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BM Elev.: BM Description: li Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400027 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure. Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Baldwin.29.29.16W, SW, SW, Lot 1, Highway 12 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: La tyand Wuman Relations INSPECTION REPORT Safetand Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Hol s Name:, ❑ City ❑ Village ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: C►1~L TANK INFORMATION ELEVATION DATA / S- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Averation Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ROAD Dt Inlet Air Intake Sep NA Dt Bottom Dosing Header/ Man. A' NA Dist. Pipe Holding Z~P 33 S Bot. System PUMP/ SIPHON INFORMATION Final Grade Man c urer Demand Model Number TDH Lift Syetem TDH Ft Forcemain Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED / Length No. Of Trenches PIT - No. Of Pits Inside Dia. Liquid Depth DIMENSIONS' DIMEN I N SETBACK SYSTEM TO P/ L BLD M LEACHING nufacturer: INFORMATION Type CHAMBER m er: System: OR UNIT DISTRIBUTION SYSTEM Header / Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems xx Mound Or At-Grade Systems Only [Bed epth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched / Trench Center Bed /Trench Edges Topsoil E] Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) (/,J L!^~ C~!f /~c, ~11( LtJ/ ~1Y7'~.Q ~~f `x.F'^/-'. 1 Plan revision required? ❑ Yes 2ril o Use other side for additional information. I& I SBD-6710(R 05/91) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 7 DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN Qro I STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ I - 3 q 53 8% X 11 inches in size. Check If revisrn previous application / -See reverse side for instructions for completing this application. [T111r-D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 0 1 aK) ~ 1p) ) "SQ % k) S T j N, R E (or PROPERTY OW' ER'S MAILIN D RESS LOT # BLOCK # CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Lopw 11. TYPE OF BUILDING: (Check one) El state owned A VILTMLAGE NEARE T ROAD L.pl~ lh1 ❑ Public ❑ 1 or 2 Fam. Dwelling-~# of bedrooms - L TAX N U 111. BUILDING USE: (If building type is public, check all that apply) tL - 7 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 K Other: Specify MIC 011% IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. tgReplacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - 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 ❑ Seepage Trench 22 ❑ in-Ground 42 Pit Privy 13 ❑ -Seepage Pit Pressure 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 C / SAO REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber __F1 F] I Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of o e sewage system shown on the attached plans. Plumber's Name (Print): lum er's Signature: Stam MP/MPRSW No.: Business Phone Number: OT 910, Plum er's Add ess (Street, ity, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanit ry Permit Fee (Includes Groundwater ate Issued- Issuing o Stamps) t'om' Approved ❑ Owner Given Initial Surcharge Fee) Adve a Determinati n X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Yqur. sanitary permit may be renewed before the expiration date, and at the 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 ~ ermit Transfe /Renewal Forrn ;SRS') 6399) to be submitted to the county prior to installation. 5. dnsite s@vvag terns must be property maintai -'he --optic tanks} m t;', be icensad 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 & Buildings Division, 6C8-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 in line A. Complete ine B if permit is for tank replacement, reconnection, or repair. V-. Type of ~.ystem. Check appropriate box depending on system type. VI. Absorpt;o.n. system information. Provide alt information requested in #?1 7. VII. Tar -rfrerz~ation. Fill in the capacity of every new aid/or existing to :k, list the total gr ~l ems , r r !,fer of tanks an l c,tas+ufacftlrer's name. indicate prefab or site constructed anr' tank rnateriai t'om' far all sept+c, ;t e`sp.,siphon and holding tanks for this system. Check expt , -i al a3ppteva' .3r-'? i :.:rsl<s received experirr+~;?ia; product approval from DILHR. VIII Respor-~b!iity statement. Installing plumber is to fill in name, license number with app op!iO ? prefix (e.g. MP, etc.), address and phone number. Plumber must sign application f(, m. IX. County/Department Use Only. X. County/w(3artment Use Only. Corgi^? t. -ins and specification:3 not smaller than 13'/2 x 11 inche~ m i-t he submitt<! t ; tt?^ county. The p'sa +s ! +r.,'ude "he following: <a,) plot plan, drawr to scale or wit` :n• ~ , a di a,err. of holdiiig : t K•~.' o i?ter treatment tan<sholiding S_- vr" 1 rtr!` 5^f;' ie(41Ce' StrE-'ar'r'i :jn,• i K. ~ !).wir),-_, si h(',-ri tanks; distnbotlcn boxes, coil - - ?15 1. ,,{a + SVSteft't nF r 1 ar a , ,e C?"3 of'kie i7lf! .g served; 3) ho1zontal a!~la r°,i+',i. flEl C) compi ,1 3peciiications fo+ purnps and controls; dose volume; elevation c,i;ierences; frictiu.r; loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if, required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE - 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated prac'eces which can effect groundwater. The monies c'ollc;cted throrigh these surcharges:are ::zeal or ,'ion+tra!is -irc r~dwatef, c -c•unc- water"contamination investigations and establishnier=t of s:arotards. - i, SBD-6398 (R.11/88) z p U, o c z o0 -u K z m m M Q m wimp r .=i O Z x COIOWJ m m < m C/) m n CID . m 0 -n m . Co Q r t r --A r- ` O O z= 0 1 > ~ D r MAC m m~ O ---i q N U) z p Q ~ m Z D 0 o C ~o z z < F- e rri O m o 0 --i Now Ccn c5 z 3 0 O zZ m c X m Im" = G) m m ` s~ mom' c=a mo _ off ~m z 7 0 3_ 6 Vim, j - o pom-4 0-I L ~°»7o mC) m M m T N~~7 s m~ m.~ 6m .m y m Sm m m m a~ am me 0 m~ oa 3? a = r m o F. a 3' an d ~ D ~m o m m=<d mo Hom m o m 3 ~ ID m~ d mm 3 m o ° a m m 7 m m° m 3 m m° mm m~ and ~ ~°'m3 m ~ ~ m W N O m dog= c° m m 7a~ m a D ~ 7N m w ym Co, o Cod ? ~d N m m c~ O 0 Qco •,3 3 < mm N 'D M 0) '0 0 T) co S~ , m ID 'a 0 Z O 7= S C m N - N H D y. am d 00. (D o o Z Q Q m N '~-i ~ ° a~ o a~ g D •O o 3 i m m .'a. . m 7 3 3~ - o>3' N CD < m 3 D SL S o CD 3 o' o CD o m ' o v < cl D 0 H '03 m f m W m m m O C. =m > m DEPARTMENT OF REPORT ON SOIL BORINGS AND SAF'E-t 1 INDUSTRY, ' rig` P.O. BOX 79att- LABOR AND PERCOLATION TESTS (1410 Al MADISON WI 53707 - t HUMAN RELATIONS (ILHR 83.09(1) & Chapt 1 to L TI NIR E (p r FTOWNS P/%UNIC1PgLITY: OT NO.:BLK NO.: SUBDIVISION NAME: OUNTY: MAIddllL`LII~IN ADDR SS: CPO USE DATES OBSERVATIONS MADE NO. B : COMMERCIAL D S I TON: ❑Residence ❑ROFILE DESCRIPTIONS: PERCOLATION TESTS: DUO- (10 ~ ~ New Replace. RATING: S• Site suitable for system U- Site unsuitable for system ONV I L: MOUND: IN-GROUND-PRESSURE: -IN-FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) [IS OU EIS OU [IS ❑U ISE] S Du 10 S E]u 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: Floodplain, indicate Floodplain elevation: --71 1 71 PROFILE DESCRIPTIONS BORING TOTAL P H R NDWATER-INCH S HARA TER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGMT TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- hJT ~ - S~:S.I S S1NQ11-,4-S DMili-t"441A B Pa i We- Xozs B- PERCOLATION TESTS EPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAT MINUTES NUMBER -AFTER SWELLING INTERVAL-MIN. P 1 P- P- 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 hoti- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION +4 I ! I i I i TN . t---~-~- i 1__L_ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the date recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : TESTS WERE COMPLETED ON: ADDR R FICATION NU ER: P ONE NUMBER( o tional): A.'a sy-76 /0 f~ U/S 06 T SI N E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner an( .,,er. DILHRSBD-6395 IR. 10/83) - Ov, SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations September 28, 1993 2226 Rose Street La Crosse WI 54603 TIM MIDDLESTADT RR 1 KNAPP WI 54749 RE: PLAN S93-41041 FEE RECEIVED: 100.00 IDEAL DOOR CO SW,SW,29,29,16W TOWN OF BALDWIN COUNTY OF ST CROIX HOLDING TANK 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 on 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. Sin erely, erard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 2247R/ 1 SBD-6423 (R. 01191) RECEIVED t ` Ability Business Co. SEP J,& 1993 A • B • C Complete Sever ServicMm a eLOGS. Div, KNAPP, WISCONSIN 54749 MEIN WISCONSIN 54751 Phone: 665-2112 35-1666 y~ rbMf i' 4.000 "1 S7'Ff t Ex,5rint4 a- ,ooo Natp'a& rmc Puf fri'v1#7Ejo G.41. Ygla d- r,N+ks y mnNrw« 1Tl~~a l? Dd~li rte 8e ,eE1MvoE!) , . . r Dnoa ~►+1y ~Idvor~,5Na OFFO X/S7 i ^'C ~ ~ ~I►i~d~~MG I SYSTEM i 160. OEFr. OF INDUSTRY. LABOR UdVISION OF SAFM v 0 E CC3 P NOENCE cv J s~?h? d: ~ : ~ TD"L W D0. 1gf8- CO gal w' s?IryG- 5-!~Hy -rim rVancowo-i So r4%,pxoyEF-S - s; ago AqA"' ►s MPQS ,7,9 5'4- 3 - fA#vQ D001N5 7Sp "UO,4 5 70rwA s; 2sv 0,01. ,NOT- 70 5041c c Cw> 3g g z -ni to ~ ~ T~ o it m co iLn -g CZ> k J CP Via sio Q, ;-A -1 O a - in : two R" (P G7 7~J V O f--A • v 00 ~z car-~ - ~ ~ t~ is 503% r 3311 HOLDING TANK AGRE Document No.. 428552 Agreement Date: This agreement is made between the local governmental unit jI+E O Town of Baldwin and the holding tank(s) owner(s) Hinrichs Properties Reed fArRt AUG 2 1993 We acknowledge that application is being made for the installation of (a) 2.7n holding tank(s) on the following property. (Provide legal land at i description.) tRrglatea of Aee4s SW SW 174, Section 29 T 29 N. R 16 W, Town of Baldwin Vol. 786, Page439 , CSM 357888 Lot #Block _ Subdivision or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83. Wis. Adm. Code, or Ch. 145, Stats. St. (nix As an inducement to the County of )9hhtf to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14 Stats. the municipality may enter upon the property and service the tank or cause to have the bank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s 66.60, Stats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assessment for the abatement of a nuisance, and the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20(3)(d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days HOLDING TANK SERVIIW MNTRACT Contract Date: This contract is made tween the holding tank owner(s) name(s)- and the pumper's name L e acknow edge the installan of holdi tank(s) on the fol owm rop rty: (Provide le al descri tion). ~J yf' Section(N, RW, Town of Vol. Page CSM~, Lot Block Subdivision 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the 'municipality", which has signed the pumping agreement required in Ch. ILHR 83.18(4)(b), Wis. Adm. Code and with the County of Dunn. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the° owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. U.1-M 83.18(4)(b) Wis. Adm. Code and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; C. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; & The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and Dunn County within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (print) Owner's Signature(s) Pumper's Name (print) Pumpers Si atu' ©41-2 l c s A" ~ r , x and sworn to before me on this date: Subscribed and sworn to before me on this date: C I? Lxt k, Y1 /Z (Z.- 11 S J' 'A17 It 5~~ a/ My commission e:;,pires: My commission expires: v S T C - 100 This application form is to be completed in full and signed by fthe owner(s) of the property being developed. Any inadequacies will only result ,n delays of the permit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), thenta 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 Hinrichs Properties Location of property SW 1/4 SW 1/4, Section 2,9 T 29 N-R 16 W Township Baldwin Mailing address 545 Midwest Trail No, Lake Elmo, MN 55042 Address of site Hwy 1 Fast Subdivision name Lot no. Other homes on property? yes No T- Previous owner of property Total size of parcel Date parcel-was created 'Are all corners and lot lines identifiable? -A-Yes No is this property being developed for (spec house)? Yes _A_No Volume 786 and. Page Number 439 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 & 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 d©scribed in this information form, by virtue of a warranty deed recorded in th 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 recorde n office of County Register of deeds as Document No. Signature of applicant Co-applicant Date of S gnature Date of Signature DOCIJ NO. STATE BAR OF WISCONSIN FORM 2-1882 THIS SPACE RESERVED FOR RECORDING DATA a WARRANTY DEED • .v% 786PKE4 42553 '1 t1. lbItKS OffiCE ST. CR x co., WI& Automatic Garage Door Co., a corporation Recd. for Raoord this 28th un er a laws o inneso a d July A.D. 19_87 t 4:45 P# COnvieiinrlcllstYroper less a Minnesota genera par hers p te' e RETURN TO ' R the following described real estate in t • r01 X County, State of Wisconsin: Tax Parcel No: See Addendum for Legal Description FEE This is not homestead property. (Is) (is not) Exception to Warranties: Dated this so..- dayof December 19_85 ` (SEAL) Automat' c Gara Door Co.. (SEAL) 01 • Ur an M. inri.c s, (SEAL) • >i-(SEAI.►' ;t: •Harve Hinrichs, AUTHENTICATION Secretary/CTMWINKENT , Signature(s) STATE OF WISCONSIN as. Anoka County. authenticated this day of ,19 Personally ame before me this 30th day of December 19 8 6 the above named Orlan M. Hinrichs an-c Harvey N. Hinrichs, the Presi ent an a . Secretary Treasurer, respectively, TITLE: MEMBER STATE BAR OF WISCONSIN of Automatic Garage Door Co. (If not, to me known to be the person S - who execut the authorized by § 706.06, Wis. State.) for of Instrument and ac no ledq t Des THIS INSTRy MENT WAS DRAFTED BY I ttbt, l A%Slop-w S - fA'flflr - 4, , sa S. -W! sY+2 Notary Pu NOTARY PUMIC-MINN'iS ITA County, Wis. (Signs urea may be authenticated or acknowledged. Both My Com ellfD late expiratloi are not necessary.) date: WTl] M 5611+90 , 19 ) 'Names of persona signing In any capacitI should be typed or printed below their signatures. NTF 2260 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms. P.O. Box 10206. Green Bay, WI 54307-02M Form No. 2 - 1982 01 WON!, I~M=" • 86PA',jE 439 410 Addendum to Warranty Deed dated December 30, 1986 between Automatic Garage.Door Co. and Hinrichs Properties. Parcel #1--Part of SW1/4 of SW1/4 of Section 29, Township 29 North, Range 16 West; St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey it Map filed June 28, 19709 in Vol. "3", page 819, ! Doc. No. 357888. TOGETHER WITH an easement for road purposes over and across that part of said ' Section described as follows: Commencing at the Southwest corner of said Section; thence S88°17'41"E 1184.13 feet to the ±aint Beginning; thence N01°27'00"W 345.33 feet; thence N88033100"E 50.10 feet; thence S01°27'00"E 348.09 feet; thence N88°17'41"W 50.18 00 feet to the Point of Beginning. a Parcel #2--That part of the Southwest 1/4 of the Southwest 1/4 of Section 29, Township 29 North, Range 16 West, Town of Baldwin, St. Croix County, Wisconsin, more par- ticularly described as follows: Commencing at the Southwest corner of said Section 29; thence S88°17'41"E, 684.01 feet to the point of beainninv; thence N01°27'39"W, 947.80 feet; thence S79°45'27"E, 306.37 feet; thence SOla27'39"E, 567.91 feet; thence N88°33'00"E, 222.02 feet; thence SO1°25'52"E, 346.57 feet, thence N88°17'41"W, 522.64 feet to the Point of Beginning. Said parcel contains 353,066 square feet of 8.105 acres. A ,4 1025na332 ® 4-V S T C - 105 SEPTIC TANK 14AINTENANCE AGREEMENT St. Croix County OWNER/BUYER Hinrichs Properties ADDRESS Hwy, 12 East FIRE NUMBER , CITY/STATE Baldwin, WI ZIP 54002 PROPERTY LOCATION: SW 1/4, SW 1/4, SECTION 29 2____9 T N--R 16_W TOWN OF Baldwin St. Croix County, SUBDIVISION None LOT NUMBERNone 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 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 verifying that (1). the on-site wastewater disposals system pispin 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 Co. Zoning officer within 30 days of the three year expiration t SIGNED: DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 E a o 3 0 3 0 3 0 o to o v~ o fA Q) (D W to 'Z O O O et L N C e = - o c y O 0 - LL 'O O y 0) O C m N ~0O m aoU os N o `v U x o L Cl) N- 0 C N V O E€a._ o obi c~c~ $°aao ~m d N a ~ ~ U) co a c7 x2 1 vH o .0 O N (0 N V U °o E - lu m~ a in o cn o Y c - ~ ~t ° ~ ooiQ I c rn I c 'v ow c •X05- d ~'v cZ to 4)0) - C c O L C C .1C O € C L C p a Y O N L Z o3icoc c 9 Z ~pC'N>j c fl Zcw m c m cc H p m o E o d~ n co u- o cv o rn o u o o~Uo o a 0-2 cn - c - o - _ N o._ ns C 3 y.~L~v 3 3 a - v 0 8 tw o c cav" o~ Q .r oL E d m -u~ E d= o0 0 0 o p o E z y 12 y E E 00 00 00 z € € 'o O N H a m a m a co O O z g v 16 1 d z CD z m f- E E co ` _ 7 3 H H FT ~ (DI • ~ m (DI O ;5 :5 1 0 m z z O m z z O N m z Z o 6 N U Z rn o aci o 0 a°i m c co R ° R w = N a~ dr a~ d- n y m mw a R.. a.. v cco m° c G W CD IL c 5a IrL m rG ra a` ° N E ;5 U) co 5- 'a .2 75 U) E~ Zr-> m OO n.ao '5 am IW 33 Z I y a o •~V A 5 a a a m a m a 1 a a a V5 1 a w w Im o N 04 r CD 04 y 00 ro 3 co °D y N J V T O> rn rn Z _rn rn rn m 0) CD M - t o w= o o c L M M O O N N O O E j C') co C M ml y C C ml y C CL N v m d z fn N ti m Q} In a v m d> fn m o o a y c a y c p w to 0 1 °O w E o f o o o Eo l O o N p U N C U N C 0 N e C V d p M Cc (n V C co y r N O~ S y m y O C in n (r C C N O - N v Z O N y v Z E y V Z N 0-4 N N v y rn rn O E to n d, O E o N O E C L 0 6 75 0) O N CO N N z y 2 H M O Z 0 U) cc D y 2 H d~ 0 z N m M L) H fn Q ee ~ I I I \ Cq ~t E = € :s v ~t a€ a a d a CL dam d a a m m o 3 o 1 3? o 3 o -1 A uIL 0 a)V omc) 0 mc) 0., o I a~i o I o N p d o rY o ~n I w y N U C (U N I N ~ 2 0~o I N v U) 4)o oU E aam) OEV o> ~ 30 c C € LD N N (0 C C O. U m 0 4)- N O C O)t wN A O 4) c FE N C a N> V 0 0 o a N c Z CL uyi y O N g m U v W3 OD- Xm 3 3.5 4) N C . 4) 4) E ¢ ° mw m ~ O I 3 0 to o I N H U) O O Z III (A IZ- r N Z E v ~ CO I Y a) F- IV C O • L 0 S Z Z w z N _ rn o E E (v co (L _ a ~o v c co co m O o O CD G G a a m N ~ w Q O c U) frn frA E WSJ z~> ! 333 n'~ Zo o v aaa a W Cl) M N J U M 0) 4) - rn rn 3 u~ (D 0 U I 2 m r c d w c rn a~ N d Q D co m O W d W C U O d O pOj O N V O N C a C a O jv` h a o v 0 ~ C y C d O C Crr O L co H C- Z L .d. 'O N N C~ r 7 E~ C t • ~y O N m 2 0 Z y Fes- (n O C~ v w# a 4) d v u (L rr`I~~i d E c c o ~1 A 0 IL2 0 U)0 L~ U l it J ur I5HLU vv 27" E - 852 87' 227.01'....... N ❑ ' on U. BLOWERS 19 49' /✓_S.p BINS ' • ~~~NG``w Z E In vrrowsEb Pu 1'Ea acc s TS' fir FT M 5N91NC SY IZ ST CROIX Cu Et FC'YK1C LV CcN7PFRq TIVE. ~G c- J OJ~b~ ~ h • 1 c`~ o (p c^p b o~ `'7' ~ 3 rn 9 N O U NOTE :81' BOTH THE RAILROAD SPUR AND THE CONCRETE PAD G P~ Ll O \ 4~~ ARE ENCROACHMENTS. Q NEITHER SEEM TO BE USED ANY MORE. SEPTIC MANHOLE SET R.R. SPIKE 1.15' SOUTH OF FO. 2' IRON PIPE LEANING NORTH IPE - V 1 NOE g, ORIGNAL 1 ~ I THE ADDITION TO THE 11 BUILDING ENCROACHES ON THE 562 •01 '4 1 "W 56.30' 3 POWER LINE EASEMENT. N07E SHADED AREA. •I • R.A. S 60'2.9'2 56.3' Z) Z~ ROAD I + N O 1 Cj I 1 J GRA I I ~I PARCEL A I I t 127,520 SQ. FT ± I 4i d: I X93 ACRES 13 126,630 S0. FT ± I (W/O9ROADR R/W) I r1' - 0. E. ' ' o DA/RYLAND POWER O COOPERA TI VE 22.5' I I 4 5' 199.50' S88'34'55"W 157.94 ---5 8833'00" W 222.02'--- I! R.A. S 88-3j' W 158.5' .........................j~ ; ORA~EL ROAD , •1 I . . . . . . . . . . . . . . . . . . . . . j •i D I O U N P L A T T E 06 d- cc I I I~ I rn W I ANDS BEARINGS ARE REFERENCED cw I N TO THE SOUTH LINE OF THE SOUTHWEST QUARTER OF O I SECTION 29, T29N, R16W. (RECORDED AS N 88.17'41 " W) I 1 ' ` I ~~v O 1'1 I 1 111 • ~ W 522.66' 7' ------UG.--- _=-~--ar 2. 64' 70th AVE. ' W 549.61 ' W26862s. s7' - .93'- - - - • 4 0 N O C * 3o -a 03V ~ c ~ I ~ > > co co ~ ~ ~ • q-0 I ~z M7! v G co M co m m n C 3 o n o m N o ° w c v cNO N • d 3 B c: 0 CO 3 j3 c N p a N p -1 CD ID R: CD co z CA ,a CD Rr -4 m d 3 w m ~ Q of CA c A P n CL v c o o j;3 9 c~i c cD 0 0 o ~Q1 CO COD O n -O O c n 00 m 0 rn 3 g 3 0 0 ° o N y o o y O p CA M CD cn c N C co av tozD awI v>m (n CD cn D N a m ca Q c (D IW 2 a W ° o N c 3 s 3 O r« CO o l~~V ~ m ~ 0. w ? co co cc n or N CO) Cam/) co OCOO N COii OODD co w Q W W d M y M M N I .mom • ° Z O <SO cSO m O z 000 ccCS M IuL~ 0 FL Wi D xc tnwcn~'I 3 co) CA CD 3 9 O D N CD O' M o C o to O CD CD O. W I a :3 a; 0) CL 0) ;F CD o o 3 w Oo N ~ 3 N N F ~ ~ i CO I a ~ I a a Z 0 ° Z z m O D D o N D D ° o w O a o CD o cc N • Q CD CD m CD CD x m x c c W m w c'D 3 a CD -i co Z Z m o ~ 0 A z 0 c (p ~ N W W ~ < tNp co O CL s Z O C o z m C H ° ? ~ I O I c I c~ d d CD O d (D CD a a C) o a o 0 I °o ~ m Z a oz a N CD a N d Cl) M ~ N 07 lzi O CD _ A O• I I ! N N 0 I I °a A I ~ O 0 A tN CD O A q 69 2 O ° ~ ~yTJ CD CL t O A+ S j~ Part of the Southwest 1/4 of the Southwest 1/4 of Section 29, Township 29 North, 1 Range 16 West, Town of Baldwin, County of Saint Croix, State of Wisconsin as described in Volume 5 of Certified Survey Maps on Page 1420 as 01 Certified Survey Number. 1410 a~0303, 5 CERTIFIED SURVEY MAP Na LOCATED IN THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER OF p SECTION 29, TOWNSHIP 29 NORTH, RANGE 16 WEST, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN, GO ~ ' N~TH~iESrE rRgNsP ~~~=-~N C PA~~ciNE rRqcKS i 3 T F ' "NY BEARINGS REFERENCED TO THE 6 3T 1 - SOUTH LINE OF THE S.OUTHWE~ T QUARTER. ASSUMED AS N88°1741 "W. o to ~ SCALE l " = 200 z1 01 wa rO 2 40 0) z of I Ii LEGEND QI -Q__ _ NBT$l2'W VI GRAVEL POWER LINEQAS6MENT 0" DRIVE -SECT/ON CORNER (AS NOTED) Ii, • -FOUND 2"IRON PIPE N88°33,00 E 22.52 M 0 -SET3/4 "x 24" REBbR WEIGHING N "_-222.02--"j 'It-- 1.502 LBS./L.F LOT 2 353,066 SO. FT. ? 8.105 ACRES cv SOUTHWEST CORNER W SECTION 29-•29-16. ' (WITHOUT R/W) ~ N FOUND 1 "IRON PIPE) 335,819 SO. FT, M 7.709 ACRES c SOUTH OUARTER CORi, N88°l7~41 W 522'66 sLcr/oN LINE NER SECTIO/V 29-29-16. J K 33.08=- 3 05 - A UND 314 REBAR) N8801741 W _ 522.64 ~D a UNPLATTEO LANDS S 8 - - l~ +~~iprexx s FILED APPROVED " MAY 181984 "U a CONMU `G a o••a~ MAY 171984 ' S-1 3 A A wask b oob a 4~ ~ MENOMONIE, Y. Wis. ST. CROIX COUNTY •'•y~ ~~y/8~••.•'• COWRENENSIVB PARKS PLANMNO f AND ZONINO COMMITTEE (SEE REVERSE FOR CERTIFICATION) SHEET 1 of 1 Volume 5 Page 1420 6T^ a:ltd e ^.L GA i A~ 'uLSUOOSLM °uospnH lasnoy;ano3 R;uno3 aoA'ananS xL0a0 '4S L99 abed `68t X008 UL aUeq paaa4s L6a~ `~3 NN -9 SVWOHl uMOyS an L4Paadoo3 aamOd pue LA'a Le aoJ Xanans e jo 4jed SL A'ana S 6L6 L 30 AVG' SIHl 43140 -awes ay; 6uLddew pup 6uLPLAL 6u L~'anans UL x Boa o A' uno a q up u LM P o uMOl aye ~ ~ ~ 3 'g S 3 3 y P . 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Parcel M 29.29.16.441 E 002 - TOWN OF BALDWIN Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-owner O - HINRICH'S PROPERTIES HINRICH'S PROPERTIES 4231 PALACIO DR SARASOTA FL 34238 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.780 Plat: N/A-NOT AVAILABLE SEC 29 T29N R16W IN SW SW LOT 1 CSM VOL Block/Condo Bldg: 3/819 ORD INCLUDES P441 F TOTAL ACRES 10.489 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 786/438 07/23/1997 707/179 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/04/2003 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 10.489 37,800 517,000 554,800 NO Totals for 2006: General Property 10.489 37,800 517,000 554,800 Woodland 0.000 0 0 Totals for 2005: General Property 10.489 37,800 517,000 554,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 002-1074-20-001 09/22/2006 12:40 PM ` PAGE 1 OF 1 Alt. Parcel 29.29.16.441F 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HINRICH'S PROPERTIES HINRICH'S PROPERTIES C - C/O CLOPAY TAX DEPT C/O CLOPAY TAX DEPT 8585 DUKE BLVD MASON OH 45040 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2231 HWY 12 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 8.105 Plat: N/A-NOT AVAILABLE SEC 29 T29N R16W SW SW 8.105 A LOT 2 CSM Block/Condo Bldg: 5/1420 ASSESSED WITH P441E Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 786/438 07/23/1997 707/179 07/23/1997 702/10 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 002-1074-20-000 Valuations: Last Changed: 11/11/1996 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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 'AF TMENT 9F INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7,969 BUREAU OF PLUMBING MADISON,'OV 53707 ❑ J CONVENTIONAL UALTERNATIVE state Plan l.D.Numbe. (If ion 1 ❑ Holding Tank 1:1 In-Ground Pressure 1:1 Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Ideal Door Company RR# 1, Baldwin, Wisconsin BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SW'-4 SW4, Section 29, T19N-R16W, Baldwin Township Name of Plumber: MPAIRSAVAdL County: nitery Permit Number: Everett Boldt 4489 St. Croix 34792 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ARNIG Lq BEL LOCKING COVER rN OVIDED: PROVIDED: R ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH W NUMBER ROAD: PROPERTY WELL: BUILDING: IVENT TO FRESH ALARM: FEET FROLINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO INEARESTR__ DOS ING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO. GALLONS PER CYCLE: PUMP qNO N L OPERATIONAL: NUMBER OF PROPERTY W LL BUILDING: V ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: PROF RY7_ TO BED/TRENCH WIDTH: LENGTH, TRENCHES DISTR. PIPE .PACING MCOVER ATERIAL: PIT JINSIDE DIA *PITS DLIQUID EPTH DIMENSIONS WELL: BUILDING: V N LE FRESH PROF GRAVEL DEPTH FILL DEPTH UISTH I DISTR. PIPE IS I MATERIAL : NO. DISTR. NUMBER OF BELOW PIPES: ABOVE COVER: ELEV. INLET - ELEV. END. PIPES: FEET FROM LINE: AIR I NLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO OIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SODDED. SEEDED. MULCHED. CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHESNO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF ILL E H AB V COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL : INO,DISTRDISTR. I DISTHIBU T ION IPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV.DIAELEV.PIPS DA. DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS Y ❑NO ❑YES ❑NO COMMENTS: PERMANENT A OBSERVATION WELLS: NUMBER PROPERTY WELL: BUILDING: FEET FRLINE: ❑ YES [_l NO ❑ YES ❑ NO NSket ch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY,, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: /^I Mailing Address: / J ~y e fI 0004 l r OM A N AN9 ~LJ/ rt) (sue / -s Property 111111111111116 VAM or Township: County: ~~cJ'/oSGJ'/aSa9 /Ta9N/R /6®(or)W o5'f. G~.eo~x of~Nu/m '~rv $rk` moo/: 4Subdivision Name/: Nearest Road, Lak or Landmark: 'State Ian 1. D. Number: / r Tr 9~ Gt//9 4 (if assigned) TYPE OF BUILDING . , El Public 010 mbe► o * F-1 Variance* ED Other (specify)* Mr" -le C"(09 edrooms: Q 1 or 2 Family *State Approval Required.' TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY O0® w0 X X LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: 4° /cSe-R o.vGo2G G EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): w Replacement Experimental ❑ Seepage Bed ❑ Seepage Pit o'~O {ternative (specify) o/•q//0L'cS % N e ❑ Seepage Trench Movrij iee5c~v gxvks - oR &%r-tL Age o V A L - /D -So - 79 Water Supply: Owner's'Name as Listed on Soil Test Report (If ter than present owner): 9 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for in ation of the private sewage system shown on the attached plans. MPRSW No.: Phone Number: Name of Plumber: i natur . Z0,40? V~R~ff 9o.Gdf PI s Address: Name of esigner: AFL cui;~ "se ie f' f' ~0~1 COUNTY/DEPARTMENT USE ONLY Si a ure of Issuing A nt: Fee: Date: _P~ APPROVED Sanitary Permit Number: TL ❑ DISAPPROVED Sly 17 9 "1 01. A" Reason for Disapproval: Alternate course(s) of Action Available: I Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) ~M 1 7 ~ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES r DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESJ,$ LOCATION: dW/4, 5~ SectionOl L_, T,;%, R/(I It (or) W Townshi or ,C / P ++~Y I- 'Q A - - - - Lot No Block No.___, -County X Owner's Name: rde o L , ubdivision Name ~Q~1 g-_~p~_~~,v~ _ Mailing Address: W 1111 .J TYPE OF OCCUPANCY: Residence No. of Bedrooms Other ~~~rv~~►~~.~ CAA EFFLUENT DISPOSAL SYSTEM: NEW x _.__-----ADDITION -REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS 7 SOIL MAP SHEET 7~ SOIL TYPE V1- 6 'SA f--`S J A"~'-._ - - PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P lA ci F- O ~ a l o P s~prr rr LJJ1 oS Y~ t, ~ tr s ~D 3~~ r, ,l D $ P- 4 It ~O Ir ^ 7e S ;?A-O llV I r 1 (l~ r SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) -0Z It 6 if 126 B_ 1 3 7-2 > S- !i er or a 0 " tr x,26 4 rl I r ` a to y ~ ~ ~ ~ .5 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. , I I V x s , ; I_ , L. . N D f ; ~ ~ ~ Imo- i I ~ I ; r:rZ o~ 5 ' ~ ; I ! I ~ i ~ f I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) ✓ee~,7~ r ~f Certification No._ Address.C~(..>/..~ (w Name of installer if known CST Sign COPY A - LOCAL AUTHORITY atur tL a t m o d A ti, f~6 ti a A.) a ~e ac ems;. f f1 Re~~ e o/d . d _ _ Vv We n~ d 04. New 7 C l pit t t • y Department of Industry, Labor & Human Relations Division of Safety & Bldgs. State of Wisconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608-266-3815 IN ALL CORRESPONDENCE c L jT'S REFER TO PLAN IDENTIFICATION NO. tJZp 5?' aaz ©l S ~7 1 1 NAME OF PROJECT rMf9~ TYPE OF APPROVAL 40 STREET AND NO. CITY OR TOWN COUN STATE r ZIP OWNER E Q. 'C 0 I _ Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. I The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. i j I i . I i In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. G This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. For Private Sewage Systems Only: Sincerely, This approval is valid for two years or it will be valid until the expiration date of the initial sanitary permit. James Sargent-Bureau Direct PLANS REVIEWED BY: DATE: I Y ('17 1 L 13 cc: D Owner DI LHR Plumber H & R (2) County _ Mfg. Rep. Bur. of Health Fac. & Services DI LH R S813-6099 (N. 06/80) Rec. & Env. Services SeIW e6713 0/811 tPt6 10M) STATiE OF WISCONSIN OIL DeWtLkd Return Upper DI~VISltI1;~fiiAl ErY & BUI.I$$ Pdl' 4f This dorm .With RUaEAWOf P I 201 E. WA 1GTM AVE. FPM 11 P.O. BOX 718 Any Return Correspond ~ MADISON, W1 53707 ~[l+Ct~~ 608-26~3g#8 DATE: APR 251983 011; !8!8s PROJECT:: ZONING ~ Peal Door Mawifacturing Compiany SW,SW,20,29,16W ' Tn Baldwin Boldt's Plumbing & Heating, Ir1c. St. Croix W1 020 Curtis Street Baldwin, WI 54002 PLAN ID. # Y: K-01415 DETACH HERE PFiOJE Ideal Door Manufac uring Company PLANT.* 83-01416 C~TPIAM~ , This is to acknowledge receipt of your,pidis specifications for the above4ndicated project. Preliminary review indicates the required fee is $ Fee Received is $ 40'00 Underpayment - Please submit the additional fee. ❑ Overpayment Refund forthcomi _ Plan accepted for review. Plans being returned. i No fee has-been remitted. Plains submitted with no fees will be Additional information required. SEE s held in abeyance. ,r V ti 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information.shail be submitted in duplicate un- ❑2 copies of PL8 80ertclpsed. less specifically rested. ❑ Deed restriction required 0 copy)- ❑ Plans not clear, egible cw permanent. ❑ Condominium declaration. 0 4co0y) ❑ All information submitted shall be signed, dated and wed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. ❑Affidavit enclosed. IV. Holding Tanks © Profile of holding tank showing vent, miinhole aia0m send manufacturer if precast. Complete constmction details, if 11. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner WHolding tank agreement signed by, 00rpW On,!z of and notarized. (1 copy)` government (sample enclosed). ❑ County onsite required` 0 copy), ❑ Design calculations ❑ Reason for installing holding tank, l if test'or str9f nt A for pressurize distribution. ❑Soil boring percolation from county (1 copy). } test data. ❑ Plot plan showing location of holding tankvr0 Iatera) tllst ❑ Cross section of system. ❑MPe lateral layout. ances to any building, wells, water WvIcs piplft,r ter Plan view of system. ❑ Plat plan. course, lot lines, swimming pools, all tisieatl i'ser 4aiid; I: ❑ Verification of Exception Status Form by County. 0 copy) Etc. Provide benchmark with elevation referia pe pair t'., iit. Private Sewage Disposal Systems x ; - V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump d~;~ K tion system extending 25' on all sides. pumped per cycle. l ❑ Elevation of permanent referencepoint (benchmark)- El Size, length & depth of force main. r x' ❑ Location of area:suitoMe for.replacemarrt system - provide. ❑ Detail & model of pump or automatic siphons i soil data. size, pump curves, drawdown and average flow rate G ❑ Plot plan showing lot sip and all lateral distances from ❑ Gross section of lift pump tank showing pumt+(ss) or sewage disposal system to buildings, lot lines, well, water siphon(s). x course, swimming pools, water ~service. piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. Vi. Systems In Fill (Fill must be. plac$61s#r #r1+>s} Construction detail and cross-section of sail absorption ❑ Total area filled (fill lid, system. before side slope tfegfq(• ,i ❑ Soil boring and percolation zest on 115 completed by cer- F-1 Depth and type of fill. , tified sail tester (1 Copy). ❑ Copy of onsite re=laa6E~ ' . i + r , , , 47- ~2d~f~~y,~n4t r G14t i"'~'b..{~~i~ 'b t la>• ~'5~Fdi~'i" ...A r f ° R s a~` 7 q t rr .qX~ ~:;5 y, ~ ~ .y,.,s~~~s t}~:'. ~ 2 ` ,yy:•, • 'F4 ~{•wi~,s,t. l~,~j, ~y 1! 13. ~ c.- ~ ~ t. c ~~~,~~/~~4.(~.,. ~•F _ '~r1' ~4~~f.~'~~1 77„ dpl.:~+V.~, jrJ 4#' i'~'~. '~.Yr (hryr'ri(J''d~'~rF#•TMI n"' e ti - ~ w~ dcc.y.- ~ - - , s ,'t r~ f yc~.~° "i . g~~.'~ q k/ ~ qq a"~ ~ -i~•~y jY t t f7Vy{{uuV~~yy~.„ T.~.3 j r:~,} t u,.,a l-xS,t4 VIP, , LAI -4 t Sit ~a r : ~ =ci9`~ 3T3ld,f{ _ °d ~K~'$ d Im,~. sy,~:~PC.L-,4t,t+3rEsJ.$`l;1`.,~.t~:'x~~ ~ `f~~fif~g ~ ~ i tlf2 lo~~IF ; ?c3L~ 4 40 _3~ a~ yR'4 s F f7 ♦ d rr r wt, ~ i t Y M a a"~- ~ ~ 6, .i- 1~ tf c~ r d :F'7T4 ,t~~* '.~C ~Ft 5 ~~~'k1~~J~' ~5i 'r•' r.d f{.d,er,R 51 a ~7, r 7 t s 1 rt Ee' 4" tl ~ '~i3 t _ •~.+;f f J ~ i ,-,j.~q t ~}~'~'j ~ r 1~p.K ti 'r+~ y - `{~t~{.~.5~`•'L ~ ±a'.fi~ f ~ 4 r~ fil 'fo Y4-~~ 1 i i~st 7`.. YS i. r 7:!S ~ L ~~~rYg'~"A,L ~cr,lt'C~"!' ~t 4` a r~ $ i~ Pf' c. t ad Jr r ,fir v gip, Y s ;'.hts f, - ; "~,.fl',v'~ i tl 'y:,'Qi.4,y" i•~ ~~Yr; ~ e~ ' 1 t e+.. f Il. a .`IA r l . tau. sr~,,rzi kx f ! z, . T- L + t h • :''r F '`11 ¢<<nd ff ;r?S 'grit~.>5K'3`.,-`Esy wf.~ro 7y r1 1s 1 l F T1 n'"•`~ s Jhr 1^t -i3 1 ..i, ~,•~'4f71`~~~a x t rstx',,.tib+ r'~;z,~ ~ tr' ,r ~ •{y.s. ,~~~~.~~~i.a'r ~a,k r i`~~ t d - s ~ ~s- vk 1 3 rRtz:a-.,r,,.~r.k: .4..~ `x:_', 7~ •S^e t ~~~t E 4 E~ ~ r~~.,t'' ~'fcl.+(~y~;dd~St,Yt'Ir~ftTt ` h` ••/'}l "t;- ~ ry ~ f ~ ~ S~} ':z5.lr.34n,}'y3~,ryE~` ~v_ s `r_ c it 1,~^`•+_ :'s it ° P-~.~~.~~jd ~~R.N~~+rr~~ 'i'~. _ :4 -d,.3: ~ r ~t., ~f~ ~ ~T~ t H,. r,F µ } t f Wisconsin Department of q Q ` 3891449, Labor & Human Relations VOL 664 PA ~f 148 Division of Safety & Buildings This document is a full, true and correct copy of the original on file and of record1i9n O office / certified NOTE: BY'hi ent is to, be drecorded in the Tract Index at the offa0~e0F8CE Register of Deeds ,in the county indicated below. ST, CROIX CO., WIL i Rec'd. for Record. this 6th I, HOLDING TANK AGREEMENT day of May A.D. 1% MAY 1 at 2 :45 P M;, ~`i 81983 - FETY & 8I-D ri-igl1A,greement is made and entered into this R•of of p day of 1b 'sand between the , hereinafter called and " e1eq~ ~oeje hereinafter called the "Owner.'r We hereby acknowledge that application has been made for a builds permit on the following described property, to wit: r ~06 ~ or that continued use of the existing premises requires that a'. holding to . &"~.'.~',P installed on the ~ property for the purpose of proper containment of sewage. We also acknowledge that said property cannot now be served by a municipal sewer or septic tank - soil absorption system. Therefore, as an inducement to the Count of to issue a sanitary permit for the above described premises, we hereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbing Code plating to holding tanks. Any time the Town or of A LJC1A.1 r.aJ , through its Plumbing Inspector of Health Officer, deems it necessary to pump out the subject holds tank, the Owner shall have same pumped out in twenty-four (24) hours, or •,&✓11 will have said work done and charge same back to Owner and place same on the tax bill as a special charge The Owner further agrees that the Town or of may enter upon the property described above at any reasonable time, to Inspect, or pump and haul wastes from the subject holding tank. 2. Owner agrees pay all charges and costs incurred by the Town or of for inspection, pumping, or otherwise servicing and maintaining the subject holding tank~ in such a manner as t revent or abate any nuisance or health hazard caused by such holding tank. '7v - - shall notify the Owner of any such cost which shall be paid by the Owner within thirty (30) days from the date of notice and in the event that the Owner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Wisconsin Statute. I DILHR-SBD-6123 (R.4/82) (OVER) Piirt: of. S 112 of SW 1/4 of Section 29-z29-16, cue;, ~ car ibed as follows, Commencing on S -line of said t ec8~ion 29, 1171.4 feet E of SW orner thoreof; thence r4-xkl k, t N 1 27'W 344.6 feet; thence S 88 331W 200 feet: thence not-h4ni-tepdt1wrtt!'. N 1027'W 569.3 feet to S'ly line of Chicago, Saint Paa,il, Minneapolis and tcs Oma~a Railway Company R/W; thence.Ely on said Sly ljne 546.5C,feet; thence ,cam S13 05' W 165.0 fs.et; thence'S 60 29'W 56.3 f8et, thdNrice S 6'21'w 274.9 feet; thence S 88 33'W 158.5 feet;; thence S 127'E 346:P feat to S line of said Section 29; thence W on said S lAne 1)0.1 foot to Place oaf' Beclinning. Subject to power line easement. si. P age VOL 664 PnE149 3. Owner agrees to have a quarterly pumping report submitted to the local government and the county which will state the Ownerts name, location of the property on which the holding tank is located, the pumper's name, the dates, volumes pumped and;the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted,to the Department of,Industry, Labor and Human Relations by the governmental unit responsible, per section 145.01 (15), Wisconsin Statutes. 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code. 5. This agreement will remain in affect only until the sanitary permit issuing agent in oix County certifies that the subject property is served by either a public sewer or a septic tank - soil absorption system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agreement may be cancelled by executing and recording said certification with reference to this Agreement, in the Tract Index indicated above. 6. This agreement shall be binding upon the indicated governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this day of . SIGNATUR OF TOWN OR MUNICIPAL OFFICIAL (Include Title): 3-06 SIGNATURE OF OWNE r, n Personally came before me this 74;e4 day of 19, the above named ~~~Nr'~71d -4A>i e opmw D R P i u Rrc µS , to me known to be ; the persons who executed the foregoing instrument and acknowledged the same. ~ ~ THIS INSTRUMENT N 0 T A R TARY PUB IC DRAFTED BY: = c P U B L I C V, commission expires : ti~ Of wl60V.%% Notary public Id of Wisconsin ,'~~~~~iuiu~~♦ MY Commission Expires Mar. !o• 1985 J EAL Do0 MFR. OF RESIDENTIAL COMMERCIAL INDUSTRIAL SECTIONAL OVERHEAD DOORS P.O. BOX 106 BALDWIN, WI 54002 (715) 684-3223 (612) 436-1139 9 111 January 20, 1988 X2219 Thomas C. Nelson St. Croix Cty. Zoning Admin. Hammond, WI 54015 Ref: Change pumping report from quarterly to semi-annually. Dear Mr. Nelson: The three (3) documents requested in your notice of December 8, 1987, have been recorded at the office of Reg- ister of Deeds. Copies of the same are enclosed for your records. 1 S ncerely, Je y Heston Safety Administrator Enclosure JH/k ;33790 oooK 801 ,~ALE22S . Document No. ' This space reserved for recording data HOLDING TANK AGREEMENT Agreement Gate REGISTER'S OFFICE 1-5-88 This agreement is made between the $T. CRDIX CO•• County or Local Governmental Unit Holding Tank(s) Owner(s) Recd for Reg - Baldwin Township I Hinrichs Properties Oan- 10, 1~ 8:35 A. M Called Munlcl ail below I . Z We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) Rsgister A. Deeds Ideal- S14 of SW14 of section 29-29-26W \ Tom. _IDC - SW's of SWk of section ,29-29-_1.6W A" irz \ - - Baldwin, Wisconsin Return 7o~ yedproperty, -------------(see next pafae) _ or that continued use of the existing premises requires that a holding tank be installed on the ro ert for the P P Y pose of pro sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sew a system~Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. As an inducement to the County of St - rrol x to issue a sanitary permit for the above we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Slats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Slats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tanK in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20 (30) (d), Slats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a report, in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing. on a semiannual basis. In the case of registration under s. 146.20 (3) (d), Slats., the owner shall submit the report to the municipality and the county. 5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property Is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) (Print) I Ow ) S lure(s) os'M Hinrichs Properties 1 Subscribed and sworn to before me on this date: I TA.v. . /,Q Municipal Official Name (Print) I Municipal Official Signature Nola Public ~ C~ I,~ My commission expires: Alton HelQeson J Municipal Official Title (Print) I /D /n Townshi Chairman I SBD-6123 (R. 10/85) This Instrument was drafted by the Stale of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. 433769 ao~K 801 PAGE-225 THIS SPACE RESERVED FOR RECORDING DATA CANCELLATION OF A HOLDING TANK AGREEMENT REGISTER'S OFFICE ST. CROIX CO., WI As the sanitary permit issuing agent in the county Reed for Record Jan. 19, 1Q88 stated below, I hereby certify that the following nt 8:35 A. M described property is now under a new Holding Tank jZ.Qister of Deeds Maintenance and Service Contract that complies with /n• n~f ILHR 83.18 (4), Wis. Adm. Code. 1 S-14 of SW-14 of section 29-29-26W RETURN TO Baldwin, Wis. 'BIN In addition, I understand that execution and recording of this docent ca a , holding tank agreement between the IDEAL DOOR CO. and DWIN TOUNSHIP that was recorded on the 6th day of MAY , 1983 in volume 664 page 148 , as document number 384448 Witness my hand and seal this 9tb day of JANUARY_ , 1988 County of St. Croix by Thomas C. Nelson, Zoning Administrator C-~ i er(s) S nature(s) i Subscribed and sworn to el~ VO i before me on this date: 9th C~)~"v r`:\`, PIT ~ - Notary Public _ _ ~ CGtcuirY O~• JT. G20/X,.J)~y~"'lj~~j~y,~r My Commission .ExJpires: NOTE: This document to be recorded in the Tract Index at the office of Register of Deeds. em 801 a228 REGISTER'S OFFICE HOLDING TANK SERVICING CONTRACT ST. CROix CO., wi Contract Date Recd for Record 1-4-88 This contract is made between the -Jan. 19, 1988 knt - --g 7.- ~ Holding Tank Owner(s) Name(s) and Pumper's Name I I Register of Deeds Ideal Door Co. I Ability Business Co. We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptic IDC - SW!i of SW of section 29-29-16W - Baldwin, Wisconsin >c- _ r- Ideal - Sk of _ SW _of section 29-29-26W -----------------------jsee next Page) t-- rI oo*G 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the ' "yniciially", which s signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of St. Croix I 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Sign ure(a) I .r _.Hinrichs _Propert.ies I \ Subscribed and sworn to before me an this date: I . I Pumper's Name (Print) I Pumper's Signature Notary Z enee yn> /F .JT e-xa--r E-OF•!+-firC~ / u is Abilities Business Co. I My commission expires:: - ,✓I Pumper's Registration Number SBD-7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department of Industry. Labor and Human riplatinnc f t i1 ST. CROIX COUNTY 0 WISCONSIN ZONING OFFICE ~y 1'i 796-2239 (HAMMOND) + 425-8363 (RIVER FALLS) HAMMOND, WI 54015 TO: Holding Tank Users FROM: Thomas C. Nelson, St. Croix County Zoning Administrator DATE: December 8, 1987 RE: Holding Tank Pumping Agreements As you know, in the past, you were required to submit a Quarterly Pumping Report to the St. Croix County Zoning Office. However, you now can change your reporting to a semi-annual basis. In order to do this, you would need to cancel out the old Holding Tank Agreement by filling out the enclosed Cancellation of a Holding Tank Agreement Form and having it notarized and recorded at the Register of Deed's Office. You would also need to fill out a new Holding Tank Agreement and Holding Tank Servicing Contract which are also enclosed. If you so chose to change to the semi-annual report, we request that you send us copies of the above-mentioned recorded documents for our files by February 1, 1988. In 1988 we will again be sending out Quarterly Pumping Reports at the end of the 1st Quarter or Semi-Annual Pumping Reports at the end of the 2nd Quarter depending on which report you chose. If we do not hear from you by February 1, 1988, we will presume you are keeping the Quarterly Pumping Report Agreement. If you should have any questions regarding this matter, please feel free to give this office a call. Also, we will be doing onsite visits periodically starting in 1988 to inspect holding tank septic systems. TCN:rmc THIS SPACE RESERVED FOR RECORDING DATA CANCELLATION OF A HOLDING TANK AGREEMENT As the sanitary permit issuing agent in the county stated below, I hereby certify that the following described property is now under a new Holding Tank Maintenance and Service Contract that complies with ILHR 83.18 (4), Wis. Adm. Code. RETURN TO: In addition, I understand that execution and recording of this document cancels a holding tank agreement between the and that was recorded on the day of , 19 in volume page as document number Witness my hand and seal this day of , 19 County of St. Croix by Thomas C. Nelson, Zoning Administrator Owner(s) Name(s) (Print) Owner(s) Signature(s) i Subscribed and sworn to i before me on this date: Notary Public My Commission Expires: NOTE: This document to be recorded in the Tract Index at the office of Register of Deeds. ument No. This space reserved for recording data HOLDING TANK AGREEMENT greement Date This agreement is made between the - - - - - - - - - - - - - - - - - unty or Local Governmental Unit I Holding Tank(s) Owner(s) Called Municipals below) i e acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) Return To - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. As an inducement to the County of to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Slats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Slats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20 (30) (d), Slats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under s. 146.20 (3) (d), Slats., the owner shall submit the report to the municipality and the county. 5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) (Print) I Owner(s) Signature(s) Subscribed and sworn to before me on this date: I Municipal Official Name (Print) I Municipal Official Signature Notary Public I My commission expires: I Municipal Official Title (Print) SBD-6123 (R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. HOLDING TANK SERVICING CONTRACT ontract Date This contract is made between the olding Tank Owner(s) Name(s) and I Pumper's Name e acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit ntimber issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Signature(s) Subscribed and sworn to before me on this date: Pumper's Name (Print) I Pumper's Signature Notary Uis I My commission expires: Pumper's Registration Number I'SBD-7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. REPORT 'OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itany Penm.it , • • State SQpt.ic,/ NAME_ rownehip S Cno~,x County Location j Section ~ u SEPTIC TANK Size S gattons. Numbers o6 Compantment.6 Vi6tance Fnom: Wet St. 12$ o,% greaten 4tope Bu.itd.ing 2 C St. Wettand.6 ~ • H.ighwaten St. DISPOSAL SYSTEM i D.iatance Fnom: Wett - 12$ on greaten .6tope St. r. Bu.itd.ing St. Wettanda Ft. • H.ighwaten St. FIELD DIMENSIONS: Width oS thench St. Depth oS noek below t.ite .in. Length os each tine St. Depth o6 rock oven t.ite .in. Numbers- o6 tined Depth o6 t.ite below grade in. Total Length o6 t ine.6 St. Sto pe o6 trench in pen 100 St. D.iatance between tine4_jt. Depth to bedrock St. Totat abeonbt.ion anea 6t2 Depth to gnoundwaten St. Requ 2 Type oS Coven: Papen on Straw -.ined anea it PIT DIMENSIONS: Numb en o6 p.it,6 Gnavet around p.it.a ye.6 no Out,6 ide d.iamete.n St. Depth b etow .inlet St. 2 Totat abaonbt.ion anea it A Area tequkned St2 . INSPECTS TITLE APPROVED i~ , DATE 197. REJECTED DATE 19 1_. 01 la State and County State Permit # PL8 67: Permit Application County Per # for Private Domestic Sewage Systems Count *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required ~_7tate Plan I.D. # A. OWNER OF PROPERTY Maili Z9 Address: We 4 L ~o o/~ Lio p y B. LOCATION: Section T R Zfar (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY O Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified oil Tester, NAME a C.S.T. # and other information obtained from tOcAAACI (owner/builder). Plumber's Signature MP/MPRSW# Phone # 6FY-.-13 7F Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. Ai L o g 421 a 40 0-0 do` E ( 0 /r Do Not Write in Space Below F R COUNTY AND STATE DEPARTMENSE NLY D jn ~f . 7 / / Date of Application - Fees Paid: State o 06 Co Permit Issued (date) Issuing Agent Na Inspection Yes No State Valid* Date Recd 1. county (wh~ a copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, W1 53701 kink co y) 4. plumber (canary copy) Revised Date 7/1/78 EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH G P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TES LOCATION: Section T 9% RA E (or) W.Township or e iy R I'W&a ;^j Lot No. , Block No. County .Sf Coeo/ A .Z"de,o L subdivision Name Owner's Name: oo.e D,rn Mailing Address: -q Y' TYPE OF OCCUPANCY: Residence No. of Bedrooms Other Com.~►~~.2 C R L EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 3a - 7 9 PERCOLATION TESTS - 79 SOIL MAP SHEET S SOIL TYPE V/- 9 f ~iL ~.O A~ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 1~) a rr „ P- 0A411 4A tr e,5 P_ a (0 1< a s , 3-0 4f je s SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 40 It if A6 B- 1P 4 t, / 11 6 y of r Z~ 5J✓ l/ Io r i PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. I 1 i w ~ r i tI 31 f .u s• 9~~t+ i ~ p0 I / S 01 d t N i p 0 ~ a 7-7 i I - o e l s Fl- I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) ✓eeef Certification No. Address Li Name of installer if known CST Signatur THORITY ' ST. CROI X COUNTY W I S c O N S I N r to L o eM1?. ZON.tNG OFFICE 196-2239 Post 0jjjice Box 221 Hammond, WI 54015 0 W N E'R P U M P E R A G R E E M E N T PLEASE BE ADVISED, That unt.it you axe again not.ij.ied, I Witt contxact with A-9-~ 06 Wisconsin, (PumpeAx) jox the puxpos e o6 xemov.ing att- waste bxom the banitaxy system to be Located on the pxopexty and jutuxe home site .located in St. Croix County, Wisconsin, Township of being in the % of the Sul % o6 Sec., (0x moxe 5utty debcx.ibed as jottowb: ) Dated this 3c day o j 197 (OWNER) State 0j Wisconsin) bb County of St. C&o.x1 19 . Pexbannateyappea,% be~oxe me this 9?Gl day aj .#"e the above named • • to me known peAson who execute t e oxegoing inbtaument and acknowledged the same. - Vy t. xoix aunty, W atax u c, My Comm. (46 pe&M ( Exp.ines I, w,44d z e s/Ao(t hexe-i.nbejoxe )tejexxed to as Pumpers, 1a.in .in the above agreement to e extent that I have a contxact with Owne)t as above stated. (PUMPER) AGRELIVIRI%:T tU This agreement, made arrd tered on this - day A 197 by and between the Township of P ddress `7 RECEIVED VEEREA S: In application has been made for a sanitation system on the following described property: May 8 1979 PLUMBING SECTIOtd ViEEREAS: Septic tank drainage does not meet the minimum standards of the ordinance of St. Croix County and state codes. V6F:EREAS: The owner agrees to install a holding tank for septic tank purposes purposes. NCV-', T<1 EF©RE: For and in consideration of the issuance by the Town- ship of of a permit for the above premises, the parties do hereby agree and bind themselves as follows: .1. Owner agrees that they will conform to all the rules and regulations pertaining to a holding tank system. They agree that anytime said township deems it necessary to pump out said tank, the owners shall have same pumped out in 24 hours, or township will have said work doneand charged to owners and place same on their tax bill as a special charge. I 2. The Township reserves the right to assess a bond if they desire to cover any possible pumping charge in the sum of $ oz? IT IS UNDERSTOOD that this agreement shall be binding on the owners, their heirs and assigns. IN VITNESS WEEREOF, the parties have hereunto set their hands and seals the day and year first above written. Township of ~t h by le s.L ed"'," State of wisconsin Departo* t of Industry, Labor & Human Kelabon8 Developer Division of Safety & Buildings or owner This document is a full, true and coftect copy of the original on file and of record in my office STATE OF, PISCONSIN) certified yt 19 . COUNTY CF ST. CRUX) SS: By Subscribed and sworn to before me this day of c 19 a vJ.:t.. 1$$t Votary ub ><c, St. Croix County Mor. t. z r REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.i.tatcy Penm 'xr✓~_ 69t State Septic NAME 11~cc Tawnahip ~ S Cno ix County a Location of j o,-4, Sectioa/D M,R SEPTIC TANK t ~ Size-.2(0Cgattond. Number o6 Compattmentd Distance Ftcom: wett / 6t. 12% on gneate& ztope 6t' Bu.itd.ing _6t. wettands 6t. H i.ghwaten 6t. DISPOSAL SYSTEM D.i.atanee F&om: wett 6t. 12% on g&eaten stope jt. Bu.itding 6t. Wetta.nd.d Ft. H.ighwatetc 6t. FIELD DIMENSIONS: width aS tneneh 6t. Depth o6 rock below ti.Ce .in. Length o6 each &tine ` Dep h ob Aock oven Cite in. Numbeh, o6 tineth o6 tite below grade .in. Totat .length o6 tope o 6 ttceneh in pen 100 6t. Did fiance b eeve Depthho b wino eFz 6. Totat abz o&bt ion area 6t2 Depth to gnoundwaten 6t. Requ.i&ed area 6t2 PIT DIMENSIONS: Numb en o j pits Gnave.2 around p.it.d yea no Out.6ide d.iamete& t. Depth below .intet 6z. 2 Totat absanbti`a~i 4 ea 6t z Gf A Area nequitced it2 rn INSPECTED BY TITL APPROVED DATE e. 4F/~ P 19 Z:r. REJECTED DATE 197. l I i State and County State Permit # `'2 Permit Application County Perm' x- ~ PL4867 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED- Date Approval Received from State if Required St-`a;-a. A. OWNER OF PROPERTY Mailing Address: ROWS— AWO' 104T1G D-40 0R ldc B, LOCATION: % '/4, Section , T N, R jk.k1N1* W Lot# -City_ Subdivision Name, nearest road, lake or landmark Blk# f' Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons 10 0 D. TYPE OF APPLIANCES: Dishwa her YES NO Food Waste GrinderYES_XNO # of Bathrooms Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks ,a00 - *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement_ Prefab Concrete x *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft. New Addition rin. lacement *Fill S stem Seepage Trench: NoFe idth e h Tile Depth No. of Trenches Seepage Bed: LengtWyA~h----~ep : le pth No. of Lines Seepage Pit: Inside LigUIe Depth Tile Size Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME C.S.T. # and other information obtained from (owner/&INW) . 1 j Plumber's Signature /MPRSW# Phone OW/1 *2 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). / 1 f iNrr ARF ii'6V., ^ii~y ref i';'l fly' / /S _ (,1R r146 Do Not Write in Spac Below FOR DEPARTMENT U ONLY j 0 Ls"pection of Application Fees Paid: State 1i%~' Cqu D to ?X ' Issued/Reeed (d ate) -~J g Agent Name J- No Valid* Date Recd m Yes 4~ nty (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 e (pink copy) 4. plumber (canary copy) Revised Date 6/1/76