HomeMy WebLinkAbout026-1133-18-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
399637 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID Na;. ---
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Halle Builders Inc. I Richmond Township 026- 1133 -18 -000
CST BM Elev: t Insp. BM Elev: BM Description:
�o . t C"' . 0 ' =CST' gw�
TANK INFORMATION 0 1 ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
0
Septic Oto Benchmark / 2 Y� ,Zj ' •�
Dosing Alt. BM
Aeration Bldg. Sewer 3 D
•
Holding St/Ht Inlet f
TANK SETBACK INFORMATION St/Ht Outlet . p� • S I
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic , �► Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe e +)
Holding Bot. Sys m �) ,pM t
9S . �fo
t
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover �C
GPM
Model Number
TDH Lift Fri Loss System Head H Ft
Forcemain r7tc th D . ell
SOIL ABSORPTION SYSTEM
NC Width TL n t�h r / ` _ o. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T id Depth
DIMENSIONS Z� �Z_� / afi Z
SETBACK SYSTEM TO N/L BLDG WELL LAKE/STREAM LEACHING , Manu yrfr. L _
INFORMATION CHAMBER OR W^rA /' JiL
Type Of System: f! UNIT Mode ILmber
J. "3D
DISTRIBUTION SYSTEM
Header /M if Id 4 Distribution x Hole Size x Hole Spacing Vent to Air Intake
"— i Pipes) ti i
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
[� Yes [W No [Yes ®No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection 001 02- Inspection
r
Location: 172nd Avenue New Richmond, WI 54017 (SW 114 SW 1/4 6 T30N R18W) (. Pine Valley Lot Parcel No: 06.30.14. ?
Ar
1.) Alt BM Description
2.) Bldg sewer length = 13 .
- amount of cover ��pt{ -4
3) 2"j 14 — lop vtt • �-t e/
Plan revision Required? ! Yes )(
Use other side for additional informatioIZ--
Date Insepctor's Signature Cart. No.
SBD -6710 (R.3/97)
ql 5 h:>
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
NVisconsin Personal information you provide may be used for secondary purposes MadisQp, WI 53707 -7302
Department of Commerce p (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
Coun State Sanitary 3 Number ❑ Check if revision to previous application State Plan I. D. Number
I. Application Information - Ple Print all Information Location:
Property er I Property Location
WI �� 1 94) 1 /4Y(/ 1/4, S L T,?O ,N, j J (or)(!�
Property Owner's Mailing Address Lot Number Block Number
n L /y
City, State Zip Code P urn Subdivision Name or CSM Number
�l SYo / 7
II. Type of Building: (check one) r C ❑ City
Y g - i'21.CG�VC� >
1 or 2 Family Dwelling No. of Bedrooms: ❑ Village � Town of .
❑ Public /Commercial (describe use):_
❑ State -Owned
/ r �. _�� Nearest Road A 0
n A 2L�t�IG 9 � a'V"I
2 x 6 $ , � c X ., u " Parcel Tax Number(s) a
III. Type of P ermit: (Check only one box on line A. Check box orl line B jfgppl' e) y
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4- .`:__..__'- 5. . ❑ Addition to
System Syste Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) A-- (&D
Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
-) 37,S 37.5 ' ? -/Z — 11 /1 -s1 Y /0/. a
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
/000 o ,,� ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown o c d plans. /
Plumber's Name (print) PI er's nature o s ps): /MPRS N Business Phone Number E
f 0
r A PB— Z?, ( / - / l 1 711- - -2
Plumber's Address (Street, City, State, Zip Code)
swo
IX. County /Department Use Only
11 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surch ge Fee)
Determination ZZ S ' 1 Zvl�/o/ eQ Jl�
X. Conditions of Approval /Reasons for Disapproval: �^ r
anak. %t So T 1 4 S a. v � j °^ue �r f ca•�a. sy s w. g ��
�►�.1,1.M� , 6�/` �..H..., 4c0 -\C- s- E- /cs�'�J f�~ - � •�,,, f1.QA.Le...
So is - V, - s V. U p2.,.-,,�,1,� /csT 3 G'� l(e - m
ils .Q 8 03 CIs, O -s�) oo 1 .�� +" dac wi. Kew
sots ` ll S f s YS S_ �
'�D - R 07 l �S l 5�- s�ti 3 — e�lsrZrd w 5�o��Vi3 ►D-r. (1 dt
Cw er�°z5 0,� Loi
�lE � u;ek, Mrs G►�k, P , ►I sn..:r2 ke'w�. QdC �QarJt sails X;f JV *- M Z� " - - t�oo�� i, �� rtecej;Sd .,y,
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Scv Sw S,(oT3o Allelg" ZZ1
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Wisconsin Department of Commerce SOI VJ�_LliFcTI , EPORT Page of 3
Division of Safety and Buildings / % ! t
in accordance with T 85 ! ►. Code 1
/ ' /r F�arcel nty C'_ f �"�O
Attach complete site plan on paper not less than 8 1/2 x 11 instres in siz . tP fti a J x
include, but not limited to: vertical and horizontal referenc� point (BM , direction and I.D.
percent slope, scale or dimensions, north arrow, and locati66 rind di hie rilare �rppd. n thg
Please print all informatign ; :P*X � !� ev wed by Date
t OUNTY ( Z./
Personal information you provide may be used for secondary purposes,(Privac ?-/0
Property Owner ti Property jqc do
LOWS E ��1� 11C, C�YL of 1/4 1/4 S T3(3 N R 'O E( W
Property Owner's Mailing Address Con4c�c+ o Block # Subd. Name or CSM#
? 0. -- 80 10 as ( & Ie sow � I
City State Zip Code Phone Number ❑ City ❑ Village XTown Nearest Rgad
(, kt L-a(- LcVR MA) 1 55 1 i I (b51 R ichewlohd I I /<A C1
New Construction Use: K Residential / Number of bedrooms 3 Code derived design flow rate qG0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 0, C1 Flood Plain elevation if applicable ft.
General comments ' TRf , 5
and recommendations:
M 4 y = S S S �" c� — (o $ Ko-
, 7$
-} e
S l i e. I; T• + ° 15,
T a - r.y
❑ Boring # ❑ Boring
1 9 Pit Ground surface elev. Jb s5 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
'1 ()-11 )0 3 a L r& P, m F g as a F
oc
)1 -23 2 . 5 1 R 4 Aeaj`�� m c D
3 a -il 75 u y LS
1 -IatS ?.S `►� - - S
4S.y� The soil test report for lot 3 was discovered to be
.y il3 A 3 y 35 eA inaccurate during the septic inspection on Nov 2,
2001. The soil horizon reported as single grain
® Boring # E] Boring Pit Ground surface elev. D ft. loamy sand was actually massive loamy sand with
S 9 occasional pockets of sandy loam. Therefore the
Horizon Depth Dominant Color Redox Description Texture loading rate must be .5/3 and not .7/1.2. If this
in. Munsell Qu. Sz. Cont. Color error is discovered on any other lot, additional
I 0 — (o {C) 01 sL borings /soil investigations will need to be performed
for the rest of the subdivision. The plumber should
C? b -11 S R 9� Nom" 7S make note of the potential for error and prepare for
3 0_3a '1.5 re w1q L s the possibility of increasing the size of the drainfield.
3a_J�► 7.5 R `( `I S � � -. �.Q� �o � Qe-w�t tS C � L��
` - 3 y 4 as °/° Co lab! — ' C, t s t�— sw [�m+•�� I
Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L t/� -�-- h _ (►„ _� w..af� t•�—
CST Name (Please Print) Sign at re R P�asiv`
Address �i
a
alb '
a oo s s -�� c `► f,t� f tz(�� -�a� �:�o�..J
t
Property Owner L ai e& i M` + Parcel ID # Page a of
F3-1 Boring # ❑
Ar Boring q 9 �
Pit Ground surface elev. ! • D's ft. Depth to limiting factor / 01(� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2
0 -9 io R 31a L aF &R ;:R oi5 or .5 -
R s1 �f L aFS " VR evj I F .5 .
3 16-al ,5 R yq " ° `s 9 rASOY, yy, -R (2 vi 1v1: 15 .9
7 -35 - ?,SqR 4 )q SL 2 r - S 6S ON ER 9
S
35-jag TS Ik 4 Iq L S
Z a .Zo
q4A °a co
[ — q — ] Boring # ❑ Boring q
Pit Ground surface elev. !41••7 ft. Depth to limiting factor /00 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2
o-6 9. 31a SL ol F&R M FE A S Q ,5 ,9
t
6-q � , s vR s s a FS6 c w I F 1
3 9 - @o - 7,.5 Yk ly �+� SL RMS ' m FR CW 1VF , S , 9
o- 7,s R .. ....n,...... L s O -Sq
rnv F?, IM , t,a
39 -10 -7�5`IR u y L . ), a
❑ Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
El Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 nig /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.07 /00)
�.Li. '1' �YIC ..:rJ.�� oo p
5 w� 5 w 'l y � Sec,. (�� T 3 oN,, R � $ � �� r� �! � �'• �r �
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S3 99 �.S'
POWTS OWNER MANUAL 8z rLJt"' °
r
'NfORMATION SYSTEM SPECIFICATIONS
rPe!rmlt1 Septic Tank Capacity mro al ❑ NA
ufacturer TT' E3 NA
Tank Man F�Ctf. q 63 �
S
E M anufacturer [3 NA
anufactu f2
Effluent Filter M �+W,
DESIGN PARAMETERS ❑ NA
Number of Bedrooms 3 [3 NA. Effluent Filter Model ►¢— I w
Number of Commercial Units NA Pump Tank Capacity gal 'B.NA
Estimated flow (average) -30.0 gal /day Pump Tank Manufacturer 19.NA
Design flow (peak), (Estimated x 1.5) Lt5 gal /day Pump Manufacturer f�NA
�
Soil Application Rate 0 . + gal /day /ft Pump Model I51, NA
Influent/Effluent Quality Monthly average* Pretreatment Unit 1�NA
❑ Sand /Gravel Filter ❑ Peat Filter
Fats, Oil 8t Grease (FOG) s30 mg/L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other:
Total Suspended Solids ( TSS) s 150 mg /L Manufacturer
Pretreated Effluent Quality ' ❑ NA Monthly average* * Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) 5_30 mg/L gIn- ground (gravity) ❑ In- ground (pressurized)
Total Suspended Solids (TSS) 5530 mg/L ❑ At -grade ❑ Mound
Fecal Coliform (geometric mean) :510 cfu /100m1 1 ❑ Drip -line ❑ Other:
Maximum Effluent Particle Size inch diameter
* Values typical for domestic (non - commercial) wastewater and septic
tank effluent.
* * Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑months tyear(s) (Maximum 3 yrs.)
Inspect condition of tank(s) At least once every
Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume
Inspect dispersal cell(s) At least once every 3 ❑ months Myear(s) (Maximum 3 yrs.)
Clean effluent filter At least once every — Z ❑ months � year(s)
Inspect pump, pump controls ez.alafm At least once ev
❑ months O year(s) "R NA
Flush laterals and pressure test At least once every ❑months ❑ year(s) M,NA
Other: At least once every ❑months ❑ year(s) b,NA
Other: At least once every ❑ month s ❑ year(s) 'Q NA
MAINTENANCE INSTRUCTIONS win licenses or certifications: Mas
indiv car ry i ng one of the followin and dispersal cells shall be made by an m' Tank ins ectio
ons of tanks a p S ervici ng Op erator . p
inspections Maint Septage Servi g erator
P
SM
Sewer; POWTS Inspe P OWTS � re t
Plumber; Master Plumber Restricted Sewe , p
must include a visual inspection of the tank(s) o check any miss oor po ding of effluent i on the ground s urface. The dispersal
volume of combined sludge and scum and Y onding of effluent on
cel l(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any p
the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate
nodflcation of the local regulatory authority.
the entire
When the combined accumulation of sludge and scum in any tank equals on
(Ys) or more of the tank volume, Wiscon
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13,
Administrative Code. tement
The servicing of effluent filters, mechanical or pressurized POWTS e performed by a certified POWTS Maintainer.nY other
maintenance or monitoring at intervals of 12 months e
i
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for he p resence concentrations are detected have i the conte
that may impede the treatment process and/or damage the dispersal cell(s). g
„r rsla ranir(sj rprnovPd by i sent;we Servidng operator prior to use.
Pict — of .—
System start up shall not occur when soil condltlons are frozen at the Infiltrative surface.
During power outages pump tanks may flll above normal highwatesr levels. When power Is restored the excess wastewater will be
discharged to the dispersal cell(:) In one large dose, overloading the cell($) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage SeWng Operator -prior to restorinti
power to the effluent pump or contact a Plumber or POWTS Malntalner to assist in manually operating the pump controls to
restore ncrmal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the arej
within 15 feet down slope of any mound or at -grade $ot( absorption area.
Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the lift of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoAne; grease; herbicides; meat scraps; medications; oil;
wintlnR Products: oesticides: sanitary naukim: tampons; and water softener brine.
A>gAN DON EM ENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be liken to Insure that the system is
property and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Admintstradve Codet
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and property_ disposed of by a Septage Servicing Operator.
h
v it
• After pumping, all tanks and pits shall be excavated and removed or their covers remo ved a nd the void space filled w�
soil, gravel or another Inert solid material.
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, W provide a code compliant
replacement system:
1 A suitable replacement area has been evaluated and may be utilized fog the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by
required setbacks from exlWng and proposed structure, lot tines and wells. Failure to protect the replacement area will
result In the need for a new soil and site evaluation w establish a suitable replacement area. Replacement systems must
comply with the rules In effect at that tlrne.
O A suitable replacement area Is not available due to setback. and /or soil limitations. barring advams in POWTS technology
a holding tank may be Installed as a last resort to replace the failed POWTS.
O The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may
be installed as a last resort to r the failed POWTS.
the
reconstructed In lace following removal of the biomat at d and at- grade soil absorption systems may be P
Moon p
O 8T
Infiltrative surface. Reconsuvctlons of such systems must.comPlY with the rules In effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.
DEATH MAY RESULT. RESCUE OF A PERSON FROM TKE INTERIOR OF A TANK MAY BE DIFFICULT OR
1MPl1t F.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name bE% 13 I Na me
Phone -'t S- - 6 - Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Namt I Agency S'r C2oiK Csu.nS1
Phon• = hone
S7 — 6 D
I
ST Mix COUNTY
SEPTIC ':'ANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FgI2,M
Owner/Buyer,
Mailing Address ( `� _ S-
Propetly Address
(VeriGeatiou required frou i Planning Department for new construction)
City /State parcel Identification Number /orz coo _
L EGA)<,, I)ES(LRIPTIO
Property Location!54) ' /.,SOU ' /,, S( c. TJQ_ N -R�/ W, Town of
Subdivision Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # (DS3 55 . Volume �[� Page #
S6
Spec hottso Q yes Q no Lot lines identifiable C yes 0 no
SYSTEM 11' AMENA.NCE
Improper use and maintenauceof your sel pc system could result in its premature failure to handle wastes. Proper maintenance
consists of Pumping out the septic tank every tbv a years or cooler, if treedod by a licensed pumper, What you put into the system
can affect the function of the septic tank as a trey anent stage in the waste disposal system.
The property owner agrees to submit to 5t. Oroia Zoning Department a cordfiC,ation form, signed by the awucr and by a
mastetplumber, joumeymmplumber, restrictedpl- i nber or a licenitApumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after in: �eetion and pumping (if necessary), the selstic tame is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirti heats imd agzeo to maintain the private sewage disposal system with tht standards
set forth. herein, as set by the Deparhnetat of Coxc- aezoe card the Departs :font of Natural Resources, Stato of Wisoousin. CetK;fcation
stating that your septic system has been maintainu I gust be completed and returned to the St. Crdix County Zoning Office within 30
days f the direr ear a iration date.
� y
T1AT1T" 90APPLICANT DATE
OW NER CEItEFI TA ION
I (lie) cextify that all statements on this ; inn axe true to the best of my (our) lmowledge. I (we) am (are) the owner(O of
the property described 6o by virtue nf a wawa ity deed recorded iu Rtakter of Deeds Office.
S . ATURE APPLICANT DATE
•'s' "'
Any information that is mis- represented a ay rosult in the sanitary permit being revoked by the Zoning Department.'•tk'•
*' Include with this application: a stamped Warr inty deed from the Register of Deeds office
a copy of the c rtifted survey rnap if reference is made in the wtrrauty deed
VOL V )JQPAGE 50$
STATE BAR OF WISCONSIN FORM 11 - 1982 653155
LAND CONTRACT KATHLEEN H. WALSH
Individual and Corporate REGISTER OF DEEDS
ST • CROIX CO., WI
(TO BE USED FOR ALL TRANSACTIONS WHERE OVER
S23,000 IS FINANCED AND IN OTHER NON - CONSUMER RECEIVED FOR RECORD
Document Number ACT TRANSACTIONS)
08 -07 -2001 9:30 AM
CONTRACT, by and between Hillvale Development Limited a LAND CONTRACT
Minnesota Lim Liability P EXEMPT 0
-- - CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 516.60
-
( "Vendor ", whether one or more) and Halle B uilders, Inc. RECORDING FEE: 12.00 PAGES: 2
( "Purchaser ", whether one or more). Vendor sells and agrees to convey to Recording Area
Purchaser, upon the prompt and full performance of this contract by Purchaser, Name and Return Address
the following property, together with the rents, profits, fixtures and other KRISTINA 0134AND
appurtenant interests (all called the "Property"), in St. Croix ESTREEN & OGLAND
County, State of Wisconsin: 304 Locust
Hudson, WI 54016
Pt 026-1022-20-000 _
(Parcel Identification Number)
Lots 2, 4, 13 14 d 15, Pine Valley Addition, St. Croix County, Wisconsin.
This is not homestead property.
(}s) (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at lace Vendor directs
the sum of S 172,175.00 in the following manner: (a) $ 5, uUu.Uu _
at the execution of this Contract; and (b) the balance of $ 167,175.00 together with interest from date•
hereof on the balance outstanding from time to time at the rate of 10 % percent per annum
until paid in full, as follows: No interest shall be charged on this Contract for six months from the execution of the same.
Commencing on the 30th day of January, 2002, and on the 30th day of each and every month thereafter, equal monthly installments
or principal and interest in the amount of $1.400.00. Purchaser agrees to purchase Lot 2 for $26,675,00, Lot 4 for S26,190.00, Lot 13
for S42,680.00, Lot 14 for $42,680.00 and Lot 15 for $33,950.00.
Provided, however, the entire outstanding balance shall be paid in full on or before the 30th day of
July _ , 2002 (the maturity date).
Following any default in payment, interest shall accrue at the rate of 10 % per annual on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entir'!
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at anytime after day of closing X XXX (9ft)
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 armor that said indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except: First mortgage to Builders Mortgage Company, LLC
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 closing. _ XXX XX
" Cross out one.
LAND CONTRACT - Individual and State Bar of Wisconsin
Corporate Form No. 11 - 1982
Information Professionals Ompany, Fond du Lee, WI 800. 555 -2021
VO!_ -Ui7� PA;:: J`9
Purchaser promises to pay when due all ta; and assessments levied on the Property or upon Vendor's interest
in it and to deliver to Vendor on demand receipts showing such payment.
Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex-
tended coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved
by Vendor, in the sum of $ NIA , but Vendor shall not require coverage in an amount more
than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall
contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original
of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to
insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall
be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be
economically feasible.
Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property
in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and
to comply with all laws, ordinances and regulations affecting the Property.
Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions
shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to
the Purchaser; a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except
any liens or encumbrances created by the act or default of Purchaser, and except: E asements, re striction s a
rights -of -way of record, if any.
Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or
interest which continues for a period of 10 days following the specified due date or (b) in the event of a default in
performance of any other obligation of Purchaser which continues for a period of 10 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 tees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the
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
to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of
the Property during the pendency of such action, and such rents, issues and profits when so collected shall be held and
applied as the court shall direct.
Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any
of 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 f rst paid in full or the interest
conveyed is a pledge or assignment of Purchaser's interest under this Contract solely 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
balance payable under this Contract shall become immediately due 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
this 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 r ye day of July 2001
Hillvale pS,..Iopm htmt d HABy-
(SEAL) (SEAL.)
r ich By: Rard elson Vendor ' G' Purchaser
(SEAL) (SEAL)
+ Vendor a - - -- ---Purchaser
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Hillvale Development Limited, a Minnesota STATE OF WISCONSIN )
Limited Liability Partnership, by Richard Nelson; Halle — ) ss.
COUNTY)
Builders, Inc. by _ of
audietttieesed this tiVfly of July 2001 Personally came before me this day
.,,. � ^ the above
named
7, ' S t --
(iTCE ) ATE BAR OF WISCONSIN to in known to be. the person(s) who executed the foregoing
s *ry. E , . _ —. _� instrument and acknowledge the same.
o hied by § 706.06, Wis. Slats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristine Ogland Notary Public County, Wisconsin
Hudson, WI 54016
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not )
necessary.) —
• Names of persons signing in any capacity should be typed or printed below their signatures.
LAND CONTRACT" Individual and Corporate -State Bar of Wisconsin Form No. 11 - 1982 Information Profassionale Company, Fond du Lac. VN 900- 655.2021
f —
oi
7 . o
i
95,0 S
2.28 A
99305 cres ± 2.18 Acr
cres
i TOP OF 2" IRON
G c i' N PIPE= 992.76
N� L NG �' / �� °'� 137.20' 175.
87,879 SgFt± w,
v,3 c^ 2.02 Acres± �n ;
s
1 1 N89 4 E
w 1 � 75.91' O
O
c"rl 33 3'
+ •o�, ^� `�
Of N y ti' ��• 58 1.4o.w .
I 7 32. 4
in
� m �'�, � .E ,ry • cp•
�\p 1 Z15 r Cp Curve Lot Tor
Z ►t I Number Number Radius B
A
116,330 SgFt± 4 8 -9 667.00' S89
-- 100' -- � 2.67 Acres± '� j `\ h
D • 0"o I R 5 9 667.00' S89
\
a p' '►� f oo. r 6 8 667.00' N72
0G' O 7 10,14 733.00' S89
6��' 2 .r 4 8 1 0 733.00' S89
\� , 00 9 R/W 733.00' N69
C29 q�1'q,.! w u b 10 14 733.00' N64
h � O 11 7 533.00' N59
C.5 x C32 S I , '� 12 14 467.00' N59
? 13 7 467.00' N72
o I "� 14 15 533.00' N72
'S N ° " 3 15 5 -6 523.00' N64
16 6 523.00' N64
12 17 5 523.00' N84
101,033 SgFt± h ti
2.32 Acres± �'�
7'E Uj
n TOP OF 2" IRON �h
? 7& t '2 PIPE = 989.07 -,��
S M NT _ —_ 8 g
164.17' 167.96' 93.44'
9.97' N89 f'40 "E 261.40'
�.M.) S89 °09'E (C.S.M.)
^$ o
N "
61 8 s �
,: ,: R LOT 1 LO
U I ----
O N N O ---- - - --- --
251 0 w
C. S. M. VOL
z
_ _ v7 y 134" 21•
604.58' — — — 63.85' — — — — — — — --
---•—.—.—.—•—•—.—•—. — •— • —•
63.85 a—DEDICATED TO PUBLIC —•-
- -- -- N89 '21� E -- -- —
NOTES:
UNPLATTED LAND_ Access to Lot 12 is limited t.
GENERAL NOTICE STATEMENT. Access to Lot 12 via 170th A
The nnrrelc chnun nn +hic nln+ �.e �.,ti ;e a ♦ ca +, I ...1.. , a r ,.., ti;. No owner or resident shall do
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 S
N Visconsin Madison, WI 53707 - 1 Site Address 01
Dep artment of Commerce
Sanitary Permit Applica `� Permit Number
In accord with Comm 83.21, Wis. Adm. code, Pe rsonal info y ou �11 L
� G ck if vision
may be used for secondary purposes PfivacY Law, s 1 m
I. Application Information - Please Print All Information a State, n�11� Pfau I.D. Number
Property Owner's Name, Parcel
t
Property Owner's Mailing Address property Location
-A Z hA; S la T e2 N. R
t,, state Zip Code Phone Number Lot Number Block Number
�^ 1� Subdivision Name CSM Number
H. Type of Building (check all that apply) ' - tf ❑City
❑ I or 2 Family Dwelling - Number of Bedrooms .p e v' ❑Village
❑ Public/Commercial - Describe Use PTOWUSNP A 4 1k . 1 11 A0 I eV
❑ State Owned Neatest Road
o r.4 sT
III. Type - of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A 1 6 0 Adi I For County use
1 )(New 2 ❑ Replacement System 3 ❑ Replacement of
stem Tank Onl stem
B. ❑ Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44 X Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 0 pressuzized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Lin
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. D' tment Area Information: ,Z A e trJ e CA m r
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
R Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation
y5� mss✓ ✓
�Y3 G�3 l_z e.l-411 Q It5 5"a Sao. 3
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons I Gallons of Tanks Concrete Constructed Glass
New Existing
Tacks Tacks
Septic or HoWW Teak
Dosing (umber
VII. Responsibffity Statement - I, the undersigned, asstmse responsibility for tion of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
VIII. Count eipartment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑ Disapproved Surcharge Fee)
❑ Owner Given Initial Adverse Z _� j /
Determination Ion, �:4fr�4-�
UL
IX. Cond of Approval/Reasons for Disapproval j
l !v<Q irl�a�Keo f �t�iJ a
� uP t✓ � MS a Qw r P e lv1Aµ� aG �1�Qr � � eGo
Attach complete pleas (to the County only) for the system on paper not lm than Ella x 11 inches in size
SBD -6398 (R. 05101)
FROM P C COLLOVR BLDRS, INC PHONE NO. : 715 549 5911 Sep. 01 2001 08:43RM P4
Ly
06 1 6va ce y
Roll sln•irer4424GV
LOT 21 LOT 20 I
1 �� ' w, :.s ■toes s_e AcnKS ,
FFF � al �+ la_s �anertl 1 *•« Aenet) � � I
03
ras•7t �!1•.0� '
• yl I
i i (
- _ - ( • • LOT 19 �, I
N .ep 2.e ACRES
;ertt�O7 r73.8r rrr n• / I" AChRSI I
�nl."•wwn
of a : PROPOS flOM — — ... - -_ —� w,wc•av F�vCMFJ�,
air
1 ( LO 17
' , \® eA AMIN I ,
1 LOT 16 I (i.r Acnlr) ( 1
I
— _ — 2.5 ACRES ( LOT 18 C al
1 la.rt AGhCiI I p I $I
I
3.1 Ad,11111 MMi 1�
44V I2A AChYq 1
I
wr r,r I 1 M
I,
1 -
LOT 15 LOT 14'
2.5 ACR'ir I : Ac11Ar
(2.9 Acn■ ;) ` I lyy Acnee) IMF A
/ \
LON i
Lov U 4'I.IbO. IWq Il_G ley maer
- A
— •— MOONIIEnM ROM
V -114-awl /
-5 c
� � �
/ � acres \ I
P. C. COLLOVA BUILDERS, INC.
MN 01073 WI 015195
(715) 549 -5977
705 County Rd. E
HUDSON, WISCONSIN 54015 z
G (,,R:
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