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HomeMy WebLinkAbout040-1207-10-000 h 0o Go cy a za o � � I N O N 1 N n� t O L Q I 7 I' O � I i c Fr can) E O o c z ~ 10 U) LL 01 0 Q C N Z y rn W Z = o a CO o I O 2 d U •� � r 00 w O. O m 2 d' C fA F- r .'. IF E 'o m N CL N O N C • O A►Ji d (� *� � O © O N Q Z m Z o O E N L 0 C W L O O N ~ > O G a >rn O N O d > 0 z • 'a a a a Z IV cc _ EL m o N 0 00 ano O fA J U cc rn rn Z m o o I ►ry m o o N N O O O t.5 o m a _ o � a) Q O O f0 N C o w G9 j N fD 00 OLr O n O ! Ur N c c O O O O O Co C 76 N C O V r r. N E O L+F Z Z "O N J r 0 Lo• �> O L O N z y O O y o F- Y 0) o — F- F- o 51 E d cc a a a w CL ID _1 A c°� a2 l, 0 U) 0 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION �C PLO.B 4969 BUREAU OF PLUMBING MADISON,WI 53707 EX CONVENTIONAL EXCONVENTIONAL ❑ALTERNATIVE StatePlanI.D.Number: Town of Troy El Holding Tank ❑In-Ground Pressure El Mound Lot 21 Glover Station 313.0 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gerhard C. Koosman Route 3, Glover Road, Hudson, WI 54016 BENCH MARK(PErm nent refereMnce poi 1 DESC I E IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV. JU Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Thomas A. Wang I2860 St. Croix 92520 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: ITANKOUTLET ELEV.'. IWARNINGLABEL LOCKING COVER PROVIDED: PROVIDED. DYES El NO DYES ONO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING. VENT TO FRESH FEET FROM ALARM: LINE: AIR INLET: DYES ONO ❑YES ❑NO NEAREST i DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING. V NTTOFRESH (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 MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO.OF DISTR.PIP E SPACING: COVER JINSIDE DIA. VPITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS �J GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW PIPES". ABOVE COVER. ELEV.INLET ELEV,END: PIPES. FEET FROM LINE: AIR INLET. NEAREST_____,. MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM 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. ❑YES ❑NO OIL COVER ITEXTURE PERMANENT MARKERS JOBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER: EDGES: DYES 1:1 NO ❑YES ONO 1:1 YES El NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO.DISTR. fSTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV.. ELEV.: CIA.: ELEV.. PIPES. A.: ELEVATION AND DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS DYES NO I DYES 1-1 No COMMENTS: PERMANENT MARKERS: b0IISERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: / 7 FEET FROM LINE: S I ❑YES 1:1 NO ❑YES 1:1 No NEAREST Sketch System on Retain in county file for audit. Reverse Side. � ` ' SIGNATURE: TITLE DILHR SBD 6710(R.01/82) Zoning Administrator 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: II. 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 a//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 Can May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commoniy 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 Ater included the creation of surcharges (tees) for a number of regulated practices which Wisco in3Ts o can effect groundwater. The surcharge took effect on July 1, 1984. All of the water tha.. buried reasu re. is used in your building is returned t_: the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The nonies clollectet:. through these sure` arees are credited to the groundwater fund adminiSl t�-reo by , e Department of Natural R.>sources These funds are used for rnon toring g ou U- g lr si.':;w -.er ._;ontciminaticn ir,astigations rand estabIisl-sment of s ,--nda-ds iroind, rt pr tec: ng 98:;'.z 03/36) SANITARY PERMIT APPLICATION COUNTY � DILHR In accord with ILHR 83.05,Wis.Adm.Code Sr CR6 STATE SANITARY PERMIT# 9Q,5-0 0 —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 L NO PgPERTY O NER PROPERTY LOCATION W GDS %, '/a, S T o2P,N, R E (o W If a PRO FRTY O NER'S MAILING RESS LOT NUMBER BLOCK NUMBER S B991VISION E d, a l /over 747``o ii Cl Y, TATE ZIP CODE PHONE NUMBER CITY -�--- REST LAKE O LANDMARK S, 6 O VILLAGE: o Ed 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. rRf 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. Dkonventional 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) p 1. a. X seepage Bed b. ❑seepage Trench c. El See a e Pit / X 3S 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOS cD�(Square Feet): �p 1 5 �7 ? 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, El ❑ Lj VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): PI Signature:(No St mps) MP/MPRSW No.: Business Phone Number: a S ,? 3 2 31 ���� Plumber's Address(Street,City,Sta ,Zip Code): N Designer: Vlll. SOIL TEST INFORMATION Certified it Tester(CST)Name CST# CST's ADDR SS(Street,Pity,Sta ,Zip cue) // '' Phone Number. o a /� �U Q k/ 5✓ l� �°'� ? 5 ),a 's'� IX. COUNTYIDEPARTWENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved ❑ Owner Given Initial 4 S rcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: �,e d b_� -Tkol-,� C, it-It ls6n 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 ;V�U ' �it-, Section 7 , -R1� W Township Mailing Address Address of Sites Subdivision Name 0_�, 1a v e r Lot Number C Q � f Previous Owner of Property 144 C°l2yj ( S Total Size of Parcel , Date Parcel Was Created 1 1 Are all corners and lot lines identifiable? 2L Yes No Is this property being developed for resale (spec house) ? Yes X _ No n i 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 I (We) eexti6y that att 6tatement,6 on thi6 6onm cute true to the beat ob my (ouh) knowledge; that i (we) am (ate) the owner(.$) o6 the pnopeh ty de.6 c i.bed in thi.6 .inboAmati.on bonm, by viAtue o6 a wa Aanty deed ne onded in the O66.iee o6 the County Regi.6teA o6 Deeds as Document No. o d ; and that I (We) presently own the pnopoeed .6 to bon the .6ewage dL6po,6aZ System (on I (we) have obtained an easement, to nun with the above deschi.bed pnopeAty, bon the condtnucti.on o6 said system, and the same has gn6 d n'Bon ided n the 066i ce o6 the County Regi4ten o6 Veeda, as Document No. cat SIGNAT OED OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) A:7 DATE SIGNED DATE SIGNED (TO BE USF,D Vol,' 1, 91:.' °A;'TIONS WIIFTI' OVI-A, $35,000 IS FIN—:c; 1i ;.':D IN 01'MAt NONXONSIJIMER i (, rit; '�:rrt b%- and between C. M. B\•e and Ucnnis �. 5��-�iu1tz, ---•-------- ------------- ------------- - ---------------------- ---------------------------------- Feb. ("Vendor", ', 8C_.SU A whether one or riore) and Gerhard C. Koosmann anCl________________________ , G - -------------• .......................... - .(- S ------------------ 5urvvorshi��o _mane,--hu,_�arlsJ. anal- iaz�e_,__a�__lu��x�ta� ���1 ?_ z4 ?exty_,_-__ ("Purchaser", whether one or more). ,- . 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_______________S _-t, CT:Q1X --_----__..__ County, State of Wisconsin: _____________________ RETURN TO it Lot #21, Glover Station, Town of Troy Tax Parcel No_ -------------------------- This -------?_S---p4t--------- homestead property. (�i5) (is not) Purchaser ::rxees to purchase the Property and to pay to Vendor at ....a place--reasonavly-- di-r--- r.- the sum of $ -1 _,(��0_.QQ-----•-------------------------------- in the following manner: (a) $---3.,�Q�_.�Q----------------_- ---- t the executio- of this Contract; and (b) the balance of ------------------ together with interest. fro;;, C hereof on the balance outstanding from time to time at the rate of------------------ ----------------------- per cent per until paid in full, as follows: $1,000 per year paid to principal plus all accrued interest (accrued from January S, 1987) , with the first payment due on January 2, 1988, to run for two years. Provided, however, the entire outstanding balance shall be paid in full on or before the--------2?ld------------ day of ------January--------------------- 19.8$___ ( the maturity date). Following any default in payment, interest shall accrue at the rate of.---.a-----% per annum on the entire amour;' 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 antic•i 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...JapLla_r`___-5-__---- 19._AK_ (m) #�xatxut�nl��TUrrxlr�aa��� 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 beer. made as first specified above; provided that monthly payments shall be continued in the event of credit of any procee.IF of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser !-t,tes that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchase for examination except: For restyicl_iens and easements of record or ti"'_ :�.•_nre. If title evidence is in t!(, fo-•-i of a, - • ,.,- ..,,, o ,:,pc•rty On_ 1ICIt. .. -- -- --- - L - - ~ ''^'. r,^^^ ' w . + -r`o 4` ,,z uJ| � ` ^.'d ' , "r t« ", o^`^cnd ��onm ��,"n� �v. . p «�"u rhoil :rep U`: iniprovements no the insured 39ainit �u or d^o, `n,c1 by fr ,arU� a."d szch ^'iio ha7^,du as V,udvr�^^, rxquir,, vu}mut co'ixsuruuce, *`rnygli iooi,s, x»r,`` � . ".� ,' in the am: of �'.['i' �-iIl����/�TC ��l��., but V,odvz d`ul\ not rc oire co,~�� in zu *xvuu_ ' Purchaser shall pay the insurance premiums when due. The policius jiwll standard clause 1��vor o f the Vendor's interest and, unless Vendor otherwise agrees in writing, the dri�-irial .. "u »".."^= ""`=^^"* the ^ '`k~^, shall^ be.-� --- - - deposited- with Vendor. Purchaser~ shall promptly give notice of companies ^nd \en-o.% �i - Purchaser and Vendor in writing, h�v pro,~,8s- ,h�/ ^»,l.,6 to t�oo or r*pv/c o� +�, 9rvnerh damaged, nr*'mod the Vendor deems the restoration or repair to b~ ^vn"mic^Uv feasible. t m� allow � � be committed the � �� the �� in tenantable Purchaser 000dbiuo and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all l*nru` n/dioxuc^n and regulations affecting the Prvnvrty' Vendor agrees that in :uae the nnr:bwuo price with interest and other moneys shall bu fully paid and all conditions shall be luUn performed at the times and io the manner above specified, Vendor will on demand, eomruxw and deliver to the Purchaser, a nYurr^utv Deed, in fee mbonlw, of the Property, free and domr of all liens and encumbrances, ozc=px any /i°uu or encumbrances created by the act or default of Porrb*omz, and except: -fb�-����[���t��--------- !,�� and'�0}�����t��'{!f- ,-----_-----------------------------------------' -----------------------------------------'------------------------------------------ -'----'-----------'---'------'-------------------------------------------------'-----' ---------'--'---------------------------------------------------'----------'-------- Purchaser agrees that time in of the essence and (a) in the event of a default in the payment of any principal or interest which continues for w period of ---6l-'days following the specified due date or (b) in the event of u default in performance of any other obligation of Purchaser which continues for a period of 6.0' days following written notice ^ thereof by Vendor (delivered personally or mailed by certified mail),then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder(in which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforceany remedy hereunder (whether abated or not) to tbe extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and pro Its of ,Tie Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any L:" Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract soley as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding I.-Jqnce payable under this Contract shall become immediatelydue and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of t'iis Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this --------------5t�b-------------------------- day of ......... J --- ''- ---- - ---'' -^ 1987 ^ {7 .-_----'(8��k�) . `�~~!^-...- ...' . . . . .' .?.x�����`�����) - Gerhard C. Koosnano ^ C. M. -�- __----- - ----------_----------�' ..- --. .. .'. (SEAL) /�L,../��/�2�k]8�'\&a/1^� .. (SEAL) Dennis R. Schultz ` Susan L. 0oosm000 � ~ . -----------------------------------------I. -- . - ' - . ..-_ .-- .. .- ..-..'-...- - ~ AUTHENTICATION ACXNOWLEDGMENT ---'�-'=^' ------- Si;outuro(») --------------' STATE OF WISCONSIN .......................... _ ___������A.�--------County. � A- - ~ --'~ 1987- Personally ,mma before om this Zlqt-_..d^v of \ `' 87 ` \ - --February- - - -- - -- - - - 19'---' oo�x� =�'"°~-~^'~'�--^^`�- -------------- __..-'�..-. -.i---------',_.,�_''��_��,_�-'�---'�-'' Co[F___ ______________ ` � ` - ­ -' TITLE: D«nm[aER STATE �&�Y�/ WISCozyGIN ([f not -._.------__.----_-_----' uvuzvu+uu authorized by § 706.06. Wis. Stat J wkb executed ho to me krown to be the personS foregoing- - inst and�~ THIS /NsrnuMEwrxv^s 1F AS J � ` [JkL -'---- -� ,-'David Y,' 1�eis'---' ' � 7^.���«u[ [8�1�,'�T.-'�40ZZ Notary Public _ Pierce __ - - � uunx may be ,vthmti,u�,l or ,,knowl~jw�� Bod` ��x r^mmiy,�n is p,rn'ux'nt. (lr nv� / � - H . z . • En H a STC - 105 r _ a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z ry OWNER/BUYER �(°U/�4rQ /ld�sl�14 YJ ROUTE/BOX NUMBER k Fire Number �^ .CITY/STATE Z I PROPERTY LOCATION:&-) ;4, Section_ , T POP- N , R Iq W, Town of St . Croix County, Subdivision C��DU�(/' Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior . to July 1 , 1978 . St . Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained-. The property owner agrees to submit to St . Croix County Zoning a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ►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. SIGNED (_7 /6"V 14z-t- DATE .7A 10 St . Croix County Zoning Office P.O. Box 98<x- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . 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; 3. MAXIMUM number of bedrooms or cormercial 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; B. 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; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; S. 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; 12. Make legible copies and distribute as re(juired. 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 cob Cobble (3- 10") SS — Sandstone gr -- Caravel (under 3") LS — Limestone *s — Sand HGW — High Groundwater cs - Coarse Sand Perc — Percolation Rate rned s — Medium Sand W — Well I's Fine Sand Bldg Building Is — Loamy Sand `j — Greater Than sl -- Sandy Loam — Less Than B *I Loarn n — Brown 4sii — Silt Loam 131 Black si — Silt Gy — Gray *cl — Clay Loam Y - Yellow scl — Sandy Clay Loam R — Red sicl Silty Clay Loarn mot Mottles sc Sanely Clay Val with Sir - Silty Clay fff few, fine, faint X _ Clay cc - common, coarse pt Pear corn — Many, rnediurn m _ Muck d — distinct p — prominent HWL — High water level, Six general soil textures surface wader for liquid waste disposal BM Bench Mark VRP — Vertical Reference Point TO THE OWNER: This sail test report is the 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 issrsance. A complete scat of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to okatairr a permit. Tile sanitary permit must be obtained and posted prior to the start of any construction. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 HUMAN (H63.09(1)&Chapter 145.045) LOCATION: SEC ION: TOWNSHI UNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: �f e SEC E le v er S "T 7"rd COUNTY: OWNER'S UYER'S NAME: MAI G ADDR SS: o l e a s,�4 $'C> 1JI, sWOl USE DATES OBSERVATIONS MADE NO.LEDRIMS.:1COMM IAL DESCRIPTION: PR IL DESC IPTIONS: PER OL TION STS: Residence New ❑Replace Q/� RATING:S=Site suitable for system U=Site unsuitable for system 4 I CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMM NDED SYSTEM:(o tional) ®S DU NS ❑U �S ❑U OS NU ❑S �U be� >Fx�t� If Percolation Tests are NOT required DESIGN RATE: �Flooclplain,If any portion of the tested area is in the under s.H63.09(5)(b),indicate: b indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 900 Af .6 NOAF 9a .vvb a S91 Gr. B- ib. o 0.P 3 t 6 n S ,D � S . B- 3 lo•ob e 6 -`/Ael0 .gyp 9// eo S i I . Do bf 5V 6,v 9,s, B-u tD.oO a,ao �1d.D0 , L) �� /oU I .6el xn S�`Cr9s'1h S B- 10-00 10P10 -,&4,60 s'o S Aso + h S r, pD ,Bra B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PER PERIINCH P- 0 7 3 dV I P- a 5.3,3 3 P- e s 3 3 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 E d C6 �l ! PI � r � E zli 4�i 1, � Yr r�n �L%�ri�;d1't X?. ?. !rah E i W j c Sao.o 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. NAMWT : TESTS WERE CO LETED ONL s /� Vag 3gF ADDRESS: CERTIFIC T N M R: PHONE NUMBER(op 'onal): r s ` CST I' (!/J✓J DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — L �-�` h a • oo pna g 0a'? Co o e v- w1 r p4 r D" rk m i n r . 10 �oynlP� U O sk a �ropcs 'NorLt ` ao` U l�b00 4 I S�tie alb l t3� rl g� sa