Volume 070, page 1876.
Lot 2 of Certified Survey map filed September 1, 1987 in Volume 070, page 1876,
iXCEPT the folUMLAg: Commencing at the S8 corner of Section 141 thence N 0039104" 8
(beasi gs referenced to the Last line of the S8J of Section 14, assumed N 0039004" 8) I
456.34 feet, thence M 89021913" M 93.14 feet to the point of beginning, thence
S 34012117" W 117.60 feet, thence M 89021113" W 204.16 fat to the meander line of I
Labs St. Croix, thence N 4021911" 8 18.04 feet along said meander line thence
6 62.25'03" 8 (recorded as S 83'04' 8 in VOlume 04140g, 'page 438)149.09 foots thence
S 99.21'13" 8 (recorded as West in volume 06000, Page 426)30.00 feet, thence ~M 0"39'04' 8 (recorded as North in Volume "600", Page 426)98.00 feet, thence
S 890211131:':
i (recorded as East) 90.00 feet to the point of beginning, including all land: lying
betv"a said meander line and said water's edge. Subject to an easement for ingress
and egress over that part of Lot 1 of the said Certified Survey )lap that is 1 rod wide
7%k .ia.stat......... homestead property, to tlis >a18 corner of the said Lot 1.
(w (is not)
Purchaser agrees to purchase the Property mad to pay to Vendor at ..4kg .p1a4Xf .Y.l4.?F~ires
he nuns at fkQS.RRQ.QQ is the following manner: (a) &Q..=..QQ.......
A the execetha of this Contract; and (b) the balance of i 210,000.00........... together with interest from date
areot en the balance outstanding from time to time at the rate of ..................103.................. per beat per annum
me Mid to too, as follows :
N=thlY payments of $2,500.00, coo■aencing on the day ofQQF&6Mk'C, 19870,
I
and ,continuing on the day ~,f' each month thereafter. `
l
1.
Pmided, however, the entire outstanding balance shall be
......l~3<.__ paid in inli oa or before tbe........ L8't............ day of
ISM... (the maturity date).
WARM WAMLM
i
I
Pardtarrr. slabs wow" by Vendor. egress, to pay monthly to vendor amousts suffleiest to pay reasonably snuci-
sod aannsl tasea, spacial assessments. fire and required insurance premiums wbon due. To the extent received by Vendor.
s"dor nerve 4 apply 108711186014 to tbe" obligations when due. Such amounts soeiived by the Vender for payment of
Ma, a>re6504481111 mad insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
lhts etberwin required by law.
Payments shad be applied first to iatert" on the unpaid balance at the rate specified and then to principal. Any
"est nay be prepaid witboet premium or fee upon principal at any time.
Is the event of Say prepayment, this contrad shall not be treated as in default with respect to payment so long
the "Paid balance of principal, mad interest (and in such case accruing interest from month to month &W be treated
unpaid Principal) Is Ins than the amooat that said indebtedness would have been had the monthly payments been
Wit as first sweifisd above; provided that monthly payments shall be contiaued in the event of credit of any proceeds
inseraset w eoodemnation. the condemned prtasiw being thereafter excluded herefrom. li
Purchaser states that Purchaser is satisfied with the title as shown by the title "Mena submitted to Purchaser
esanduatits MOW:
• Mortgage from vendors to The First National Bank of River Falls, Wisconsin
Mortgage from vendors to The First National Bank of Hudson, Wisconsin.
(See attached Addendum for Additional Terms)
Purchaser agrees to pay the cost of future title evidence. If title evideaoe is in the form of an abstract. it shall
retain" by VlnAor un#-4 ♦k._ Iz.1• 1_ . I.
v!; l ~ I rA~,t ~GiG1
Purchaser promises to pay when due all taxes and asseasn,ents levied on the Property or upon Vendor's interest
in it and to deliver to Vendor on demand receipts showing such payment.
R
101111
tlwoc ~tlNciff(~I
It I xd~s~tlcsi etxs~sn~taQcriec ubtlbthK3tpwtitsek~sibeoc XltatNc>~°°~esge~t ~~Ac9)
isroatsasnuooCxArc~utiXlbwtwCXIC~ICWt y~ Wyk
bet~OESSdf:tlc ~Bags3cf~trtapaYs~X7~
Id 0M Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property
in good tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and
to comply with all laws, ordinances and regulations affecting the Property.
Vendor arras that in can the purchase price with interest and other moneys shall be fully paid and all conditions
sh" be fully performed at the times and in the manner above specified, Vendor will on demand, smute and deliver to
the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except
any liens or mcumbramees created by the act or default of Purchaser, and except: .tiitbOl IMIL.Ind
..xmitgIrt. onIi..Qf...x1tggr4.
.
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 ....ESQ.. days following the specified due date or (b) in the event of a default in
performance of an other obligation of Purchaser whkh continues for a period of.6(1..... days following written notice
thereof by Vendor delivered personally or mailed by certified mail), then Use entire outstanding balance under this ca►tract
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 bathrough 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 snd other amounts due hereunder (in which event all amounts previously
paid by Purchaser shall be :forfeited as liquidated darnaga for failure to fulfill this Contract and as rental for the
rid if purchaser fails to redeem , or (U) Vendor may sw for specific performance of this Contract to compel
immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of
default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser
shall be liable for any deficiency' or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion
thereof; or (iv) Vendor may degare this Contract at an end and remove this Contraetasacloud on title in a quiet-title
action if 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 (i), (ii) or (Iv) above. Notwithstanding any oral or written statements or actions of Vendor, an electio:► of any
of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses
induding reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to ti-e
extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in.
curred, and " be included in any judgment.
Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents
to the appolntment of a receiver of the Property, Including homestead interest, to collect the rents, issues, and profits of
the PrgwrtY durbsg the pendency of such action, and such rents. issues, and profits when so collected shall be held and
applied w the court shall direct.
Purchaser shall not transfer, sell or convey any legal or eRditabie 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
wavered is a pbdge or assignment of Purchaser's interest under this Contract coley 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 payaWe under this Contract shall becomi immediately due and payable in full, at Vendor's option without notice.
Vendor shall auks 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 Mortgages if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on
this Contract.
Vaud" May wain 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 bens to of the heirs, legal representatives,
svocesaon and M of Vendor and Pumbaser. (It sot an owner of the Property the spouse of Vendor for a valuable
""SWeratiom jolns n to release homestead rights in the subject Property and we" to join in the exeeut;on of the
deed to be made in fulfillment )ereof.l
Dated this ...........i c ds f t!~........, :9.137
(SEAL)
an ki e C . Cudd -!fa!!~
(SEAL) - (SEAL)
• Charles C. Cudd Wilcox
AUTHENTICATION ACKNg~~OWLEDGMZNT
STATE OF g4&JJKA
Signature (5) .
ss.
WA5.h i ng t.QT) .............County.
authenticated this ........day of 19...... Personally came before me this ...r)...... day of
....UOY.elober ...................0 19...al the above named
• ....bw.5 alp .na...►~ . .,...>3.ns~...v.i.Qt.Qx .5....
TITLE: MEMBER STATE BAR OF WISCONSIN W.i.I,C.QX
(If not .
authorized by 4 706.06, Wis. Stets.)
to me known to be the person 5......... who executed the
foregoing instrument an sck ledge the tame.
THIS INSTRUMENT WAS ORArTEO BY e--" /L 7 / /
C ~.L II
Keith Rodli At:,tarney at Law ` L
1. Vendors shall remove the existing buildings from the
above-described real estate no later than November 30,
1987.
2. Vendors agree to release to Purchasers, by warranty deed,
either of the lots which are the subject of this con-
tract. As a condition to any such release, Purchasers
agree that the unpaid principal balance under the land
contract shall be no greater than $105,000.00. Purchas-
ers agree to pay for all costs and expenses incurred in
connection with any such release. The monthly
installment may be reduced to $1,500.00 for months from
and after the time that the contract balance does not
exceed $105,000.00.
3. Seller shall pay upon, and keep and perform.all
conditions of, the three mortgages presently of record
against the premises, so as to prevent the occurrence of
a default in respect of such mortgages; and seller shall
assure that at all times the aggregate of the unpaid
balances of such mortgages shall not exceed the unpaid
balance of this contract. In the event seller fails in
this regard, purchaser may make such payments and have a
credit for all amounts so paid, against the payments next
coming due under this contract.
4. The easement referred to in the legal description is not one rod
vide, but is described as follows:
Commencing at the SE corner of Section 14, T29N, B20W;
thence N003910411E (bearings reference.to the East line
of the SE 1/4 of Section 14, assumed N0039104"E) 456.38'
to point of beginning; thence S0039104"W 101; thence
N89°20'13"E to a point on the easterly line of said
Certified Survey Map; thence N34012117"E on said easterly
line to a point 93.14' west of the point of beginning;
thence S89021113"E 93.14' to point of beginning.
ic-~~_ WtLGOx
-.3 k'r.. rJr hC
n~6~ z OF y
CROSS SECTIDKJ OF A BED S~STEI'I
~'*VE1JT TaIPC- \Z'' Q~oV~
~ I l,3 % GC'b STZ A9 E
L G
SOIL FILL Z" OF AGGREGATE
I-I'I. Pv C
DISTRIBUTIOU PIPE APPROVED SyWTHETIC COVER
MATERIAL OR 9" OF STRAW
~j OR MARSH HAS
Lo OF;(?
ELEV. OF q6.S FEET
ps=RFoRATED PIP` Tn
CDT-1'oM Cdr @ED
MSTRIBUTIOIJ PIPE TO BC AT LEAST 3Z UCHES BELO\✓ ORIGIIJAL GRADE
AUD AT LEAST ZO WCHES BUT MO MORE TRAM `iZ RICHES B--OW FINIAL GRADE
MAXIMUM, DEP:-H C)F EXCAVATIOU FROM ORIGIUAL GRADE LJILL BE WC-HES
j%IWIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRADE WILL. BC -INCHES `
SIGIJED~
L IG C I.I SE IJUMBE R: G S -
UAT C :
PUMP CHAMBER CROSS SECTION A?JD SPECIFICATIONS pp~G~ OF y
VEUT CAP
i
I
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
MANHOLE COVER WITH
JUAJCTION BOX
> 25' FROM DOOR, WA~►J1NG LABEL,
WIIJDOW OR FRESH I2"MIU. I
W TAKE
I
GRADE
ELEV. VDO.3 I 4" MIU.
/ I 1B"MIU.
COIJDUIT
I6"MIN.
INLET PROVIDE I
AIRTIGHT SEAL ( III
APPROVED JOINT A I III APPROVED JOINTS
W/C•I• PIPE I III W/C.I. PIPE
II ALARM EXTEMMUG 31
EXTENDING 3` I II ONTO SOLID SOIL
ONTO SOLID SOIL B I i
I I oN
C
ELEV. ~D 1 FT. PUMP
OFF
D
ELlry, Q~ • SO CONCRETE BLOCK
RISER EXIT PERMITTED OIJLH IF TANK MANUFACTURER HAS SUCH APPROVAL
SPEC-IFICATIOUS
r rr r p7LT++r~"~
DOSE w`
TANKS MANUFACTURER: I 03MEM 1 PTI U~U IJUMBER OF DOSES: PER DAy
-
TANK SIZE: O~CO GALL0MS DOSE VOLUME , _
S.S. El-~C ~ SY~ IS INCLUDIMG BACKFLOW: l GAtLONS
ALARM MA►,,)UFACTURER:
MODEL NUMBER: V~ w CAPACITIES: A= l _IMCHES OR GALLOUS
SWITCH TYPE: iz-iM C.UT~_ 1-'/ B = Z- INCHES OR S7'~ GALLOUS
PUMP MANUFACTURER: 1'14 s CIZ. C=4_INCHES OR N_'Z' GALLOU5
MODEL IJUMBER: SS 4 D=_lY-L"4JCHESOR Y4_3 GALLDUS
SWITCH TYPE: t_lLzTzClu MOTE: PUMP AND ALARM ARE TO BE
INSTALLED ON SEPARATE CIRCUITS
M1IJIMUM DISCHARGE RATE GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AN0 DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . FEET
T.
+ S FEET OF FORCE MAIN X X95 Fo FLFRICTION FACTOR.. 0"03 FEET
TOTAL D~3MAMIC HEAD = ('"3Z FE.ET
INTERNAL DIMENSIONS OF TANK: LENGTH 9q'7t,0 ;WIDTH g/ IE•;LIQUID DEPTH
a oT•
F►S i'~1Z P,t%i.►vFINc 2~-yZ
$oTl~, i A1'.EF~ = 3. 14/ k Ih.3 = Z3 J = ~ GFl C./) Y).
y
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'Owner'+ name San. Permit No.
Lf
• - H63.05 PLOT PLAN
Show:~ lOoc~ Gh~ W~ESEl2 >
to " t Location of building served Dosing chamber Cos►c-rtE-re 7flLjh-
t2.so GRc tiv►ES~ Q Vertical/horizontal reference point
Septic tank Co►v c. --j-e
a Building sewer system elevation is q6•S
Effluent system Q Well C »KJ l ctPNt; ttiN`t7E12>
Replacement system area E j i Property lines w/in 50' of system
NA Distribution boxes Scale = 1~~ =L40 , or dimensioned
UJ~ Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle
Place check mark in appropriate box, indicating item is shown on plot plan below:
mehi PIPE t
mevhl. ¢&jGE F~~r t-OT LW L
2s,513 - S'
x rl
_ ZS'h,N
J X45' ~o'oF
c °F S_ Cx
tM EL 100, p ® glro
1- '25•
E/I
$RASS cAp
3jb
~ 4nERFURRTeA ~
~ ~ ~ ~ wC P1 P@-
'
"15 t-ip ? I I ? :j Lj o cou G
J L0L J B1
Bt % i
35" i VENT
~ LOT LINE
S
pipe
$ rnETA L_
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St.CroixCounty and theSt.CroixCounty Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omiss n, examination oversight, construction, or any damage that-may result in or
after nstal tion.
n
P r s 1 na ur 1-1-c e- -n-s -e- Dar-el
T' 3
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFEIY & BUILDINGS
DIVISION
INDUSTRY,
LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX 76
ON WI 3707
HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145)
E : SUBDIVISION NAME:
- LOT NO.:BLK. NO.
TOWNSHI MUNICI
~ SECTION:
LO CA
s'/a SE'/a J TZ9 N/RAE (a ~votZ`r~ t~sur., Uo~1 p )8~6
TION: R'S NAME: MAILING ADDRESS: L S 9o t.v ) G ~}I~1~10~J A R
COUNTY: WN UYE
S~ CRvIX ~!C`NZ W11-Ct X \Zt) L4 1"1N SS! ZS
DATES OBSERVATIONS MADE
USE (PROFILE DESCRIPTIONS: R OLATION TESTS:
NO. BEDRMS : COMMERCIAL DESCRIPTION: r7
A
(Residence y N urJNew ❑Replace `2_ k-) -
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING S7REWMENDED SYSTEM:(optional)
®s ou ®s ou 2s ou Ns [:]u os lXL/6`CDkJL)a-17 AL
DESIGN RATE: If any portion of the tested area is in the N `t\ ,
If Terco lation Tests are NOT required I'i
unILHR 83.0915)(b), indicate: C' L~ S Floodplain, indicate Floodplain elevation: _1 I PROFILE DESCRIPTIONS
EST. HIGHST TO BEDROCK IOF OBSIERVED (SEE( ABBRV ON BACK jEXTURE, AND DEPTH
BORING, COLOR, NUMBER !6- I-OTAL ELEVATION DEPOTSERVED GROUNDWAT
B- q9.7 NVO►UE 7 ~.5 Z.s' 8ti ; y•o` '3'r, vKet~ S w/6H
0-4~' l~h-6h1S 15;1:~'D\z.~>1Gr.~S;y,~~13r,h~Q~Q4w/Gr
B- IOU•OI
B- 3
I 1. 3' tl ; ~l• 8 I t
1bp.Z t rr > 7 .3 \,Z t
y
1 r
B- S -7-W lbo.4 7 ~•y' 1•~' 'I ~.8' tt ;3.b
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATER INCH ES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PER
P-
P_ U t-l W Ll U I U l
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
►,J1LT"N11- s R n sye~r PAGE S1 r~ T
of land slope.
SYSTEM ELEVATION RU, a b. s
~L, to3 3'bN 'To? or
~`ttP Mt' CAL' FWce POST
, S1 LOG S LOT_Z N• 0340k1'.
7 zo/ n`eS
L_ -mss r _ N
IN -
jj 0. m,
o
P1 x
to,
o ST.
J ZD 8 ~
Z-- T LN*A:
-Inn LL4aLL L\ u'
1" ►~o~ 5 >tN. t PI - SGt~LE 1 `I= (40'
the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
(print): TESTS WERE COMPLETED ON:
1R i?~v 1., w~G~1Z~R ~z-tom-8~
Q,OV~ L B~K ZZ CERTIFICATION NUMBER: PHONE NUMBER (optional):
L.~ ego S-1 71S- Zs-O/L
CST SIGNATUR :
ginal and one copy to Local Authority, Property Owner and Soil Tester.
/83) OVER -
+ VI
ST C- 105 r
y
SEPTIC TANK MAINTENANCE AGREEMENT r'
0
St. Croix County
v
y
OWNER/BUYER V1 «-afz_
ROUTE/BOX NUMBER 33 Fire Number
CITY/STATE MaKTFi Z I P (5 9e)
PROPERTY LOCATION: ~4, Sections T J, Of N, R a0 W
LI /1a
Town of CT k/Cr-Y, ALcIS6ki , St. Croix County,
Subdivision Lot number Z
- 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 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.
J
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- v
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. f
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.
f 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 V%(_- a_ IL40K
Location of Property `E ._'Z, Section _11~, N-R2L C) W
Township U~ I r a-0 e C4, A h A;4-\ PLIOU fI
Mailing Address 333 C7^1- H Q Rd.~
Address of Site -333
1110 2TH- /~zA05oN . W l
Subdivision Name
Lot Number Z-
Previous Owner of Property rhNe
p[~
Total Size of Parcel
Date Parcel was Created ~2,~t-t2 Z~ T l q&7
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes ✓ No
aav
Volume _797 and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
I (We) cv ti.by that att .atatementa on th.i,a bonm ahe true to the but ob my (oun)
hnowtedge; that I (we) am (ane) the owner (a) o6 the pnopent y dean bed in th,i,a
inbonmati,on bonm, by viAtue ob a w=anty deed recorded in the Obbice ob the
County Regi.6ten ob Deeda as Document No. 1~3c~3 ; and that I (We) p,%Uentty
own the pnopoaed .6 to ban the sewage dispoa sya em (on I (we) have obtained an
eaaement, to nun with the above deaen,i.bed pnopehty, bon the construction ob said
.6ptem, and the came has been duty neconded in the Obb.iee ob the County Regi.6ten ob
Deeds, as Document No. ) .
VA 47W
SIGNATURE OF ER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED