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ety B epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
and uilding Division R s `
INSPECTION REPORT Sanitary Permit No:
88
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:
Albert, Todd Springfield, Town of 034 - 1078 -90 -000
CST BM Elev: Insp. BM Elev: SM Description: Section/Town /Range /Map No:
34.29.15.5278
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number.
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
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 Y I No Yes No
I� es � -� � -J
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 3090 60th Avenue Wilson, WI 54027 (SE 1/4 SE 1/4 34 T29N R1 5W) NA Lot 1 Parcel No: 34.29.15.527B
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
3.) Contour =
Plan revision Required? ❑Yes [] No
Use other side for additional information. _ I
Date Insepctor's Signature Cart. No.
SBD -6710 (R.3/97)
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County. Sanitary Permit Cation ST. CROIX COUNTY WISCONSIN
In accord with 15.04 St. Croix County S to nance ZONING OFFICE
Personal information you provide may be used c urposes ST. CROIX COUNTY GOVERNMENT CENTER
[Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road
L D Hudson, WI 54016 -7710
(715)386 -4680 Fax(715)386 -4686
Attach complete plans fo r the system on per 11 me as in size.
Coin Sanitary Perm t�, Check if ision to p evioileh , tfon
.S1' 7 C On y
I. Application Information - Please Print all Information Z i_ cation: C V
roperty Owner Name 5 _)i }; ,�� r 1 1/4 ir 1/4, Sec S
ZONING OF "CE N, R ✓ W
Property Owners Mailing Address lot
B) Number Biotic Number
City, State Zip Code Phone Numer Subdivision Name or CSM Number
�� „ 't �'� ° ?. > .f-� 1�' y � X1 6= � /�`!'S "�'�`'•� �_5 _i � �C'' .4��� �` � 'L n ,
!.E
tl T pe of Bui ga a f Village n of
■ 1 2 Family Dwelling - 6. of Bedrooms:
Publ' ascribe use):
State -owned Nearest Road
11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) /� V
Par ax Number(
A) J 1[]Repair 2 Reconnection 3�Von-plumbing Rejuvenation
Sanitation 5_ — D C^ L
Permit Number Date Isssu d
✓ State Sanitary Permit was previously issued 2 3 3 / Z
IV. Type of POWT System: (Check all that apply) ` 5
n Non - pressurized In- ground Round — S” �/ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other
Dispersal/Treatment A rea Informat
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed (Gals. /day /sq.ft.) (Min. /inch) i Elevation
I. e7 ell 14J 1. Tank Information Capaic in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic
New xisting allons Tanks Concrete structed glass
Tanks Tanks
ri
T iZW�T
ov
ill. Responsibility Statement
I, the undersigned, assume responsibility for repair nnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A
license is not required for terralift repair or the instakation 'of non- lumbin sanaption system.
Plumber's Name (print) PI ers Sign ps MP /MPRS No. 1131.0ness P ne Number-
lumber's Address (Street, City, S , Zip ode)
111. Couroy Use Only
Disapproved Sanitary Permit Fee D to Issued I wing Age t Signal o stamps)
c
Approved Owner Given Initial Adverse �� _
Determination i S
IX. Conditions of Approval /Reasons for Disapproval:
61 STPM nwNFR•
Septic tank, effiuent filter and
dispersal cell must all be serviced/maintained
as per management plan provided by plumber.
2, Ali setback requlrem
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F4 SANITARY PERMIT APPLICATION Safety and ui i i in g gs A t e r
Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
ach complete plans (to the county copy only) for the system, on paper not less County
han 8 1/2 x 11 inches in size. ST CROIX
See reverse for instructions for completing this application State Per t Number
se s sanitary
�33Q�2 --
IThe i m nfor ation you provide maybe used b other government agency programs Y 9 9 Y P 9 ❑Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan LD. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF ORMATION S9 5 -40582
Property Owner Name Property Location
WALTER HILLSTEAD SE 1/4 SE 1/4, S 34 T 29 • N, R 15 Y10 W
Property Owner's Mailing Address Lot Number Block Number
448 HOMER TRAILER CT, RT 8
City, State Zi Code Phone Number Subdivision Name or CSM Number
MENOMONIE WI 4751 (715 )235 -4513
II. TYPE OF BUILDING: (check one) ❑ State Owned 0 cit� Nearest Road
El Public L3 1 or 2 Family Dwelling - No. of bedrooms _ 5 O Town of SPRINGFIELD 60TH A VENUE
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 034 1078 -
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. [N New 2_ ❑ Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an
___System -------- System - -- ---- - - ---- Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
1 1 ❑ Seepage Bed 21 [1 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -in -Fill
VI. AB SORPTION S YSTEM INFORMATION:
1. Gallons Per Day 2. Absorp, Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Z Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
62 5 625 1,2 N/A 97. Feet 99.29 Feet
VII. TANK Capacity
Site
in gallons Total # of r Prefab. Fiber- Ex er.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Co steel Plastic p
New Existin strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank 1750 1750 2 MIDWESTERN PRECAST ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 10001 11000 MIDWESTERN PRECAST ❑ ❑ ❑ ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumbe 's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number:
9
BENNIE HELGE SON MPRS 3215 715/772 -3278
Plumber's Address (Street, City, State, Zip Code): 54767
W1229 770TH AVENUE, SPRING VALLEY, WI
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved X� Vpel ? o y Permit Fee (Includes Groundwater ate Issue Issuing Ag nt Si nature (No a s)
❑ Owner Given Initial A roved Surcharge fee)
pp Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SUD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
----� � OWNERSHIP CERTIFICATION FORM
Owner /B — I ob b A&BERi - r
Mailing Address 7762 Qd 5-A Ate Sb)� Str , wl G - W Z S'
Property Address 3 0 -7o � 30 J 6 &0
(Verification required from Planning Department for new construction.)
City /State � fc�s�aJ, ��S Parcel Identification Number D3 V /07I —o
LEGAL DESCRIPTION Glm-W 0 3y_ /0 2 /�O - mU
Property Location 5C '/4 , 5� '/4 , Sec., T 2 / N R W, Town of
Subdivisio Lot #
Certified Survey Map # 9� ' Volume Idl , Page # _—_� 3 U
Warranty Deed # :7 &6 4 1 �j , Volume -� , Page # 7Cos
Spec house s yes Lot lines identifiable ;4 no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix County 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.
I /we, 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 Zoning
Departm within 30 days of the three year expiration date.
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the
property cr; ed above, by virtue of a warranty deed recorded in Register of Deeds Office.
S' S�
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
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Parcel #: 034 - 1078 -90 -000 05/25/2005 08:28 AM
PAGE 1 OF 1
Alt. Parcel M 34.29.15.527B 034 - TOWN OF SPRINGFIELD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
TODD ALBERT * ALBERT, TODD
3090 60TH AVE
WILSON WI 54027
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.140 Plat: N/A -NOT AVAILABLE
�.. SEC 34"T2 15W PT SE SE BEING LOT 1 Block/Condo Bldg:
CSM 10!2930 .14 ACRES
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
34- 29N -15W
Notes: Parcel History:
Date Doc # Voi /Page Type
06/21/2004 766437 2599/466 WD
1125/35 WD
2005 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations Last Changed: 06/25/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.140 7,350 31,600 38,950 NO
Totals for 2005:
General Property 1.140 7,350 31,600 38,950
Woodland 0.000 0 0
Totals for 2004:
General Property 1.140 7,350 31,600 38,950
Woodland 0.000 0 0
Lottery Credit Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r M N N R oo m
i ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
--�� Hudson, WI 54016 -7710
(715) 386 -4680
March 7, 1996
Walter Hillstead
3096 60th Avenue
Wilson, WI 54027
Dear Mr. Hillstead:
On March 4, 1996, I visited your property and spoke with you about
the violations created by the mobile homes. You have told me that
the second one placed on your property is to be used only for
storage, and not as a residence.
I have agreed that it may remain only if all of the plumbing
fixtures are removed. A deadline of March 31, 1996 was given to
allow time to complete the removal. You agreed to notify me when
it is completed, and at that time, I will return to your property
to inspect the mobile home for compliance.
At that time, I will also expect the first mobile home, that is
your residence, to be moved to comply with the required setback
from the road. If it is not, legal action will be taken to obtain
compliance.
Should you have any questions, please contact me.
Sincerely,
Mary7. P ienkins
Assistant Zoning Administrator
cc: Clerk, Town of Springfield
File
I
f
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
110
1 Carmichael Road
r Hudson, WI 54016 -7710
(715) 386 -4680
e ruary 20, 1996
Walter Hillstead
3096 60th Avenue
Wilson, WI 54027
RE: Violation No. 95 -V -24 & Violation No. 96 -V -11
Dear Mr. Hillstead:
On September 14, 1995, a violation was issued to you for the
placement of a mobile home less than the required setback from the
road.
On September 26, 1995, you visited my office, requesting that you
be given more time to move the mobile home farther from the road.
I agreed, with the condition that you keep me informed of the
progress you were making in the fall to bring in fill. I also
agreed that you would be allowed until spring to move the mobile
home. My records indicate that you agreed to have the mobile home
moved by March 1, 1996. I have not heard from you since September,
and yesterday, a second violation was issued due to the fact that
an additional mobile home has been placed on the property. I have
given you until March 15, 1996 to remove the additional mobile
home, however, urge you to remove it immediately due to spring
thaws making a difficult situation for moving the mobile home.
I will also extend the deadline to move the first mobile home back
from the road to March 15, 1996. If that has not been done,
however, and the mobile home that was most recently placed on the
property has not been removed by that time, I will, without further
notice, turn both violations over to the county's legal department
with a request to begin legal action to obtain compliance.
Should you have any questions, please contact this office.
Sincerely,
Ma Jenkins
Assistant Zoning Administrator
cc: Corporation Counsel
Clerk, Town of Springfield
File
i
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
_ 1101 Carmichael Road
. = Hudson, WI 5401 6-7710
(715) 386 -4680
�uary 20 , 1996
Walter Hillstead
3096 60th Avenue
Wilson, WI 54027
RE: Violation No. 95 -V -24 & Violation No. 96 -V -11
Dear Mr. Hillstead:
On September 14, 1995, a violation was issued to you for the
placement of a mobile home less than the required setback from the
road.
On September 26, 1995, you visited my office, requesting that you
be given more time to move the mobile home farther from the road.
I agreed, with the condition that you keep me informed of the
progress you were making in the fall to bring in fill. I also
agreed that you would be allowed until spring to move the mobile
home. My records indicate that you agreed to have the mobile home
moved by March 1, 1996. I have not heard from you since September,
and yesterday, a second violation was issued due to the fact that
an additional mobile home has been placed on the property. I have
given you until March 15, 1996 to remove the additional mobile
home, however, urge you to remove it immediately due to spring
thaws making a difficult situation for moving the mobile home.
I will also extend the deadline to move the first mobile home back
from the road to March 15, 1996. If that has not been done,
however, and the mobile home that was most recently placed on the
property has not been removed by that time, I will, without further
notice, turn both violations over to the county's legal department
with a request to begin legal action to obtain compliance.
Should you have any questions, please contact this office.
Sincerely,
Mary Jenkins
Assistant Zoning Administrator
cc: corporation Counsel
Clerk, Town of Springfield
File
,.�. ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r r r r r r r r r rnrf ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
NOTICE OF VIOLATION (715) 386 -4680
February 19, 1996 Violation No. 96 -V -11
Walter Hillstead LOCATION: SEhSEh, Section 34
3096 60th Avenue T29N -R15W, Town of Springfield,
Wilson, WI 54027 St. Croix County, Wisconsin
Dear Mr. Hillstead:
As required under the ST., CROIX COUNTY ZONING ORDINANCE, notice is
hereby given that you are in violation of Article 15.15(1)(d) of
the ST. CROIX COUNTY ZONING ORDINANCE.
The violation noted is the placement of a second residence on a
parcel of land.
This violation is noted to have occurred February 14, 1996.
REQUIRED ACTION: By March 15, 1996 remove the mobile home from the
property.
Failure to comply with this order will result in this office
seeking enforcement through circuit court as allowed by Chapter
145.20(2)(f), Wisconsin Statutes and /or through the issuance of a
citation in the amount of 250 per day for each da
ci i $ p y Y the violation
continues beyond the deadline given above.
Should you have any questions, please contact this office.
Sincerely,
Mary a. Jenkins
Assistant Zoning Administrator
cc: Corporation Counsel
Clerk, Town of Springfield
File
I
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
Email ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
. _ Hudson, WI 54016 -7710
NOTICE OF VIOLATION (715) 386 -4680
February 19 1996 Violation No. 96 -V -11
Walter Hillstead LOCATION: SEkSEh, Section 34
3096 60th Avenue T29N -R15W, Town of Springfield,
Wilson, WI 54027 St. Croix County, Wisconsin
Dear Mr. Hillstead:
As required under the ST., CROIX COUNTY ZONING ORDINANCE, notice is
hereby given that you are in violation of Article 15.15(1)(d) of
the ST. CROIX COUNTY ZONING ORDINANCE.
The violation noted is the placement of a second residence on a
parcel of land.
This violation is noted to have occurred February 14, 1996.
REQUIRED ACTION: By March 15, 1996 remove the mobile home from the
property.
Failure to comply with this order will result in this office
seeking enforcement through circuit court as allowed by Chapter
145.20(2)(f), Wisconsin Statutes and /or through the issuance of a
citation in the amount of $250 per day for each day the violation
continues beyond the deadline given above.
Should you have any questions, please contact this office.
Sincerely,
Mary J. Jenkins
Assistant Zoning Administrator
cc: Corporation Counsel
Clerk, Town of Springfield
File
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Qr
ADDRESS 3Q�o d- 3c)f( �
C�'(so
SUBDIVISION / CSMJ LOT
SECTION T S N_R 1 1 :� - W, Town of ` \
ST. CROIX COUNTY, WISCONSIN
PLAN VIER
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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INDI CATI' 14ORTH hPPOW
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Provide setback and elevation information on reverse of this form -
Provide 2 dimensions to center of septic tank m<�nhole cover
� f
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BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
,coo
Manufacturer: r-,,, f herd - Liq Capacit ?�
� P Y = goon
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Setback from: Well House �� Other
Pump: Manufacturer UDct1 Model# Siz
Float seperation Gallons /cycle: ��7a
Alarm Location n V✓o1�¢�S Mp�o��2 r„/V1
,�taw�, SOIL ABSORPTION SYSTEM
Width: _$ Length �g �� Number of trenches
Distance & Direction to nearest prop. line: (C)_ S4—
Setback from: well House �`j Other
t-
ELEVATIONS
Building Sewer ST Inle %0(.3r ST outlet (pl, a3
PC inlet f ( ( , d PC bottom `�/'� 5� Pump OfS D--
Header /Manifold 4 ?7 ( oq_ Bottom of system 7 C
Existing Grade ,O Final grade 99.E
DATE: OF INSTALLATION: l - (S -- f ! j
PLUMBER ON JOB: 11- A� t4L e LICENSE NUMBER:
NUMBER:
INSPECTOR: _`� ✓� p
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Wisc�nsin Department of Industry PRIVATE SEWAGE SYSTEM County:
Lab, andc4uman Relations ST. G'RC►IX
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No - :
P ffEF o { i :WALTER E] City E] Village G7 Town of: State PI
CST BM Elev.: Insp. BM Elev.: BM Description: � Parcel Tax No.:
�( >. �. / s -r /" i
TANK G—
INFORMATION ELEVATION DAT
� /�G S's', . 7
B
TYPE MANUFACTURER CAPACITY STATION O S HI FS E4 V.
Septic Benchmark 5 �"
Dosi ng . `r
Aerati Bldg. Sewer
Holdin -_ -- St'/ It InPet - 7 c/3
i
TANK SETBACK INFORMATION St/)(t Outlet
TANK TO P / L WELL BLDG. A ir ir I to ntake ROAD Dt Inlet
A
,i
Septic NA Dt Bottom z � � a ;
Dosing NA r /Man.
Aeration NA Dist. Pipe
Holding Bot. System ;r /
PUMP /'d'INFORMATION Final Grade
Manufacturer � � Demand -15, ��
� c�-
Model Number �7� `t P a.7�'
TDH I Lift �(� Friction / / System, TDFgc/ ? "`Ft
ad H
Forcemain Length Dia.4 ` Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Li th
DIMENSIONS ? '?� / DI
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEAC Ma cturer:
INFORMATION Type O CHAMa
/I e _� r Model Number:
System: YV , _�_.c� - - �j .) > /G) OK
DISTRIBUTION SYSTEM
Header / Ma n f old Distribution Pipe(s)� - x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length _ Dia. r Spacing ' �p
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ SSodd xx Mulched
Bed /T Center Bed /TrgMttr-Edges Topsoil ❑ Yes Ly'IV0 ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Springfield.34.29.15W, SE,- SE,.60th Avenue
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Plan revision required? ❑ Yes ❑ No
Use other side for additional information. 7 I R�A?l
SBD 6710 (R 0/91) Date /y , Inspectors Signaturd Cert. No.
} s� Safety and Buildings Division
��II�r■r� SANITARY PERMIT APPLICATION Bureau of Buildin Water S
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P -O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 'inches in size. ST CROIX
6 See reverse side for instructions for completing this application State Sanitary P Number
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
_ [Privacy Law, s. 15.04 (1) (m)).
State Plan LD- Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S95 -40582
Property Owner Name Property Location
WALTER HILLSTEAD SE 114 SE 114 S 34 T 29 , N, R 15 Y100 W
Property Owner's Mailing Address Lot Number Block Number
448 HOMER TRA CT RT 8
City, State Zi Code Phone Number Subdivision Name or CSM Number
MENOMONIE WI 47 1 (7 15 )235 -4513
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
Villa
Public 1 or 2 Family Dwelling - No. of bedrooms _5 rX Tow OF SPRINGFIELD 60TH AVENUE
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo 034 1078 -
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT (Check only one box on Ii,ne A. Check box on line B, if applicable)
A) 1 (N New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
______System System _ Tank Only System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 FA Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
-50 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
62 625 1 N/A 97. Feet 99.29 Feet
Capacity VII. TANK in allo Total # of r Prefab. Site
g Fiber- Exper.
INFORMATION Gallons Tanks M anufacturer's Name Concrete Con- Steel glass Plastic App
New ETanxistis n structed
Tanks k
Septic Tank or Holding Tank 1750 1750 IMIDWESTERN PRECAST ® ❑ ❑ ❑ ❑ 1 ❑
Lift Pump Tank /Siphon Chamber 1000 11000 IMIDWESTERN PRECAST ® I ❑ I ❑ I ❑ I - U - 1 ❑
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumbe 's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number:
BENNIE HELGESON MPRS 3215 715/772 -3278
Plumber's Address (Street, City, State zip Code): / / /// 54767
W1229 770TH AVENUE, SPRING VALLEY, WI
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sa i ary Permit Fee (Includes Groundwater D ate Issued Issuing A nt i nature (No a )
Approved I ❑ Owner Given Initial �yl Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
StID -6398 (R. 05/94) DISTRIBUTION: Original to Cour.ly, One copy To: Safety & Ruililings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) .years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3815.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Ccmplete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks receiv(A experimental product approval from
DILHR
VIII Responsibility statement. Installing plumber is to fill in name, license number w th appropriate prefix (e.g. MP, etc.),
address and phone number- Pll r -ber must sign application form.
IX County / Department Use Only.
X. Count: ' / Department Use Only.
-te L ia, :. ant; sf _cifications not smaller th..�n 8 1i2 x 1 1 inch -s rnr,lrt be su )! to the county The plans must
t;!i )vvirr_. A, t lot ��ian, dray.�r tc sc�l!e or with curnp!at,.� Sic „,'oCation of holding tank(s), septic
`xa idine ,< . r wells; water ice eat -ind lakes; pump or siphon
u urn o, li< I ate of the building served,
.. v,. C S, Ie �I f r t,., P5,. ld co�,t-o!”; cr)"e vol
V,;
nCE' C . :�y:_. ) t '10-�" -., . `_!`?l., , _.` ^SS 52CtlOn
} III C mlormatlon.
GROUNDWATER SURCHARGE
1983 Wisconsir. Fact 410 included the creation of surcharges (fees) (or a number o ' ri ;ulated practices which can
etfect groundwater-
.
1 monies collected through these , urcharges are used for monitoring groundvvat �r contamination investigations
and establishment of standards -
I
i
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
June 26, 1995 2226 Rose Street
La Crosse WI 54603
HELGESON EXCAVATING
W1229 770 AVE
SPRING VALLEY WI 54767
RE: PLAN S95 -40582 FEE RECEIVED: 190.00
HILLSTEAD, WALTER
SE,SE,34,29,15W
TOWN OF SPRINGFIELD COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above - referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
OD chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50 -64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincere
rar M. Swi
Plan Reviewer
Section of Private Sewage
(608) 785 -9348
1290R/ 1
SBDA- 798718.101911
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S95 -40552
Perforated Pipe Datall
0
End Vlew
) Perforated
End Cop � PVC Pipe
Permanent End Markers
.d Jot` ova
s Holes Located on Bottom
are Equally Spaced
PVC Force 6lain
y From Pump ? �d
E PVC
No
CAp Monlfold Pipe BELA�IUWS
V Pvc- SDR NUM AN
lA BL'tL4tttUS
Distribution. r. �.`�• $AF�Y
Pipe
Lott Hole Should Be
Next To End Cop
Distribution Pipe Layout
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R
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X 5
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Signed: ,.�� Hole Diameter �_ Inch
License Number: Lateral " f Inch (es)
Date: (p S Manifold " - Inches
Force Main II " Inches
Toe of �-Ct.Tcra
'S 444, S Per �aI e
t
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Page — Of
S - 491�382
Straw, Marsh Hay, Or
Synthetic Covering
A$ - %M G -3 3 Distribution Pipe
Medium Sand lees. 9.d
H _ c l q7.7
Topsoil _ _ - _
,, p
,�. 3 E
w o
Slope. 96.0
�] Bed Of % 2 Force Main Plowed
„n 4 2 2
ro � � Aggregate From Pump Layer
�._
3nt.
t,���s
D _�_ Ft.
Cross Section Of A Mound System Using E Ft.
GO A Bed For The Absorption Area F •77 Ft.
G I Ft.
Signed: A Ft. H 1,9 Ft.
B 7g,a Ft.
License Number: /�lo.PS _a�i K f (). Vi Ft.
Date: / y 5 L jq Ft.
J :Z, 3 Ft.
Alternate Position T 11,3 Ft.
of
Force Main W .9- Ft.
L
Observation Pipe —�
8 K
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�0 - - - -- -------- - - - - -- ---------------- -- - - --�{ Force Main
Distribution Bed Of 2— 2
I
Pipe Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
_ r J
PulfkP CHAMBER CRGS` SEC'IC,J AMC, - SPECIFICA I "IUF!`,
(� ° F'r
V E 1.1 T CA P S •: � e� ° �� .< ,'�
`I C.I. vE1:T PIPE
WEATHERPROOF APPROVED LOCK ; % ;(.•
Z5' =R0!'1 GOOK,
JUIJCTIO►J BOX MA)`JHOLE COVER
WIQDOW OR FRESH 12 "MIU.
AIR INTAKE
I
GRADE
411 I i" MIN.
16 MIN.
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COIJDUIT
18 "MIAI.
INLET
�•�.:13kGHT SEAL I I iI
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APPROVED JOINT A °� I I III APPROVED JOINTS
W /C. =. PIPE III W /C.I. PIPE
EXTENDING 3' i' r ® (y�11►� I II M EXTEIJDIAIG 3'
OW 1�t)
TO SOLID SOIL � t I I I ALAR ONTO SOLID SOIL
�, �5•� �,e u �ti,e� I 1
�a14 s> I I O .
ELEV. FT t
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co PUMP -�� OF
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CONCRETE BLOCK
RISER EXIT PERMITTED OIJLy IF TANK MAAaUFACTU R HAS SUCH APPROVAL
CGL^ Ga I f 7so G•c_I
SEPTIC E SPEC. IFfCATIOAJS
DOSE \ J� n�
TANKS MANUFACTURER: ��c�L7XS� Crin Q v" - aS c NUMBER OF DOSES' PER DAy
TANK SIZE: 1 b GALLONS DOSE VOLUME / g � 5 7
ALARM MANUFACTURER: - 7� • Re' vG S� rf'evn IAJCLUDING SACKFLOW: l GALLONS
BER: I'ac E4U-1 S •7Y6.lJ9'
MODEL QLIM
CAPACITIES: A= �9 � '� IAICHES OR GALLONS
SWITCH TSPC: Meke, s
- INCHES OR -?
pp ._�2 GALLOAI5
PUMP MANUFACTURER: � 1 3 C INCHES OR 7 • 25 GALL0U5
MODEL NUMBER: 3b''7/ Dw INCHES OR 2 Y31 " GALLOUG
SWITCH TYPE: D ���le / "� FI�C NOTE: PUMP AMD ALARM ARE TO DE
MINIMUM DISCHARGE RATE � `�y GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP.,OFF AND DISTRIBUTION PIPE., (O.(�� FEET
+ MIAIIMUM NETWORK SUPPLY PRESSSUR • • , , • • • • , , 2. 55 FEET
+ • 5� FEET OF FORCE MAIN X -J--J — O F /oflirFR R I ! . /
ICTIOU FACTO' �r� c� FEET
TOTAL DyWAMIC HEAD = JS[, _ FEET
l q i y
INTERNAL DIMEMS10Nt OF TANK: LE 7 /b ;WIDTH ;LIQUID DEPTH 3 _
(o'y'F
LICE.NSF UUMBER: _'. /. s —DATE.
Y � _
4
_,�_ s MODEL: 3871
Subn�ersib ��T�_ � - ��S
SIZE. 3/4 SOLIDS
Effluent Pump RPM: 1550
HP: 0.4
S95 t�
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METERS FEET 7C
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0 00 10 20 30 40 50 GPM
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CAPACITY
[9GOULDS PUMPS. INC.
SB•ECA FALLS WW 40W 13148
Effective October, 1988
O 1988 Goulds Pumps, Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A.
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CERTIFIED SURVEY MAP
LOCATED IN THE SE 1/4 OF THE SE 1/4 OF SECTION 34, T29N, R15W, TOWN OF SPRINGFIELD, ST.CROIX
CO. ,W1.
PREPARED FOR: WALTER HILLSTEAD
NOTE: BEARINGS ARE REFERENCED
TO THE SOUTH LINE OF THE SE Ri
114. (ASSUMED).
UNPLATTED LANDS
� FLED
JUN 1 1995 ► 2
S 90 185. 00' �4 KATH jj AISIi 3
St
L
cr
LOT I
Q z
1.14 ACRES Z
Z
p 49,674 SO. FT. Q
1.00 AC. EXCLUDING R. o. W, ro W J
J
v' 43569 SO. FT. t N
_ 00 W.
a .................................................................................................................................................. ...............................
Q Sv m .
(L HWY. SETBACK L INE
z APPROVED co �
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0
ST, CROP COUNTY
Comprehen ive Planr:ec
Zoning and
_ N 90 185. oaa rs Cc mmitlee
----------- - - - - - - ----------------------------- - - - - -- ----- - - - - --
I w If not recorded w
w 60TH AVENUE within 30 days of o
.... ..
approval data °i
1913.45' 541.65'
N 90000,00"w — N 90 185. S 9o° 00' 00 "w
� void
w SOUTH LINE OF THESE 11'4
-------------- - -1 - -- ---------------=---------------------------------
S 11'4 CORNER OF SECTION 34. SE CORNER OF SECTION 34
( COUNTY MONUMENT FOUND). ( .LANDS ( COU� j l (�I(JMENT FOUND).
C y �r��� AW 1 0 0
a
' 01
o -SET I" X 24" IRON PIPE WEIGHING 1. 13 LBS JAMES M.
PER LINEAR FOOT. S WEBER A
5 1 &04
50 5� I �� 1 SPRING VALLEY
WIS.
GRAPHIC SCALE — FEET �'''�`A 5U R*4��, ®°
JAMES M. WEBER S -1804
SHEET i OF 2 NELSEN -WEBER LAND SURVEYING
95 -53 THIS INSTRUMENT DRAFTED BY JIM WEBER DATED
VOL. 10 PAGE 2930
I
DS SCR I 1=>T I CIV
A parcel of land located in the SE 1/4 of the SE 1/4 of Section 34,
T29N, R15W, Town of Springfield, St.Croix County, Wisconsin, more fully
described as follows:
Commencing at the SE corner of said Section 34: Thence S90 "W along
the South line of the SE 1/4 a distance of 541.65' to the POINT OF
BEGINNING:
Thence continuing N90 "W along said line 185.00';
Thence NO3 "W 269.00';
Thence S90 "E 185.00';
Thence S03 "E 269.00' to the point of beginning.
Contains 1.14 acres subject to 60th Avenue right -of -way over the
southerly 33' thereof. Also subject to any and all aeditional easements,
right -of -ways or conveyances of record.
SL_IRV aYOFR ' S I P I QA
I, James M. Weber, registered land surveyor, hereby certify: That in
full compliance with the provisions of Chapter 236.34 of the Wisconsin
Statutes and the provisions of the St.Croix County Subdivision Ordinance
and under the direction of Walter Hillstead, I have surveyed and mapped
the above described parcel of land and that this map is a correct
reapresentation of the boundary thereof.
' 0041641 n°t ��►i►
31zQ
Dated this day of rn�� , 1995. i'
James M. Weber S -1804 ES JAM
NELSEN -WEBER LAND SURVEYING AM m.
WE
Rw�s�� S -3t -9S S-1804 7C
SPRING VALLEY
fo Wis.
ys�,Q eS FN
NOTE: THE PARCEL SHrWN ON THIS MAP IS SUBJECT TO STATE, COUNTY AND TOWN
LAWS, RULES AND REGULATIONS (i.e. WETLANDS, MINIMUM LOT SIZE, ACCESS TO
PARCEL,ETC.). BEFORE PURCHASING OR DEVELOPING ANY PARCEL, CONTACT THE
ST.CROIX COUNTY ZONING OFFICE AND THE APPROPRIATE TGvN BOARD FOR ADVICE.
I
SHEET 2 OF 2
95 -53 THIS INSTRUMENT DRAFTED BY JIM WEBER
VOL. 10 PAGE 2930
5�98�
EASE MENT AGREEMENT
TUTS AGREEMENT, is by and between WALTER HILLSTEAD AND NORMA
HILLSTEAD (hereinafter Walter and Norma), husband and wife, Route 8, Box 448, Homer's
Trailer Park, Menomonie, Wisconsin; and LARRY ALLEN HILLSTEAD AND JULIE A.
HILLSTEAD (hereinafter Larry and Julie), husband and wife, 1207 Main Street, Menomonie,
Wisconsin:
Walter and Norma hereby grant, bargain and convey to Larry and Julie the right and
privilege to use the water well located on the real estate owned by Walter and Norma. Such use
is for personal and family uses including outdoor wateri of nlantc anrtlens and sh.mbs,
Further, Walter and Norma hereby grant, bargain and convey to Larry and Julie the right
and privile.ge to "hook" into and use the private waste disposal system located on the real
property owned by Walter and Norma.
Larry and Julie hereby grant, bargain and convey to Walter and Norma the right and
privilege to install a main sewer line from their residence running in a Westerly direction under
and across the real property hereinafter described and owned by Larry and Julie.
Each of the parties hereto acknowledge the receipt of good and valuable consideration
for the agreements herein made. In addition, each party agrees that all costs incurred as a result
of the maintenance of the well and private disposal system shall be shared equally by Walter and
Norma on the one hand and Larry and Julie on the other.
The Real Estate owned by Walter and Norma and subject to this agreement is described
as follows:
The Southeast Quarter of the Southeast Quarter (SE' /a,SE' /a) of Section 34,
Township 29, Range 15, Except that portion thereof described hereinafter as the
property of Larry and Julie.
The Real Estate owned by Larry and Julie and subject to this agreement is described as
follows:
Lot I, Certified Survey Number .79.3& , as recorded in Volume /o , Certified
Survey Maps at page - 8o , in the Office of the Register of Deeds of St. Croix
County, Wisconsin, also described as follows: A parcel of land located in the
Southeast Quarter (SEI /a) of the Southeast Quarter (SEI /a) of Section 34,
Township 29 North, Range 15 West, more fully described as follows:
Commencing at the Southeast corner of said Section 34; Thence S90 °00'00 "W
along the South line of the SE Quarter (SE' /a) a distance of 541.65' to the Point
of Beginning; Thence continuing N90 °00'00 "W along said line 185.00'; Thence
NO3 °28'25 "W 269.00'; Thence S90 °00'00 "E 185.00'; Thence S03 °28'25 "E
269.00' to the point of beginning.
This Agreement executed this day of `l , 1995.
WALTER HILLSTEAD
4MA LI
S#3day and sworn to before me
t ,1995.
M
Notary Public
State of Wisconsin
i
My Commission is permanent.
Drafted by:
JUN 7 1996
BAKKE NORMAN, S.C.
2403 Stout Road {
P.O. Box 280
Menomonie, WI 54751
715- 235 -9016
sage ofvVisooiain
of tMc thts is a fun;
true and a wit *W of the doeamn" on
file and of NO W in sir g" and Iws been
compatW by w&
June 7 - 19 95
Kathleen H. Walsh
Kathleen H. Walsh Registier of Deeds
- 1
n +rncrkiVy M �►rs2
I & "m bum bns su f
n»d *a t• -,a soft va d bnm to br'f,
AM yd bmug
-- -•met - f ':,
VOL 112 5
529854
E ASEMENT AGREEMENT
TUTS AGREEMENT, is by and between WALTER HILLSTEAD AND NORMA
HILLSTEAD (hereinafter Walter and Norma), husband and wife, Route 8, Box 448, Homer's
Trailer Park, Menomonie, Wisconsin; and LARRY ALLEN HILLSTEAD AND JULIE A.
HILLSTEAD (hereinafter Larry and Julie), husband and wife, 1207 Main Street, Menomonie,
Wisconsin:
Walter and Norma hereby grant, bargain and convey to Larry and Julie the right and
privilege to use the water well located on the real estate owned by Walter and Norma. Such use
is for personal and family uses, including outdoor watering of nNnts, c prd?ns and shrubs.
Further, Walter and Norma hereby grant, bargain and convey to Larry and Julie the right
and privilege to "hook" into and use the private waste disposal system located on the real
property owned by Walter and Norma.
Larry and Julie hereby grant, bargain and convey to Walter and Norma the right and
privilege to install a main sewer line from their residence running in a Westerly direction under
and across the real property hereinafter described and owned by Larry and Julie.
Each of the parties hereto acknowledge the receipt of good and valuable consideration
for the agreements herein made. In addition, each party agrees that all costs incurred as a result
of the maintenance of the well and private disposal system shall be shared equally by Walter and
Norma on the one hand and Larry and Julie on the other.
The Real Estate owned by Walter and Norma and subject to this agreement is described
as follows:
The Southeast Quarter of the Southeast Quarter (SE /a,SE /a) of Section 34,
Township 29, Range 15, Except that portion thereof described hereinafter as the
property of Larry and Julie.
The Real Estate owned by Larry and Julie and subject to this agreement is described as
follows:
5-
Lot Certified Survey Number .W_q; , as recorded in Volume /o , Certified
Survey Maps at page - 1 8o , in the Office of the Register of Deeds of St. Croix
County, Wisconsin, also described as follows: A parcel of land located in the
Southeast Quarter (SE' /a) of the Southeast Quarter (SE' /) of Section 34,
Township 29 North, Range 15 West, more fully described as follows:
Commencing at"the Southeast corner of said Section 34; Thence S90 °00'00 "W
along the South line of the SE Quarter (SE /a) a distance of 541.65' to the Point
of Beginning; Thence continuing N90 °00'00 "W along said line 185.00'; Thence
NO3 0 28'25 "W 269.00'; Thence S90 °00'00 "E 185.00'; Thence S03 °28'25 "E
269.00' to the point of beginning.
L I
VOL 11.2 (JPAI 4.91
This Agreement executed this 315f day of � w , 1995.
WALTER HILLSTEAD
O MA TEAD
L R ALLEN HI STEA
ULIE A. HILLSTEAD
S 0 3day and sworn to before me
t ,1995.
Notary Public
State of Wisconsin
My Commission is permanent.
i
Drafted by:
J U N 7 1996
i BAKKE NORMAN, S.C.
2403 Stout Road
P.O. Box 280 r
Menomonie, WI 54751
715- 235 -9016
State of Wisconsin
Cou of 9t. G�obt
i ceMy that this tut:tetnront b a full;
true and no Ft c W of the document on
file and of woad M PW of8oe and has been
compared by Me.
wnpet June 7 . 19 95
Kathleen H. Walsh
Kathleen H. Walsh Register of Deeds
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER LARRY HILLSTEAD
MAILING ADDRESS 1 9 0 ` / ' �a f r\ m o Q1
PROPERTY ADDRESS '3 (o ki w
(location of septic system) Please obtaitArom the Planning Dept.
CITY /STATE
PROPERTY LOCATION SE 1/4, SE 1/4, Section 34 T 29 N -R 15 W
TOWN OF SPRINGFIELD ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER 1
CERTIFIED SURVEY MAP � , VOLUME ft) , PAGE .T 36 , LOT NUMBER 1
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The roe owner agrees to submit to St. Croix Zoning a certification form signed b the owner
P P rt3' !n' g � � Y
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained m be completed and returned o the St. Croix
County Zoning Officer within 30 days of the three year pir do e.
SIGNED: - 4
DATE: Z5
St. Croix County Zoning Office
tY g
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
sTC -100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner /contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------------
Owner of property LARRY HILLSTEAD
Location of property SE 1/4 SE 1/4, Section 34 ,T 29 N -R 15 W
Township SPRINGFIELD Mailing address
0
Address of site S & O fl r (00 -t-14
Subdivision name Lot no. 1
Other homes on property? Yes '� No
Previous owner of property
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? X Yes No
Is this property being developed for (spec house)? Yes X_ No
Volume lu and Page Number 'r9 -3 as recorded with the Register
of Deeds.
-------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. ' and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
S g ture of Applicant Co- Applicant
Date of Sianature Date of SianAt11rP
STC -105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER WALTER HILLSTEAD
MAILING ADDRESS 448 HOMER TRAILER CT, RT 8, MENOMONIE WI 54751
PROPERTY ADDRESS 5
s
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE ` OqD
PROPERTY LOCATION SE 1/4, SE 1/4, Section 34 T 29 N -R 15 W
TOWN OF SPRINGFIELD ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED: �$
DATE: <J
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner /contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property WALTER HILLSTEAD
Location of property SE 1/4 SE 1/4, Section 34 ,T 29 N -R 15 W
Township SPRINGFIELD Mailing address 448 HOMER TRAILER C T, RT 8
MENOMONIE WI 54751
Address of site 4 c , -�
Subdivision nam Lot no.
Other homes on property? Yes No
Previous owner of property - p4v, !1, LLS.i -
cA
Total size of property ?�, $(� 4c
Total size of parcel $� Ac-
Date parcel was created S
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for (spec house)? Yes \_ No
Volume and Page Number as recorded with the Register
of Deeds.
-------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
n
Signature of Applicant Co- Applicant
Date of Signature Date of Signatures
~ STATE 1SAR OF WISCONSIN —FORM 1
»Y VOL 619 FACE 494 w SERVED F �o
THIS SPACE RESERVED OR RECORDING DATA
k : w REGISTERS OFFICE
DE)tYl between _Qayid A. Hillstead and ST. CROIX CO., WIS.
!stead. husband and wife Reed. for.Re�cord this 21st
Grantor d" of u cc a A. D. 19
X&J liar 9:- A l l sttgkil st nd wnrma m 17 mt ,
a t i :00 A. o ic
N4# an joint tnnanta_
Grantee, ` • Deadi
Y li t 4 h �t the said Grantor for a valuable consideration One
t IV e t�f t 0'0) and other valuable consideration RETURN To
to Craatse the following described real estate in St. Croix
,+ 1. $tarn of Wisconsin:
$Otttheast Quarter (SE 1/4) of the Southeast
: ;Quarter (Sr 1/4) of Section Thirty -four (34) , Tax Key No.
,reship Twenty -nine (29), Range Fifteen (15).
t
{
TMJ SfR
s : :n S &.
f:
3
d
,. >= is not
TWA. homestead property.
04) (is not)
S x, Togedwr with all and singular the hereditaments and appurtenances thereunto belonging;
v w arsats that the title is @pod, indefeasible in fee simple and free and clear of encumbrances except
aai wilt wsraat and defend he same.
~' Do"dFthis day of September _ ' 1980
x
1-
9ru
(tl ` (SEAL) (SEAL)
s #
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated thi da y of STATE OF viii l
i „ 19 Is'►If1i 1 ss.
r+ County. j
Y
Petsoota4 came before me, this 1 � day of
• SQA±em6er the above named
TITLE: MEMBER STATE BAR OF wiSr_ONS1N David A. Hillstead and Patsy
*
(If not
authorized by 5706.06, Wis. Slats.) Hillstead
This instrument was drafted by
ROBERT G . WALTER to known to be the persun.L who executed the. fore -
go' g o rument and acknowledged the same.
VnttlAM dt.Ahe
Notary Public. Wayne County, Midi
(Signatures may be authenticated or acknowledged. Both
98
<< _ are not necessary.) Notary Public ounty, lYiaJ*
r. My Commission is penman pt I f not, state expiration
date: ( o
•Names of persons sigtina io any capacity must be typed or printed Below their signatures.
"i AAdRANTY D[ED— [TAT_ O■ WISCONSIN, TORY NO. 1 -1977
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