HomeMy WebLinkAbout026-1143-80-000 a
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
487953 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
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:
Nelson, James Richmond, Town of 026- 1143 -80 -000
CST BM Elev: Insp. BM Elev: SM Description: L / Sectionlrown /Range /Ma No..
20. 0.18.1049
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchma k
f) (�(c 3. /a 3- . a
Dosing / Alt. BM a• 7
Aeration L Bldg. Se •v S �
r T
Holding f !t/Tit Inlet ` N � -� S
S t O utlet J �I
TANK SETBACK INFORMATION �O �7
TANK TO P WELL B to Air Intake ROAD Dt Inlet Septic y Dt Bottom 4-�
Dosing ead /Man.
Aeration Dist. Pipe
maty
Holding Bot, System
Spits y
T
PUMP /SIPHON INFORMATIO Final Gra e
Manufacturer Demand St Cover qq
GPM
Model Numb
TDH Lift Friction Loss ead TDH Ft
Forcemain Length ia. Dist. to Well
SOIL ABSORPTION SYSTEM Z
B DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS [ CHAMBER o. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 /„ Q - —f 7 .. :
SETBACK SYSTEM TO l � ff P/L BLDG WELL LAKE /STREA LEACHING Manufacturer.
INFORMATION Typ f System: OR lJ
l0 / UNIT M del Number:
ST�t IBUTION SYSTEM ej f[.e; P L F'b>F1u► e�tA+dt� Ad
Header anVgld Distribution x Hole Size x Hole Spacing Vent to Air Intak
I q 4 Pipe(s) n h f
ngth I Dia " Length Dia Spacing i - I -
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 No j Yes A
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:i D ftZDspection 9 2:
Location: 1053 144th Av nue New Richmopd, WI 54017 (NE 1/4 SW 1/4 20 T30N R1 8W) Wald'rofff[,M�eaaddo`w.s Lot 8 Parcel No: 20.30.18.1049
1.) Alt BM Description
2.) Bldg sewer length
amount of cover A/ - - -� --
r F
Plan revision Required? [,Ves [' No >/ Q
Use other side for additional information.
Date Insepctor's Signatu Cart, No.
SBD -6710 (R.3/97)
• 1
l
1
I N Safety and Buildings Division Coun
f k , .4 �� MM a d 201 W. W P v n u �u� _ � SCaI �s�ff To n, KT, 1) Sanitary Permit Number (to be fi ed in by Co.)
Dep artment of Commerc 08)2bF375T q e o
- 7 K3
Sanitary Perm p ati" V %00 State Plan I.D. Number
In accord with Comm 83.2 1, Wis. Adm. Code, perso in rmation you provide
may be used for secondary purposes Privacy Law s15.0t11j(r r OIX COUN f Y Project Address (i different th ailing dress
OFFICE /0 )
A
I. Application Information — Please Print All Information J 7 `�
Property Owner's Name Parcel # Lot Block #
Property Owner's Mailing Address Property Location
,3 ,
C
ity, State Zip Code Phone Number f-- Y. ,5�J Y4, Secti0n,2 r
` 1 I 'In ' `) / rcl, r one (Q L �) n v �S C/ N; _ / W
H. Type of Building (check all that apply) T Il
Subdivision Name CSM Numbe r
r2 Family Dwelling - Number ofBedrooms
❑ Public /Commercial - Describe Use !y
❑ State Owned - Describe Use ❑City ❑vill ship o
b
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A * S stem ❑ Replacement System ep y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System
B. ❑ Permit Rene ermit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expirati Plumber Owner dD I's-
IV.3yp of POWTS System: Check all that apply) / /
on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -G ound El Holding Tank [J Peat Filter El Aerobic Treatment Unit 11 Recirculating Sand Filter El
Recirculating Synthetic Media Filter aching Cham Drip Line ❑ Gravel -less Pipe ❑ Other (e am
V. Dispersal/Treat ent Ar Informatio .
Desi flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area koposed System Elevati on
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site 8teel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit ' -
!/
Dosing Chamber
VII. Responsibility Statement- 1, the undersig assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's ame (Print) Plumber' ignature MP/MPRS Number Business Phone Number � �
a
Plumber's Address ( treet, City, State, Zip e)
� -K 1�
VIII. un /De artment Use Onl
pproved Disapproved Sanitary Permit Fee (includes Groundwater Da Issued Iss ' g Agent S store (No tamps) ed Surcharge Fee) �/ 20
❑ Owner Given Reason for Denisi y
IX. Conditions of Approval/Reasons for Disapproval
A d
M, C'ST/ �t,�• x ALI d
Atwh complete plans (to the County only) for the system on paper not less *n 812 x 11 inches in sire
9 �l s� -� �2.� W C a- OtA" sxv/Lf?At 4-&(-J ahem wz�✓
SBD -6398 R ���` p
(. 01 /03) o ok ay- mx ' l � � t3,3 /45 9/,& 15 c7--
O_,zc.J Ghlz
S i est d System PLOT PLAN
PROJECT James Nelson ADDR S 319 N. Pearl St. River Falls Wi 54022
NE 1/4 SW 1/4S 20 /T 30 /R 1 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/20/05 BEDROOM 3
CONVENTIONAL XXX IN-GROIN ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
IL BENCHMARK V.R.P. Walkout Foundation ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.8/94.1
Pro Town Road
Plans Designed Using
Conventional Po Vent
Manual Version 2.
>6 » Standard Biodiffuser
of
Leaching Chamber
Cover
with 31.1 ft2 of Area
6' Long 11 "
Grade at System Elevation
34"
Well is to meet all
setbacks required by
WDNR
180'
Original Soil Test was
worthless, it was done in
complete fill and in a old
railroad grade. This was
verified by Pam Quinn
during inspection!
Pro 3
Bedroom
House
B.M. * 15'
5'
20'
ST 10' B -3 22 5'
25'
Vents
70'
488' Property Line B -2 55 ' 15'
B -1
2 -3' X 69' Cells with >3' Spacing 9% Slope Property Line IF
Property Owner _ Parcel ID # Page of
a Ong # ❑ Boring C'
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
O S �._ PIS _7 1, ,
F-I Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Boring # ❑ Boring
F
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
[ Ell Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
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 130 mg/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.
SBD46330 (R.bUO)
Mcon'sin oepartinent of Commerce SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
. - in accordance with Comm 86, Wis. Adm. Code County
Attach complete plan on paper not less than 81/2 x 11 inches in size. Plan must _54 C roix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re by Date
Personal information You provide may be used for secondary purposes (Pricy Law, s. 16.04 (1) (m)). Q • Z
Property Owner 1 Property Location
Govt. Lot 1 (,f 1/40)1/4 S Zo T R l E (or)
Property Owner's Mailing Address Lot # I Blodc # Subd. Name or CSW
.t' . Mead s
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
1 1 ) r ;� tchrnand _ C -
M New Construction Use: ® Residential / Number of bedrooms . 3 � Code derived design flow rate d GPD
Q Replacement Public or commercial - Describe:
��
Parent material �T U"�a1r�_S v Food Plain elevatio applicable ft.
(
General comments �Y�t-r vY e 2l) do f C /o. 60 I�CX���(� Ov
a nd recommendations: n L4• C/O 2-6
- fa P { err 4 ?_Qr, of, Qcrr ,^rvc�
" C 1 5
_ bS G
Boring Boring
ng
F fl Pit Ground surface elev. ft. Depth to limiting factor Rate
Soll Horizon Depth Dominant Color Redox Description Texture Structure C inasteno Boundiiry r Roots ;
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. - _fiAF1' `Etf#2
1 p —?q t 3 Z • 1 2 5 .
Z Zq—S31 10 N14 -( Z -Fr C_ 5 .�'
Boring # nC Boring a pit Ground surfaceelev. 93.2D ft. Depth to limiting factor 13 in. Sol A Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i 'Eff#1 'Eff#2
i ! (31 Sr�l 2 c VC . - 5 8
2 10 I Si 2 c 5 8
Z S - _ % — — _ 1.
3 _ -1 t� rylto - f a m! -� 2
zo
* Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg1L
CST Name (Please Print) nature CST Number
) tq 25 q
Adder Date Evaluation Conduced Telephone Number
2 3 6 - zo - CJcD j5 )Zy7 -UC0
Property Owner Parcel ID # Page 2 , of * . : '
Q
Boring # Soli Rate
P Ground surface elev. r Depth to limiting factor in.
kDominant Col Redox Description Texture Structure Consistenoe Boundary Roots GPDift? Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *001 •Etf#2
' I Z C 15 -Fr c t _ o _ -•
6 9• � /os.
# ❑
Boring F 2 ® Pit Ground surface elev. 9 y . 2 U ft Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 •Eff#2
l 2 -- S; 2 c 1 v-� . 5
- 7 /• 2
G�
F Borg # ❑ Boring
® Pit Ground surface elev. 80 ft. Depth to limiting factor �Q� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. I Munsell Qu. Sz. Cont Color Gr. Sz Sh. I •EW •Eff#2
el l 21MM I 1 VYYn lr c5 1 vC . 5 . S
5' Z tr'Fr c S — . 5 • 8
�f '- m5 O m� r — -� l•a
•
Effluent #1 = BOD > 30 220 n9t and TSS >30 <_ 150 mg& ` Effluent #2 = BOD <_ 30 mg/L and TSS _< 30 mg&
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.
S81 -8330 (807/00)
I -
PAGE
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NAME(6)g(gf fO!g LOT# `!S LEGAL DESCRIPTION NE' /nSW4,S20T3Q N,Rl E (or) CM
SCALE: 191= 7 d
BM 1 ELEVATION 100 '
BM 1 DESCRIPTION � p O SLt r IC a lo ck !'
BM 2 ELEVATION
BM 2 DESCRIPTION ' 1p
SYSTEM ELEVATION -60 f0- c6O LawAr $
ALTERNATE ELEVATION '
CONTOUR ELEVATION 47 �
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n - �aN�inee
�Q,o011.o AN INVESTMENT []3
DEPARTMENT STORE IN YOUTH REALTOR-
Three Levels Of Fine IS AN
Merchandise INVESTMENT
Greater Selection & Quality IN TOMORROW FARMS - RESIDENTIAL - COMMERCIAL
"RENTALS"
New Richmond Wisconsin 358 North Knowles Avenue OFFICE: 715 - 246 -6042
01 Be A 4 -H Leader New Richmond, Wi sconsin 34017 Home: 715 - 246 -6052
Safety an d Buildings Division County
201 W. Washington Ave., P.O. Box 7162 �� 1
Alf ` ������I� Madison, WI 53707- Sanitary Permit Number (to be filled in by Co.)
(608) 266 -3151 z4 9 4- 9 5- 3
Department of Commerce State Plan 1.D.Number
Sanitary Permit Application
In accord with Comm 83.21, Wis. Adm. Code, personal information you pro de ro (if different than mailing address)
may be used for secondary purposes Privacy Law, sl5.04(1)(m) L /
I. Application Information - Please Print All Information p R N ED � /o / y� ( 4 ' Ave
Parcel Lot Block #
propertyOwr,er'sName � 2905 4-"-
Property Location
Property Owner's Mailing Address ' S7_ CROIX COUNTY f � /r
l �r G OFFICE / y�% y., Section
City, State .
Zip Code er -
-}- rrcl e
I• �� 1 'KD rr N> > - E r W
- 4�.� - 3ype of Building (check all that apply) as �er 4 w�`" ` ' Subdivision rjanle
r, 2 Family Dwelling - Number of Bedrooms
_
� GGGrrr///
❑ Public/Commercial - Describe Use
❑City ❑Village w �s} of
❑ State Owned - Describe Use
III. Type Perrm t: (Check only one box on line A. Co lete line B if applicable)
A ' w System Replacement System 11 Trea t/Holding Tank Replacement Only ❑Other Modification to Existing System
List io Permit d Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑Change of?, ❑ Permit Transfer to New ' S
Before Expiration Plumber Owner
r
IV. a of POWTS System: (Check all that appl
❑
- Pressurized In-Ground L] Mound 124 in. of suitable soil ❑ MO u d < 24,•7 1,. of suitable soil ED] At- g e Pass Sand Filter
El
Constructed Wetland El Pressurized I round El Holding Tank ❑ Peat i tee ❑ Aerobic Treatment Unit El Recirculating Sand Filter
❑ Other plain)
Recirculating Synthetic Media Filter Ching C bet ❑Drip ine e l-less Pipe ❑ uAk`
re AA Z
V. Dispersal/Treat ent Ar nformation: b ` Dispersal Area Pro sod (s ^ S evaU n
Design Flow (gpd) Design Soil Application Rat gpd Dispersal Area uir (sf) sp ' -7
CJ /
Ca aci m Total Number �' Manufac or Prefab Site 1 Fiber Plastic
VI. Tank Info P ty Concrete Constructed Glass
Gallons Gallons ofUni W( A -
New Fasting f�
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment U nit f
Dosing Chamber
VII. Responsibility Statement - 1 , the undersigne nine resp sibility for installation of the WTS shown on the attached plans
MP/MPRS Number ' Business Phone Number
Plumber' Name (Print) Plumber' store 7 � � v � J
_eZ_U rti
Plumber's Address (Street, City, State, ode)
VIII. Coun /De artment Use Onl
San' Permit Fee includes Groundwater Date Issued lssuin Agent Signature (No Stamps)
Approved ❑ Disapproved S ge Fee)
❑ .ven Reason Denial 8 Z
IX. Condition prov
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in sift
SBD -6398 (R. 01/03)
kUNDPRESSURE T PLAN
PROJECT James Nelson DDRESS 319 N. Pearl St. River Falls Wi 54022
NE 1/4 SW 1 /4S 20 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/20/05 BEDROOM 3
CONVENTIONAL XXX IN- CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 , ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top 1/4" rebar location unknown! ASSUME ELEVATION 100' Filter ZabelA -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
AL SYSTEM ELEVATION 89.2/88.7' 5' below qrade
Pro Town Road
Plans Designed Using
Conventional Powts
Manual Version 2.0 Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 )7
Well is to meet all 34" Grade at System Elevation
setbacks required by Soil Test is absent of all benchmarks. '
WDNR System location and depth will be
determined based on boring elevations!
180' Flood plain elevation and
stakes will be established
before installation!
50' -1 ID 0 ' � 55' - B-5 Pro 3
Bedroom
15' House
d L 0'
ent� B-3 _ 20' D
95'
-2 6% Slope B-4
2 -3' X 69' Cells with >3' Spacing
488' Prop
I�
4UNDPRESSURE T PLAN
PROJECT James Nelson DDRESS 319 N. Pearl St. River Falls Wi 54022
NE 1/4 SW 1 /4S 20 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/20/05 BEDROOM 3
CONVENTIONAL X IN- )00( CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top 1/4" rebar location unknown! ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 89.2/88.7'5' below qrade
AL
Pro Town Road
Plans Designed Using
Conventional Powts
Manual Version 2.0
Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 1191
Grade at System Elevation
Well is to meet all 34" Soil Test is absent of all benchmarks!
setbacks required by System location and depth will be
WDNR determined based on boring elevations!
180' Flood plain elevation and
stakes will be established
before installation!
B -1 B -5 Pro 3
50' 40' 55' Bedroom
15' House
0 ' O Vents B -3 20'
40'
95'
6% Slope B -4
2 -3' X 69' Cells with >3' Spacing
488' Property Line
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
Option #1. If system fails, determine cause of failure, use alternate area and install new
system in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ��" ¢`� ��y7�✓
Mailing Address 3/ 1 41\
Property Address D A �
(Verification required from Planning & Zoning Department for new construction
City /State Parcel Identification Number oZb - 1143 8 - oL'z
LEGAL DESCRIPTION
Prop Location L 1 /a I/4 , , Sec. -Q T N Rj Town of
Subdivision �iV `J r� / I t-CJ� , Lot #.
Certified Survey Map # , Volume , Page #
L,q v D Co-K1 AC-T -
# 7k , Volume Page # f 0 Z
Spec house yes Lot lines identifiable no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
U e certify that all atements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property e:ed above, virtue of a warranty deed recorded in Register of Deeds Office.
SIG OF APPLICANT(S) DATE
* �* Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
U. 2709 P 102 - 7 8175925 `
STATE BAR OF WISCONSIN FORM 11 - 1982 KATHLEEN H. NALSH
LAND CONTRACT REGISTER OF DEEDS
Individual and Corporate ST. CROIX CO., MI
(TO BE USED FOR ALL TRANSACTIONS WHERE OVER
Document Number $25,000 IS FINANCED AND IN OTHER NON - CONSUMER RECEIVED FOR RECORD
ACT TRANSACTIONS) 12/06/2004 10: 20AN
CONTRACT, by and between David J. Waldroff and Julie A. LAND CONTRACT
Waldroff. husband and wife ( "Vendor ", EXEMPT •
whether one or more) and James Nelson REC FEE: 13.00
TRANS FEE: 186.00
( "Purchaser ", whether one or more). Vendor sells and agrees to convey to COPY FEE'
CC FEE:
Purchaser, upon the prompt and full perfomance of this contract by Purchaser, PAGES: 2
the following property, together with the rents, profits, fixtures and other
appurtenant interest (all called the "Property "), in St. Croix County, State
of Wisconsin:
Lot 8, Waldroff Meadows. St. Croix County, Wisconsin.
Recording Area
Name and Return Address
l <: x.031 -AND
^ T
_ ill. = Y AT LAW
P.O :Ox 3:59
W1 54016
026- 1143 -80 -000
Parcel Identification Number (PIN)
i
This is not homestead property.
(is) (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at place Vendor directs , the sum of $ 62,000.00 in the follow` lg
manner: (a) $ 6,200.00 at the execution of this Contract; and (b) the balance of $ 55,800.00 , together with interest from date hereof on
the balance outstanding from time to time at the rate of 8.00 percent per annum until paid in full, as follows:
On January 1, 2006, Purchaser shall pay to Vendor an annual payment of interest only ($4,860.26)..
Provided, however, the entire outstanding balance shall be paid in full on or before the 1_` day of January 2007 (the maturity date).
(which amount shall include accrued interest).
Following any default in payment, interest shall accrue at the rate of_ %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 to Vendor amounts sufficient to pay reasonably anticipated 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 elosine
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balancc A
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 s., ^id
indebtedness would have been had the monthly payments been trade as first specified above; provided that monthly payments shall be continued+;n
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: A
Mortgage to Central Bank to David and Jule Waldroff in the original amount of $150,000.00, dated August 27, 2001.
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 .
" Cross out one.
STATE BAR OF WISCONSIN Information Professionals Company, Fond du Lac, WI
LAND CONTRACT - individual and FORM No. 11 - 1982 800 -655 -2021
Corporate
` U 2709P 103
Purchaser promises to pay when due all taxes 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, extended coverage perils and such
other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the sum ofS 62.000.00 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 ofthe Vcndoes 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 ofthe 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;; e
Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except:
Easements, restrictions and rights -of -way of record, if any.
s
Purchaser agrees that time is ofthe essence and (a) in the event of a default in the payment of any principal or interest which continues for
a period of 60 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 60 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 Vendors 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 Purchasers 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 ofthe 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 ofthe 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 ofthe 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, election of ofthe foregoing remedies shall only be binding upon Vendor ifand when pursued in litigation and all costs and expenses
e , an c anY g B Y g P P g P
including reasonable attorneys fees 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 incurred, 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 c a
receiver ofthe Property, including homestead interest, to collect the rents, issues, and profits ofthe Property during the pendency of such action, a-id
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 first paid in full or the interest conveyed is a pledge or assignment of Purchasers interest under this Contract solely
as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendors 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 ofthis Contract shall be binding upon and inure to the benefits ofthe 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 th is day of December , 2004
(SEAL) _ ' " - - -- (SEAL)
Davi J. W aldroff ,* �-* ►im Nelson - -- --
(SEAL) — - -- - - _ - - - (SEAL)
ulie A. Waldroff •
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) David J. Wald and Julie A. Wa ldroff, STATE OF
husb an wife a nd Jim Nelson ) ss.
County )
authenticated this � of December 2 004
Personally came before me this day of
-
____ the above named
' Kristina Oglan
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by # 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland `
Hudson, WI 54016 Notary Public, State of
My Commission is permanent. (lf 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 signature. Information Professionals Co., Fond du Ls , WI
STATE BAR OF WISCONSIN 800655 -2021
LAND CONTRACT - Individual and Corporate FORM No. 11 - 1982