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PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: -X Trench:
Width: Lenith: :22 � Number of Lines _ Area Built:Z,�_
Fill depth to top of pipe: �
i
Number of feet from nearest property line: Front, O Side, O Rear,Ft .
Number of feet from well: dJ1,4_1
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, O Rear, QF�•
Number of feet from well: J
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: Plumber on job:
License Number:
3/84:mj
• AS BUILT SANITARY SYSTEM REPORT Form - S T C - 104
OWNER /Jh, � �� TOWNSHIP SEC. _ T EL_N-R W
ADDRESS, j� `46f ST. CROIX COUNTY, WISCONSIN
4�L , �4 ,y 1=�17
SUBDIVISION 6"e'1C'T'J LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
7T
o�
.ids !o?.<S3: 85.77
�OJJ.�p
c/
10 k
TNDT G
i
ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference oint:
p Proposed slope at site:
SEPTIC TANK: Manufacturer: Gy„),a ;1/ ; Liquid Capacity:
Number of rings used: Tank manhole cover elevation: g�v
Tank Inlet Elevation: _ Tank Outlet Elevation: &o'
Number of feet from nearest Road: Front, Sid
e,Q Rear, O 4Z-2 / feet
From nearest property line Front 10 Side,O Rear,(D feet
i
Number of feet from: well 4� building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
L SEE REVERSE SIDE
DEPAIRTMENT4OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
SW,SE,S12,'T31N-R18W XZ1CONVENTIONAL ❑ALTERNATIVE State Plan 1.0.Number:
(if assigned)
Town of Star Prairie ❑Holding Tank ❑In-Ground Pressure El Mound
Lot No. 8
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT10 DATE:
Tim Sullivan 242 North 4th Street, New Richmond, W 54017 -�7'���
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV..
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Calvin Powers Jr. 1563 St. Croix 92476
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
[:]YES ONO ❑YES ONO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM FEET FROM LINE: AIR INLET
DYES ONO 1-1 YES ❑NO NEAREST
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY. JPUMP MODEL. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ONO DYES ❑NO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING.JVENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) ❑YES ❑NO 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:
WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING. COVER INSIDE CIA. SPITS LIQUID
BED/TRENCH TRENCHEES MAT AL' PIT DEPTH
DIMENSIONS � -
GRAVEL DEPTH FILL DEPTH IDISTR.,PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH
BELOW PIPES ABOVE COVER ELEV. NLET.ELEV.END PIPES: FEET FROM LINE: AIR INLET.
NEAREST------w
1P
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.
❑YES NO
SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES 1:1 NO DYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER: EDGES.
DYES 1:1 NO DYES ONO 1:1 YES El 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. ID ISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEVATION AND
ELEV.: ELEV.: CIA.. ELEV.: JPIPE S DIA..
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
DYES El NO El YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING.
�t1 FEET FROM LINE:
V S
1:1 NO ❑YES NO NEAREST
l
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE. TITLE:
DILHR SBD 6710(R.01/82) Zoning Administrator
Thomas C. Nelson
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;
I!. 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'/2 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 a.ter
included the creation of surcharges (fees) for a number of regu;ated practices which Wisco En`s
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasure
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.
0
'le monies collected through these surcharges are credited to the groundwater fund adminis-
t .e.; by the Department of Natural Resources These funds are used for monitoring grounn- t
wh-t' ,, g�our..=wwater contamination irwestigations and est�bli mnent of standards saroundw=iter,
s wr rt protec mg.
3� -a9v
.','_03!36)
lJ DILHR SANITARY PERMIT APPLICATION COUNTY
_ In accord with ILHR 83.05,Wis.Adm.Code r,
STATE SANITARY PERMIT#
9au >4
—`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 LAS) NO
PROPERTY OWNER PROPERTY LOCATION
%4 '/a, S / T , N, R E (or)®
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK UMBER SUBDIVISION NAME
tli
CITY,STAT ZIP CODE PHONE NUMBER CITY NEARE T BQQQ,LAKE OR LANDMARK
VILLAGE
11. TYPE OF BUILDING OR USE SERVED: a3$- // /-Po oohs
Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable)
1. a. ® New b. ❑ 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.1-1 Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. X seepage Bed b. ❑seepage Trench c. ❑seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTI AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Squ ON are Feet):
19 1 col 3 Feet ®Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in allons Total ##of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber ❑ ❑ 1 ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): r Plumber's Signat e: Stamps) MP/MPRSW No.: Business Phone Number:
s 3 s &I
mber's Addre ( tre t,City,Stat Zip Co e: V Name of Desi er:
10Z S-4/ 7
Vlll. SOIL TEST INFORMATION
Certif' d So Tester(CS ame EPho�ne
U s
CST' ADDRESS(St et,City,St Zip Code) mber:
S77 ag-
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
ICI Approved ❑ Owner Given Initial `!DJ //11 !!,, S rcharge Fee 7 `r//
Adverse Determination /U O U U� b"�/ l�MCvQ N Gb I rh,c
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
Location of Property ',S.,k) _3L, Section , T N - R j_ W
Township ---
Mailing Address
Z&-
Subdivision Name
Lot Number fj
Previous Owner of PropertyAnr S 1� �•1��.� /
Total Size of Parcel Z ,�-zd R
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 ^7 S'� and Page Number _ as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
5. 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) centi6y that att atatementa on thi 4 6oAm axe true to the beat 06 my (oun)
knowledge; that I (we) am (ane) the owneh(s) o6 the pnopenty deach i.bed in this
.in6o4mati.on 6onm, by vi tue o6 a waA&anty deed necohded in the 066ice of the
County RegiA ten o6 Deeda as Document No. , and that I (we)
pnesentty own the pnoposed & to bon the selvage diApo,6at system (on I (we) have
obtained an easement, to -tun with the above deac, i.bed pnopehty, bon the
con6tnucttion o6 said system, and the same has been duty %econded in the 066ice
o6 the County Regi6ten o6 Deeds, ad Document No. )
SIGNATU OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
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jo alup aql uo I3ajj0 u1 ajua aq Iu uoaaagl Isaaalut gltm 'oauleluq SulPulegsgno aatlua aql So IuawAud llnj Pug a48tpawwt
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aql aoj luluaa so pus I3ualuop stgl [ltjlnj of aan(lu; aoj saSlewup palupinbtl so pallajaoj: aq llugs aasugaand Aq piled
Alsnolnaadsqunowle llleluDAa431gmu1)aapunaaayanpslunowgaaylopuya4up gins uo I3ajja ut aqua Dill Iu llnujap jo alup ayI
woaj uoaaagl IsOaaqut gltm 'Daurlleq Yulpulelslno aatlua Dili jo IuawAud llnj s,aasuy3and uodn pauotltpuo3 aq of uotldwapaa
So Allnba Aug gltm aansol3aaoj 13tals ySnoagq )lauq Alaadoad ayI aano33a Pilo Alaadoad ayI ul Isaaalul Pus all!1 1914212
s aasvyaand pule javaluop s14I alttutwaal 'uotldo sty Ile 'Auw aopuaA (t) :Altnba ut ao mul Aq paptnoad asoql of uotltPPv
ut (mul Aq paptnoad suotlult tl Au ; IDaf puv slq:ta 2lulmolloj aqI DAloq Oslo lluqs aopuaA pu13 '( 0A1v&
w
Agaaaq aasuy3and 4311m) a3llou 1nogllm puu uotldo s,aoPuDA lu 'llnj u1 algvAud puv anp Alaqutpawwt awoaag dugs
Iaualuoa s1Nl aapun aauuluq 2u1Puujgno aatlua all 11041 '([!out paIjIlaa3 Aq pallsw ao Alluuosaad paaaAllap) aopuaA Aq joaaagl
831I0u uall!am 2utmolloj scup 09 -;o potaod v aoj sanulluoa yatgm aasugaand jo uotlleSilgo aaglo Auv ;o aauvwaojaed
ut llnujap v ;o Iuana aql ut (q) ao aqup anp patjtoads aql Sutmollo; sAvp... 9"' jo polaad v aoj sanutluoo yatgm lsaaalut
ao ludmutad Aug ;o IuawAud aql ut llnujap v jo Iuana aqI ut (g) pus oauasso aql jo st awtl lvgl saaaSv aasugaand
........ °•--•.....•••-••---•-•••-•--...r-•----•..............••-••----•--•-•--•--•°------._......................................••-°-----
•--•..........................................••-•••--••-••.....-•-••-•---.._.....--••••--................----........_.....................--_.....--•--................
................................................. ----..........-••-•••-••-••--•-•.......----------.....--••--•-•--••---•---••---•....------•..............--•••••--.....
. - ...._•--....•-•-..._......-• .
--•--•----- =- •a:�� fib_-stxz5t�:�rt�c�.-s�x .pu�._.s�:ud-tu�s�d.._ .sa�u�utgzri
- •52----•- • daaxa ule 'aas13 aan o nv a ao av a A saaa saouva tunaua ao sua[ Aus
�izTUOZ p>:t�-''�-�dz�-ziznW 1 P q d d II 3 P I aql q Pal q .T
gdaaxa 103uuaytunaua pug suall jig jo av013 Pug Oaaj 'Alaadoad eql ;o 'aldtuts aaj ut 'paaa Aluvaavb 13 'aasvyoand Dill
of aaAT1ap puv agnaaza 'puuwap uo Tltm aopuaA 'palyaads anogv aeuuutu aqI ut pug sawtl aql lv pawaojaad AlTnj eq llugs
suolllpuoo liv puu ptvd AlInj aq dugs sAauow aoggo Puv Isaaalut gltm amad egg
g3and aql aeso ut Iggl saaaSv aopuaA
•Alaadoad aql 8utlao;le suotquln2aa puv seouvulpao 'sing{ llv gltm Aldtuo3 of
puv 113vaquop stgl ;o nail agl of aotaadns sua11 woaj aaaj Alaadoad aql Bawl of 'atsdaa pus uoll!Puoa alg8lugual pooe ut
Alaadoad aqI daaN of `Alaadoad aql uo pall!wtuoo aq of agsle& &01113 aou 91913m I[urwO3 01 IOU 24ugu0AO3 aangoand
•91gls8aj Allvatwouoaa
aq al aluriaa ao uol4sao4saa aql swaap aopuaA 041 paptnoad 'pa2vump Alaadoad aql jo atsdaa ao uotivaolsea of patldd13 aq
Ili is spa03oad a3u8ansul '2ullta& ut aaa2v eslmaoglo aopuaA pug aasugoand ssalun •aopuaA puv setuvdutoo eSuvansut
of ssol jo a31lou aA1A Alldwoad i184s aasleg3and •aopuaA qlt& paltsodap aq [legs Alaadoad aqI Suuano3 satoi1od 11T ;o
luulSlao aqI 'Su1411m ut saaaSu astmaa4lo aopuaA ssalun 'puu Isaaalut s,aopu0A aql jo tons; ut asnul3 paepuvis agl ulvluOD
11846 satagod atj,u -anp uaq& swnituaad oauuansul agl Aud llugs aasugaand •Iavaluop styl aapun pa&o aauuluq aqI uuyl
aaow Iunowv uv 111 a2Ba0eo3 aatnboa Iou Tlugs aopuaA Inq '-----•-•--••-••---••--•--•-------V/g ;o urns aql ut 'aopuaA Aq
panoaddr saaansut tlSnoayl 'Dauleansut-oa Ino4gim 'Damboa AMU aopuaA Ile spaszvq aeglo gins pus sltaad 92uaano3 papual
-xa '0atj Aq Pauotsuno aNvulup to ssol Isutr.Yr, paansut Alaadoad agl uo sluawaeoadwt eqq chat; [Iugg aasvyaand
•;uawAud lean, 1•,rmoys sgdwaa purwap uo aopuaA OI aantlap oI pu13 It ill
Isaaalut s•aopuDA uodn iaad0.td ayI uo pal,^.D[ squauls+;. m saxvl llu anp uages Aud oq uaslwoad aasvyaand
DOCUMEAT No. STATE BAR OF WISCONSIN FORM 11—1982 THIS 6PACL RESERVED FOR RIj,CORDINO�DATA
i I _ LAND CONTRACT -6
�P Individual and Corporate
�i /GG8.;� ;l(TO BE USED FOR ALL TRANSACTIONS WHERE OVER 3
$26,000 IS FINANCED AND IN O r1I1 R NON CONSUMER
AGT RANSACTIONS)._.
Contract, by and between James -H. _Johnson and-
---- ------ -- ---- -
_...��exl_.�.�._. Alin snm.---gas__.kenants._.in_.�.ammab.-------_---•-------
........................................••---•._._....._--•------------ ("Vendor",
whether
1l more) akixls�lar�d_wx.'llynmaxi.talSpxAgext
with•_rights of ?-ux_Y_�-VQrC/Purchaser", whether one or more). 1
Vendor sells and agrees to convey to Purchaser, upon the prompt and full per-
formance of this contract by Purchaser, the following property,together with the
rents,profits,fixtures and other appurtenant interests (all called the"Property"),
in................• t t .... r........................................
S . CrOlX County, State of Wisconsin: i RETURN TO
Tax Parcel No. ..................................
Lot Eight (8) , Johnson & Associate' s First Addition to the Town of
! I
Star Prairie.
�i
TOGETHER WITH an Easement for ingress and egress over a private
street, designated as Outlot One (1) Private Street in said Johnson &
Associate' s First Addition.
This _.;-S--X1Q._........... homestead property.
(is) (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at SUCK P1aCE' aS designated
the sum of $.____b.,_QD.Q...QQ---------------------------------- in the following manner: (a) ............................
at the execution of this Contract; and (b) the balance'of $_S,.0.0A_._0.0................... together with interest from date
hereof on the balance outstanding from time to time at the rate of.ten..percant....(1Q.U. per cent per annum
until paid in full, as follows: In annual installments of $11000. 00, commencing
March 1, 1987, and on the 1st day of each succeeding March,
17th
Provided, however, the entire outstanding balance shall be paid in full on or before the.......................... day of
Je------•-•---------. 19.9.1-- ( the maturity date).
Following any default in payment, interest shall accrue at the rate of___ % per annum on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due.To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after._..X145 -1-1g..._...X4K7..':-'1('0217
1:}t ere-rms�-bo-•�Io--gre�ey�r►er+t-of�ri�cti�et}-�wlthouG-�er>�ies}o-n-o€-�errder,•
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such_case accruing interest from month to month shall be treated
as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
F�Iwhasor-stc�toe.tl►aL�'ur-0haaes-is-satisfied-�v�tl.-the-titlz-.ac-s�c�►-by-tl�e-Lit1e-ov�der+ee•$>sbn��tie�-te-�t>'t�hase�
"P.sixamicayiIM-"GeV. VENDORS are obligated to furnish merchantable title on
ultimate closing date.
except for abstract at ultimatdlos!
Purchaser agrees to pay the cost of future title evidence,Iff title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitle to take possession of the Property on..........CZOSlIlg--•-_-__•.---•---------------X ........
'Cross Out One.
IIcAlAprconflvwrylM1 STATE. BAR OF WISCONSIN Stock No. 13011
FURN No. 11—1982
L
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<. STC - 105 r
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SEPTIC TANK MAINTENANCE AGREEMENT
0
St . Croix County z
tj
a �
OWNER/BUYER
ROUTE/BOX NUMBERf � /��•� �f= Fire Number
CITY/STATE ZIP
PROPERTY LOCATION:_,S_kL_'k, Z x- k, Section ' , T,R_N, R-019--_W,
Town of����l � p,Q�,�oj/= St . Croix County,
Subdivision , 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 I!
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St . Croix. County residents m_ y be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1 , 1978 . St . Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master .plumber ,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (.if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. H
0
I/WE, the undersigned , have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- u
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 . /r
SIGNED / w
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 .
INSTRUCTIONS FOR CtlIMPLETINO FORM 115 - SBD - 6395
To be a complete and accurate soil test,your report must include:
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project;
1 MAXIMUM number of bedrooms or commercial use planned;
4, is this a new or replacement systern;
i. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately Ideating your test locations. Drawing to scale is preferred. A
separate sheet may be used if desired;
3. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
0. Complete all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exemp-
tion,if appropriate;
10. If the information (such as flood plain,elevation)does not apply, place N.A. in the appropriate box;
11. Sign the form and place your current address and your certification [lumber;
12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st — Stone (over 10") BR — Bedrock
call Cobble (3- 10`.) SS — Sandstone
gr Gravel (under 3") LS Limestone
"s — Sand HGW — Nigh Groundwater
as Coarse Sand Fero - Percolation Rate
reed s — Medium Sand W Well
is — Fine Sand Bldg - Building
Is — Loamy Sand > --- Greater Than
*sl Sandy Loam Less Than
*I Loam Bn — Brown
*sil -- Silt Loam Bl Black
si — Silt Gy — Gray
*cl Clay Loans y _._ Yellow
scl Sandy Clay Loam R — Red
sicl — Silty Clay Loam mot — Mottles
se Sandy Clay wl - wish
sic Silty Clay fff - few, fine, faint
"c — Clay cc - cornmon,hoarse
Pi Feat mrn — Marty, [[tedium
m — Muck d distinct
p — prominent
HWL — High water level,
* Six general soil textures surface water
for liquid waste disposal !3M — Beach Mark.
VRP Vertical Reference Paint
TO THE OWNER:
This soil test report is tht, first step in securing a sanitary permit. The county or the Department may request
verification of this soil test in the field prior to permit issuance. A complete seat of plan,, for the private
sewage systems and s permit application must be submitted to the appropriate local authority in order to
obtain a permit r hc sanitary permit mUsl be. obtained and roasted pr for to the start of any construction,
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
INDUSTRY, C DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WBOX 76
I 537907 9 53707
HUMAN RELATIONS
(H63.09(1)&Chapter 145.045)
LOCATI N4 SECTION: for TOWNSHIP/MUNtefPALITY: LOT NO.:BLK. .: SUBDIVISION NAME:
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
�` �
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COMMERCIA" DESCRIPTION: PROFILE DES RIPTIDNS:1PERCOLATION TESTS:
Residence New ❑Replace
RATING:S=Site suitable for system U=Site unsuitable for system /
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYST -IN-FILLHOLDI A K:RECD MEN EDSYSTEM:(optional)
[ZS ❑U GAS ❑U S ❑U [:]S U DS ZU
If Percolation Tests are NOT require DESIG RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTHM, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B- k
B- >
B-3
B- 8 -_ — -szw r
6-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER R4etfeS AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD PERIQQ3 PER PER INCH
s-
P-
P-
P S` �
P-_
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION &Z
-- - -
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I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME rin"): TESTS WERE COMPLETED ON:
Ap CERTIFICATION NUMBER: PHONE NUMB R(optional):
_ �- .
CS N R
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
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PAGE OF
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Fresh Air Inlelc And Observation Pipe
Approved Vent Cap
'•�W Y! "�"'� A Minimum 12"Above
S*17 Final Grade J
I
20-42"Above Pipe _4"Cast Iron
To Final Grade Vent Pipe
Marsh Hoy Or Synthetic Covering
i Min 2"Aggregate
Over Pipe
OlstrlDullon
pipe — o 0 0 0 0 —Tee
Beneath Pipe Pol
Be neolh e 0 Perforated Pipe Below
Be
o
Comp ling Terminating At
Bottom Of System
pruPosel� �►nwl qr�.t <
ion
SOIL FILL
DISTRIBUTIOF•1 PIPE
APPROVED $4fa�NETIC COVER
MATEIt11�L OR 9 OF STRAW
r OF AG 6 R E 6 A.,E OR fjARSN HAy
° (o
OF ?—/z AGGREGATE
ELEV. OF -FEET b
° i
4
DISTRIg1JTI01J PIPE TO BE AT LEAST IIJCHES BELOW ORIGIMAL GRADE
A1JU AT LEASTZO IIJCHES BUT AIO MORE THAN y2 IAICNES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVATIOP FROM OWINAL 69A0a WILL BE /L— INCHES
PVNIMUM W" OF EXCAVATION FROM, *41MAL GRAVE WILL BE ��_ INCHES
SIGIJEO:
LICLUSE ULRABER:
DAT E : ���-R'7
Rio
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