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HomeMy WebLinkAbout002-1015-10-000 W*consin bepartr-2nt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 139 (ATTACH TO PERMIT) GENEI�41- INFORMATION State Plan ID No: Personal k rmation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Gausman, Stanley Baldwin, Town of 002 - 1015 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /00-0 / U6, 0 G«&& 07.29.16.97 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1G6O Benchmark /60 ^ n n q 6 p y 96 Dosing �Qb Alt. BM ! 0 Aeration Bldg. Sewer . � Holding St/Ht Outle reA, ( � TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DtInlet A 2i5 eptic Dt Bo ttom S Do ng Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP/ PHON INFORMATION w Final Grade acturer //,� Demand St Cover r 99-- r� W1kik4t G GPM Z Model Number TDH Lift Friction Loss Sy Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER R Type Of System: UNET Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil H Yes 0 T No Yes ❑ No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / 5 Inspection #2: Location: 1067 Hwy 63 Baldwin, WI 54002 (W 1/2 NWI /4 7 T29N R1 6W) metes & bounds Lot a Parcel No: 07.29.16.97 ) 1.) Alt BM Description = �Q�( �Q(,UtQ/Z/ 2.) Bldg sewer length = —AJ L` l7 Q /J � J/W n G�C.C�o - amount of cover = �r f �Q,�, i s J n L _ L Plan revision Required? Yes i � o Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signatur Cert. No. i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This to_ certify that _I -have inspected the septic tank presently serving the residence located at: N0 S Section -? T N, R A W, Town of r Upon inspection, I certify that I have found the tank and baffles to be in good condition, andjt appears to be functioning properly. Last time serviced: �5 ✓ O Did flow back occur from absorption system? Yes - g - No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known): Age of Tank (If known): t,J L l` G ➢� L L L F (Signature) c (Name) Please print (Title) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name i,J fqi r 45A A),6 t(4 yZ44 Signature (�� __ MP /MPRS - M ? A-5 I r i i j ► s i ' 3 q c�et l l. Y3 y 5 •� spa } I i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND RECEIVED OWNERSHIP CERTIFICATION FORM Owner /Buyer MAY 1 �� 200 .� 1 bi b�wat bcrud� � PIMMIN'1(i 6 ZON" Qff16E Mailing Address /0 o Property Address / 7 1-4 c 3 r✓ � yo o 02 (Verification required from Planning & Zoning Department for new construction.) City /State : ,, c,5 ; Parcel Identification Number o o a - ! [ 5 -!o - 0 0 0 LEGAL DESCRIPTION 22 Property Location IJ W 1 /4 /4 , S ' , Sec. - 7 , T o N R /G W, Town of 43 Subdivision Plat: , Lot # Certified Survey M p Volume Page # > g Warranty Deed # (before 2007)Volume , Page # Spec house I yes _? no Lot lines identifiable 1 1__I yes : no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of our septic Proper stem could result in its premature failure to handle wastes. Pro Y P Y P P maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a`master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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 virtue of a warranty deed recorded in Register of Deeds Office. Number f edrooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) P �11N County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN G in accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT �o�fs Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)) a 1� 1101 Carmichael Road K Hudson, WI 54016 -7710 (715386 -4680 Fax (715)3N-46W Attach complete plans for the system on papeWt I x 11 inches in size. County Sanitary Permit * ❑ Check if revision to previous application 7 pp lication Information - Please Print all Information Location: Property Owner Name E 4-3 1 / 4 5 1/4, Sec 7 S - rA- a G 0 (..-, 5 A AA a I' "09 dZ9 N, R //p E(or Property Owner's Mailing Address ' H ST C�Ot FiCE Lot Number Block Number o -7 4P City, State Zip Code Phone Numer ubdivision Name or CSM Number j8R'LDwr_t 5y 00 eo Ac.,.,�. , It Type of Building: (check one) L G+� Mity ❑ Village ®Town of IR� 1 or 2 Family Dwelling - No. of Bedrooms: 5•r"`�' ❑ Public /Commercial (describe use): ❑ State -owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax Number(s) A) 1,0 Repair [.W 4. ❑ Rejuvenation tl6 2 , /e t r-1 d o oa Sanitation C. 7 - 7 B) Permit Number Date Issued State Sanitary Permit was previously issued /78 IV. Type of POWT System: (Check all that apply) ff pressurized In- ground ❑ Mound a 24 in. suitable soil ❑ Mound S 24 in. suitable soil ❑ Mound A +0 D Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line D Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other D At -grade D Aerobic Treatment Unit ❑ Recirculating . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade 5-0 Required 41 Pro �s ffi (Gals. /da yisq.ft.) (Min.finc ! � O j Elevation ..- . 10 J VI. Tank Information Capaicty in G Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing � alions Tanks Concrete structed glass Tanks tj Tanks o ( � P, G [3' D D ❑ ❑ VII. Responsibility Statement the undersigned, assume responsibility for repair/ reconnenction /rejuvenatioNinstailation of non - plumbing for the POWTS shown on the attached plans. A ense is not required for terralift re air or the installation of non-plumbing sanitation system. umber's Name (print) Plumber's Signature (no stamp } MP /MPRS No. 18usiness Phone Number ALr E A Nif ctoo,t La tdA - 7 -1 t 0 754 -3- � ;? — ber's Address (Street, City, State, Zip Code) Z N r6 ounty,U Only d Sanitary Permit Fee Date Is ued Issui Agent S I nat Approved Owner G' r r Adverse ? Z , ay 05/61 ation itfons of Approval /Reasons for Disapproval: SYSTEM tawN R: 3� 5,,.�. a .1 -GW' " c.l,,, �t Sin 1. Septic tank,A ft and P dispersal cell must ail be services, / maintained Per"" ' k W" 65jeJ Q A @.w as per management plan provided'by plumber. 2. Ail setback tetquirbihimts must be maintained as per MV#md* cede I at'dinences. 4 P) � � � �b ul 1 N 1'►l LLi � t �(t, ju 1 41 f ``fit C - • S-, • j�� , �!/if'l��Tr'D�v ? ! � �Ti ov o� �.a'i si`ivG— Q.c°>pi�V 1�i �`� MIL s YsT- s of c 1/ r' c- t - r�a.v / Z Wisconsin DepwbTwA of Commerce SOIL EVALUATION REPORT Page Division of Safety and Suitdngs in accordance with Comarn 85, ors. Aim. (;ode ��, s•.�,�, Ci2 O /'� Aaadn complete site plan an paper not less than :J� tfon i��tsst inaude. but not limited to: vertical and host Pai I.D. 0 . // ' /Q - 0-0v percent diope. scale or lions. north arrow, and distance to nearest Please Print all 1 �AN 1 2009 e�ewea Dace ftmw kewua on you provWmmy be toad for porpwn tPdmW rte. a.1s a (1) t > 1 2Z Properly ,Q ZONING Of Fic SW 1 y /Ce 114 114 S T N R E(, W PropertyOwnees Address s/ft IfApo� Lot # Block # Subd. Name or C" loco? �wy 6 3 ep 'Of-4e Slate zip Mode KZZ Number ❑ Cdr ❑ Wage 0 Town Nearest Road lot S�IOoZ t 7 /s �✓�G /aJVIA/ Hwy �3 ❑ New ConsWiction Use.4 Residertial / Nrmrber of bedrooms ? ` code derived design now rate 3aU ' S'S"D GPD ❑ Replaceownt ❑ Public or cornnwdal - o Parent materiel � S U.P f. : 5 AJf�Y - fi f/S Flood Plain elevation tf applic N it Gerwal convnents . VER! �i ��t- Y OF U and 58ti, S A-OXA- GiFaT" T Am x �X /STjNIr l � �¢D fli?r4 %ni i F[� wnti hall so sys em po uor . C O © soft ❑ 14 �7 ph Ground sufaae elan. ��' � R Depth to Nrrr*V factor > ! K Soli Appliceft Rate Horimn Depth DwdnwtColm Red= Description Teld" Shicdxe Consistence Boundary Roots GPOW inn. iMunsell flu. Sz Cont. Color Gr. Sz. Sh. 'E1nEi1 'Etf112 I s ,t A CS 2f- Lee y S L f s bt R cs Z-4�Lnooq 00k U �# ❑ s U ❑ Pit Ground suface elev. R Depth to Rd" %ClOr inn Rate Sol Apjpkathn Horh m Depth Domes Colot Redox Description Te*" Sbuo" Coke Boundary Roots GPDNf In. Vtasell t]u. Sz. ConL Color Gr. Sz. Sh. *EM 'E11112 Musa #1: Bt, > 30 _< 220 mglL and TSS ' :S 150 rng& ' Eminent 02 = BOD :S 30 mall. and TSS _ 30 ffsk Address / o r �`- 11.e � Evalu� nd om caurctad T elephone 2- e i(/DU '71S. CA4jP M 1' &v % 1A 71 o-v of 1�� %.v�i�Ll7. l�iC'� /.vFi'f�U v.�- y " � •-� v-�cn p� P (�-) 10 h 5 T ,4 1 /Y -PA 6 '' 5, eew" , "Po etc iii •7 :77 774 mm mm �. a s1�rt r� �c.3 0 m •kA p c n k 1S`S b ` C Q 1 � -� 0 n 0 �y Exhibit "A" to Offer to Purchase S94 ?89 LAND CONTRACT KATHLEEN H. WALSH Document Number Form 11 ST. CRO OF C DEEDS ST. ROIX CO., WI VOL I 3U1 PAct 453 RECEIVED FOR RECORD CONTRACT, by and between Gerald E. and Veronica M. Kusilek, aka 12 -31 -1998 8 :00 AM Veronica May Kusilek,husband and wife (Vendor) and Stanley Gausman and Susan Gausman, husband and wife, as survivorship martial property LAND CONTRACT (Purchaser). Vendor sells and agrees to convey to Purchaser, upon the EXEMPT M prompt and full performance of this contract by Purchaser, the following CERT COPY FEE: property, together with the rents, profits, fixtures and other appurtenant COPY FEE: TRANSFER FEE: 355.20 interests (all called the "Property "), in the County of St. Croix, State of RECORDING FEE: 3 Wisconsin: Recording Area Name and Return Address Bakke Norman, S.C. 900 Main Street PO Box 54 Baldwin, WI 54002 07-29-16-965,07-29-16.97, 07 -29 -16 -986 (Parcel Identification Number) See Attached Exhibit "A" i This is not homestead property. 1996 Real Estate Taxes shall be paid by Vendor. Purchaser agrees to purchase the Property and to pay to Vendor at 2176 County Road "E ", Baldwin, Wisconsin the sum of $118,400 in the following manner: (a) Assumption of Amount of Credit Services of Wisconsin's underlying mortgage debt at execution of this Contract; and (b) the balance of $88,465.29 together with interest from date hereof on the balance outstanding from time to time at the rate of 6% percent per annum until paid in full, as follows: Purchaser shall make payments due Farm Credit Services of Northwest Wisconsin, on the debt of Vendor, assumed by Purchaser and secured by a first mortgage on the property. Purchaser shall make monthly interest only payments of $442.33 on the remaining balance of $88,465.29 for the years 1999, 2000, 2001, 2002 and 2003, to be paid in two equal installments of $221.16, on the 5`" and 20`" of such months, by dairy milk assignment, commencing on January 20, 1999. Commencing on January 1, 2004, the remaining balance shall then be amortized over 20 years and interest shall accrue at the best rate for which borrower would qualify at Farm Credit Services of Northwest Wisconsin. Payments shall be made by milk assignment on the 5" and 20 of each month. The interest rate shall be adjusted annually on January 1. Provided, however, the entire outstanding balance shall be paid in full on or before the 31" day of December, 2023 (the maturity date)_ Following any default in payment, interest shall accrue at the rate of 12% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Purchaser may prepay up to $5,000 in any year without permission of vendor, if notice is given to vendor prior to September 1° of any year. Purchaser may prepay an additional $5,000 in any year with permission of vendor, which permission shall not be unreasonably withheld. In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to prior mortgage to Farm Credit Services of Northwest Wisconsin and Farmland Preservation Agreement. Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor Purchaser shall be entitled to take possession of the Property on December 29, 1998. VOL 1 :391 ?ACE 454 Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the sum of full insurable value, but Vendor strdtt rMt require coverage in an more -than the - balance: owed -under -this-Cc ntract, Purchaser- shall . pay-the .insurance .premiums- whan.due- The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 30 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 60 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and - Wit hout - notiow(whielr Purchaser - hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shalt be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor faits to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this X qq day of December, 1998. - ,�P ev *Gerald E. Kusilek Vendor •St ey Gau an Purchaser Veronica M. Kusilek Vendor ua Gausman Purchaser AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gerald E Kusilek . Veronica M. Kusilek _ STATE OF WISCONSIN Stanley Gausman Susan Gausman ST. CROIX COUNTY Personally came before me this day of , 1998 authe 'sated this day of t . the above named Gerald E. and Veronica M. Kusilek, to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. signature signature Thomas R. Schumacher type or print name TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisconsin. (If not, My commission is permanent. (If not, state expiration date: authorized by g 706.06, Wis. Slats.) ) THIS INSTRUMENT WAS DRAFTED BY "Names of persons signing in any capacity should be typed or printed Thomas R Schumacher below theirsigrratufes- EXHIBIT "A" 1) ' /West Half of Northwest Fractional Quarter (W -1/2 of NW Frac.1 /4) EXCEPT North 28 -1/2 rods of West 28 rods 1 foot thereof and EXCEPT that part lying West of State Trunk Highway '63'; and the West half - of - North Half of Southwest Fractional - Quarter (W -1/2 of N-- 1/2 of SW Frac.1/4) EXCEPT commencing at the Southwest corner of the North half of the Southwest Fractional Quarter (N -1/2 of SW Frac.- 1/4 of Section 7, Township 29 North, Range 16 West) running thence East on the one - eighth line to the Southeast corner of the North Half of the Southwest Fractional Quarter (N -1/2 of SW Frac. -1/4); thence North on the one - quarter line 208.5 feet; thence West 836 feet; thence North 230 feet; thence West to the section line; thence South to the place of beginning. 2) West 100 rods of North Half of North East Quarter of Section 13 -29 -17; EXCEPT part to Vrieze Farms, Inc. in Volume 531, page 227. 3) West 910 feet of East 975 feet of South 370 feet and West 910 feet of East 975 feet of North 690 feet of North East Quarter of North East Quarter of Section 13, Township 29 North, Range 17 West. Parcel Identification Numbers: 07- 29- 16 -96B 07 -29 -16.97 07- 29- 16 -98B AS BUILT SANITARY SYSTEM REPORT OWNER �- i �-�U S �L i c K. TOWNSHIP SEC- Tt"N-R ADDRESS ST. CROIX COUNTY, WISCONSIN. i I v I 10 LOT LOT SIZE 90 � es PLAN VIEW i 1 1 i ;arnces and S dimensions to meet requirements of H63 aH04L_RVERYTHING WITHIN 100 FEET OF SYSTEM i , C O I di a e o#hj Arrow SC Ad: : ItiAh'11MAR1(: (Permarnent reference Point) Describe: 1� : ov:r tion of vertical reference point; /00 o Slime at site: 1Y, /—' CoR^)ere - I dqA# lei SI-J'TIC TANK: Manufacturer: e- ,—' -5 Liquid Capacity: 4,9 ad (z''4C. Number of rings on cover : p ie. Tank manhole cover elevation: 99 •�'" Tan Inlet Elevation. Tank Outlet Elevation: q�► a PUMP CHAMBER Manufacturer: Number of gallons Ov Number of gal. pump set or a cyc e� 0 gallons; total capacity of distribution lines ` gallon: size of pump 0 ' head; gallon per minute horsepower / rand name of pump :ind model number �c ; Tyi)e of warning evic 10 )i,u I NC 'I`ANK: Manufacturer Number of gallons REPORT OF INSPECTION - INDIVIDUAL SLWAGL SVSILM Sang tahy P(l t • State S e p t t c MEW j ','II wIpllA(J St. l I(U.t X l UUY1 t /►w �_ i Sec t i.on Lot Subdivtiekon � yuYl'urte Nurribe - lt 06 comCtahtment6 6u 7-, _ 12o ex.OPe _ _ __- Htghwateh ��• ('ilAMBLR �aZton4 Pump Manu6actu)Le4 'v" _Modee Num � © -- TANK - yaUorn4 Nambeh o6 Compantmente Akanm S ye te.m week �._ buJXd.cny 12 4X ope.__ 14 t "_9hwa.ten ON I I I 0 0! ! o ! ►r!: We.EY 8u4..Qdin Hi yhwate r! `-- -' w I I I V I W N S I O N S n 0(v R V'qu ! �(ed ah -a 9 4" (� f 'ii 1'ltch Kiklr (1t UeCrth u(� much befow tike ri Y ( Yt U e.pth u 40 c uu t-i'e a r! 1'vrn,yth u6 Zine.4 0 - Depth o6 ti e be1uw ghwdv '01CO between fi.n.ee �P __._.� S-eopv u 6 tLe.nch G -- <ri . pv1 l 100 '-t i ul�� �lhK) ti.un ahea � 6 Tyre u6 Cuveh: Papert o1i e 0mAj ! ONI G 1111.0urLd P4 010 I�,rrl11'(e�h �j( Vepth below tnZet 61 t'. 7j I l iY1 l ll'!I � ✓' Gv __.. _ - �- TITLE. State and County State Permit P LB 6 Permit Permit # 45/24- Permit Application Y for Private Domestic Sewage Systems County zr*. nxo/ >< Y * DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: a e- A iq LJ i�05 r,t.. , j ,g L d L " B. LOCATION: I YOW _ % SE 'I4, Section T N, R $ (or) 1 Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Towns W44x. (w;, j C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family _ X Duplex No. of Bedrooms 3 No. of Persons D• EPTI S C TANK CAPACITY O ©D Total gallons No. of tanks O/J e HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concret Poured Fiberglass Other (specify) New Installation lacement Lift Pump Tank or Siphon Chamber Total gal ons re a concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. V New Replacement x Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: ___Length 2f Width Depth 36 „ Tile depth (top 3'1Z � No. of Lines Twb Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land © ge Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if ot her than p 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 Soil Tester, NAME V E 0,-e- f'f' D/t!. f C.S.T. # ,�J ��� and other information obtained from ,,, .. (owner/builder). Plumber's Signature MP /MPRSW# M00 - 419? Phone # 'j/9 -- 6$5 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. _ 3 yes ®gym _A,w.. �m�..um .. ., ... 4 ~ DEPARTJ1flENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDIN INDUSTRY DIVISIO LABOR AND PERCOLATION TESTS ( 115 P.O. BOX 796 I� HUMAN RELATIONS 1 MADISON, WI 53707 LOCATION: AI(/('' SE CTI O N: T /0 6(orl W TO T NO.. LK. NO.: SUBDIVISION NAME: COUNTY: OWNE 'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS,: AL DES PTI N: �{ TE Residence ❑New ►ai Replace _ /� / J3 —3'1 . % � RATING: S= Site suitable for system U= Site unsuitable for system Ki CONVENTIONAL: OUND IN- GROUND - PRESSURE: S STEM -IN -FILL HOLDING TANK: RECOMMENDED M: {o � ❑u I as ❑u asou as au osau �7 �G e s - If Percolation Tests are NOT required DESIGN RATE: SY ELEV. If any portion of the lot is in the ifs 9�, under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain ele '` :, PROFILE DESCRIPTIONS .: BORING TOTAL -DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, E, AND DEPTH NUMBER DEPTH IN. ELEV OBSERVED E HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON B- > 7A 9 q 9 // "� ' > , S /o "- .5 �. a $L . 3o,f Sc L ao ,� g- g- g. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERS ELLING INTERVAL -MIN. PERIOD 1 PERIOD2 PERIOD3 PER INCH 0 40 / P ALO s P- 3 0 P P_ PLAN VIEW: 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 and the direction and percent of land slop. SYSTEM ELEVATION 7 ` fi IL G � ��� ._� � t p§ y .4v ...„S_e _...... -„- �-.....F._...e -,- e ». d....,.....Wp.«..e..N......�... e®.a tt 4 �......... �... .., w.T..�............ �. T c I L fl o O N T> tA ' C 'i' cl • 7 0 2 § ) ' A % k ' \) 0 7RRI k.0 7 �kk� � f / Zk 0 ; §r, kk 2 o \z 0� // # n Q . 7 ' I E § B B :t 2 co ' ■ � , $ k 7 / E e 7 ; { . } / I }f }_ G k D < } ' « \ � 2 C 2 ■ e E \ 3 2 ) / \ e ' , 2 « k 0 0 0 2 -� _£ �_ a a a j $ k k � 2 � B k / D G 2 § = 2 E < § 77 f J » q . , �§ ;2 ° § o %° ■ ■ 8 '_ m E o § § 0 k k Lo u \ L6 a � @ m m 2 , o f ]§ 2 k) 2 o» m �2 $ k )$ m 2 2$ ; � : L: IL ® E)' @a§ k jIL 2 o 0 8 t C if h C C tz CO r-i ry L O C O) L 3 C W o E a E °) Em c 6) E I p N 0- .0 0 o LL N Oa C C U O C g 7 O L U >. 3 > E E� c 3 >.E o -�v a) 0 7 m ' C o N> O a) C) C i � a.> ssmM @ i> n.> ° a)M m N N C N N C EIn 00o Ev o00 vt o — �a - o ri ono aci c� @ E on•o ` cZ @ E n a) e ° o @° N D L a) 0° o@ O 4 N Q c E - o aXO>._ E Y° °ico�g 7 (l7 O C C •� L @ a) — N a O C C •� L @ a) — LL c mo o:° oc�a c L 0 m _m o 00. n at@ Ts 0CL•aa)� o-t@ O Z' ° L O N O o a- 7 ° L m a) a) O o a. C d E Q E N m E N N N m @ N U : U M 1 a- v E o Z d : c v o aD N h •- �' °1 a) o E E CL @ Q O N i Q. U) C? O O N Q I , Z [o Z N N C L a) = @ O O otS fl• :a .i. .. > 2 > 2 N 1 d i d O W L Q) W L O Q El v E N N U) U) i 1 LO O O O •►y aaa CL in J Q rn o) Z Z co a a _ m Q ( Q S, rMj O O ° O N C E O •a E O C @ U Q) C co 0) U N C co 0) 4 F o v m c c ° ° G £ E c E E d o o L h (7 N @ Co C E @ • a N N N @ Co C E @ Z3 N N p ` co c l c m m a) c co fl c m m 5 a) c co co a'U C) m n o c o 0 Z) co o o E E c °° E E r O Y C ° z N m m a. z V) 7 2= a z V) � ' I w . E E m _ a � • R a. z •2 d a > +. E u 'c c d D c°aa�j;oinm Parcel #: 002 - 1015 -10 -000 01/10/2007 11:08AM PAGE 1 OF 1 Alt. Parcel #: 07.29.16.97 002 - TOWN OF BALDWIN Current ; 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 STANLEY & SUSAN GAUSMAN O - GAUSMAN, STANLEY & SUSAN 1050 HWY 63 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description 21 z SC 0231 BALDWIN- WOODVILLE AREA J SP 1700 WITC / J�/ 7 C1t0 Legal Description: Acres: 36.000 Plat: N/A -NOT AVAILABLE SEC 7 T29N R16W W 1/2 NW FRL EXC PT W OF Block/Condo Bldg: HWY Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -16W Notes: Parcel History: Date Doc # Vol /Page Type 12/31/1998 594789 1391/453 LC 07/23/1997 422/325 2006 SUMMARY Bill #: Fair Market value: Assessed with: 153366 Use Value Assessment Valuations Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 34.000 5,700 0 5,700 NO 00 OTHER G7 2.000 8,600 13,000 21,600 NO 00 Totals for 2006: General Property 36.000 14,300 13,000 27,300 Woodland 0.000 0 0 Totals for 2005: General Property 36.000 7,600 9,400 17,000 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount 010 - GARBAGE SPECIAL ASSESSMENT 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 r ta K� nB . ,n y `�i ry ( � F' hs�y t Fo aV WWI ': •'�. } i y . r (/� i � ' "�.� E.s .,,� t �� { fix _ 2)+ �.� r `7 v L C Y x z xr � ` �� �'rc. `sly' .�is�yaeNC�' S �i, �• fix;. 3+ � a 1 385 000 FEET +� 5 rz s� �3 f N/ S�✓C4r Lfob Parcel #: 002 - 1015 -20 -000 01/10/2007 09:54 AM PAGE 1OF1 Alt. Parcel #: 07.29.16.98A 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): 0 = Current Owner, C = Current Co-Owner DOUGLAS D & MARY E HOLLE 0 - HOLLE, DOUGLAS D & MARY E 1031 HWY 63 BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description ` 1031 HWY 63 SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.500 Plat: NIA -NOT AVAILABLE SEC 7 T29N R16W PRT 112 SW 114 COM 208 Block/Condo Bldg: 112 FT N & 836 FT W OF SE CORNER, N 230 TT, w 0 W LN, ON W LN 230 FT E - T'C r Tract(s): (Sec- Twn -Rng 40 114 160 114) POB, TOWN BALDWI 07- 29N -16W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 /47r 07/23/1997 G 2006 SUMMARY Bill M Fair Market Value: Assessed with: 153367 166,300 Valuations: Last Changed: 10/27/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 27,200 142,800 170,000 NO 00 Totals for 2006: General Property 2.500 27,200 142,800 170,000 Woodland 0.000 0 0 Totals for 2005: General Property 2.500 9,700 106,500 116,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04117/2001 Batch #: 510 Specials: User Special Code Category Amoun 010- GARBAGE SPECIAL ASSESSMENT 45.0 Special Assessments Special Charges Delinquent Char Total 45.00 0.00 0 Parcel #: 002- 1015 -50 -000 01/10/2007 MUM PAGE 1 OF 1 Alt. Parcel #: 07.29.16.99 002 - TOWN OF BALDWIN Current 1X' 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 JOSEPH E &ANNA MARIE KUSILEK O - KUSILEK, JOSEPH E & ANNA MARIE 2209 CTY RD E BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 41.000 Plat: N/A -NOT AVAILABLE SEC 7 T29N R16 S 1/2 SW R 1/4 TOWN Block/Condo Bldg: BALDWIN Tract(s): (Sec- Twn -Rng 401/4 1601/4) Notes: Parcel History: Date Doc # Vol /Page Type 12/31 /1998 59478�-0/1 139 36--- LC 07/23/1997 2 2006 SUMMARY Bill M Fair Market Value: Assessed with: 153369 Use Value Assessment Valuations Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 6,400 0 6,400 NO 00 UNDEVELOPED G5 2.000 200 0 200 NO Totals for 2006: General Property 41.000 6,600 0 6,600 Woodland 0.000 0 0 Totals for 2005: General Property 41.000 4,200 0 4,200 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 - 1015 -80 -000 01/10/2007 10:11 AM PAGE 1 OF 1 Alt. Parcel #: 07.29.16.101 002 - 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 JOSEPH E &ANNA MARIE KUSILEK O - KUSILEK, JOSEPH E & ANNA MARIE 2209 CTY RD E BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: '- --Acres;-- 56.750 Plat: N/A -NOT AVAILABLE SEC 7 T29N R16W NW SE & IN E 1/2 OF N Block/Condo Bldg: 112 OF SW 1/4 TOWN BALDWIN - Tract(s): (Sec- Twn -Rng 40114 160 1/4) 07- 29N -16W Notes: Parcel History: Date Doc # Vol /Page Type 12/31/1998 594784 1391/436 LC 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 153372 Use Value Assessment Valuations: Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 56.750 9,700 0 9,700 NO 00 Totals for 2006: General Property 56.750 9,700 0 9,700 Woodland 0.000 0 0 Totals for 2005: General Property 56.750 6,000 0 6,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04117/2001 Batch M PRGRM Specials: User Special Code Category Amou Special Assessments Special Charges Delinquent Char Total 0.00 0.00 Parcel #: 002- 1015 -40 -000 01/10/2007 10:13 AM PAGE 1 OF 1 Alt. Parcel #: 07.29.16.98C 002 - TOWN OF BALDWIN PCL XL e r,,BMrent X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type Subsystem: KERNEL 00 0 T5 lWdressk teya1Tag Owner(s): O = Current Owner, C = Current Co-Owner 94 W Ut AN M GAUSMAN O - GAUSMAN, STANLEY W & SUSAN M �f �Y 616 BALDWIN WI 540 �%�1. n/J ,,,4. 02 � j'``' of 0 J Districts: SC = School SP = Special Property Address (es): ' = Primary Type Dist # Description SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC l Legal Description: Acres: 20.750 P t: N/A -NOT AVAILABLE SEC 7 T29N R16W T OF N 1/2 SW lock/Condo Bldg: FRL 1/4 & INC W 1/2 N 1/2 SW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 29N -16W Notes: Parcel History: Date Doc # si /Fag Type 31/1998 594789 1145 LC 03 575130 30 WD 03/16/1998 575129 TD 03/16/1998 57 1306/049e y ' QC 2006 SUMMARY Bill #: Fair Market Value: sassed with• 153368 Use Value Assessment Valuations Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 20.750 3,400 0 3,400 NO 00 Totals for 2006: General Property 20.750 3,400 0 3,400 Woodland 0.000 0 0 Totals for 2005: General Property 20.750 2,100 0 2,100 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 - 1015 -30 -000 01/10/2007 10:11 AM PAGE 1 OF 1 Alt. Parcel #: 07.29.16.98B 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 GERALD E &VERONICA KUSILEK 0 - KUSILEK, GERALD E & VERONICA 2176 CTY RD E BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC SW /VW I l-� Legal Description: Acres 20.750 Plat: N/A -NOT AVAILABLE SEC 7 T29N R1 6W N 1/2 SW FRL 1�XQ :OR „ Block/Condo Bldg: SW CORN 1/2 SW JF T :�R, N 208.5 FT, W 836 N 230 FT, W TO SEC Tract(s): (Sec- Twn -Rng 40 1/4 160 114) LN, S TO POB.. TO ACRES 07- 29N -16W SW ASSESSED WITH PARCELS 98C & 101 Notes: Parcel History: Date Doc # Vol /Page Type 12/31/1998 594789 1391 /453 LC 12/31/1998 594784 1391/436 LC 07/23/1997 25 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 002 - 1015 -80 -000 Valuations Last Changed: 02/10/1999 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 M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charge Total 0.00 0.00 0.0