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Parcel #: 038-1123-50-000 01/12/2006 05:10 PM
PAGE 1 OF 1
Alt.Parcel M 30.31.18.513A 038-TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
LAURENCE R&JOANN BELISLE O-BELISLE, LAURENCE R&JOANN
1907 CTY RD C
SOMERSET WI 54025
Districts: SC=School SP=Special Property Address(es): •=Primary
Type Dist# Description ' 2147 90TH ST
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 30 T31 N R1 8W PT SW SE 1.00AC LOT 1 Block/Condo Bldg:
OF CSM 5/1260 EXC PART TO CO HWY AS IN
783/286&784/202 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
30-31 N-1 8W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1064/177 QC
07/23/1997 908/379
07/23/1997 776/14
07/23/1997 723/517
2005 SUMMARY Bill M Fair Market Value: Assessed with:
119726 191,600
Valuations: Last Changed: 10/15/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 53,800 134,500 188,300 NO
Totals for 2005:
General Property 1.000 53,800 134,500 188,300
Woodland 0.000 0 0
Totals for 2004:
General Property 1.000 53,800 134,500 188,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
i
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: 2_ Trench:
Width: Length: 5 Number of Lines: Area Built: _
Fill depth to top of pipe: ;;�&2 //
Number of feet from nearest property line: Fron , Side, O Rear,O Ft
Number of feet from well: f,�
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, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: 7 Plumber on job:
License Number:
3/84:mj
-
- AS BUILT SANITARY SYSTEM REPORT Form - S T C 104
OWNER e"t��f� TOWNSHIP ���- � 11 /i= SEC. T �N-R��W
ADDRESS , ST. CROIX COUNTY, WISCONSIN
x,,r
SUBDIVISION ► LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I-LHR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
f •
P �
�Ymay'
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: /®fj.n Proposed slope at site:
m ;
SEPTIC TANK: Manufacturer: / Li uid Ca acit
���I�i+CL�a•�2r q P Y: �-�
Number of rings used: ` Tank manhole cover elevation:
i
Tank Inlet Elevation: � /!� Tank Outlet Elevation:
Number of feet from nearest Road: Front,O Side, Rear, Q _( feet
From nearest property line Front,O Side,®Rear,O _ � feet
Number of feet from: well A,11,4 building: r
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR&!HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P,O.ROX 7969 BUREAU OF PLUMBING
MADTSON,WI 53707 �pI
SW' —R18W ZNCONVENTIONAL F-1 ALTERNATIVE State Pg^nIiD.Number:
(If assi
I Town of Star Prairie ❑Holding Tank ❑In-Ground Pressure ❑Mound
Lot 1
NAME OF PERMIT HOLDER: ADDR d
ESS OF PERMIT HOLDER: INSPECTION DATE: n
Lester Martell Rural Route, Somerset, WI 54025 — — ,3 0
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:
alvin Powers Jr. 1563 St. Croix 92488
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.'. WARNING LABEL LOCKING COVER
q P VI D: PROVIDED:
YES NO ❑YES NO
BEDDING: VENT DIA.: V .: HIGH WA
�U6
NUMBER OF ROAD: PROPERTY WELL: BUILDING: V TO FRESH
JALARM. UNE. AIR INLET:
❑YES O ❑YES NO NEAREST!!--3l`![OM + `OP a� c�
DOSING C AMBER: �0�0
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑NO Y ❑NO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF L NE ERTY R��jUILDING AIR INLET.FRESH
(DIFFERENCE BETWEEN FEET FROM
PUMP ON AND OFF) ❑YES 1:1 NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMI, R MA ERI L 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 DIA. *PITS LIQUID
BED/TRENCH r TRENCHES f MATERIAL: PIT DEPTH
DIMENSIONS I Z J
GRAVEL DEPTH FILL DEPTH DISTR.PIP DISTR.PIPE DISTR.PIPE MATERIAL: NO. TR. NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH
BEL W PIPES: ABOVE COVER. ELEV.INLET.ELEV.END: PIPr� FEET FROM LIrrN��E: /� AIR INLET.
�p NEAREST c! 0J 4 �
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES ❑NO
SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS
❑YES ❑NO ❑YES IL
N
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL- SODDED SEEDED MULCHED
CENTER. EDGES'. EYES ❑NO
DYES : NO ❑YES ONO
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.DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.: ELEV.. DIA.: ELEV.: PIPES DIA.:
ELEVATION AND
DISTRIBUTION
HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION ❑YES ❑NO PLANS.
El YES El NO
COMMENTS: P MANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
o FEET FROM LINE:
❑YES NO 1:1 YES ON NEAREST
0
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE: TITLE:
DILHR SBD 6710(R.01/82) Z
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.
------------------------------------------------------------------------------------------------------------------------------------------------------------
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 i
result of over 2 years of steady negotiation and public debate. The groundwater bill l;rpUnd�llya143� _
included the creation of surcharges (fees) for a number of regulated practices which ,l1(iscorStn`S a
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried re Sur
is used in your building is returned t;- the groundwater through your soil absorption o
system or the disposal site used by your holding tank pumper.
n
The �rnonies collected through these surcharges are credited to the groundwater Band adminis-
tered by the Department of Natural Resources. These funds are used for monitoring ground- t
w:ate;; groundwater contamination in ,estigations and establishment of standards. Groundwatg� ,
i"s worth protect ng.
JC-rS39K(8.03;86;
DILHR SANITARY PERMIT APPLICATION COUNTY
b "°�........�..� In accord with ILHR 83.05,Wis.Adm.Code STA SANITARY PERMIT#
D 41 YK
+-Attach"complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER
8'/i x 11 inches in size.
-See reverse side for instructions for completing this application. PETITION
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES IN NO
PROPERTY OWNER PROPERTY LOCATION
Sj, '/ '/4, , N, R JR E (or&
PROPARTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK UMBER S_�J$�IVISIONIJAFifT1/'/.9l9
CITY,STATE ZIP CODE PHONE NUMBER TOWN OFi--Y NJJE�riiA��aa STT•S.•R��i�J D, A OR LANDMARK
❑ VILLAGE:
II. TYPE OF BUILDING OR USE SERVED:
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. V 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. X 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. ® 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 lions Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted zow Se tic Tank or Holdin Tank /960
Lift Pump Tank/Siphon Chamber ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation oft rivate sewage system shown on the attached plans.
Plumber's Name(Pri Plu s Signatur :(No to MP/MPRSW No.: Business Phone Number:
S - , 3
Plum is Address(S eet, ity,St Zip Cod Name of Designer:
2K� U-9 el;z�kl 7
VIII. SOIL TEST INFORMATION
Certifie Soil Tester(CST)Name CST#
CST,s DRESS(Street,City,State,Zip Code)' Phone Number-
,,of,
r S-
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps)
®Approved ❑ Owner Given Initial S rcharge Fee (/ /
Adverse Determination /vv as•0� ^ �� 7 11'1 �'ry Y►'lC
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
sEe
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a
dam`
PAGE OF
CrUSS SZC � tUr� O � �1 � e17 �ySlen�
� ✓� Fresh Air Intel& And Observation Pipe
r /V C f—Approved vent Cap
Minimum 12"Above
Final Grade
20-42"Above Pipe _4"Cast Iron
To Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
Min 2"Aggregate
Over Plpe
pipe
DlUrlbullon —Tea
—� 0 0 0 0
6"Aggregolm o Perforated Pipe Below
Benoolb Pipe
o —Coupling Terminating At
Bollom Of Sysrem
i
0SeD �Ir1fu c�raclt
SOIL FILL
DISTRIBUTIOI.I PIPE p41NTM
APPROVED .7 ETIC COVER.
NIATERII1I- OR 9" OF STRAW
rOFA6GREGATE � e �/ OR MARSH NAB
ale, (o OF 2 -21/2 AGGREGATE
i
'ELEV. OF,&r FEET--
DISTRI5UTI0AI PIPE TD BE AT LEAST Z2C2 IIJCHES BELOW ORIGIIJAL. GRADE
AMU AT LEAST?-0 IIJCHES BUT AIO MORE 7HA1J 42 IMCHES BELOW FINAL GRADE
MAXIMUM DEPTH OF EXCAVATImW.i FKOM OKIGINAI. 6KAoF. WILL BE —2s2— IIJCHES
MINIMUM M" OF E'ACAVATIOW FK0 '0k1(.IWAL GRAD€ \A/ILL BE nZ2 INCHE S
.I
SIGMED:
LICEIJSE DUMBER:
DATE : �? J
tto
r.RTMENT OF REPORT ON SOIL BURING6 t-NU D) V I:> ON
TRY, PERCOLATION TESTS (115} P ° RO>• -,/07
)RAND MADISON• A't'I X707
AAN RELATIONS (H63.090) & Chapter 145.045)
-- --
LOT NO.:9LK. NO.: SUBDIVISION tJAME' --- -
C� �T�
t T-,CAT�ON ON/T3) N �g E - M>ra
'"`� 4y MAILING AD Rz_SS:
OUNTY: --- O`WNER'S/EtY=�?S NAME: _ S p� E�IZ FYI VV !• S q pZ S
t✓ �)X 1 -�ST��Z 2T ALL `� DATES OBSERVATIONS MADE
E PROFILE DESCRIPTIONS: PER LATION TESTS:
NO.BEDRMS.: COMMERCIAL DESCRIPTION: S�1New
�R esidence
3 — �� 3
ATING: S=Site suitable for system U=Site unsuitable for system _-
-- —
IONVENTIONAL: MOUND: IN-GROUND-F _SSURE SYSTEM-IN-FILL HO�j � ECOt"',�rNDED SYSTE M:fopnonal® S DU S C U f S [�U C�S MU -D0op'
—_ DESIGN RATE- �JS•y
t Percolation Tests are NOT required I Ii < +y pornon of the tested area is in the O
A1119 LF Ic.dpla n, indicate Floadp a n elevation:
ender s.H63.09(5)(b),indicate --�-- --------- -- --- - -- ��FcT
PROFILE DESCRIPTIONS _
30RING TOTAL DEPTH TO GROUNDWATER-tom CHARACTER OF SOIL WITH THICKNESS. COLOR, TEXTURE, AND DEPTH
IORINR DEPTH ffit ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.)
- -
8 I o5 B1 L; 2.z�Bhcs w�cab; z.8.13nCS kIGi-j o.9' Br, yn�Q s
B- �.'� )0q.8 S t�o►J�
B- Z -5 tio1l.o S ,I 1p• p ' f,.�'
'B- 3 .S l04 Ss
6' S C .� �.5
z o
)D ,t , 2• ) f
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-I'.CHES_ _ _ RATE MINUTES
-- ---- PE RIOD 3 PER INCH
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIODt PERIOD2 T____
- ----3
ONE -s Z Z�/ Z �/(�_ 1 Z
P_ Z 36 0
P- 3 38 A10A) S .
P_
P_
P __1—_-I-----------
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 eievation at all borings and the direction and percent
OF 7PI-'� �
of land slope. �OT`SZ)r"1 : �9 SOtt_ S�.CiVEY- 11U�t3DcLZ�
11Jt-nP%L - lol.SID
SYSTEM ELEVATION 7�C�cis Mir - ioo --
_ I I I
1 J l
I �
Sw o
f --. - ---
IJVIT/,9L o.�i •i
—I
PE P
ME
1 I �—1�_•�_g��.5�__I�--1--So�iN_ �'�-5�7--"-57' I I I I I l I
'
U5t I it I L"C 4 t J S _e cH
- --F--- ---I - �-i� I •-i�t t'POU � t � I � I I
��cN 0-i
I
ToT' of - —Sp—
'f'4
I " - 1 I Ih
Tv .� a -
�A p I -
T I --
11 Pti QoW `\ '
SCN%-Ie \i' ° 50 • -- ---- - S> CT101�1 30
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the hest of my know:rdge and belie}.
-- --
-- �TLSTS W RE COMPLETED ON:
NAME (pr [-'
- -- — ---
CE RI IFICATION NUMBER: IPHONE NUMBER(optional):
ADDRESS: Z S7(, 71 S- NzS- 9381
__— ------ CST SIGNAT E:
/VOTE ; EN /i5 /QEvicasLY /L60 ON 11 - 4 - $2
ar thaf n:•,r . g�
DIST RIBUT ION, 01,9 el and o ne copy to Local Authority,Pioperty Owner and Soll Tester, J
'l
IiR r>r)(7,19' .c r?182) —OVER
(7,19'
z
H
i a
ST C - 105 Y
r
SEPTIC TANK MAINTENANCE AGREEMENT o
' r St . Croix County z
OWNER/BUYERS
ROUTE/BOX NUMBER Fire Number
�s
CITY/STATE _C��YtA w`/ZV ZIP
S = l
PROPERTY LOCATION :S� , L 3L, Section D'C� T,��N , R W,
E Town of _S�714 r r a, i r/ 10 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 f`
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. '3
0
I/WE, the undersigned, have read the above requirements and agree U)
to maintain the private sewage disposal system in accordance with x
H
the standards set forth, herein, as set by the Wisconsin Depart- �0
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 .
C..
SIGNED z ,r
DATE �/ l
I St . Croix County Zoning Office
P.O. Box 98-
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address .
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
inner of Property -5�� r I l aL r�0_
Location of Property S� ' , Section .. � , T_--j),/_N-R , g W
Township __57 � 0 l�at ) y-
nailing Address
Address of Site w l .S G
Subdivision Name
. Lot Number
Previous Owner of Property
Total Size of Parcel
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 -� 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
1 (We) centi.6y that atC statements on thus ace tltue to .the best o6 my (oun)hnowtedge; that 1 (we) am (ace) the owne&(sfor the pnopWy duchi.bed .in th.ia
in6armation 6o4m, by vi tue o6 a wavcanty deed neconded in the 066.ice o6 the
County Reg.usten o6 Deeds as Document No. S`/ and that I (We) pneaentPy
own the phopoaed bite bon the sewage di,6pos sys em (on I (we) have obtained an
easement, to nun with the above debchi.bed pnopehty, 6oh the conatnucti.on o6 said
system, and the same has been duty neconded in the 066.ice o6 the County Reg.ia.ten o6
Veedd, as Document No. 1 ,
SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
QQQQUMENT N4. -�—.-I STALAND CONTRACT—Individual WISCONSIN—FORM and i
' }{, FA"156b a/}jy, Corporate
VOL ��� ^�•5fi� it THIS SPACE RESERVED FOR RECORD
INQ tN►TA
,
365 419
REGISTERS OFffCE
Contract, by and between ___Nancy_ G._ Pet_ersp�__.i�...Ilex' „ ST CPC!X c04 YVM
own right _and__as,.aurv_ivixl-_h. .r_-__to._:L thur---J_.__P-et!erson ,
---------------- ------------------------- --- ----------------------- ----------------_--- (,Vendor"
Res d. for R word this 30 h
Nether pqe or more) and____eS 4X__i�x__ is x' e✓_1 wnd_-Pfl�'cr__F'_. day of,____Ju_ ly -A.D. 19_`80
lvldrtell: -2aCh -d._1 1._-i1 ?IL�4��PurcQhaserx1 whether ther one orQmore). at 8• •
-----------------
>_ 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 w
rents,profits,fixtures and+other appurtenant interests (all called the"Property"),
In..._... .u_..--•----St_..._Gr-Q1X_...----•-•-------------- County, State of Wisconsin:
All that part of SE-4 of Section 30-31-1$N lying , RETURN TO Swenby's
Sly -of Carrie's Apple 'Itiver Addition, Ely of _ New Richmond,,Wiscons3'in
Country Trunk 14ighway "C" and W ly of Apple River ,
Tax Key No. ....................
and Lots Seven (7) , Eleven (11) and Twelve ( 12)
Carrie's Apple River Addition to Town of Star Prairie
This contract corrects contract dated June lst , 1979, donument number
,1.
35705 and recorded in Volume 595 , pages 116 and 117.
r Purchaser agrees to purchase the Property, and to pay to Vendor at _- �GW_ `-1011--- - -f y- '� y SOZla`t].1�'ti
the sum of$.... -------------------------------- in the follo in manner $._.b3 �.a �--------------_-------------------
' at the execution of this Contract and the balance of $ -1 r, together with interest from date
hereof on such portions as remain from time to time unpaid, at the rate of____ __________ __ per cent per annum,
until paid in full, as follows: x•6`_:6.39 due Septer�'Oer is , l°79 and. cu�:rterly thereafter
until-principal and interest are fu=-ly pai( . Payments to be credited first
on interest then d!i,, and remainder on principal . If these lots are sold
the following amount:: will be ?aid to Vendor, Lot 7, $52"')0.00; Lot I1
$5200',00; and Lot 12 , $5200.00. Pre payment privileges oj' any amount at
' anytime is hereby granted.
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor payments sufficient reasonably to anticipate
the payment of taxes, special assessments, fire and required insurance premiums. 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.JUne._ -1,9.t----------- 1979___ �Wy,
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.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except: no exceptions
i !
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 be entitle to take possession of the Property on------__- ------ @- LSt------- ------
f .
Cross OU> 'One.
TO BH] USED IN NON-CONSUMER ACT TRANSACTIONS)
1
LAND CONTRACT—Individual and STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
+ Corporate FORM No.t i—1977 Milwaukee, Wis. (Job 82862)
k _
4,
4
nr MED s
:. MAR 171983
�gbli,r
of seed. C40
$4 Crag s.mti,
3� 2 ,�. CO
MAP
CERTIFIED SURVEY
LOCATED IN THE SWI 14 -SE114 OF SECTION 30,T31N,' Q P
R 18 W, TOWN OF STAR PRAIRIIE ST. CROIX COUNTY
Wl'SCONSIN OWNEDSY LZSTER MARTELL
RFD , SOMERSET, WISCONSIN 54025 h
E: See Reverse Side For Description.
A6)
,. 0
BEARINGS ARE PEFERENCED TO THE / 13
*K. SOUTH LINE OF SEC. 30,T31N,R18W
x ( ASSUMED N 89017 '3► E ) k 1��o
O- SET I"X24" IRON PIPE WEIGHING ^ I
{ 1.13 L.B.S PER LINEAL FOOT. f ��
° 4, (4- O
�± MEANDER
/ LINE— 01i
N
�0 LOT 1 III
'1) 1.0 ACRES /
0.73 ACRES TD M�
/�
Q). d (31714 SQ.FT.)
All
:a p IV a �•
APPROVED
s �\ 0
a" `30'O�
MAR 1983 �, .' 0 zOl
SL k+ti,tX COUNTY
I
6nl�tr<�t��rJ�vz fwRKS r'u�+w!va J • � / � �<�
AND ZONING CleMwK3W.4 p
LOT-? t3 /
^, - 1.05 4CRES 10 M
(45941 S0.FT)� �' j (z ,
Mop r
h
/
V
qK 3 /� SCALE -- _ ___ ► } �
100 2.00
J � pO /
h3' 11?E ANDER1��
,.I 5114 CORNER C� LrvE
i AL M, ?,T3fNFD.)
(A LN.M. MON. FD.)
N89°fT'3 "E 82.74 .70'• -- -------9
f§ 482.58' 03- E CORNER
y�— SOUTH LINE F THE SE7/4 OF SEC 30 SEG. 30,T3fN,RfBM' 82 - 150A
/ TOTAL DISTANCE -2674.54' (ALUM. MON. FD.)
r
UnrP1,ATrEo Volume 5 pp P 1 60
LANDS
f•-- •yam ` .. k
7TTU 4
K"
-tj"4
i '
BOARD OF ADJUSTMENT DECISION
lsqu4st' of Mr. Lester Martell for a )
y ' 4ar �tnce to Article 8 . 4 B 3 b , Setback )
rk frori County Highway, ST. CROIX COUNTY ) 45-82,
r r ZOAI G ORDINANCE. Location : SE`s SEA, ) October 26 , 1982
I Seri on 30, T31N-R18W, Star Prairie )
Towtt1thip. )
The St .' Croix County Board of Adjustment conducted a public hearing
3 on 00tober 26 , 1982 , to consider the request of Lester Martell for a
0ari*nce to Article 8 . 4 B 3 b , Setback from County Highway , ST . CROIX,,
tOU 'Y ZONING ORDINANCE.
sf The lt . Croix County Board of Adjustment conducted an on-site inspec-
A
` „ Mott" of the site in question .
�tf 0 r inspection, the St . Croix County Board of Adjustment entered an "
,x*�*tive Session to discuss the request . t`
� f
k
.0 J`
iftet returning to open session , the following decision was rendered .
w toti-on by Supervisor George to approve the request for a fifty (50)
'^ `6ot . setback from the water and a seventy-five (75) foot setback from
C" . Seconded by Supervisor Stephens . Motion carried .
Vote to approve :
Ceorle, yes
{ t} xeiA 0, y0s .
Robe i7�t Step ens , Secretary
St . Croix Qounty Board of Adjustment•
' HB: R$:wjo
Mr . Lester Martell
Muth-`A. Johnson, Clark
s.
0,!,5
f`
d`