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HomeMy WebLinkAbout040-1211-20-000 !C o 3 0 N p (n O a O C O Y N N O) ti ti c0 C OI p N W U �� O N FD Cl) C Z N x 7 N 00 LL c 7— O O O M a Z y CD £ U) € v` Z N y °O N a m � H U) C O O 2 c U = w O fn H N Z C � � N = r O N Q N O O O •Al d fn s �I O Z m Z U N N ° Z (O C -O U d N w m E t > U 41 ° C7 m d O a c a 0 c .m CD > O O O Z •ti ean. a N a o V7 7 0 O (A J U = rn rn O : } M �l f� 07 N M y 0 N OO co O = M ) y = d co (V LO 16 � N C O O' 0 0 d � 0 0 0) r N V• YL�i r a N W �',' _ U Cv V CV CD O O r O N Z (O OD N - U @ O O O H O LL O O Z — F- 0 A 61 d • C 0) 0 1 d C C w `1 A vat IOaio , Parcel #: 040-1211-20-000 04/12/2005 08:02 AM PAGE 1 OF 1 Alt. Parcel#: 07.28.19.1001 040-TOWN OF TROY Current X! ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): =Current Owner *GOODMAN, MICHAEL P&BARBARA S MICHAEL P&BARBARA S GOODMAN 345 W GROVE RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description 345 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.357 Plat: 2597-WEST GROVE ESTATES SEC 7 T28N R1 9W LOT 2 WEST GROVE ESTATES Block/Condo Bldg: LOT 02 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/14/2003 730178 2313/523 WD 07123/1997 1116/393 WD 07/23/1997 831/259 07/23/1997 786/81 more 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27788 296,400 Valuations: Last Changed: 08/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.357 74,800 222,200 297,000 NO Totals for 2004: General Property 2.357 74,800 222,200 297,000 Woodland 0.000 0 0 Totals for 2003: General Property 2.357 77,000 243,000 320,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PUMP CHAMBER <I Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). 4M,X12 93,.E 3 9 3.�3 SOIL ABSORPTION SYSTEM Bed: V Trench: Width: I� Length: Number of Lines:— Area Built: (DU 0 Fill depth to top of pipe: i Number of feet from nearest property line: Front, O Side, 0( Rear,0 Pt . Number of feet from well: ICS Number of feet from building: 5w1 (Include distances on plot lan). 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, O Ft. 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: 3/84:mj " Form - S T C - 104 AS BUILT SIFARY SYST EM REPORT OWNER I 1 C) TOWNSHIP SEC. T QN-R W ADDRESS a,13 Locus' ST. CROIX COUNTY, WISCONSIN SUBDIVISION ( _`'1 LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i b 5�r to( loco C NJ I ` 1 t� f)K rye 1 INDICATE NORTH ARR BENCHMARK: Describe the vertical reference point used j i bE �o Elevation of vertical reference point: Q0, 6 Proposed slope at site: SEPTIC TANK: Manufacturer: W c F_KS Liquid Capacity: 000 qA (� �a0 Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: C} Tank Outlet Elevation: 9J• V Number of feet from nearest Road: Front,Side Rear, ' / feet From nearest property line Front 10 Side,0 Rear,O feet Number of feet from: well r�, building: (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 DIVISION LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS 2- BUREAU OF PLUMBING .P.O.BOX 7969 MADISON,WI 53707 S' ,SWZ,S7,T28N-R20W KRCONVENTIONAL E]ALTERNATIVE State Plan I.D.Number: Lot 2 West Grove Estates ❑Holding Tank El In-Ground Pressure El Mound Town of Troy NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSP CTION DATE: B'ornstad Builders 616 Michaelson North, Hudson, WI 54016 J BENCH MARK Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: e 1 D Name of Plum ber: MP/MPRSW No.: County: Sanitary Permit Number: Richard Hopkins 1059 St. Croix 92560 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING C OVER P PROVIDED: 10 d E NO S .111 DYES SAID BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T FRESH ALARM: LINE. AIR INLET: C ' FEET FROM I / 'INLET NO OYES NO NEAREST DOSING C AMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER. IWARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ❑NO DYES El NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING.TV ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES E1 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: -j- WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING. COVER INSIUE DIA. *PITS LIQUID BED/TRENCH TRENCHES: NJ/kTER1AL PIT DEPTH DIMENSIONS I (� J �P a GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL. BUILDING: V NT TO FRESH BELOW PIPES: ABO E COVER: ELEV.INLET ELEV.E/D: ^� PIPE$ FEET FROM LINE'? I,1� CL AI/ ey �C,o Q,�,35 �i3. 7 L J` NEAREST J lJ J to r MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 0 N OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES 1:1 NO DYES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER: EDGES. ❑YES 1:1 NO F-1 YES ONO ❑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: IND DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.: ELEV.: DIA.. ELEV.. PIPES DI A.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. 1:1 YES El NO OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: 00 DYES El NO ❑YES 1:1 NO NEAREST r �.$g 7 Sketch System on � T(Tyf*l�for audit. Reverse Side. SIGNATU TITLE Zoning Administrator DILHR SBD 6710(R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT 1, 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 mushbe approved bVtKe permit issuing authority. A new*permit,may be nee0ed if there is a change in your building plans;sys� m-'ocation, estimated'wastewater flow (number-of bed- Looms, etc.)„ dlepth of!system, or-type of system 4 i 4. Changes in ownership or plumber requires a Sanitary Permk ransWe /f#ehewal Forrn (SBD 6399)to be R,w submitted to thercounty prior to installation; 5.. ' Private se*age'syste'ms must be properly maintained. The septic tank(s) should be pumped bye a licensed # > pumper whenever necessary, usually every 2 to 3 years; 6. If,you have questions concerning your private sewage system, contact our local code administrator or the State of Wisconsin, Bureau,of Olumbing, 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, certificajion number, addressr 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 treatmerit 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-motet r. commonly known as the groundwater protection, Law. This change in statutes �s the .t t f, result of ove­2'years of,4eady negotiation and public debate. The grburldwafer bill Ground t9tf; included the creation of surcharges (fees) for a number of regulated practices which Wisco in's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasuire is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. 0 The Foonies collected through these surcharges are credited to the groundwater fund adminis- iered by the Department of Natural Resources. These funds are used for monitoring ground- t water gr-)ur+dwater contamination in,estigations and establishment of standards. Groundwater, s \Nortl.,, protecting. EBD-E•398!R.03/86) SANITARY PERMIT APPLICATION Coy + DILHR In accord with ILHR 83.05,Wis.Adm. Code r - STATE SANITARY PERMIT## —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO PRO12ERTY OWNER PROPi_30%, S Y LOCATION 'K R wSiA 1 6 To Y, N, R Q b E (or PROPE OWNER'SpAl ING A DRESS LOT NUMBER - BLOCK NUMBER SU DIVI N ME IES A e CITY r ZIP CODE PHONE NUMBER CITY o I�E�1R ROAD,LAKE O LANDMARK —�..� O VILLAGE: f1 /�_b` GoVe KOAD 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify):CowV'ufi4PA FR(� III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. I'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. Xconventional 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. ,fee 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): REQUI ED(Square Feet): PROPOSED( quare Feet): �Q ( Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New xisting Gallons Tanks Concrete structed glass App. Septic Tank or Holding Tanks Tanks Tank an 0 Dd Wee ❑ Lift Pump Tank/Siphon Chamber I I ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber' Name(Print): Plumber's Signature:(N9 Stamps) , MP/MPRSW No.: Business Phone Number: 6 S9 (it's 384 9bao Plumber's Address(Street,Cit9l,State Zip de): N r1c.f D signer: II R �A Now c. M(j�d r 0 Rat �6Vkp my VIII. SOIL TEST INFORMATION Certified Soil jester(CST)Nam CST## c, vA N � CST's ADDRESS(Street,Cit ,Stat Zip Code) Phone Number: 1� )I � s o 8 - � S dso C- IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial '\ rchharrge Fee ^/ Adverse Determination l�V `�� OJT,V X. COMMENTS/R SONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber L. ' 67 0 PLOT t r, S S E C _l_ 101\1 O, PROJECT _ .13LUPE I[. - . NA E s NAM E '►s� RNs "`0 C AT I O.N_ e s r 1 ...�— -j;-j C E N S E =ft- (o. DATE PL O1 MAP �e5� G Rw Ror�� r l #q + 3 '5d Roo Mr A= BeNc.6 is I 1 A�k p►pe iN 91°w"'d Nett CoRNeR Ion- S'FAKe N W Lev= FaO.O 1 o 'ay SO lalo 8x3 M 4� B� A Itc�ervA�e , SU 1 s VAU4bf ot, t B, o k: FRESH AIR INLETS OBSERVATI`0N PIPE CI10SS SECTION 14, z Approved Vent Cap 1 �4 Minimum 12" Above �� Final Grade q 4 " Cast Iron Above Pipe Vent Pipe t To Final Grade-----..__. . ,r d Marsh Hay Or Synthetic Cove r).ng Min. 2" Agg.r_eglal c� Over. Pipe Distributio 4• �- Tee Pipe Aggregate Perforated Pipe Below �o -�M 6d Beneath Pipe 4 Coupling Terminating At Bottom of System • 'l INSTRUCTIONS FOR COMPLETING 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 system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; & Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and your certification number; 2. 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 col: - Cobble (3- 10") SS — Sandstone gr — Gravel (under 3") LS — Limestone *s — Sand HGW — High Groundwater cs Coarse Sand Perc Percolation Rate ; med s — Medium Sand W — Well fs Fine Sand Bldg - Building Is — Loamy Sand > - Greater Than sl - Sandy Loam < ..-- Less Than *I — Loam Bn — Brown sil Silt Loam BI Black si — Silt: Gy — Gray cl — Clay Loam Y - Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot -- Mottles sc - Sandy Clay w( with sic — Silty Clay ffff - few,fine, faint "c Clay cc — common, coarse or - Peat mm — Many, medium m Muck d — distinct p — prominent HWL — High water level, Six general soil textures surface water for liquid waste disposal xa BM — Bench Mark VRP --- Vertical Reference Point „ z TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county orthe Department mayrequest Vol itiication of this soil test if) the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit: must be obtained and posted prior to the start of any construction, J DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, C DIVISION HUMAN NDATIONS PERCOLATION TESTS (115) MADISON WI 969 (H63.09(1) &Chapter 145.045) 2 � SUBDIVILOCATION: SE �O TOWNSH�iht Y: LOT NO.:�TL9N/WE ( COUNTY: OWNER' BUYER'S AME: MAILING DRESS: / �- D5.4i• S 2l 3�p c a.sf S c��.C�.Sci� s f/4lG USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER AL ESCRIPTION: PROF DES IPTIONS: ER 72Z, ATI TESTS: Residence 3 vNew ❑Replace Z �j � RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUNDPRESSURE:T]S TEM-IN-FILLHOLDING TANK:RECOMM ENDED SYSTEM:(optional) ®S ❑U NS ❑U f�S ❑U ©U ❑S ®U T^ If Percolation Tests are NOT required DESIGN RATE: 4 � �� If any portion of the tested area is in the under s.H63.09(5)(b),indicate: o L, Floodplain,indicate Floodplain elevation: I PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH K ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) , B- , 7 33 G,j` AJOnt 7 ,�3' /, z S B/s/ 3, 7S s Z, Acy fr j`T/;; Zi74.vs ,:f SCwc�.o8'CS495;.*­,40 %4S B- 7 fe, 7 > 7 -7719.,c r . s ' l c 13- 3 7. 94.17 7 �a s ' � 2,z.t' ,sp c s B- °� �, 9 7 $, /,o" /s/ 41,1,�z/�5,'�h Y �tJ3 20�4 c y e� /�.�� �"-33 9 /- 7, ,L -' B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER AFTE SWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH . P- .t 1� 3 G 3 P- 2 q c4' 3 G < P l�' 3 6 < P-_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION J2,17 € r _ __ _� .lei► ► clo _ _-- l�QI� i� tN ( _ _ , E t � -.,..$�».'._J. !E!(! {7{ t € 1 I € 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 best of my knowledge and belief. NAME (print): TE;71Mt7 COMPLETED ON: I GJe ADDRESS: CE IFI ATIO NUMBER: PHONE NUMBER(optional): or 7 3" CST SI DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — . ti F "• r f� 1 .F.j° • i ....r �ti } �ft = r•Y \ I� �n r .0 i Vb 4f 1 i i •4li» 1 � � _-./iiF 1 i C7 t can = I rn • J CC arM cn 0 r 03 D :ZA I i i j: j ' c I ..4 -:_noxrl ,,.� i • Y ST C - 105 r r • SEPTIC 'TANK MAINTENANCE AGREE MLNT o St . Croix County t4 0 " y m OWNER/BUYS K Bjornstad Builders KOUTL•'/BOX NUMBER A10 St . Cro ix St _ N _ Fire Number CITY/STATE Hudson , Wisconsin _ZIP 54016 S. -35 of S . W. Section 7, T . -28 R . -19 Pltonlc'Y LOCATION : SE � � _ SE 44 , Secti6n_12 � gyp. 28 M , k20 —W , 'town of Troy St . Croix County , Subdivision West Grove Estates LoL number 1 &2 Improper use and maintenance of your septic: system could result in its premature failure to handle wastes . Proper maintenance cun- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed SUptic tank LurLer. What, " you put into Lhe system can affect the function of Llre.> svhtic tank as a treat- munt stage in the waste dishusal system . SL . Croix . Cuunty res`idents.; muX- be eligible ' Lu r,eceivu u grant fur. a maximum of 6.0% of the cost of *replacuwenC'- of' a . failing system, which was in operation . prior to. ,July 1 , ­L978 . . ;.St . Croix County accepted this program in Augur'st, of .1980 , .'.with che' ruclulrement th*ut owners of all new s steins'. agree to keep thul'r``.systems properly ma in Lained . The pr.uperLy owiier agrees to submit to St . Cruix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricLed plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal SysLeur is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 " E I/WE , the undersigned , have read the above requirements and agree N to maintain the private sewage disposal system in accordance with H the- standards set forth , herein, as set by the Wisconsin Depart- �c orent" 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 . SICNEll DATE St . Croix C .runty Zoning Office P . O . E'o x 98 Hammond , WI 54015 715-75;6-2239 or 715-425-8363 Sign , date and return to above address . APPLICATION FOR SANITARY PERMIT S T C - 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 tt d to this office with the appropriate deed recording. Owner of Property Bjornstad Builders z o _ Location of Property S. E . 5 E . _ , Section 12 , T28N N-RZL_ W Township Troy Nailing Address Address of Site —_Go\IPrnment, Tot 1 an 2. of West Groyp P,stgtpg Subdivision Name West Grove Estates . Lot Number 2 Previous Owner of Property Rue Elston Total Size of Parcel 2 Acres n 1-U,� w Date Parcel was Created May 1 4 , 1 987 Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? x Yes No Volume 5 _ and Page Number 40 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: i A Warranty Deed which includes a Document number, .volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) ceAti N that aU b tatementd on this oAm an.e true to the beat o6 my (oua) knowledge; that 1 (we) am (cute) the owneA(b� o6 the ptopehty deAcAi.bed in thiA in6o4mati.on 6oAm, by viAtue 06 a waAnanty dead keeo&ded to the 06 ice o6 the County Regi6ten o6 Deeds as Document No. ; and that 1 (we) pneeentty own the pkopoded bite 60,% the 6ewage CUApo,6aZ Ay6 em (on I (we) have obtained an easement, to A.un with the above da cA i bed ptopeUq, 604 the condtnuc ti.on o6 said e y.6 tem, and the .same has been duty keeokded in the 066.ice o6 the County Req ieteA o6 Veede, as Document No. 4-1 2 0 3 0 ), SIGNATURE Oh OWNE SIGNATURE OF CO-OWNER (IF APPLICABLE) 42, Z DA IGNED - DATE SIGNED J 9411D M M N0. I rear tees amnae1010 w annow 10 sass 8'!a!�8i� •Y00 8U1 � >il•films �1 - e _ I► ►wc. o fl fte 1t. lstcw sad Clara LEI SL OM C06 Wi L tea a Maori AN446Lm— oMa � /edVie��rri Mi _ MW 1 "'M .0110 or .1 • �"ltiaet10sa�".teh.fhee asl10 ter swr). �� R01ir a&sari asesss b UMV 0 PWdWW,on as/1010tH Wd tilt pw► O fasoaase of this m"M 4 luaA"W the m wrs p vmw tw"w wow** iI sasq�rime��..s.a.�and tether htrwte too oaivd do b►.3:4!l11..QT..TiRY.e._ osuulr. st10a of wiesssri: ,,.,,. s LR 2nd y ; jl 8tvaets All that portion of the lands described on attached pwksm Iii S4016 .1h li v JI 17� i%XNIBIT 1 lying ,southerly of the Boundary Line S, 0 ;described on attached Exhibit 2. Tax,Subject to the easements described on EXHIBIT 1 and Pascd ......................�_. iiattached EXHIBIT 3, but with full right in the Purchaser to use of said +sasements .and the lands thereunder in any manner not materially inconsistent with the easement rights of others therein. .Purchaser shall forthwith prdoeed to subdivide said lande, constructing a public road in the A of SIfi of Section 7-28-19, and a gravel trail there- from upon the easement described in attached EXHIBIT 3. Said road and trail shall be constructed during 1986, except insofar as the town, county and/or state may delay construction until 1987. Vendors shall join in execution of .any plat(s) and other documents necessary for such development. Vendors shall release lots upon payment on principal of the sum of $17,500.00 per lot to be released; the sum of $525.00 paid by Purchaser shall be credited an the first lot-release payment, thus reducing Sams to $17,075.00. This ............ Ot......... heeatead ;)s pent. Vendor's residence, being (is) (b 04) 720 North Pearl Street Parchmer ass... a porehass the Pswerty Red to pay to Vander at .ALyAr ZA11a.,..W !CgrAJ"022 the ems of i1�5.,0II0.A0.::..�-- .-01:01--.--in the fanowim uss see: (a) at the mmutiss of this Contrast; and (b) the balsam or if.l7.�,.12S��DA-01:01.:--.;torsthse with inaswt fsoin Oct. 1, 1988,an the balsam outstanding fare tbae to bale at the ram per 4" per asses GWA mew is fWk r file..: Principal payments for releases of lots as provided above, but principal shall be fully paid by October 1, 1988. There shall be no interest prior to October 1, 1988, and thereafter at lot per annum on any unpaid balance, but this shall not be deemed to be waiver of Purchaser's obligation to pay the entire balance by October 1, 1988. The sum of 0525.00 paid by Purchaser shall be applied by Vendors to immediate payment of the real estate transfer fee so that no further transfer fee shall be required upon lot-releases. Purchaser shall provide deeds for such lot-releases. Provided, bowman the entire evistaadine balsas shall be paW is tall es se badw10 October...1.................. 19.98.. (do .r.A m I'm date). rdhming any default is payment, jai ut ;all aeerue at the rata of......1Q.% per a010101m as the andre a01roant in default (which shall include, without lisaftatim,ddiwpmt interest and, t pea amelerali s se 1100610siq►. we Nth principal balsam). Purchaser.xdmKmwm&ftwMWw seven to w ONE peed annual tame,epedai aeemereesa,tiro and required issarame presshess when Area. 1 m01lssst ;pisses Payments sban be applied bat to sabre t on the slsp&M balaaee uk the rate spedlW and the M pri10dpd. ANY Renault Rut be prepaid with" preshe Be fes upon principal at any tied MIRUX lissdtafocifc>tfc>raNml�t �11lx In the cant of any prepayeest, this eatraft shall not be treated Be is default with ewpaM in payment ce bee as the unpaid balsam of prhdpat,and Iona t (and in such eae accruing interest!root.math Is Rsssth shall be treated as un"M principal) is bas than the aasoalt that slid indebtedness would have been bad the eestNy psysw01a been wads as first specified above; provWd that monthly,payassate shall be emtinoed in the event of credit of say prcoosds of insurance or seadessaatien, the sooda wud prrebm being thereafter excluded berefross. Purebseer states that Purchaser is saball d with the title as shown by the title ovWeaee submitted to Pueba fee anaeinatieswMMfx Real estate taxes for 1985 and 1986 shall be prorated as shown on attached EXHIBIT 4, and each party shall contribute their respective share in pro- portion to the installments as due. Purchaser agrms to pay the ant of future Neil avWaa. If title evidence is in the form of.an abstract, it shall be retained by Voador until the fan purchase prim is paid. Purchaser shall beentit)ed to talc posesssiva of the Property sex.. ..iMmedi atelyl... .. ..................)W........ 'Cron Out One. LWD COMMACT—J&dWJ a" aeO •TAT/ OAR OF WISCONSIM Wiwon,.r. l..r.l Blank Co. li.e. C-0— FORM so. I:—11081 Muww►.e. Wu. J k 1 , b k to d s ���b en wYft a yam. LI! W IY 11b�w err#�toil iiiwr- M Velar w t • loos d •Mnnp PdWal=wb Yiri r rip aw nwira. low W b Vendee. b tie otm « I hil 3 .. but Vendee that art taw r r than W ttmlaw oeNm1 andee this Ono" P—dm-r sW W famwraw wba. F, Purchases, sham PON coatata the atandatd elaume r laser Ot V � � in@nranaeorapaniss and Vandoe. and Vandw albe�:apes+Is w+1�i.W �n w be applied to restoration es r•palr st them Pespeey iraa/ed. peavNad Qo1 essnomicalty feasible. Pnrdaesr cove neda mnt to mmo mit waft w tMmw wstM to be•sasialNod an W Prs�esliy is beep rho Is eon �with�ifl rcpab so tot Trapeegw P� superior to W Men d Mb ply we, ertf eaj�icrla tflltWg Vendor screw that is some tit purchase prier with isle — and other anneps AM be!ate MY tad a/ shrill be fully perforao•d a the times and to W coats tors• ap"AA Vendor WUl en amaM.ettwlm ter/ the Purchaser, a Warranty Deed, Is he d■p1%of the hepoety. fro• tad deen of an iwm tad Atlaiiaratlr}y�� any liens or eneuabewnw created by de ad er ddaak of Purehams , and esanpt:4fs f} �.. »-�- - • ..................................................................................._............................................................_....,,............... ................................................................................................................................................. --•- -• Purchaser agrees that time is.................................. of #0 soowee and.(a) in the event of a default in the payment of aq petao11 1 oe interest which continues for a period of.AQ...days twowing e.*epedfw dw da or (b) in tb nabs s(s Mfaalt r performance of any other obligation of Pwdmw which eentinues for a p•rMd of 0...days f in a soda thereof by Vendor (delivered personally or mailed► mUflod mail).rhea the anti»onbtsAdIng balance shall become immediately due and payable is full,at Vandoes option and without notice (which Porchame laorcb waives),and Vendor @hall also have the felMwing rights and remsd as (subject to any liwltatiows prc+idd h law) In addition to those yyrovided by law or is ogaity: (I) Vendor may, at his uption. terminate thle Contract and Pirdsomo'1• rights, title and iatsrest iA the Property tad recover the Property bads through strict foreelc@nn with any Nair►► redemption to be conditioned upon PurehaoWs full payment of the entire outstanding balance,with intorset the date of default at the rate in effect oA such dateassd other anountedus hereunder(is wW&eveat all Esuwnt@ y paid by Purchaser shall bp forefeited as liquidated damages for failure to fulfill this Contract and as rw�tal tw immediate to and full payment of ti)ri outstanding( balance, with intetspecific il W � in this effect W �me default and other amounts due hereunder,in which event the Property shall be auctioned at judicial sale and Pursbaesr shall be liable for any d:fieieAey or (lit) Vendor may sue at law for the entire uRpaid purchase price or say p�etlen thereof; or (iv) Vend' may WM that Centraet at an end and remove this Contraetasadoud on tide in a qu Ric action if the equitable interest of Porshaar is in@igaifiant; and (v) Vendor may have Purchaser ejatod frcm poomm n of the Property and hale•A receiver tented to collect any rents. issues or profits during the pendency of any action under (1). (ii) or f ) abovs.NotwMiitanding any oral or written statements or actions of Vendor an section of any of the foregoing remt;aies shall only be binding upon Vendor if and when pursued In litigation and W cot@ Mil onpwass including reasonable attorneys fen of Vendor incurred to enforce any remody hereunder (whether ahattd er net) is tY extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Pw dneor. as in- curred, and shall be included in any judgnmt. Upon the coma m osio t a darioCtha pswk5"M49 of any action of forocksure of this att,Patabwsr nM ft to appointment of a receiver of W Pr*Pwty. homestead tateeest,to senses tiw ssnh.hones.aa�pe�11t yerty daring W of sad action. rents.issues,and profits when so edbsltd shah M YY astii applied is the court shall id rect. d t7fEtt1ltlriliYlilfii�Ig7fitdbY Aet1111t1�- 71111OYt� >1i[lfllt lttlr[ lm���>�>lKllr� ]Ot m • an payments n• under env no iWi__i4U1aWfnC against the Prepal M this Contract (except for any mortgage granted by Purchaser) or under any note secured theeebjI peNHN Pardatto makes timely payment of the amounts tben due under this Contract. Purchaser may make an .tae ynaenb directly to the Yortas if Vendor fade to do w and all payments so mad• by Purchaser mum be omtsidttad payuMnit maM en this Contract. Vendor may waive any default without waiving may other subsequent or prior default of Purebwr. All terms of this Centract shall be apes and mare to W beAeNr of W Mad successors and aes of Vendor and Porehae@r if wet an censor of the property W @p•a@e of Venime n wlaaMc consideration jotus herein to rdeaa be nestend right in the wbjoet Prop" ud agrees to jotw Is the Olttatke et the dud to be Au1de in lwN11ament 1 Datedthis ...._._ ..........�. ... ......... day of ........ May_.. . ... _...... .......... .. ........... BJORNST BUILDERS, INC.. (SEAL) By: J�.lt (f1tAL) ue R. lston .Orin B. Bj stad,.. President ... ._................................................. 5�...: ..... .�ii ......:...........(SEAL)And: .0 .a `.. ........... (sswL) • C lara.L.... Elston..... . ....... ............ •Donald. E. .Bj.ornsiad,...Secre..Lary AUTRIIINTICATION ACKNOWL>sDOWNUT Signature(s) .......... STATE OF WISCONSIN sa. ' Clara..L...Elatan....hushand..and..Wifa, ST. CROIX _Cou„ty. 1 i nay of.......May .......... 11...86 Personally cases before mo this ......0..day of auth ' ted this "" ` � `...4n MaY......... 11..$Et. W thew named ..... . ...... ................. .Qxi.n...A.....aiQxnsllms�....�r�lsidfuatt.....at►d • Charles... ...Whint�..................................... TITLE: MEMBER STATE BAR OF WISCONSIN Bjornstad..- Sg $.e... I1S'r...a...t.Q..WO.... Pifer ............ ..................... known..to..bti-_01.Ph--- f.f authorized by § 706.06, Wis. State.) to me known to be the person$........... who '�IFaw••• foregoin instrument F acknowledge W Cji@ �' a o sa' a ion byI ti ty. l alb INSTRUMENT WAfl DR AFT[D eY f _� William J. Gilbert,- Mty..___ ..-. �/�/ aR+17tf..... .... . ....,��1af1d }� . Wi1lialn Gilbert Gilbert, Mudge, Porter 6 Lundeen - ' Hudson, Wisconsin- 5{016 . .. ..... Notury Public rri�g���.• �!'f'�. ...... , �!N>> (Signatures: may he authenticated or acknowledged. Both My Commissron is rocrNan t.�ii•�et r.emaaF�w •� nre not necessary.) date: :a�`:'t •••••'' Nolcujr Pubri�' �•� Stoto of Wisco" "'Names ,f pot•u rn siemne in.any rbpiorltk .Iw.a ' or i rinted imlow lbrir .ienel grew. M If rwoune LAND CONTRACT—isdt •d. ww.aiti rwe Toe.to—asst r J