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Wisrx~sin Department of Commerce
Safety and Bindings Division
GENERAL INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Personal information you provice may be used for secondary purposes [Privacy law .15.04 (1)(m)j.
~a`~aHSSe rGfus~'orrt Homes, ^ uty ~ ~if`1~s~n °I"ti~'inship
CST BMElev.:- j~ Insp. BM Elev.: BM Des ription/:
(0 •b ' ~ /
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic W
Dosing
Aeration
Holding
TAN~TBACK INFORMATION
TANK TO P/ L WELL BLDG. vent to
Air Intake ROAD
Septic ~JT~ ~ / ~-- NA
Dosing A
Aeration A
Ho g
PUMP /SIPHON INFORMATION ..
Ma ufacturer errand
Model ber G
TDH Li L ~ tion System TDH
terrain Length Dia. Fi ell
SAII oRSARPTION SYSTEM /~..l,.ti _ ~„~~c
EI EVATIDN DATA
count~t. Croix
Sanitaly~ie~t/No.:
StateState Pllaoon331D No.:
Parcel~~Ng 370-40-000
STATION BS HI FS ELEV.
Benchmark p.3p 0,'~jU CID .D
' ~ Z`~ /OHO. Oho
Bldg. Sewer $~• I ~ a ~, / 3
St/ Ht Inlet (0.31 / D 3~
St/ Ht Outlet G , SS /0 3.71
Dt Inlet ---~
Dt Bot
eader /Man. /0 3.
Dist. Pipe ~ ~D 2'
Bot. System /~ ~ ~~r, ~~' ~
~~ ~-
G6yt •,~~,
f'~Ct 0~
~3=/b .~ -
B~9 RENO Width r Length f No. f renches PIT No. Of Pits Inside Dia. Liquid Depth
IM N 1 N 2 •Sb IMEN I N
SETBACK
SYSTEM TO
P / L
BLDG
WELL
LAKE /STREAM LEACHING Manua rer:
~ ,
INFORMATION Type O ~ 5 ~ ~-- AMBE
OR UNIT Mo a Num er:
System: ,
fl1~TRIR1 ITIAItI CV~TFM y ~fo ic)ac~t. P//
Header / a~ i OI ~
~
~~5 Distribution Pipe(s) x Hole Size x H ing Vent To Air Intake
Dia.
Length ength Dia. pacing
SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only
i
I
L
i
Depth Over ~ Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
~
/
Bed /Trench Center ` ~ Bed /Trench Edges Topsoil ^ Yes No ,Yes No
/COMMENTS: (Include code discrepancies, persons present, etc.) /I, a/
Location: 994 Parkview Lane, Hudson, WI 54016 (NW 1/4 NW 1/4 16 T29N R19 - 6291 ,2 6 ~
Parkwood Meadows -Lot 40~~ ~{ asRw~" ~~ P ~ ~s ~ f ~'• ~~
1.) Alt BM Description = h
2.) Bldg sewer length = /Q ~ $~~5 ~ /"~'~
~~~' G , ~ ~.2 S IDS I
-amount of cover = ~ ~ , ~ I a, Io ~~~
Plan revision required? Y s ^ No ) /
Use other side for additi nformation. ~ a4 d
SBD-6710 (R.3/97) (ppt:,~j o Date In Signature Cert. No.
a ~3s
Sanitary Permit Application Safety & Buildings Divi:
In accord with Comm 83.21, Wis. Adm. Code'' 201 W. Washington F
`~SCOifilSiin See reverse side for instructions for completing this application PO Box 7
t)eDartment of Commerce Personal information you provide may be used for secondary purposes Madison. WI 53707-7
[Privacy Law, s. 15.04(I)(m)J ' (Submitcompleted form to county i;
-°'`-`~` state own
Attach tom lete tans (to the count co onl )for the s ste ,oft a er not less t 8-I/2 x I 1 inches in size.
Court •~ St3 g~nitary permit Number O Check if vision to previous application, .State Plan I. D. Number
I. A lication Information -Please Print all Information - , ~h. ', 'L cation: '
Property Owner Name .,
Property Owner's Mailing Address
S 7~ c.7`15~
r". -` ? z
f
uOtJIVTY
:~r~nu:h~r_ nGC~~
t.o~,rvu~r 81ock Numb•
,~
A~
ubdivision Name or CSM Number
P~.~:~~ f.4~C
O City
O Village
II Type of Building: (check one)
~ I or 2 Family Dwelling - No. of Bedrooms:~_
O Public/Commercial (describe use): •
O State-owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable)
A) 1. ~lew System 2. ^ Replacement 3. O Replacement of 4. ^ Addition to
S stem Tank Onl Existin S ste
B) Permit Number
O A Sanita Permit was reviousl issued
I~V. Type of POWT System: (Check all that apply) ,
ax Number(s)
0-1.376' ~fD~DC1
on-pressurtzed In-ground \~~~5 D Mound O Sand Filter O Constructed Wetland
O Pressurized In-ground 3a D Holding Tank O Single Pass D Drip Line
O At-grad r~~~ ~~ ~ Aerobic Treatme 'U 't Recirc sting D O~hcr. '~
Q.t -
r
V Dis ersal/Treatment Area Information: ~ - p~
I . Design Flow (gpd)
(~OC~ 2. DispersalArea
Required
Soc~ 3. Dispersal Area
Proposed
.5'l 4. Soil Application
Rate (Gals./day/sq. ft.)
/, 5. Percolation R
(Min./inch)
VI Tank
Information Capacity in
Gallons Total
Gallons ~ of
Tanks Manufacturer Prefab
Con-
New Existing -
Crete
~ I /n1YSUl """~
VII Responsibility Statet
1, the undersigned, assumt
Plumber's Name (print)?
Plumber'/s Address (Street,/C~ity~ State, Zip Co.
VIII County/Department Use Only
v. .a~a~cm ucrauvn ~ r. rmar ~raac
f = J -~ jGU . yU ~ Elevation
9y~ ~ '
te~ Steel Fiber- Plastic
Con- glass
strutted
tess Phone Number
s~~~~~~yyS.
Approved O Owner Given Initial Adverse Surch a Fee) tTD
Determination 2Z ~, "
IX. Condtttons of Approval /Reasons for Disappro al:
as ~ ~~ a~~~ -~°~
Sip t k,S~-a~xr,.yt~~- .
for installation of the POWTS sho on the attached lans
i Signature (no scamps): MPRS No.
v~~
coca
Issuing Agent Signature (No stamps)
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Wisr~nsin Department of Industry, $ O I L AND SITE EVALUATION R.E.Q-QR T Page 1 of 3
La~ and Human Relations - ~._
Divis,Ton of Sziety ~ Buildings in accord with ILHR 83.05, Wis +4cff~t.~:Code-~ x `~
,_ O'NTY
Attach com lets site Ian on a er not less than 81J2 x 11 inches in size Pla~i hiu~t inclu ~ b~~ St. Croix
p p p p ~ l~'. ~ ~ PARCEL LD. #
not limited to vertical and horizontal reference point (BM), direction and % of;5lope, scale or
dimensioned, north arrow, and location and distance to nearest road ~ ~ ;' ~ a 0 0-1028-90
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~~iX{~~~ R VIEWED BY DATE ~I
a)-~; <<
PROPERTY OWNER: ,OPER ';`
LaCasse Custom Homes, Tnc. GOVT L4T.- NW v~CElyW~yJd~s'16 T 29 ,N,R 19 8(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # ~tD~T~~" :5(,1(~D~ E OR CSM #
521 McCutcheon Rd. 40 ~ ood Meadows First Addn.
CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE SOWN NEAREST ROAD
Hudson, WI. 54016 (715 381-5405 Hudson McCutcheon Rd.
[~ New Construction Use [~ ] Residential / Number of bedrooms 4 [ J Addition to existing building
j ]Replacement [ j Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpd/ft2 •8 trench, gpd/ft2
Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpdJft2
Recommended infiltration surface elevation(s) 100.90 ft (as referred to site plan benchmark)
Additional design /site considerations trenches spaced to code 4.00' below grade
Parent material outwash Flood plain elevation, if applicable na ft
S =Suitable for system
U =Unsuitable for system CONVENTIONAL
®S ^ U MOUND
®S ^ U IN-GROUND PRESSURE
®S ^ U AT-GRADE
®S ^ U SYSTEM IN FILL
®S ^ U HOLDING TANK
^ S C~ U
SOIL DESCRIPTION REPORT No~. I~
~~.,.QO rr
e$,. `~~u.Jw_ ~~ ~ 1 : ~
Boring #
..................
.................
..................
.................
..................
1
Ground
elev.
104.9 ft.
Depth to
limiting
factor
+ "
Boring #
2!
Ground
elev.
I' 104.9 ft.
Depth to
limiting
factor
~~
Depth Dominant Color Mottles Texture Structure Consistence Bour>da Roots GPD/ft
Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench
1 0-7 10yr3/3 none 1 2msbk dsh cs 2f .5 f .6
2 7-21 10yr4/4 none sil 2msbk dsh gw if .5 .6
3 21-30 10yr4/4 c2d 7.5yr5/6 sil 2csbk dsh gw if .5 .6
4 30-90 7.5yr4/6 none Osg ml na na .7 •' .8
i
o,,-f- Imo. 0
~~5~~ `(
Remarks:
1 0-10 10yr3/3 none 1 2msbk dsh gw 2f .5 .6
2 10-28 10yr5/4 none sil 2msbk dsh gw if .5 .6
3 28-37 10yr5/4 c2d 7.5yr5/6 sil 2csbk dsh gw if .5 .6
4 37-90 7.5yr4/6 none cos Osg ml na na .7 ~ .8
~-
~`~
Remarks:
CST Name:--Please Print G L. Steel Phone: 715-246-6200
Address: 1554 200th. ve New Richmo WI 54017
Signature: ~ ~ n Date: ~ 30_99 CST Number: m02298
PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT Page? of
PARCEL I.D. # 020-1028-90 `~
t -
Boring #
3
Ground
elev.
103.8 ft.
Depth to
limiting
factor
~~
Boring #
4
Ground
elev.
102.5 ft.
Depth to
limiting
.factor
+84"
Boring #
.::::..........:::
5
Ground
elev.
103.0 ft.
Depth to
limiting
factor
~~
Boring #
..................
Ground
elev.
ft.
Depth to
limiting
factor
Horiz
n Depth Dominant Color Mottles Texture Structure Consistence Bax~dary Roots GPD/ft
o in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh
1 0-13 10yr3/3 none 1 2msbk dsh cs 2f .5 .6
2 13-36 10yr5/4 none sil 2csbk dsh gw if .5 .6
3 36-90 7.5yr4/6 none cos Osg ml na na .7 .8
`~ s 8
Remarks:
1 0-7 10yr3/3 none 1 2msbk dsh gw 2f .5 .6
2 7-29 10yr5/4 none sil 2csbk dsh gw if .5 .6
3 29-84 7.5yr4/6 none cos Osg ml na na .7 .8
Remarks:
1 0-9 10yr3/3 none 1 2msbk dsh gw 2f .5 !.6
2 9-29 10yr5/4 none sil 2csbk dsh gw if .5 ~ .6
3 29-90 7.5yr4/6 none cos Osg ml na na .7 .8
Remarks:
Remarks:
.~
STEEL'S SOIL SERVICE
Gary L. Steel LaCAsse Custom Homes, Inc. 1554 200th Ave.
CSTM2298 Nw4ivw4 s16-'r29N-R19w New Richmond, WI 54017
MPRSW-3254 town of Hudson (715) 246-6200
lot # 40-Parkwood Meadows First Addn.
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use, The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted..
.IA ~ Q
~~'_ _ `
Gary L. Steel
c~ 30-99
~.
N
1"=40'
BM.= top of 1" pvc pipe C el. 100.00
Alt. BM.= top of 1" pvc pipe C el. 101.70'
3-16-1995 12:A0PM FROM P.1
<e.
A na~n w~ylwar~n~ w Inavnur,
(~ a,~d Human Rslerione
fL'.1:'t-inw of f..afdv A I~u74~r,oe '
~V•IL AIYIJ ,11 ~ tYAaLVA 1 IVn 1"iCF'VM 1
F'8ge + OT -~
T III 4YFV~V w,u, IVr„. V.7.VJ~ •.~~• tea... ,. vwa ~~{{11
CVV
Plan must include
but
Attach com
er not teas th
n 8 1/2 x 11 indtes in size
lete sit
lat, on
a ~ - CrOiX
,
p
p
.
p
e p
a
not gmited to vertical and horizanta) refer®nce'point (BNn, direction and ~ of sbpe, scale or PAFiC L I.D. iY
dimensioned, north a-row, and location and distarroe m nearest road. 0 -
APPtICANT INFORMATIONwPL6gSE PRINT ALL INFOiiMATIpN FIEVIEWE08Y oaTE
PROPERTY OWNER: ~ PAOPCsR1Y LOCATION
Iat~se ~g~ •g, ~, ~. LO7 ~T t/4 • Itilirr 1r>~,S 16 T 29 ,N,R 19 Sta)1N
PROPERTY OWNER`:S MAILING ADDRESS LOT k . BLOCK s 8U6b, NAME OR C3Nt a
521 1!fcCutctteon Rd. 40 tie Par'kWOOd Meada~ws First Addn.
CITY, STATE ZIP CODE PHONE NUIN~ER CITY ]VILLAGE ('OWN NEAR 8T ROAD
Alf't Wl. 5401fi (719' 381-5405 ~ PtiCCtttc2>~ Rd.
(~ New Consth~dion Use (x ] Residential 1 Number of bedrooms a (]Addition hts existing building
(] Replacement ( ] Public or commerrJall deseibe '
Code derived daily Aow 600 gpd Recommended design loading rate . 7 bed, gpdHt2 ' 8 french', gpdAt~ .
Attsorption area required 858 bed, tti2 750 trench, R2 Maximum design loading rate , 7 Dad, gpd/ft2 .8 Qendt, gpdRt~
Rewmrnended infiltration swtece elevation(s) 100.90- _ -__ _ K (as referred to site plan Dsrtchmark}
Additional design /site COn51d@ratianS 'tr8 spaced Y.O •GOQe 4.00' bel09r grade _ _ _--
P~entrrtaterial ouLuraQh Flood plain elevation, it applicable.. na___-- N
$ ~ Suitable ftx System GONVENTIQIVAL MOipVD INr~ROUND P(3ESSUpE AT-GRADE 'SYSTEM IN FM_L FIOIDIIVG TANK
u= unsuitable for rem ~l S O u ~ s p u ®S ^ U ®s p u ®s ^ u ~p S Q u.
SOIL DESCRIPTION'Rf=PART
Boring ~
Gtaurld
P~eY.
10~,,~ R
Depth o
limiting
rector
q
Baring #
2
Grptrrd
elev.
104.9 ft
DepCl m
liming
factor
Horizon pepth Dominant Color Mottles
Texture Structure
Corts~
~~
Roots GPD/ft
in. Munsell Du. Sz. Cant. Color Gr. Sz. Sh. Sad lerdt
1 0-7 10yr3/3 none 1 Ztfasbk dsh cs 2f .5 .6
2 7-21 10yr4/4 none ail 2tnstak dsh gv if .5 .6
3 21-30 10yr4/4 2d 7.5yr5/6 ail 2csbk dsh ga if .5 .6
4 3~A0 7.5y1r4/6 name co .s Osg enl na na . 7 . B
_o
Remarks:
1
0-10
10yr3/3
none
1
Zte~sUlt
dsh
ga
2f ,..
.5 .6
2 J.0-28 10yx5/4 none ~ si 1 Zmsb~k dsh gw 1 ~ . 5 _6
3 28-37 10yr5/4~ c2d 7.5yr5/6 sit 2esb1K dsh gr+r if .5 ~ .6
4 . 37-90 7.5yr4/6 ¢tcaae cos Osg tat na nai .7 i .6
3~ ~ '~'~ .`~ .
Remarks:
5ignarurc: ~~ ~ ,~~'~-~• Date: ~Zh_oa CST Nurrtt~er: m07298
3-22-1995 5:06PM FROM
r
i ~
P. 1
~~ STEEL'S SOIL SERVICE .~
Gary L. Steel ~~~ ~~ HO[Oefir ~. ~ 1554 200ti1 AVe.
CS~'M2298 ~ S16-T2911~R19W ~ New Richmond, WI 54017
MPRSW-3254 to~am of Hudscm ~ ~ (715) 246-6200
lot # 40-Parkr'iovd Meadow First ~,ddrt.
This soil evaivatica vas e~euduCted to satisfy a ZOAilx+g regvirement, it may or taay
not be suitable for your u~r. The lot~atict- of the ~t may of may not be as slyout-
as pe~nent lot litres v~ere not established at the ti~ae t'tie teat tva~s epiodu~d. .
N
1 °~0
S°i. = top of ~." pvc pipe ~ ei . 100.00
~•
C~xy L_ 'Steel
30-99
A V ~
a
>!, ~ .
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In-Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWYS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
Table 1: Svstem Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow -Peak (gpd) ~ ~'
Estimated Flow -Average (gpd)
Septic Tank Capacity (gal)
Soil Absorption Component Si (ftz) d
Type of Wastewater Domestic
Table 2: Soil Absorption Component -Limits of Reliable Operation
anret~.
S fc Tank Component Soil Absorption Component
Design Flow -Peak (gpd) 128e Sl
Maximum Influent Particle Size (in) 1/8
Maximum BODS (mg/L) 220
Maximum TSS (mg/L) 150
Tab le 3: Maintenance Scnedu~e
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se tic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filte shall be cleaned as necessary to ensure
Groper operation. The filter cartridge shou no be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
~- i Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the sepfic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank maybe difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
•Apr-27-O1 09:43A
P~u~
ALTERNATE SYSTEM AREA AS~S,H~.1nA~N ON SOIL TEST, MUST BE LEFT UNDISTURBED.
IF ALTERNATE AREA IS~84&TERBED, REPLACEMENT AREA MAY NOT BE FOUND.
ANY DUESTIONS PLEASE CALL
BRADY UTGARO ...........................(715)268-6995
OR
ST. CROIX COUNTY ZONING..........(715)386~680
P_02
S'1' C1tOIX COUNTY
SLl''1'IC 'TANK MA1N'I'LNANCL AGRLLML~N"I'
AND
OWNI?1tSII11' CLIt'I'II~ICA'1'ION 1~OItM
Owt-er/Buyer _ 1. ~ C.~3.~5`. ~ u 4 ~v~rK 1~rn~-~ i svG
Mailing Address _ ~ 713 ~~ f -/ (~ ~¢ I-ri~-d 5~ ~ i.V ~
Property Address
~!' ~'/~ r l~' l//Q~J
(Verification tcyuitcd (iota 1'launing Ucpatfntcut far new amshuction
City/Slate ~,~• cl d ~~o--a. (j,~j t',irccl Itla-tilicutittn Nu-ul~cr
LrGAL DESC1tII''I'ION
Property Location ~(~ t/,, ,~Lt~ t/,, 5cc, ~~ •1• ~Z~ I~-1t~,W, 'Town of f ca
SuUdivision e. t'~ (~~~~n~,tl~~ /S~ Lot # _`~_.
Certified Survey Map #
Vuluntc ,Page ~~ "~
Warranty Decd t'E 5`9 ~ f~lO , Valun-c ~ Page #
Spec 1-ouse ^ yes.~'ito
Lt-t lines idcntiiinl)le dyes lJ no
SYS'I'I!.M MAIN'I'I~NANCI~
Improper use and ntaiulenauccof your septic system could tcsull in its prcmahuc failwe to handle wastes. Proper maintenance
consists of pumping out the septic teak every three years or sooner, if needed by a licensed puntpcr. What you put into We system
can airect the futtcliou of the septic lack as a ttcaUncul stage in the waste disposal syslent.
The property owner agrees to subutit to St. Croix Zoning Dcpattutcnt a certiticalian form, signed by the owner and by a
masterplumber, joumeyrnan plumber, restricted pluutber or a licenacd puutper verifying that (1) the ou-site waslewaterdisposal system
is iu proper operating condition and/or (2) alter inspection and pumping (if accessary), the septic tank is less than 1/3 full of sludge.
Uwc, the uadersigued have read the above rcquiicmeuts and agree to ntainlain the private sewage disposal systetu with lire standards
set fortly ttcreiu, as set by rite Department of Catumerce and the Dcpartnteut of Nahtral Resources, Stale of Wisconsin. Certification
staling that your scpt'c system has been maintained roust be completed and returned to the St. Croix County Zoning Otlice within 30
days tltr e y r expiration date.
SI AT'URE r API'LICAN'r bA'I'E
O«TI);R CCR'I'II~ICA'I'lOi~
I (we) certify hat all slalcntcnts on This form otc Uuc to the I~csl of ury (aur) knowledge. I (wc) am (are) the owner(s) of
the pr rly desc be a~ovc, by virtue of a wauanly decd recorded iu Regislcr of 1)ceds Ollicc.
~~/ ~ / ~ ~ 1
SID ATURE OP AI'PLICAN'I' llATE
Any information that is utis-rcpresculcd may tcsull iu II-c sanitary pcnuit being revoked by lire Zoning DeparUneut.
** Include with this application: a stamped wauanly decd from the Regislcr of Uecds office
a copy of the certified survey map if reference is made itt the watrattty deed
~o~ 140 PacE616
-~ ~-
STATE BAR OF WISCONS{N FORM I1 - 1982
LAND CONTRACT
Individual and Corporate
(TO BE USED FOR ALL TRANSACTIONS WHfRE OVER
DOCUMENT NO. 325,000 IS FINANCED AND IN OTHER NON•CONSUMER
ACT TRANSACTIONS)
Contract, by and between Howard ~VPn . rr -, Personal
~prec ntativ o h a a. of nna L .aV~ture
("Vendor',
whether one or more) and LaCasSe Custom HorneS Inc.
__ ("Purchaser', whether one or more).
Vendor sells and agrees ro convey to Purchaser, upon the prompt and Eull performance
o! this contract by Purchaser, the following properly, together with the rents, pro(i[s,
lixrores and other appurtenant interests (all called the "Property"), in
St. Croix County, State of Wisconsin:
THIS PROPERTY IS IN THE WELL ADVISORY AREA.
5981 16
KATHLEEN H. WALSH
kEGI5TEk OF DEED5
ST. CkOIX CO., WI
RECEIVED FOR RECORD
OZ-19-1999 11:30 AM
LAMD GORTRACT
EXEMPT Y
CERT COPY FEE:
COPY FEE:
TRRMSFER FEE: 2520.00
RECORDING FEE: 11.00
PAGES: 3
THIS SPACE RESERVED FOR RECORDING DATA
-'~ NAME AND RETURN ADDRESS
fie..- ~.
N~yh,,~~
~a.x l~-S
j'{JC~So. Sy~~6
;_....- _
020-1026-90 020-1029-00
mn_lo~a_~o; own-io24-ao
PARCEL IDENTIFICATION NUMBER
SWI/4 of NW1/4; NW1/4 ofNWl/4; NW1/4 of SW1/4 andSWI/4 of SWl/4 EXCEPT all that part lying
Southerly of the former Chicago & Northwestern Railway Right of Way and EXCEPT that portion of the
former Chicago & Northwestern Railway Right of Way located within the Certified Survey Map in Vol.
7, page 2046, Doc. No. 443210, all in Section i6, Township 29 North, Range 19 West, St. Croix County,
Wisconsin.
This i s not homestead properly.
(is not)
Furchaseragrers to purchase thrPropzrty and to payto Vettdar at ~1_~2- VPndrr di- et-~,a- .
the sum of $ R4(1 • ~00.On in the following manner: (a) $ ~~n - Mn _ nn
at [he execution of [his Contract; and (b) the balance of E ~_~., 000 00 , rogether with interest from date
hereof on the balance outstanding from time to time at the rate of Savan („']~,',) percent per annum until paid in full, az follows:
See Attached Exhibit "A"
Provided, however, [he entire outstanding balance shall be paid in full on or before the ~ S ~ day of FebrLary,, ?004
~X (the maturity dace).
Following any default in payment, interest shall accrue at the rate of 8_S% per annum on the entire amount in default (which shall
include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly [o Vendor amounts sufficient to pay reasonably anticipated annual [axes, special
azsessments, 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 [o principal
~ ', except as to lot release payments as provided on attached
Exhibit "A".
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 principap 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 [hereafter excluded here[rom.
Purchaser states that Purchaser is satisfied with [he title as shown by the title evidence submitted to Purchaser for examination except:
None.
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 entitled to take possession of the Property on day Of C10Sirif3. }~IQC
• cry an Drat.
STATE BAR OF WISCONSIN Wlscons~n Legal Blank Co., Inc.
LAND CONTRACT - Individual and Corporate Fonfi No. 14- 1982 hFlwaukee. wro,
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