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HomeMy WebLinkAbout030-1075-90-000 ST. CROIX COUNTY ZONING DEPARTM - AS BUILT SANITARY REPORT �-�-� Owner lU 5 Address .S GL t t,q City /State Sa Ai, - 7 - sr C8 ox ' A COU OVI y x ziDtWl�q� Louul I /away llNlunt � � Lot AIa Bloak _AI Subdivision/CSM # /� '/4 AW '%, ,A69 Sec. ,22, T„VN -R4-W, Town of ST, �oseo <1 PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank >ianufacturer WE4� &'S Size ST/PC 12m//492 Setback from: House 'Well Z,E_' P/L , Pump manufacturer Z O E4L i-=2 Model 13 7 , Alarm1location A:� -�� DING TANKS ONLY) Setbacks: Service roa resh air intake Meter location Al SOIL. ABSORPTION SYSTEM Type of system: TR ( Width �_ Length Number of Trenches 3 Setback from: House _ _ Well 130 P/L 1-6 Vent to fresh air intake /DD ELEVATIONS Description of benchmark Ups -,c-7 SCE L0 1 LA K4 Elevation //" Description of alternate benchmark Elevation Building Sewer 9721 ST/HT Inlet_ 9 / ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover 0 Distribution Lines (2) 2, (3) 9V: 78 Bottom of System O 9� �� O ,� • �� O 9�, f� Final Grade () ©D () /D D () Ao G Date of installation �� Imo$ Permit number X17 74L State plan number dA Plumber's signature License number gjZ7Y l Date / / Inspector Complete plot plan or Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count • INSPECTION REPORT 54. Grc, GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑City [_1 Village ❑ Town of: State Plan ID No.: �'o h h 5c, h `� 4 94 , So s c CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /ocv 63o- /075 16 -Mo TANK INFORMATION ELEVATION DATA ACT8Qo ( O TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se tic w" �� Ben hm rk VD$ 10 Dosi n � 10C) Aeration Bldg. Sewer �CQ F7 1A8 $"17 7 Holding Inlet /O4 y /S— 9 <0,e TANK SETBACK INFORMATION St Outlet 00, S /c/ 55 TANK TO P / L WELL BLDG. Air I to ROAD Dt Inlet ��� O � , 1_3 Airintake Septic f (� ��(� ' 1V1P. NA Dt Bottom / g / 9 2- S Dosin 3 bsi NA Header / Man. 0 Aeration NA Dist. Pipe ?•? •� Holding Bot. System 0 8•7 S•95 PUMP/ SIPHON INFORMATION Final Grade /VA t5,—w Manufacturer � l Demand G�;,� s— /a Q Model Number 13 7 () GPM i TDH Lift Lrictior� Syetem �. TDH /Gyb t ;7 Forcemai n Length Dia. F c� I Dist. To Well SOILABSORPTION SYSTEM �•bZ BED/TRENCH Width Len th No f Trenches pIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number* Syste Q 1 +1 50 - OR UNIT DISTRIBUTION SYSTEM Header /Manifold tr Distribution Pipes) n / x Hole Size x Hole Spacing Vent To Air Intake Length Dia LengthT.�'SDia. Spacing f0 6c N1 G✓ h �/ 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 ed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 5,,S S/, 3 0, (Gj. 2(o S(3 Nw Plan revision req &ed? [:]Yes No Use other side for additional information. - SBD -6710 (R.3/97) Date Inspector' ignature Cert. No Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division I NSPECTION REPORT �T � C;RO�X GENERAL INFORMATION (ATTACH TO PERMIT) Sanit48!W".: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. SC 1 N SIN i �i P Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: = ription: Parcel �SQ r0 TANK INFORMATION ELEVATION DATA 'A98,00604 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben hm rk (xj :� Dosing �? Aeration Bldg. Sewer Holding ---------- St /Ht Inlet IQ 57 q 4 TANK SETBACK INFORMATION St /Ht Outlet,2, TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dos' td (,� NA Header /Man. , 4 17 Aeration NA Dist. Pipe ?- Holding Bot. System , Ims PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand T- IMF tII* ] Model Number l�'"7 1 /66 PM ke&, (p / TDH Lift 16 Friction System TDH1 ,( �� 4'{,7 Forcemain Length ! L/,Q I Dia. Z' 1 Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width �� Length No. 01 renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING MnAt INFORMATION Ty p_ , _ 1 CHAMBER Mo el Num r. syst (Q ! t OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipes) x �y Hole Size x Hole Spacing Vent To Air Intake 2_L c � Length � Dia. Length Dia. '` Spacing ' Y —( 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) L,OCAT it ST.' JOS 27.30.19.265BAW,Uw &D IMEY VI'EW 2RA ;L. J. Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buihdings Division `�SC011S %11 SANITARY PERMIT APPLICATION . Washington Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 - 7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 1 C/rb /X • See reverse side for instructions for completing this application State Sanitary Permit Number you provide may be used b other government agency programs ���� The information Y P Y Y 9 9 Y P 9 Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Numbed I. APPLICATION INF RMATION PL ' ASE PRINT AL INF RMATION —� Property Owner Name Property Location Zia A I&I 1 /4, S Z7 T 30 , N, R E (or)o Property Owner's Mailing Address Lot Number Block Number 677V AIJ NA Cit ,State Zip Code Phone Number Subdivision Name or CSM Number ( o II. TYPE OF BUILDING: (check one) ❑ State Owned it Nearest Road 01 44cr-1 07e Vile Public 1 or 2 Family Dwelling - No. of bedrooms O Town OF Try ST III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 107 5 1 ❑ Apartment/ Condo 9 7-30 . 1q. xo5 D o — - go 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. ❑ New 2 W 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 N Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit I - V 43 ❑ Vault Privy 14 ❑ System -In -Fill ty�.G� ( �! `� � K 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 /r Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation (o 0 -7 O 3 Feet 1,06 Feet C VII. TANK a aclt in g allons Total # Of Prefab. Site Fiber- Exper: INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank `s 1 ❑ ❑ ❑ ❑ ❑ j 7iftP.mpTank ] 1 pkaniekambar — ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ Vlll. SPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s shown on the attached plans. Plumber's Name: (Print) Plu 's Signature: (No Stamp PRSW N Business Phone Number: umber's Address (Street, City, State, Zip Code): L ' — — IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includesGroundw* ate I ssued Issu inWQent Signature (No Stamps) M Approved ❑ Owner Given Initial Surcha efee) / Adverse Determination 0V �. O ct 6�� X. CONDITIONS OF APP REASONS / OR DISAPPROVAL; (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, plumber Was i in I MEN 0 W"M min. m MEN i ; • , i t . t- i � t ! I I I i _ I , r i r i . i _ ; AI + - I , W ! I }- } - - - - -- -- - -T -_. - - 1 � ' I i , T , , , I q4 _s__ - - - - - . - - -- - - -- — a = - Fri Nil i 1 i , , i ,I 1 , , T 1 � I i : , DEPARTMENT OF RE PORT ON SOIL BORINGS AN D SAFETY & BUILDINGS` INDUSTRY, C DIVISION -LABOR-AND PERCOLATION TESTS (115) MADISON W1 79 HUMAN RELATIONS (ILHR 83.09111 &Chapter 145) LOCATION: SECTION: TOWNSHIP /I��': LOT NO.:BLK. NO.: SUBDIVISION NAME: '/4 NW 1/4 27 /T 30 N/R 191( W St . Joseph n/a n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Bruce Penman 314 N. Cove Rd., Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ERCO ATION TESTS: Zfesidence 3-4 n/a ❑New Replace I 11 -27 -90 11 -27 -90 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROYSTEM- IN- FILL TAN K: RECOMMENDED SYSTEM: (optional) S ❑ U GS ❑ U ❑ S Liu ❑ S l? U conventioanl If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: n/a I Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 42 BrB BORINGI TOTAL DEPTH TO GROUNDWATER- fNCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH3�C ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 1 7.25 99.72 none >7.25 1.25bl.s.l. 2.00bn.l.s. &gr. 4.00bn.c.s. B_ 2 17.46 99.68 none >7.46 .75bl.1. 1.58bn.l.s. 4.83bn.c.s. B _ 3 1 6.91 99.78 none >6.91 .75bl.s.l. 1.58bn.l.s. &gr. 4.58bn.c.s. B- B- B- decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L- INCHES RATE MINUTES NUMBER 13 AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH P- 1 3.54 none 3 6 6 6 <3 P- 2 3.50 none 3 6 6 6 <3 P- 3 3.60 none 3 6 6 6 <3 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings it and percent of land slope. 7 81 SYSTEM ELEVATION 96.18 m _ E ' �r z E E : E , 6 �� 201 - • PAGE OF PUMP CHAMBER CRO55 SECTIOM ARID SPECIFICATIONS ' VC MT CAP 4 "C.L. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE COV JUNCTION BOX ER ►IIaM nnnn, IR "MI►!. 1. d1N0UW UK FRESH I AIR INTAKE I I GRADE i y "MIN. 18' MIN. COWDUIT -- - - - -- -- - • PROVIDE I - -- INLE T AIRTIGHT SEAL - 7 I I v T A ( III APPROVED JOINTS APPROVED JOIN I I W /C.I. PIPE W /C.T. PIPE I I ALARM EXTEWOIN6. 3 CKTENDINI+ 3' ONTO SOLID 6016 ONTO 601.10 *OIL s I I ON C LLCV.. FT Pump—,- -� OFF D I CONCRETE BLOCK 3 APPAwrto . i I RISER EXIT PERMITTED OWLy IF TA MAIJUFACTURCR HAS SUCH APPROVAL gEDpl SEPTIC E SPECIFICATIOIJS DOSE ,,II TANKS MANUFACTURER: &tS NUMBER OF DOSES:. PER DAy TANK 51ZL: „� ©DD GALLOWS DOSE VOLUME �^ p ALARM MA INCLUOIAI6 OAGKPLOW: 1 l°fD' y GALLONS NUFACTURER: l�s�d�.— � `- �L U9 N GALLONJ MODEL WUMBER: CAPACITIES: A= IuCNCS OR SWITCH TYPE `CCU & -L 8 INCHES OR q3 7 GOLLOAIS PUMP MANUFACTURER: ��� �� C =_SG_INCHES OR $W►LLO MODEL NUMBER: 132 D INCHES OR " GALLON6 SWITCH TYPE: C L!UfV MOTE: PUMP AND ALARM ARE TO bE MINIMUM DISCHARGE KATE— --rpm INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AW0,015TRIBUTIOM PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE .. . . . . . FEET + 1 00 FEET OF FORCE MAIN IA � FYofT.FRICTION FACTOR.. FEET i .= TOTAL DtJWAMIC HLAD ag"FEET I �•((1�- ¢� � ILITERIJAL. DIMEWSIOWt OF 'TAWK: LEWTaTH ;WIDTH e© " ;LIQUID OEPTH . y? SIGNED: LICENSE NUMBER: DATE:.��� TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE " 9 • MODE 137-139-140-4140 EFFLUENT AND DEWATERINC MODELS C MODELS 137/139 140/ +140 Ft. MNerf G.I. Llr•. C. 1. Llr•. ! 1.0 a 332 •. S!• 0 12 D 10 305 79 rM to 141 140,4 140 q • S7 N 242 35 - r0 6.10 36 134 73 279 to » .0 • 30 e3 rSe 0 1 1/2' - 11 1/2 NPT In $14 VI u • .S I]I2 - - • ]. e Ise• W�•• !•' •!' o.(? 1 1� f to 1 1 F _ 1 910377 s A B C D E F 0 0099 1371139 4 314 7 3I8 1 8118 1 4 314 1 12314 4 U.S. cALLO74s 10 so 30 + so eo 7o so 90 too +10 140 4314 85116 813132 4 314 15 6114 LITERS ep 160 240 320 400 I I I c FLOW PER MINUTE 4140 4 314 I 8 5116 1 8131321 4 314 118 251321 114 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 2001208V or 230V - 1371139 Models. • Variable level control switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems. an alarm. • Double piggyback variable level float switches are available for variable level • Mechanical alternators, for duplex systems, are available with or without long cycle controls. alarm switches. • Long cords are available in lengths of 15- 25 -35 -50 feel (Maximum 25' length • Combination starters are available for 3 phase pumps. for 14014140 models Q 115V) • Control alarm systems are available for 1 phase pumps. • Over 130•F. (54•C,) special quotation required. 137 Series - 47 lbs. 139 Series - 51 lbs. 140 Series - 53 tbs. 4140 Series - 73 lbs. • Refer to FMO806 for 200' F. applications. Sin le Seal Control Selection Listings MOM Volts -Ph Mode A SI x Duplex CSA UL M1371139 115 1 Auto 10.7 1 or 1 e - Y Y SELECTION GUIDE N137A39 115 1 Non 10.7 2 or 2 3 7 3 or 5 3 6 Y Y 1. Integral float operated 2 pole mechanical switch, no external Control requited. N137 115 1 Auto 10.7 2 Y Y 2. Single piggyback variable level float switch or double piggyback variable level 0137/139 230 1 Alb 5.8 1 or 1 &S - Y Y float Switch. Refer to FM0447. 1371139 230 1 Non 8 2 or 2 8 7 3 or 5 3 6 Y Y 3. Mechanical okemator'M -Pak 100072 or 10.0075. H1371139 1 Auto 5.5 1 a 6 - Y N 4. Combination Starter. Refer to FM0514. 1137/139 200.206 1 Non 5.5 2&7 3 or 5 & 6 Y N 5. See FMO712 for correct model of Electrical Alternator •E -Pak'. J1371139 200.2011 3 Non 2.6 2&4 334 or 538 Y Y 6. Vari�le level control switch 10 -0225 used as a control activator, specify duplex F1371139 230 3 Non 2.6 2&4 334 or 566 - y y G137 460 3 Non 1.4 234 334 or 536 N N 7. Four (4) hole 'J Pak', junction box, for water tight connection orwired simplex (3139 460 3 Non 1.4 2&4 334 or 536 N N or 2 pump operation, 100002. 11014140••• MODELS Control Selection Listin s I B. Two (2) hole 'J - Pak', for Watertight connection or splice, 100003. Model Model Voss -Ph Mode Amps Simplex Duplex CSA UL N140 144140 115 1 Non 15.0 2or237 3or536 tN N 9140 E4140 230 1 Non 7.5 2or237 3or536 N 1110 1 Non 7.5 or 2 &7 3 or 3 N SN140 1 BN4140 115 1 Non 15.0 2or237 3or536 N N CAUTION • Na nolded 1 • Sin* pWilted aw4dl :!coded All installation of controls, protection devices and wiring should be done by ••• Double aesl avtNlbla 1•AI1)1d1011a1 moishffa am m Sal Fal indictor fgIt available in NEMA 1 or NEMA 4X a qualified licensed electrician. All electrical and safety codes should be PwrKamustbeopelatedinuprightposition. followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Twee phase units require a control switch to operate an external magnetic or combination starter. For WOMI Alm on additional Zoeller products refer to catalog on Combination starter. FM0514; PlggybadVanable Level FtoelSwilches. FMO477: Electrical Altemator• FMO486: Mechanical Altema- for. FMO495. AIarmPad" It. FMOS13 : and Sump/Sewa Basins. FMO48 RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. mAll To: P.O. cox 16347 '' LouisWrle. KY 40256-0347 ManulaclUrersol. . OELLE/� SHIP TO: 3649 Cane Run Road LouisnYe,KY4o211 -1967 Q Lldlq - rPulivaSAff /999 PUMP l0 (502) 778.2731.1(800) 926 -PUMP FAX(502)774.3624 _, - 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Oft N Sc yy In i TT Mailing Address / (o �© n"" 4a e �F �Lz EQ - l �Z Property Address 6 �i�f e<<. Te, z; S / Oa S (Verification required from Planning Department for new construction) City /State ADM &es&7 Parcel Identification Number _ 63 6 757 �0_ ^_OO D LEGAL DESCRIPTION Property Location ' /4, UJ ' /., Sec. 0 2-7 , T N -R_Z_� W, Town of 5 J'0-5e " . Subdivision A) 4 9 Lot # Certified Survey Map # /V 1 , Volume , Page # Warranty Deed # 1 -17 Z / , Volume /0 Page # -20Z Spec house ❑ yes P] no Lot lines identifiable ® yes ❑ 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 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. Itwe, 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 Office within 30 days of the three year exp date. M1 ,9 - & AtURE 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 described above, by v' a of a warranty deed recorded in Register of Deeds Office. /44U /Z S ATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented 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 a copy of the certified survey map if reference is made in the warranty deed oce No- Rwm Unn o STIPULATION HA TYPE OR PRINT USING �IAL'K M so" aNWftj* OwMI1 10AV GG t Ow- MtWilliddrall: IrNOr91w/fst�rwllr , a r 1 / , �� +i►�(V f�+✓ ��falLy✓fA� 12. � 1, , 1 1; to 1; " vk"w 'o. tr•s. S4ol ,. w* Street Address City County City / State 8 Zip Code (ll1111— al Tall ai l �lX/,ts;' 41 s ;3"�b/ wlPrgMfy: uaw: Seiler a Telephone Number 0 area code) / 7 G Levi FAMW WIN PtOWlly (May attach seperatesheet) aunt)'. Stott of 11 isconsin: ,j Ivv Part of fit(- N(frt hw(..,t to J t1 1 (lunrt c r of Section 27, 1 30 North N�N(;rthw(st (1u of :rN fill lows: + ),( 19 Wt•St dcscrihcd Tax Parcd No. Commencing at Nor thwest.corner of said A rods: ,�' �� 1 �•.. Section 21; thence East along North line of -RAd Sect ion, thence South 20 rods Parallel with the West line of Bald Section; the West 8 rods to the best Section 1the t said ; thence North along the West line oC said Sec to Point of 131 "ginning. tion e R. •taking final tilt ..- or r. v AItP trio •late el tray +sf.r r hP ,..... } Pf1 to 04 $it1 i loggits;1M To ,, - P. -w a Slip .lat Iha Seller of the residenlial rental bVildntg must plur • 1, 1 : 1 h,rwtt . q P at 11 cal a goal nnraddress bof it bek)w The Sbptllatton moat Ihot tNp a tbir lied In DII HR an A ithn, led Mur, r pA n u• „ u L, ,., ., val dst „n 11 , nt. , !)It till for a tat 0 Agents and Authorized Municipalities) It your loco! m,,rnr party is not 8ufhor4Pd or a Olt Hq Agent not n yrlur arel The r' pt 1.11 1 �n a* 011111,46 ,iowf o , idable h' fee (der rot sterWevA) should be sent t., DII. HR no: .t... Veathen•at,on Po,g P O'Bott 7911 Mad N/' 53 Make sure 11 rt k .." 'IP i ay,rble to DII t!R or your municipality. whichever is applicable, and that iii ,, ipanies this St pulahnn applfr al n The D!L .a a ,red Shpulaton htl - . I w ! he ter iwn f to fhe purch er, unless another r ­ ly is designated in writing • The nu haser should enter a Stipulation agreement ts'gn below) -1 the propoov s a rental hu hav low o, !aver dweting ,.nits lnncnaserial ndPrafa too, cupy one ,dwelLng unit in the building as their primary re Bence wdhm n .ear M this original St but cam rr r,,py mo of r' ­ I rig 1rvneP nhl r- t ,merit tenants To satisfy this Stipulation, the purchaser should n ly DILHR at the trm- ne snip fat -s o aufa „ Cr SPnli wr hen ! (;I! on , d ( rx ,�11;Inry and .1 r „ I this SUp�,lsi to DILHR DILHR wdl rnnt by return ItittC+ j This anf N 'r Waiv no STIPULATION AGREEMENT porbw MlPtrlallon or Wahor N cunaMly on file for$” Pr 0 Pefly. I !wP) a• rPhr all' -anon, t ­ ty to t nq the above des( bed esidentiat rental building into complance w Chapter '' HR 67 no rater ,tan one tl year hom tiro date of hanetP• lr a rr.;t "'I r• „n a r rpP, tc w cordrncP with ILHR6708(3). ILHR67 1314) and Iiii onc Statutes t01 122 P►IM Pa►ehaser'a a : P a s y J/ � OMa float _ fur haen 46 '!r@et/ ddress Purchaser's City, 961a & Zip Code Purchaser's Telephone N ,mbe (mr woo code) V�,dated Bv. Dlt HR Data Validated Expiration Date (add one 11) year to Dale fprt f ill Ar1o Autnnn7nd � +un+npatdy July 26, 1991 July 26, 1992 Aup or Tax Rev N A,.5�i .nn.n jR ANIMM P if, ('r! (L a, c Name . 1t�r s , Qrature EnMr DILHR Transfer AU1hon7allon *�� , O ' Number rrom Stamp Here: James 0 Connell � - S - s _2 4 _ 7 St Croix R• •ter of Deeds _ _ 8- 35927 TRANSFER OF STIPULATION t „v- to r bPd ­ ­1­1 at -Petal bu,)ding(s) is transferred within one year of the validation date of this Shpulation and before 'lip rr srdentia! rental buikbng has beers . I 1 .ts tw nq •n ro ,h! ,'ere vi fh ILHR 67, the new purchaser must sign below and forward a copy of th dtxument to nILHR By !•rgnmg below. the now purctioW l ,, r note the r rmp.i:anrP , Pal.nns,b fy , n this Stipulation, thus requiring Cote compliance "Into the a cp date given above. Print Ne■r hKCllraa/'.11nM ( ei / ll�jntMln(id' Dow k tVP «ts.;;r dress --- ib,35a ip _.� _ -.._.. ...._ 1en+phoneNumWt(ind Wee t — — 6� Suit) 711 1 lie" I wllwrPW ra�llll! -OLf+R � T v" f . ....... _ ... ................ , 19 ........ ...... __..... TITLE: ME HER STA . BAR OF W1 ........... _ - . ............... { If no authoritrtRd tly 4 706.0(1, Wis. Stet..) to inn known to lie the portion - Who executed the k ` r...,., l.,.. :. .r... r, .nt .rid r76P ..ova