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HomeMy WebLinkAbout002-1043-90-000 ,y o a•°i °o I � °o I ?o o (D I y o C v e =:- r Q•—Z o � I I N o x I (D > vi d� a� oaci v N ID - .Q co-'.,C p N w N C W C O. to CD(n a o za°)i € LC3goi r� > a 3 cva, U-0: Oc p Q m C C O.:-.Y rlC+t L N I O O C ° to+-� M C .cc N v� m I ID C' N t_ o �. a z L 3 E a I c a z o�0Lo m c c LL C U) r- w IL C N D y A a OE a E 0LE (0 0LL v I � co I m O I v C � E I � E I CO z ''. 4j °o I w0 °o tr v z M I � � z am IL I I I o I o z g c I — U) H E c c z c E E q v co VA m aD a) y CL a5 H •� a = ° _ o O 'v O S Q o zIMz =° zz z N Cq c C4 c c E E N O _� .. A N _ W .. l+'0 N � � fCl Z pa CL CL y d N W y y Lu c O ° C 17 IL • I - C 17 D ID. •L1 O N E m 3 p m 3 3 0 a m m —2 5 0 z •fit ma aaCL o m (L a 3 0 0 o m L N J U °—T rn pOi O I 0) 0) O°i O _ Z 1 = � Z ° pMj O 1 0 t0 n O CO u7 izz O O O •t7 O F m N m C a N C y F a) N d Q N d Q O (V a l0 o m o u5 c o o m y 5 o E N ° mCO o c ''� aUi c c v o rn °o V M H U c m € U C W v to rn Co d YN N N 12 7 T a+ 7 7 (D w 7 Z' E L o of Eo L co o u, la o L o o fn co o O — m Uc14rn z y = z U o z Q ra I I I r� �. v v� d M IL a tii • �' U IL CL tes m ._ III' d m m c m c r� o �1 A c°� IL � O a) V omU L,At5UFi M-HUMAN HtLAI IUINJ PRIVATE SEWAGE SYSTEMS P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NW1-4,NW4,S19,T29N-R16W ❑CONVENTIONAL ®ALTERNATIVE State Plan l.D.Number: (It awgned) Town of Baldwin M Holding Tank ❑In-Ground Pressure ❑Mound S88-00907 U.S. Highway 63 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Christian Reformed Church Route 2, Baldwin WI 54002 - $g BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No.: County Sanitary Permit Number: Dale E. Hudson 6629 St. Croix. 106126 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. OYES ONO OYES ONO BEDDING. VENT DIA I VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING JVENTTOFRESH ALARM FEET FROM LINE AIR INLET ❑YES ❑NO DYES ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIOU ID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES ❑NO ❑YES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) DYES ❑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: BED/TRENCH WIDTH: LENGTH TRENCHES DISTR PIPE SPACING MATERIAL. PIT NSIUE DIA 101ITI DEPT H DIMENSIONS GRAVEL DEPTH FILL DEPTH ID11TR'PI11 DISTR PIPE DISTR.PIPE MATERIAL: NODISTR. NUMBER OF PROPERTY WELL. BUILDING VENT TOFRESH BELOW PIPES ABOVE COVER. ELEV. NLET ELE V.END'. PIPES FEET FROM LINE AIR INLET NEAREST------0-1 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. DYES ONO SOIL COVER ITEXTURE PERMANENT MARKERS O WE LIS DYES ❑NO YES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED ISEEDED MULCHED CENTER EDGES. DYES ONO 1:1 YES 1:1 NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES LATERAL SPACING JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATE HIAL.&MARKING ELEV. ELE V.'. DIA.. ELE V,'. PIPES DIA.'. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ❑NO COMMENTS: ]PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING. FEET FROM LINE DYES El NO DYES ONO INEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Administrator =i1jL, SANITARY PERMIT APPLICATION COUNTY_In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. S88—DO 907 —See reverse side for instructions for completing this application. PETITION I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES X NO PROPERTY OWNS PROPERTY LOCATION Gd '/4 W'/a, S 1159 T Z9, N, R Q (or W PROPERTY OWNER'S MAILING ADDRESS LOT N jM�R BLOCK NUUfJyIBER SUBDIVISION NAME CITY,STAT Z� ZIP CODE PHONE NUMBER /CIITTY NAY NEAREST ROAD,LAKE OR LANDMARK P2 TOWNOF DO Z 5, lo�y Z9Z O VILLAGE �;Way 10.3 II. TYPE OF BUILDING OR USE SERVED: / �( / Number of Bedrooms if 1 or 2 Family OR .I�.J Public(Specify): (fAar' G III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ New b.X Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued_ Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ❑Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ;9 Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank3 V. ABSORPTION SYSTEM INFORMATION: (Check one) /,,Q 1. a. El Seepage Bed b. El seepage Trench c. El Seepage Pit A /' 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED( quare Feet): PROPOSED(Square Feet): A/ /vX N� Feet ❑Private Joint ❑ Public VI. TANK CAPACITY ##of Prefab. Site Fiber- Exper. in allons Total Manufacturer's Name Con- Steel Plastic INFORMATION New xisting Gallons Tanks Concrete glass App. Tanks I Tanks structed Septic Tank or Holding Tank 000 4 o Z 6&k./re,-5- :T.Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: -Dale- C, a Son �,z9 � �8 -337F Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## .Dd/e 34 /3 CST's ADDRESS(Street,City,State,Zip Code) / Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) Approved wrier Given Initial Qb 12 ,cn rcharge Fee J� Adverse Determination L{� 111 X. COMMENTS/REASONS FOR DISAPPROVAL: �/O-h to�/ SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; Ill. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 816 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This, change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground $f BT included the creation of surcharges (fees) for a number of regulated practices which Wisco in'S. e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried IBa&tar; is used in your building is returned to thg groundwater through your soil absorption u system or the disposal site used by yourlholding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) DEPARTMENT OF REPORT ON SOIL_ BORINGS AND SAFETY&BUILDINGS DUSTRY, DIVISION h'V G P.O. BOX 7969 LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.090)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: '/a�'/a 19 /T29N/R/G cor 23n ,/,e.v.r� �t/f A4A AbV COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: � USE DATES OBSERVATIONS MADE NO.BEDRMS.:ICOMMERCIAL DESCRIPTION: PROFI LE DESCRIPTIONS: PERCOLATION TESTS: ❑Residence ❑New Replace N Nr9 ,� N 1� C u .� RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) ❑U ❑s ❑u ❑S ❑U ❑S ❑U -1 MS ❑u 4� If Percolation Tests are NOT required DESIGN RATE: ,� //� I If any portion of the tested area is in the under s.H63.09(5)(b),indicate: N '4 /7 Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 7L B- Q B- � B- B- c� PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 PER 100 3 PER INCH 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 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 slope. 0 SYSTEM ELEVATION I I I I I 4 1 4 I _._..A..._ _.„ ............. ' ._ ' _. r Y t f w E I � 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 the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: lDa/e �> s � ADDRESS:/ �OX / — � CERTIFICATION NUMBER: PHONE NUMBER optional): - 113 CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — � Y ' INSTRUCTIONS FOR COMPLETING FORM 115- SBD - 6395 ' To he a complete and accair'ate sail 1-1, %,wll w)) m I mkt"t includo: I. Complete legal description; 2. The use section must clearly indicate whether this is i residence or commercial project; 3. MAXIMUM number of bedrooms or cornmc rciai use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and plaWe your current �Adre,ss and yore certification number; 12, Make legible copies and disflih tc as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10") BR - Bedrock cola -- Cobble (3- 10") SS — Sandstone gr Gravel (under 3") LS Limestone Vs — Sand HGW - High Groundwater cs - Coarse Sand Perc Percolation Rate med s — Medium Sand W - well fs - Fine Sand Bldg -- Building Is — Loamy Sand > - Greater Than Fsl -- Sandy Loam < Less Than "I — Loam Bn -- Brown sil - Slit Loam BI Black si — Silt G -- Gray *cl — Clay Loam y --- Yellow scl — Sandy Clay Loam R - Rent sicl — Silty Clay Loarn mot Mottles sc -... Sa;uly clay with sic - Silty taay .{ ,1,,, fine faint x. c Clay cc - cornmon, coarse pt: - Peat rnm -- Many, ntediunr m — Muck d - distinct p prominent HWL — High water level, " Six general soil textures surface water for liquid waste disposal BM Bench Mark VRP --- Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to hermit isszrrnce. A complete set of plans for the private sewage system an(] a permit: application must be subrid!v;r9 to the appropriate local authority in order to obtain a perrnit. The sanitary permit must be obtained and posted prior to the start of any construction. rf 10 fn fn � �J. F1m�N z n. g rn J- qi (a W 3 �• �' Ut, v H o c oo � tn, Ll w 4,2 ° �.. Ui t� COO 14 "► ,°,a w o Cx i" A Meo vi S� W j s P n td 'A � o (D W a ct mt7 DrN r- 0 0 m m -s �. .r. ct O p m = 3> > W d (D .. W W c•F V► r(D 1C m ((D a C-+•r m (n�t �r � � cm m c ;0 .. .�. •L7 d � Z (MD ll-� •. N NL C A no C Q ►-r ft 4 -v (� -+• Z O c'•(• n m -p . Cr E .. ` Cl -.•• c ro e ro cni C+N _ m CA a 00 0 � .C+ -h :�t .� d O o ti N n w -� a la v z r -n a, �l m - z ►-. o v '°n 3Eoa > > = A v wp cNn rn w (+ m c CIA m n -n cn a o ! m o v w n z y n -at O —i Z C0+ m C N N V� —I .-. O O c3i� ('oD m(�D -3 m Cn p s (� Z W , o;� G LA " (3 �' c m `+ n , a 1 O '�'►'t° C -� m ?° CL -n �. S C t� m r ,r h. ::E a (D to r.o ;l m n o ) o m a tn � aa � rr o n N m n m m n m o 0 ccnn m �A / A O C+ C+ v 3 w• ° 0 n : o �_• J,• (D 06 (, "f W T7 O C TM -+• __ C+ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR AND 1 P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.090)& Chapter 145.045) LOCATION –SECT—ION: TOW /M 1 ' UBDIVISN NAME: W AV� J / / i 9 2 R/Z for A fn ,/ J/ CODUNT/Y: O/W'NER': BUYER'S NAME: –/ M,AILIN ADDRESS: / DATES OBSERVATIONS MADE USE TESTS: ND.BEDRMS.:1COMMERCIAL DESCRIPTION: IPROFIL D�RI 10 S: [OResidence N� r ❑New Replace Il N RATING:S=Site suitable for system U=Site unsuitable for system ICEIS ONVENTIONAL: MOUND: lN-GROUND-PRESSURE: S STEM-IN-FILLHOLDIIN`G TANK:RECOMMENDED SYSTEM:(optional) C1U EIS DU D S [lU El S ❑U B S ❑U DESIGN RATE: If an If Percolation Tests are NOT required �� y portion of the tested area is in the `/ under s.H63.09(5)(b),indicate: lFloodplain,indicate Floodplain elevation: I PROFILE DESCRIPTIONS BORING TOTAL DPTH TO GROUNDWATER-INCHES CHARACTER Cl SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST-HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) B- B- Z?e B_ a en 57/ B- / B- a PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D 2 P R 100 3 P- 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 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 slope. SYSTEM ELEVATION :k 4 tN 3 { i � t I k _ i I i I ! : I i ! l - 1 � _.. 7 _ _ . . _ _ 1,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 the location of the tests are correct to the best of my knowledge and belief. NAME(print): TESTS WERE COMPLETED ON: - /e 4'. s ADDRESS: CERTIFICATION NUMBER: IPHONE NUMB ER(optional): CST SIGNATURE: -RIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. -SBD-6395 (R.02/82) –OVER – ^ , INSTRUCTIONS FOR COMPLETING FORM 715 ' SBD ' 6395 ' r" h,^ c"mplm,noxncn/m, v,i| ^"/. v"v, ,,/*nm",ti^c|,m,: 1. Complete legal description; 2. The use section must clearly indioamwhmh,r this is residence orcommercial project; 3. MAXIMUM number of bedrooms orcommercial use planned; 4. b this a new o, replacement systom; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED UN SOIL CONDITIONS; G. PLEASE use the abbreviations shown here for writing profile descriptions undonmp|mLingthorlotp|on; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to oou|* is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain dato, percolation test exemp- tion, if appropriate; lO. |f the information (such as flood plain,elevation)does riot apply, place N.A.in the appropriate box; 11. Sign the form and place your current address arid your certification number; 12� Maki,! |oVib|v copies and Uig,ibu/, '; n,y/imo, ,'\LL 3U|L TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 38 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10^) BR — Bedrock cot) — Cobble (3' 1U^) SS — Sandstone y, — Gravel (under 3'') LS — Limestone ~o — Sand HGVV — High Groundwater cz — CoaneSand Pv,c — Percolation Rate m,do — Medium Sond VV — vVo|| Is — Fine Sand Bldg — Building ` Is — Loamy Sand _ Greater Than °d — Sandy Loam / — Less Than °| — Loam Bit — Brown °oi| — Silt Loam 8\ — Black ,i — Silt. G — G,nv °d — Clay Loam Y — Yellow o| — Sandy Clay Loam R — Red oid — Silty Clay Loam mot — Mottles `r — Sandy Clay with ,i^ — Silty Clay f f — few' tine' faint 'u — C1ov oc — unnmon' coaov pt — Rot mm — Many, medium ' m — Muck d — distinct p — prominent HVVL — High water level, . ° Six general soil uatuns surface water for,liquid waste disposal B0 — Bench Mork VRP — vortio,| Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county Or the Department may reClUest verification of this wpii test it) the field prior to pe,mk issuance. A r*nnp|,s, ;,t of plans for the private sewage system and permit application must be submittod to the appropriate |000| authority in order to obtain u permit. The sanitary permit must: be Obtained and posted prior to the start of any m`nSt,uotion. i o0 qj 'Job 000/ El a � N Ci Oho a `M O -=► ° CAJ 0 3 � o •� n W f� Q v qj o � v PC, 3 `� CS C) V 2 p ob HOLDING TANK CROSS-SECTION AND SPECIFICATIONS Approved Approved Locking Vent Cap Weather Proof Manhole Cover w/ Padlock &T Junction Box Warning Label 4" C. I . 12" Min Vent Pipe i 25' From Final Grade I 4" Min Any Door or I Window I Approved Joint `- -- � 18" -Min Water Tight Seal Nigh Water Note: C.I. Alarm Switch` 1 r Blind Plug Used SPECIFICATIONS Approved To Seal Unused Joint w/ Openings TANK Manufacturer : M;016[JeS e-r17 19eG r',oS C .I . Pipe Tank Size : 21000 Gallons Extending 3 ' Onto ALARM Manufacturer : s. S'vs e/rIS Solid Soil Model Number : 2— Switch Type JyerCUeV NUMBER OF BEDROOMS /SOSGQ�"i�'19 C'QPQG//Y d 3" Approved Bedding , . f OWNER 'S NAME: CAri ' r. ADDRESS : Rf, 2 B01dzj,1rj , ' LEGAL DESCRIPTION :so ,AL,?gZ 14,S e c . /9 TZ_N,RAW TOWNSHIP/MUNICIPALITY: ` ' �- COUNTY: Sf. Gi-oiX SIGNED : LICENSE NUMBER: MP DATE: -//-?$ _ ST. CROIX COUNTY WISCONSIN ZONING OFFICE 796-2239(HAMMOND) 2 425-8363(RIVER FALLS) HAMMOND, WI 54015 April 13, 1988 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Christian Reformed Church property, located at the NW-4 of the NWk of Section. 19, T29N-R16W, Town of Baldwin, St. Croix County, revealed that there is limited space for a septic system and therefore, no percolation tests were taken. This site should be suitable for a holding tank. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator TCN/rc _ Bou 807 PAUL 525 DocumenjNo. This space reserved for recording data 4333 ,.80 HOLDING TANK AGREEMENT Agreement Date , This agreement is made between the RE��8T�R�S OFFICE County or Local Governmental Unit T I Holding Tank(s)Owner(s) ILGQT' Ct�OIX CO., WI G p,��kl �h i Baldwin Christian Reformed Recd for Record Church (Called Municipality below) I APR 13 1988 We acknowledge that application is being made for the installation of(a)holding tank(s)'on the following property,(Provide legal land description:) of to,-,30 t* M yy g A C,. 7 fi NW 31, NW Section 19 T 29 N R 16 W. R of Deeds Return To or that continued use of the existing premises requires t hat 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. As an inducement to the County of St- craix 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 as. 146.13 and 146.14,Stats.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,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 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),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 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. Owners)Name(s)(Print) I Own s)Signat�rs 7 Baldwin Christian Reformed - (7 .._.._ Church I Subscribed`anOworn to before me on this date: Municipal Official Name(Print) I Municipal Official Signature +- Notary Public /l ch g � �{/ate`( � I My commission expires: � I Municipal Official Title(Print) I � �ihy (Votary Public-State of Wi C,1'e �' col w I SBD-6123(R.10/85) This instrument was drafted by the State of Wisconsin Department of Industry,Labor and Human RQ,ations,BureaiidY Plumbing. APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractq-c, ("spec house") , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property �"��f/ /QI'? 11 e J D ✓ 172 'ae7G _ Location of Property �1 ' ' , Section �� T �� N - R W Township 1jQ/(�GV1 12 Mailing Address Rf 2 3 Subdivision Name Lot Number Previous Owner of Property P/e>I2 Total Size of Parcel — Date Parcel was Created Oa. Zt� Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) T, Yes No Volume and Page Number .'5-2 7 as recorded with the Register of Deeds .SZ e INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (we) ceAt 6y that aU atatementa on thus joAm ane ticue to the best 06 my (ouA) k.nowtedge; tint I (we) am (ane) the owneAtfl of the pnopenty de,sn bed in the 91so in4onmation SoAm, by vi4tue of a wauan.ty deed Aecoaded in the 066ice of the County Regiz teA of Veed�s as Document No. ,,," 2 � _; and that I Iwe) (G7ZZ� paeaentty ows the pnopoaed .bite joA the �sewag:­di6po,6at .6yStem (oA 1 (we) have obtained an ?,"emen�t, to )Lun with the above dezchibed p%opeAty, 4oA the conbtAuction o6 .chid system, and the bame has. been duty Aeconded in the O�6ice o6 the Count] Regi6t Deeda, as Document No. ) . SIGNATURE OjF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED r ST. CROI X COUNTY W1 S C O N S I N h '1; '� ZONING OFFICE 796- 2239 r . u�i� « �� -, . u Post 0664ice Box 227 Hammond, WI 54015 O W N E R P U M P E R A G R E E M E N T PLEASE BE ADVISED, fha.t untit you axe again no.ti6ied, I wilt c.ontAac.t with �� L �� �C,, Ysa 06 Z"-'a e c -5�w-eRSe'QVe Afi4con.sin, (Pumper) , bon the purpose o6 temoving att waste 64om the Aan.i.-tany system to be toca.ted on the pxopex.ty and 6u.tuxe home site tocated in St. Croix County, W.ca cousin, Township 06 Baldwin b¢,i.ng in the NW h o6 the NW 4 o6 Sec. 19 , T. 29 N. -R . 16 W. (Ox mo At gutty des cxib ed as 6 ottows : J Dated .th.i s _[_! day o6 ZU f�i� 19 1P. . O W N E R ) State '06 Wisconsin) sa S 88 — 009 ® 7 County o6 St. Cxoix ) Pexsonnattyappeaxed be6oxe me this day o6 19 Ore. the above named ,7, to melknown to -Fe—the pexaon who execute t e oxego.c.ng .cns.txu .t and acknowZedged the same. u .cc .t. no.cz- C our—y, My Comm . (iA p exm a n t 1db�r �'ub �P�t6 taL�+C .urn , My Commission Expires Aug. 27 19W hexeinbe6one xe6 exned to as Pumpers, jo-.n .tn the above agreement to .tie extent that I have a contract with Owner as above stated. P U M P E R ) AS BUILT SANITARY SYSTEM REPORT OWNER C'fi o TOWNSHIP __SEC.JT9N, R 101 W ADDRESS ST. CROIX COUNTY WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions to meet requirements of H62. 20 - SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ule- • Nb 0 � v t I di, ate po thj Arrow SEPTIC TANK(S) /eo IT?R. L ee es- CONCRETE_ STEEL N0. o rings on cover 0 Depth 3'• PUMPING CHAMBER SIZE PUMP MFGR. ,�� — M=D�L NO . GALLONS Per Cycle TRENCHES NO. of width length area BED NO. of lines _� width /z' length S' area depth to top of pipe NUMBER OF SEEPAGE PITS Outside diameter total pit area AGGREGATE /Z- ,f', , PERK RATE AREA REQUIRED e36 ° AREA AS BUILfi Disclaimer : The inspection of this system by St. Croix Cdunty does not imply complete compliance with State Administrative Codes . There are other areas that It is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR DATED 7— PLUMBER ON JOB LICENSE NUMBER A ... - REPORT OF INS PECTIONINDIVIDUAL SEWAGE SWEMAlew (?Od'�p San. #any Penm.i ` State SPp .ico? NAME I' wn4h.cp,, s��Cl�..�., S;. c4oix County r • Lp as#gip K���k� S ec,ti.o n....�,..�...,�„�, ', SEPTIC TANK S4ze 9444004 , Numbers ob Compa4.tmen#4,� I pia#once from; WeCt bt. 1�� oa ynea#en 4.Cope„,,,,_„_,,,_bt ' �a.ildi.nR�„„b�. We#I~and4 ....._.b�• �i�.�hwa$���6�• DISPOSAL SVSTEM r D.i,o#ance Fnam: We#� bt. 12� on ynea#ea b#ope�,6#. Wettan44 Ft.. . H.�ahwa���•�b�. FIELD DIMENSIONS: W;dth 06' .trench it. Depth ob noak Wow, #.t,te ,i.n. Length 04 44ch Une it. Depth ob flack. oven ,t.i#e in. Number a ."ne4 Depth ob tite be#ow gnade .in. To#a.0 U4 9th 06 # .nea �#. SZo pe o b t4ench .i.n- pen 10.0 b#. D"tante between #..ne4 �.t. Dep,th to 'beduak Tota.L ab4o4buon a4ca_6#Z Depth to 94oundwa.te4�b#. Requ.ined area t Type of Cowen: Paper o4 St4aw PIT DIMENSIONS; Numbers ob pi44 anaund .i.ta eb o 044444e 44metc-4 Pepxh bezow 4.AZ&t #. Totat ab4oKbuon area i$2.. z Axea �ceq�i.ned b�� m IN;PECTED By rITtf APPROVED DATE REJECTED DATE )97 ON..., State and County State Permit PC-B 6 7 Permit Application County Perm,i # for Private Domestic Sewage Systems County s� *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: a B. LOCATION: '/4 '/a, Section T N, R & (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township Anl/C. C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family X Duplex No. of Bedrooms _� No. of Persons D. SEPTIC TANK CAPACITY /O©cD Total gallons No. of tanks ON ei HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement x 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 X Alternate (Specify) Seepage Trench: No.of Lingal Ft. Width Depth Tile depth (to No.of Trenc �s Seepage Bed: Length Width Depth_ N Tile depth (top No.of Line wo Seepage Pit: Insidegiameter Liquid Depth No.of Seepage Pits Percent slope of land % Distance from critical slope— WATER SUPPLY: Private X 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 1 have sized the effluent disposal system from the EH-115 prepared by the Certified it Tester NAME /Q it &L. C.S.T. # �'.S'- �'5�5� and other information obtained from 4JrJei2 (owner/builder). ��`r Plumber's Signature MP/MPRSW# m` T 9 Phone # 7/3� 6o Plumber's Address c S 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. IL E ; E i . . ..... 3 s to ,o u_d ow .. 3 0� 3 H .�. �. , AX CIO 3 e E � F F Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE Ot#7t // o� Date of Application I �� Fees rPaid: State,��—; dP County Date fo — (:93` 0 Permit Issued/R�jL d—(date) -4;;734 C./ Issuing Agent Name Inspection .Yes NO State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 EH .t1L kJ Rev.9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309,MADISON,WISCONSIN 53701 LOCATION:&A—)%A•W2%,Section 1,TA9N,R&ff (or)W,Township or Manici}Tatit� Lot No.—, Block No. 'r c i ame County S�•CRalx Owner's/Buyers Name RI S41,Ru a Mailing Address: L A w, rJ S ` TYPE OF OCCUPANCY: Residence X No.of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT x ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 5'-27` F10 PERCOLATION TESTS s— SOIL MAP SHEET 6A ` __// 1 NAME OF SOIL MAP UNIT Sint SA TT RC PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE NIUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P_ 96 fr if r Q 7 P_ t( tt u O s A 3 P— P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE,MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- 7-4`` > 9L o;c., 90'k R Ve B- � 1>1 ft 11 9 It B 70ft r > R `t O r r r B- B- B- PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the�lo2tion a?d square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy O Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. m s . _ I G 4* 45 ,----- G Dv , i ( m N Ac 41- 2. i i i P s qq pp e 8 i I I,the undersigend,hereby certify that the soT tests reported on this form w re made b me in a 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) T �O L Q Certification No. Address t t S Name of installer if known ✓«- °� "I-60L4+ Copy A—Local Authority CST Signat 3 � °. Warranty Deed. R M N :21.7 Printed'and For Sale by the Sentinel;Co.,YNwaitN, �11� �lLc�ellti�re Made this - da ifl�-' -- -- - -- c>c- -- f _____ _ in the;year of n I d, one thousand eight undred d ninety-�-L __ £,� bet ee "�'c __ _-- �e- :-f L s�A--_GAL c c G _ t o(, ' , -- ------- -"� -- ------- --- - - - - - - ---- /�/ C� ------------------------------------------ -GZ� - -L C ✓/ ----- - - - - _-- -: ----- - - - rt-1- ---of the and -------------------------------------------------------- - Z=c-c `------ - - - ----------------------------------------------------- Jtw / - ---�-----------------------------------------•------------------------- - ----------Par __of the second pvlti rt, . YtE �3C t That the said p//a��rt_�__of the first part, for and in consideration of the sumo 4 . U v --- - fYl -c 0 -- - - - - �= - -------------------- _ to�____ _________in band paid by the said part�-�.(of the second part,the receipt whereof is hereby confessed and acknowledged,ba 'ven, g , granted, bargained, sold, remised,released, aliened, conveyed and confirm;and by these presents do_4---giv grant, bargain, sell, remi e,'release, alien coney and confirm unto the said second - ---- ,� '�` `: ` j d1 e r f the ` c 3 ga/ part, --------- i's sntees;gne forever, the following described real estate, situate 'n the county of_ __,__ � 'Z.c- _and st a of Wisconsin, to wit:__------------- _ __________________ _ --- ---- - �--- ----------- ✓ - -- - t"ti � / -- - - U- U -_ ------ ----- --- - ���1�' e _4119 )11 A - -1 -------------k- , - IX- --------_ ---- --- - - - - - =- - - _a--------- -- _ - _ --------- -- - ----- --- ---- ---------- --- -. ---- ------ -- - 1� -1 ----- --- �� �- ------------------------------------------- __-__-----------. 7_.___..__________ ______.___________________--- ______________________________________________________________________________________________________________________ --------- - ---------------------------- _ R, ----------------------- ----------------------------------------------------------------------------------------------------------------------------------•------------- ---------------------------------------------------------------------------------------------------------------------- - ------------ - ..........................r .. r l -------------------------•------------------_---------------•--------------------------------------- -_ -- ------------------------------------ �i (Vogether with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate,right, title interest claim or demand whatsoever,of the said art�'of the first r , P part,either in law or equity,either in possession or expectancy of,in and to the above bargained premises,and theirAereditaments and appurtenances, (To Vavq 414 to Vold the said premises as above described,with the hereditaments and appurtenances,unto the said paro--t--o_of the second part, and to- :-- = °= ----JyAm and asf gns forever. i And the said:- - ----------- -----•---- - ------------------------------------------------- - ---------------------------------------------------------------------------- ------------------------------------------t' --- - ---------- -=- - --- ------- -- -------------------------------------------------------- ---- ----- for--: - - ----- - --- - ------�_-� _.heirs,executors and administrators,do.^covenant,grant, argain and agree and with the said par��f the second part,_f!__ -�_ aSSigog,that at the time of the ensealing and delivery of these presents_ ^ __ _ well seized of the premises above described,as of a good,sure,perfect,absolute and indefeasible estate of inheritance in the law,in fee simple,and that the same are free and clear from all incumbrances whatever,_'��_ •- - __ •- r-�-- . �M �._� -- - -----------------------------------------------------------------------------=^- -- -- - -- ------------------- - - --- -- - --- `` - - ------ - - `` ---=-- _ - - - - - - --------------- ------ ------ ---------- and that the above bargained premises in the quiet and peaceable possession of the said part_CACA he second part,_ against all and every person or persons lawfully claiming the whole or an art thereof _ _ ------will forever warrant and Regend. j11 Mitnss `p heljeo f, the said part_("----of the first part ha-__t_1C_hereunto set hands-and seals_the day of the date hereof. t Signed, Sealed and Delivered in Presence of ------ _ L_4_Zl------ n - ,`-------------------------- [SEAL.] -------------------- [SEAL.] ----------- - -------------------------------[SRAL.] ^---L - - ? --V�- ------- ----------•------- --------•----------------------[BEAL.] 1 toli�gonBill, , :-, .� • mid -- -- - -------- ----C Ty. Person y came before me, this---------------•-f------------------day of 189 __, the above named---- -- --- - - - - - - ( �L- - �_ �c�lt' �c�.✓�, k ----------------------------- - --------------------------------------------------------------------------------------------------------------------------------------------- :x ----------------------------------- ----------------------------------------- ----------------------------------------------------------------------------------------------- + to me known to be the persons-who executed the foregoing instrument, and acknowledged he same. x41r C, 4� ---------•---•-------•------------------ i -� r `A z' trxt 5"a-9Bd uo °spaaQ jo : .. .. ----- -IOA ut paptooaa Pim '3V 313010,0 • -- - - - jo Sep- ----- ---still paoaag aoJ paeTaaaff <; � 'sib'asxnop•------------ ----------- -- ---• , . . . • 701-Mp s�x�ssi%��� 3 • ,, {{i S Y' *• 4P�+ 4uralV + . A 1 !x. t .. K oZ .F �,r.. - : f" L F $ 01 affi i•7 S t Y. r r � t F 4 °r • i &n ~�, 11 y.-�r y. good.Warranty WO P•nt d•and For Sale by the SentlnellCo.. Milwaukee. ♦ � 1 �txr / ---day of_ L_-t._i_ti_c-1_C?c-__1C [iLde�iture aae this_________[_________-__ _ in the;year of our:Lo d, one thousand { undyed and nin between - --- - t - �L cry l�-c t t L r-Q Coo zuGc -- -- - -- - ---------------- --- -- -------- ------------ ---- a- --- ----- ---- --- - -------------------------------------------•----------------.--------------- ----------------------------------------------- ------ ---- --- - -------- ----------------`- - - -- ----- -- ----- ---- - ,-- - - - - - -: -----------------------e fir n - ------- - - -- --------Par ��o the st and � ..---- - �'Q- - ✓ --------mot dl C c? -- /'- F' � U IiC Cc ` -•J - -- --�-- � `-~-��--- --- -----� -------------------------------------------- L --- - - - - . f < ----------------------------------------- tt --- ---------------------------------------------- ---------part Lei! of the second part, t # PAY, That the said part_____ of the. first part, for and in consideration of the sum of_S.%_ _______________________________ __________ ------ - --- ---------------------------------------------------------------------- --- - - - -- --- - - -- - - - - to=_ =----in hand paid by the said part[f-✓of the second part;the receipt whereof is hereby confessed and acknowledged, ha_K-_1C given, ,#ranted, bargained, sold, remised,released,aliened, conveyed and confirmed, and by these presents do_---give,grant, bargain, sell, remise, release, alien, convey and confirm unto the sai�pa t__ f the second part,j _ tS� ^?�n -_ke�ac�sig�s forever, the following described real estate,si din the county of____-- / .__/ t_� �'_ a>�ci state oKV iseonsiu,to w t----------------------------- ------- z--------- "-- —------ f t L � � � Ltv vl/ ii1.0-_ �= ,- � �,fr`Ctt�'Z fitLd. Li �-1i "- L- -� c� - - - - -- - !L------- .--- - �- �- 1, c clone - = �-c ?fir -' =�c t_� °� = -- L 1 /►D ---'� - l c 1 .mac t� - -- � LC t � t 7 L1/L t�u� �'Z.(}�Ci '�- / ---- -------- -- -- - - -- - - - - --------------- - � r _ j �,.lr. S4 - - --- - - - --- - -- - -�- - - -- - 11 1 ;.,� Y �C-at� �--=- =i= ,c..l- --- -- - fit- ------ V_ /I -- _A ------ ------ --- = --- .- - ,nom - - - - l_------- ---------�.Ct-4_S._� �!� C �- � C� -l--J�`C T--�`----�- ------ - 1� _�'w--- z � - - " c t -- --- ----- u `=_- -- --- -- - - ------------ - -- - -~ `-- - -- -- - - --------- -------------------�-- -- ----• ---- -- ------- `-----.. ..---------- --- ----- ------------ ------- ---- ------ -- ----- -••- k' -- ------------------------------- ------------------------------- ------------------------------- -------------------------- gagether with all and singular the hereditaments and appurtenances thereunto belonging or in any vise appertaining; and all the estate, right, title, interest,claim or demand whatsoever,bf the said part fC!of the first part,either in law or equity,either in possession or expectancy of,in and tlho abuve bargained premises,and their 1rwnditaments and appurtenances, _4 so VaU ild to old the said premises as above described,with the hereditaments and appurtenances,unto the said part UO_of the second �G c e c.F a 0-*L v part,and to -----`n - - signs Or @tie . 1 -- t==t=----- -- - ----- - - ---- - - ==--=--�'-----_�--------�=t_- cwt,---- and the said_ - - - - -- - - ---- --- -------------------------------------- -------------------------------- -------------------------------------------------*----------- ----------------------------------- --4�- -- --- --- --- - - - ------------------------------------------------------------------------------------------------for _______ _ _ _ ___________J_______ rL heirs,executors and administrators,do..�-Covenant,grnt,bargain and a fire to and with the said part_�of the second part :Clr-_�1 ' ,that at the time of the ensealing and delivery of these presents� Lt 1 r c "t_F__well l seized of the premises above described,as of good,sure,perfect,absolute and indefeasible estate of inheritance in the law,in fee simple,and that the - - same are free and clear from all;<ncumbranees whatever______________________________________ '�- --- _ �• and that the above bargained premises in the quiet and peaceable possession of the said part_ t-0,'f-the second part, against all and every person or persons lawfully claiming the whole or any part thereof ----------- 1 ---L _-i __will forever Warrant and f efend. �11 Witlless `�thelte0 f, the said part of the first part ha�_hereunto se ands-and seals_the day of the date hereof. -----/ (?411_/ - ---------------[8EAL.] signed, Sealed and Delivered in Presence of i X % L`/�{/ Cd ZZ lZ CG iC /1 ------------------ [SEAL. -- j -- --------------- �----- -- --- ---- - -- -- -- - -- - - - -- --- - - -------._...---------------- [SEAL.] _ - .. -� -------- ------------------------------ - -/�. !f J rte•!"�!�' [SEAL.) It eiagon�in, i / - - -- Co Y. erso ame before me, this---------(----- - - - -day of - -=� '`G -- - _ t�� _ -"i'-- -- ------ - GC �--- -- 1 above name - --------•----- -- ----- -------------- -'--------------------------------------- ----------�---------- --- -- -------- ---------------•------------------------------ ------------------------------------------------------------------------------------------- -=--------------- --- -- --------- ----- -- -- - -- ---------------------------------------- ----------------------------------------------------------------- to me known to be the person 5_who executed the foregoing instrument, and acknowledg 'the same. z js A PLE lot ep9aQ/o � a zs �t - :- ---•---abed uo's o 10A Un papaooac pue xoojo,o .8I V .v------------ ' f ... ✓ k ;o SUP --- S?lq3 pJoaaH 10 paetaaag Aw f..... +.� ({YS.t W :.. ( 3+ 4 -------° - - - - - - - ---- _ _ .F Mn IV � w 'x k Lao ,moo fi WWI Z AVE a n: f J 4* ) k hi., $ inly r we 1A E& ' X YM 'r. d .d' r ' X1'16 Jw' 'g QV Ky r a" p inn Y � C � �d ' AX t �1 a nil{ I