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Parcel #: 002-1019-90-000 02/01/2006 08:34 AM
PAGE 1 OF 1
Alt. Parcel#: 09.29.16.135 002-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
JEFFREY D&COLLEEN A LEAVITT O-LEAVITT,JEFFREY D&COLLEEN A
2386 CTY RD E
BALDWIN WI 54002
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description *2386 CTY RD E
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 9 T29N RI 6W SE SE(EZ-U-1117/149) Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
09-29N-16W
Notes: Parcel History:
Date Doc# Vol/Page Type
07/23/1997 1039/267 LC
07/23/1997 898/158
07/23/1997 786/594
07/23/1997 556/606
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
86722 Use Value Assessment
Valuations: Last Changed: 05/18/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 9,000 74,000 83,000 NO
AGRICULTURAL G4 24.000 2,600 0 2,600 NO
UNDEVELOPED G5 2.000 200 0 200 NO
AGRICULTURAL FOREST G5M 12.000 4,200 0 4,200 NO
Totals for 2005:
General Property 40.000 16,000 74,000 90,000
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 20,200 74,000 94,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch#: 510
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
Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
��� J(j)j OWNER *� -f_. TOWNSHIP SEC. T4-L_N-R W
ADDRESS LAIR ST. CROIX COUNTY, WISCONSIN
SUBDIVISION /�) LOT ,( LOT SIZE
PL—VIEW —T•
�4L
Distances and dimensions to et requirements of I•IHR 83 y
SHOW EVERY HING THIN 0 FEET OF SYSTEM 1 4
�.�• 100. ti. A ;
J
r el
�y
char ��
7
t
n �6qn
31
eT. '`E ''
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used S�ff
Elevation of vertical reference point: ` Proposed slope at site:
SEPTIC TANK: Manufacturer: j a Liquid Capacity:/
Number of rings used: _ Tank manhole cover elevation: ".7t
Tank Inlet Elevation: Tank Outlet Elevation: 91, 1'b
Number of feet from nearest Road: Front,0 Side,Q Rear, t feet
From nearest property line Front 10 Side 19 Rear,0 feet
Number of feet from: well building: 2?
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: _ y Liquid Capacity:
ilLor
Pump Model: O-S _ Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation: &6_ ?�
Pump off switch elevation: g 7 ;75-- Gallons per cycle: �
1. /
Alarm Manufacturer: .S,`1 - j!2,C" Co Alarm Switch Type:l ►1'W-(Ar "5`vA
Number of feet from nearest roperty line: Front, O Side, Ft.�
t
Number of feet from well: !1q/
Number of feet from building: �S
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: 'M r� Trench: 3 7�
Width: Length: Number of Lines: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear,(—%Ft .
Number of feet from well: ��ll
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one) .
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector: � ^
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707
SE!4,SE1,4,S9,T20N—R16w El CONVENTIONAL ®ALTERNATIVE 4StatePlan I.E.Number:
)
Town of Baldwin ❑Holding Tank ❑ In-Ground Pressure ®Mound County Trunk E N OF PE I HOLDER: ADDRESS OF PERMIT HO LDER INSPECTIO
t ble Route 1, Box 60, Baldwin, WI 54002 '`�� $-$7 �,�?C�
BENCH MARK(Per anent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV..
Name of Plumber: MP/MPRSW No_. County Sanitary Permit Number:
Bennie Helgeson 3215 St. Croix 96028
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID C ACITY: TANK INLET ELE TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
/ l �j �j PROVIDED: PROVIDED: �r-
W / /�'/ v YES ❑NO OYES '5NO
BEDDING: VENT DIA. . H IGH WATER NUMBER FEET FROM OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
LARM l LINE L❑YES NO / EYES O NEAREST /J / J 17S
DOSING CHAMBER:
MANUFACTUR R BEDDING: LIOUID CAPACI7V. PUMP MO EL PUMP/SIPH N MAyOF ACTURER WARNING LABEL LOCKING COVER
✓V /l 75-0 ^ 33 / / O IDES. PROVIDED:
/' YES ❑NO o C�/�%A"� YES ONO YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROL OPERATIONAL NUMBER OF PROP ERTV W IBUIy DIyG VENT TO FRESH
(DIFFERENCE BETWEEN J� FEET FROM LI / < AIR INLET.
PUMP ON AND OFF) / YES ❑NO NEAREST lId
SOIL ABSORPTION SYSTEM.Check the soil moisture at to epth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire,construction shall ce se until FORCE
MAID
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH. LENGTH. NO.OF DISTR. IPE SPACING. COVER JINIIDE DIA. #PITS: LIQUID
EfD/Tn TRENCHES MATERIAL: PST DEPTH
;��tMENS#QNS
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE ATERIAL: NO.DISTR NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE COVER. ELEV.INLET ELEV.END. PIPES. LINE. AIR INLET.
FEET FROM
DEAREST
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 riteria for medium sand. TIONS MEASURED.
AYES ❑NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
\_\rj Y ES ❑NO ES ❑N O
DEPTH OVER TRENCH/BED DEPTH OVER TRENCHieED DEPTH OF TOPS IL. SODDED .. SEEDED. MULCHED.
CENTER EDGES v YES ❑NO
LJYES NO YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
1� WIDTH. LENGTH. NO.OF LATERA SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER.
TRENCHES:
`MANIFOLD PUMP MANIFOLD DISTR.PI P E MANIFOLD ATERIAL NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE M TbAL&MARKING.
' E V. EL" DIA E PIPES. DIA.:
C1ST1lf!6TION HOLE SI7F HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
414000M}4TIOIN 17- PLANS.
ES ONO
VES ONO Y
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER"LINE3 P OPERTV WELL: BUILDING:
FEET'FR 2 2 3 YES ❑NO YES ❑NO NEIIII
Sketch System on n in county i for audit.
Reverse Side.
SIGNAT RE: ITLE:
Zoning Administrator
DILHR SBD 6710(R.01/82)
SANITARY PERMIT APPLICATION COUNTY
DILHR In accord with ILHR 83.05,Wis.Adm.Code St. Croix
STATE SANITARY PERMIT#
—Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLA�D.NUMBER
8%x 11 inches in size. 87_03870—S
—See reverse side for instructions for completing this application. PETITION
1. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES K NO
PROP R PROPERTY LOCATION
SE '/a '/4,S 9 T29 N, R 16 / (or)W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOC NUMBER SUBDIVI ION NAME
Rt., 1 Box 60 NI N�A NIA
CITY,STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD,LAKE OR LANDMARK
715 )684_39A
Baldwin- WT 1 5009 VILLAGE
aldwin pp County Trunk E
II. TYPE OF BUILDING OR USE SERVED: �o�— l0�7"'
Number of Bedrooms if 1 or 2 Family 3' OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. ❑ New b.0 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. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑x Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. 0 seepage Bed b. ❑seepage Trench c. ❑Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Bottom of B e
43 376 376 93.45Rp4 ®Private ❑Joint ❑ Public
VI. TANK CAPACITY Site
in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xisting Gallons Tanks Concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber 25o, Precast
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 ignature:(No Stamp ) MP/MPRSW No.: Business Phone Number:
Bennie Hel eson 32'15 715 77�-4425
Plumber's Address(Street,City,State,Zip Code): Name of Designer:
Rt. 2 Spring Valley, WI 54767 Bennie Helgeson
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
Bennie Hel eson 3094
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
Rt. 2 SPring Valley, WI 54767 ] (715 77$-4425
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps)
Approved ❑ Owner Given Initial `b 'l` S charge Fee �7��//�
Adverse Determination 'Y� J&V( vU 17,)5. 17—/— /"'/1,(. Aj yrq•
X. COMMENTS/REASONS FOR DISAPPROVAL:
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"it the time of renewal any new
criteria in the Wisconsin Administrative Codevill be applicable;
3. All revlslons to this permit must be approved by the permit issuing authority. A new permit may be eeeded
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; Y _
5. Private sewage systems must be properly maintained. The septic-tank(s) should be pumped by a locensed -
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, 608-266-381.5. -
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;
III. 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 8% 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 serves; 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.
----------------------------------------------------'---------------------------------------------I-----------------------.--------------------------------- t--
e e
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 negot ation and public debate. The groundwater bill GroundW44er��'
included the creation oi s •c`�ar es es; to a number re uialed �.. ac ces wF ch 1 '
g 9 Wlb v:tStn 5
can effect groundwater Tne su char ",I, t fifer` July 1 198 A t r t1 7a Curl -1 }ieasure r.
Is used in your �,. = of ltr�c 41b� t r i� ��G '" i t
system or the riiso- ,;,;
Tho mo,ie:
tore d by
wakor,
;v-,)398(�.03/c
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/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
Owner of Property 41<rbert
Location of Property _58 ' _ ��L, Section ��, TAN-R _ W
Township
Mailing Address � JdT�O da 1. _e. i dD _
Address of Site
Subdivision Name a-n�
Lot Number
Previous Owner of Property
.Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house) ? Yes No
Volume! and Page Number CA� as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPFRTy OWNER CERTIFICATION
I (We) centi.by that a t statements on this boxm cute tlrue to the bust ob my (oun)
knowledge; that I (we) am (ate) the owneA(,$) o6 the pno pen ty da chdbed in this
inbonmati,on bonm, by viAtue ob a wa�vcanty deed neconded in the Obbice ob the
County Reg.usten ob Deec6 as Document No. Jk4a ; and that I (We) pneseny
own the pnopoded d.ite bon the sewage divspod zys tem (on I (we) have obtained an
easement, to hu.n with the above descni.bed pnopeAty, bon the cowst.ucti.on ob .said
system, and the same has been duty tecotded in the Obbice ob the County Regi.6teA ob
Deeds, as Document No. .�_ ) .
Gw
SIGNATURE OF OWNER SIGN OF CO-OWNER (IF APPLICABLE)
D E SIGNED DATE GNED
r
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gk
MI
all scrom a"slom
k' R
K ' •o tadt pd 1102 tiseaeese
llatai+Wl,:.i�Iwlwil
bathsnc�t # twcer,°:rns 'ilntema"d venetian
. :
1 'Pon of the iial estate.
,�Na C011MYIts aid ,1lsesisl• Vta�ar/ sg .' ptrchase the above
•ult�'' �1!iilEetor ar eMoe4tiR
�►1t..T6o $75 000.00) - --- Dollars,
411 s : ," :at tht ptactdio.bomof, dge
U YQe achnowl� d, and
the balance
toptlter with llMatetK ew►R 9diMeaRt M M1 tRM o tac to time uoP+W.at the rate
4
not paid is 194L till GOUG n1 iald priaG'W Vksll be payable in_40=tbl7
r#;� 4Y6.42 � g an tta_� Set,
r j prwi d Interest shall be fully POW withi.
. wir+lYl•YtiMC�te.�._
h
W
�5%.Yw.N'Y �'�,� '?rjM'�c 4 5{1 fi:• � T�i��#}#J`:` ':..
` l{ ied first to in eso i11E(l1tR hahtwnW-fit "' tlpao�ia! a" than to
' 4wis OwHaiiseF066 16►iiti► 1 •j • •s l..ttdlaa��lisa•
SAW-dolkWAbs-a USSR"
rltrs
Vendor sl►a11 furnish the Purchaser thirty days prior to the date of ultimate closing, and the Purchaser sban aeospt N •
iaif!'sbowileg of title,
J.�arwl4emilP.�.Liilw�aausaoe/�ImPYy •w��'�-•�-~O VW�. jy
ra•Yhim araeerewtrYerE�•merchantable abstract showing the Vendor's title is the condition calUd tw by
this agreement. U as abstract is furnished, the Purchaser shall notify the Vendor,in writing,of any objections to title withw tea 0
dqs after receipt of such abstract, and the Ven,;vr shall then have a reasonable time within which to rectitythe title or furnish•title
policy above described.
rIT'iaakPorchos"shall be entitled to take possession of said premises on_ -_AU9Uff 15__ , 19-IL- Ia case
sASition is to be obtained by the Vendor, he shall have a reasonable time after such data In wh,cb to remove say nee• 'iant. The
hsaat,ahall be entitled to remain in possession as long as he performs all covenants and agreements herein meatioa e 'k his part
11t psefietlyd ,wd no longer.
a1uIMIC..INTf"s co.. a"6"110,win.
fttYR'UAt. AND CORPORAT2-$TAT& BAR OF •taCON51N, yORM NO I 1 - 1911
A, .j�d_Y
fit��r'
To P1 Marr .i bee.New
become
ant to
Isar
fs»taiRms wnesen�rintr dRe and to a
foe dec
ttWWs b lie itallor s lstenld�nh with esisaraao� 4 r; .
ay Mme. and a_i leje 3 C
i. To i ap`t1w promises in od sui �it�taitott4
g' /itiM tapair
t d
To hwq ilia pifmloes free foe liens atysrior to tl/e . ° � }
l ` lint N ooattxk waste su for-erase*.to het. �
/at to do a"act which shall � �� �
4",rt>in, IRaoalr the vela thareo�' x , .! 1f`
cease any spelt lases or a&sessmsul remain `x
bMtrN#dW app�ed�policies de losses—
"t arMi _' Sam
{ posited.or lain insurance premiwts pay,'' �► Tma itt m
es sea waste,added bender may cure*.each defaults, and all sums**paid fherlk'lmmad�e��,be N be added to and dNad part of the purchase price. and boar iatarest at the• �to the Ve
a&W*�
eador
hereby agrees Provided that in case the aforesaid or d a purdtase price with iron inter and other
isre� lded a6aR be tally Psrtormed at the tlmgs and in da moaner above �c
�"a"M M executed cad delivered to the Purchaser, a good and sufticMot Ma=@sa Dept, 1 Wive
eorlh**#Me and Clew of 81110901 leeas and encumbrances,axe �+'
and WMICi al and --j-- p wt any liens or encumi"0100s created M*0 Coe"
way purpogiiii--
except
r,
TM Purohaasr hereby covenants and a
ate" is the paysNw!o[ tomes that time shall be deemed to be of the essence of this ceafesel ay Aded,of
any principal or interest when the same shall become due,or in the performance of nay d tie eandlfloa OgS
or Promises by�Plttaiaser herein to be kept a
P Per[orsneal and such default shall continue for a '
spice.,declare the contract at as cad, all r period t � -
paid by by a",Ptedta ae rights of the Purchaser under this aQeemeot cascdlad,lay Y'
�a for tM fa8tw c hereunder forfeited, the cane to remain the Vendor's property as rental of said premises and as
osrPlete►y to fulfill this atRaaMat; and tha Vendor shall forthwith and without nutu r have the rl�t �#
at the option of the Vendor and without notice to the Purchaser, nou�r being hereby expressly weaved, the the f :ss
Principal shall be deemed to have become due and payable; in case such
together with all sums which may be cc have been paid option shall be exercised, the unpaid
rate aforesaid&hall be collectible in a suit at law, or the Vender as herein authorised with interest oa suchPr
` Principal had been due at the time when any such default foreclosure of this coairact In the same manner as if the whole of saki
Interest all the oecurred,:and the indebtedness shall embrace,with said
sums so disbursed with interest as aforesaid, tmpaW priaeipN"d
attorney's fn case es tSha Proceedings t fn enforcement of aq remedy here der, whether abated or not, all expenses,iail
tees, shall be added to the principal. become due as incurred,cad In case of judgment &ball be included thane
Upon the coatmpaceaAeas or during the poodancy of guy action at luenclostaro of this contr act. the court
the Premisea, including homestead interest, and may omp. or the racoiver to collect the feats, lashes, &fad Pr�bas appoint lvse el
during the Pendency of such action, and may
shall, from time to tams,direct. y Order each r 41-8, ismns. and profits when so C, ,act so to be held and applied as pthe romises,
All terms cant'`: s .
.canditiorm,Coven a;s,wa"GOUes and Is .aides heroin&ball be binding �
rep►esentativea, suiceaaore and assidas of the vender cad qN S Won and inure to the benefit of ano heirs,legal ,.
a valuable consideration joins benia to release ha d*r e d puichae&r: H not as owner of the
deed to be el�nts ht the subject Property the spouse of the wader toot?
shads In falfiilment bereot, b{ Property and agrees to join In the execution of
>5xocuted at Baldwin, M LeConsln s,
r
ails 5th ay of July X77.
x AND •f, s� �y - A
AGHBD AND SEALUD fit
PRJ=NCE or
Ire rim
Herbert Go1
Dorothy M. Goble
s=
4
At"WOMCATM #
Signatures of x
authenticated this ,
19 ayfi x".
Title: Member State liar of Wisco"In or
Authorised under Sec. 706.06 viz.
STATi Ole fplfSIIf pp ,
St:-.Cron county. `..
P �anNsbefore me, this Sth r
.,t day of Tas t y
l9jj._.
I'loint tenant
tO• person—8 who executed the foregoing
j. r instrument and acknowledged the same.
This instrufeeRt was drafted by — 'd
'
Harold D. Olsonokty. Harold D. Olson
Notary Public St. Croix
Cry. cols.
t� The a"of witnesses is optional.
} My Commission(Sopi,ey(is) +.e..a..e
Hales of persons signing in any capacity should be typed Or printed below their signatures.
LAND CONTRACT- `
tNDlVIDUAL AND CORPORATx-STATR "a OF WISCONSIN,
roRtt No. a ;x
H
z
H
a
STC - 105 r
r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT Ho
St . Croix County z
OWNER/ R ac tLnd 17 1
ROUTE/BOX NUMBER �bjy 1 ,Boys, (on Fire Number
i
CITY/STATE (,,J 454W ZIP
PROPERTY LOCATION : _14, _14, Section_ Ta!N , R_J4 _W,
Town of 12a tj.cyrr. St . Croix County ,
Subdivision AJ,+ Lot number__.
I
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes . Proper maintenance con-
sists 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 treat-
ment 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 systems properly
maintained .
The property owner agrees to submit to St . Croix County Zoning a
certification form, signed by the owner and by a master plumber ,
journeyman plumber , restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. Ho
E
I/WE, the undersigned, have read the above requirements and agree N
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- ro
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date .
SIGNED
DATE
Lel
St . Croix County Zoning Office
P. O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address .
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS
DIVISION
INDUSTRY, C
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS (H63.09(1)& Chapter 145.045)
LOCATION: SECTION: (or) TOWNSHI ]LOT NO.:BLK.NO.: SUBDIVISION NAME:
COUNTY: OWNER'S MAILING ADDRESS:
I er b,, e Gt.�t� We
USE DATES OBSERVATIONS MADE
NO.BEDRMS : COMMER IAL DESCRIPTION: PROFI E DESCRIPTIONS: PER CO)-)
10 TESTS:
Residence A f ❑New Replace I ���� 4< �3
RATING:S=Site suitable for system U=Site unsuitable for system
r ONVENTIONAL: MOUND: IN-GROUND ESSURE: SYSTEM-IN-FI LHOLDING TANK:RECOMMENDED SYSTE :(optional)
❑S J�U S ❑U ❑S ❑S NU LEISOU I Mo
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: Floodplain indicate Floodplain elevation: IVA
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-WeI+ES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH W. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
.7' Sil Ts ,y' .8•t S./ �F,p one.A46)I-+-
B- , 3 .� 9/ yS m7 ' a,/ , R
•7'Dh 6y ! rd Ts .8,�&. S,� .8 &, SJ. "`'/rro or j. M
B- o
B- 3 �� I 1 �. 8 Gy S;/ r 5 6` �/ FF� Rolf 'Oec�
-� ,V,Dk S.-TS ,4 '8K orl r�kl
S./ is 40M dl"g• tito
B-5 p� I !. `� c
5°l T5 1.0 145A S;1 _050,01111"43 dt, Mo
ar
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH
P ES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE IOD1 PER I002 P
2 b I g
P_
P I II
P--
P-
p_ :
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicates 1�1gYdistan Descryo hat are the horn
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevati0t�all�}cing and a QiGe ion and percent
of land slope. 3 11 ,f / �j CE
IVE
dt JI 1� t
SYSTEM ELEVATION 9 '�"''` ° °� �� �' �ssx
JL
E i
r I 1
t�
tN
< _ -
. _ ..a,._._,,._.., r. —_ r.,... I _,. ..,....�...,.,.i........._a._ � Vf0
e
:
t
_.
E
I � z
Ai_r �
t , N
_.
t---
.. � •'- _
Af
-r
I,the undersigned, hereby certify ghat the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,aed that tht data recorded and the location of the tests are correct to the best of my knowledge and belief.
WA—ME(prinlI.L. TESTS WERE COMPLETED ON:
PN o/SP e 14Z -.So 4ER:CERTIFICATI N NUM ONE NUMBER(optional):
/ 09 9 8— Yy�r
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
INSTRUCTIONS FOR COMPLETING FORM 115 - S 1 - 6396
To he a cornplete and accurate soil test,your report must include:
1. Complete legal description;
2. The Use section must clearly indicate whether this is a residence or commercial project;
3, MAXIMUM number of bedrooms or commercial use planned;
4, is this a new or replacement system;
�. 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 Iocati=7g year test locations- Drawing to scale is preferred. A
se}Aerate sheet may be, used if desired;
8, Make sure yow benchmark and vertical elevation reference point are clearly shown,ar;(_i ate perrnanent;
9. Complete all appropriate boxes as to dates, narnes, addresses, flood plain data, l)err.olation test exemp-
tion, if appropriate;
10: I the irrforrnation (Srl£"la as flood plain, elevation)dons not apply, place N,A,in the appropi iate box;
111. SiyII thca foals and place your current address acrid your certification number;
12. [Male legible, copies and distribute as required. ALL_ SOIL TESTS MUST ICE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Slone (av"e' 10") BR — Bedrock
colti7le (3 - "IQ") SS — Sandstone
gr _ C,ra4el (undei 3") LS — Lirnestonc
Saar{ HGW — High Gir>r€ dw<atar
Sa-ar= Peic - "'er «Iat,s 7 Rate
F I"Ie S<rr,ci Bldrt - t",lilydirrcd
lr —
L'-',;Era{SaI,d
? - C7seutf_, T laart
sl .. S<anchy L.slam <, Less Than
Loam Cart _ air r vvn
;r l a°tt;i Ri — k
si -- Silt G
�
C�Icr d oat Y
sr:, S"In dy ("Iav Lmm" c
S€lt% 0w, Locs!!,
n it __ ai tkS !C'.S
-- Srr.,Cry Clta°, »v%
i t s. y
a, '-� �Ic<y ft> ..1 rP1n lairlt
CC
NvrfL -- Hi(jllh ',aa ei lm;el,
Six gent"'la, *oil (t x-Wr es ri.'i t;t. walf: r.
'I'l €d ',cash( d sposal BM — 13 e 3" 'h 1'l a r
V13P - trr ticaf R =feien , F�ri?at
rs ri s trst >£:'F) in sr.TW rre(!a;',rnitary permit,T hr, county or the De:)artmenl may t0quest
art t r;:; so I I,st i" thy, field p i)r tc> permit iss=',w c.£e. A complete srri €;Ef plrrras Scab the private
...l1 *arat:l r j fin-lit: IIpphcai on nMist l e Sul rrrltte£.i ;1T -P:he aIpplon` €2a*e local ;ult lar-srr"�-1t lli Order to
o ', sF i r Inii . 1 hr :<; 3a ,rs}' �'.,.;13t rt1t.1�'= i3r ()i'I ld._ed and j`3omed I)iiorto the, start of aany co t I&t t i€c t i o n'
PETITION FOR VARIANCE WISCONSIN DEPARTMENT OF OFFICE USE ONLY
OF A RULE'IN THE INDUSTRY, LABOR AND HUMAN RELATIONS Petition No.
WISCONSIN ADMINISTRATIVE CODE DIVISION OF SAFETY&•BUILDINGS E-Number
P.O. BOX 7969, MADISON,WI 53707 E—
Name of Owner // Iluil ali ng Occul):1ncy or Usti l ue.l.Atotiw,i tor Enginuuring Firm �lyt
Ner ' CTo s d ' t-,01, �k e - SQ 3 =
Company Tenant Name,if any Strcet& No(. V
/04 NA 4¢ I
Street&No. Building Location,Street&No. City State& Zip
City + State& Zip City County Ph ne C/(/
A W'i L y OO Z C '7
Phone Plan Number(s) Name of Contact Person
IF KNOWN `
1. Rule m---0) of the Wisconsin Adminstrative code cannot be entirely satisfied) because:
Lbrr1S_�•�� _�C 'fir_ /fo_ rl��_- h-Sci.LtdttaZC _klfd�rl_Sat�_2�1e1_- Ll�_
s------------------- -
3
2. In lieu of complying exactly with the rule,the following alternative is proposed as a means of providing an equivalent
degree of safety:
xrs` L I-
--°?_s���v_�i�'_�-Q4tiLt.J
------------------------------------------------------------------
3.Supporting arguments are:' 1 L _
-#--------------------------------
VERIFICATION BY OWNER-PETITION IS VALID ONLY IF NOTARIZED
For Fee Information See i LHR 69.15 or Contact The Department at (608)•267-7843
NOTE: Petitioner must be building owner. Tenants, agents, designers, contractors,attorneys, etc. may not sign petition unless a Power
of orney•is sub itte wi a Petition.
being duly sworn, I state as petitioner;that I have read
(NAM of PETITIONER Please type/print)
the foregoing petition,that I believe it to be true and I have significant ownership rights in the subject building.
OFFICE USE ONLY
Signature of ow
Ate-
_ ^ Date Received Amount Paid Receipt No.
Subsc Ib d a sworn tome this date: ,i
unty,Wisconsin.
Department Action
Notary Public Office of The Secretary Date
My commission xpires:- NM1 Rthlu.Sh o of MIL4 M0
sB•B IR.tzrsa► My Commission Expires Jan.18, 1988
3�.......
pwMBINO
0 CATIONS
d ,.
DEPARTMENT OF D SAF L R j. E A li Gi
DIV 1
E 0 SESP ENCE
wait
IcDY' A)Or��
703870
Dew I 9o°
,Qtapnsu.'fco' �(� �l .�W�f � a e� Si .k Rocc b-&
To Gut6t ` �µ MC)cch�.
aper�c? t.tne E 100 6 i 5E �orn¢C'
S.w}« SL
cent ,g EycPQf As shows,
GJ
Aso .
'L 8l
r Charr<bco- A rc 800" 7o Easi
u
P <
� P c Fe,rct
Mki*-.
�r o ct t
i
83 ;59e f
M
31' 714
i
- - _ CeKkr l•�ne .. -
non et' �Pr�pr� (rcg h/ PAGE OF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
o f Ben A l'-e e
—VENT CAP
4'C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
25 FROM DOOR,> JUNCTION BOX MANHOLE COVET
Witt, t�artnl �.a�e'
WINDOW OR FRESH 12"MID. I ''g
AIR INTAKE
GRADE I
I /
CO►JDUIT
111 t/✓. 99 O
INLET, PROVIDE I _
AITIGHT SEAL I I
r 5%"%s I II
APPROVED JOINT A V� 4to I I I APPROVED JOINT:
W/C.2. PIPE n III WIC.=, PIPE
EXTENDIM& 3'
ONTO SOLID SOIL R�1P�`a I) ALARM EXTENDING 3'
Q �� I II ONTO SOLID SOIL
GS I I
C ���`{ �v I ON
�.
PUMP OFF
D EE G
CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC AND /000 Gal. S�,oL�c (( SPECIFICATIOt�1S
0-SE TANKS MANUFACTURER A: We",Jeyk Pnfccalsf ;NUMBER OF DOSES: Y PER DAy
TAWK GIZE : _2TO j) e / GALLONS DOSE VOLUME: /.Pig GALLOAIS
ALARM MANUFACTURER: CL c rYO Pvt^S CAPACITIES: A= IUCHES OR GALLONS
MODEL NUMBER: _ 1 0/ H B=—L`_INCHES OR ',9 GALLON5
SWITCH TYPE: `P�- (.lYc., pit C=_INCHES OR I RX CALLOUS
PUMP MAIJUF'AC_TURER: ,. cl r- d - Mr {r L D= INCHES OR .,ay- GALLOUS
MODEL NUMBER'. �2S I7 ,�� NOTE: PUMP AND ALARM ARE TO BE
SWITCH TYPE: 72A(,,PC MC'rflAr , T/Octf INSTALLED ON SEPARATE CIRCUITS
PUMP DISCHARGE RATE - y0 GPM �'7
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 3L FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.5 FEET
+ --_.�.6 FEET OF FORCE MAIN X g2- 2FYoFrFRICTIOu FACTOR..----o79 FEET
TOTAL DYNAMIC. HEAD — FEET
p
INTERNAL DIMENSIONS OF TANK: LENGTH-4 ;WIDTH J & ;LIQUID DEPTH
SIGA]ED: LICENSE NUMBER: �a�s DATE: a /
Page_ of _
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
Topsoil H- a
I E D
3
2 % Force Main Plowed
OP ,
�R� 0 e From Pump Layer
0 N OF S GE
E A Ft.
G Cross Section Of A Mound System Using
A Bed For The Absorption Area F • 7$ Ft.
G / Ft.
Signed A S Ft. H /�5 Ft.
: � � """
B 147 Ft.
License Number: 1 S K /. q.5-Ft.
Date: - L 71. 9 Ft. /�
Alternate Position 9 Ft. 8703870
I /y fFt.
of
Force Main —�.. W 31 _ Ft.
L
j Observation Pipe
A
�,; lo----T----- 1----------------------.�
Distribution Bed Of %�— 2 %u
2 z
Pipe Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
Page _ 01
PLUMBING
(fonjitiona
p O D TRY; OR h Hui+ .� AELATIONS
Perforatl T F SA Y Uit_ 'S
a
`�EUARESPPPN4D ENCE
� r
End ViewQt'1VLahen�
)Perforated / M ar kcrs
End Cop) �\e�" PVC Pipe
occs
Holes Located on Bottom,
�S Are Equally Spaced
.'7
PVC Force Main,,.
* * From Pump
doer �,2f em(
Q PVC
FNo
Ca Manifold Pipe
Distribution..-
Pipe
Last Hole Should Be
Next To End Cap
Distribution Pipe Layout P ,
S S
h._�_._ 5 s
Signed: J Hole Diameter — — Inch
.,ter-�----
License Number: Lateral / Inches)
Manifold -2 Inches
Date: tc 4Z - '7 Force Main Inches
Lj
81ate Of Wisconsin ` Department of Industry, Labor and Human Relations
JusnC 22, 1 '€ I
SAFETY&BUILDINGS DIVISION
REPTIVED
JUL Y 1987, '( i t 1 c�i), r,. t i-C 7 P
L� ZONING I
A0u (: : ;� OFFICE ',
St. Cy Ay, E (.'!4);C;:, 1
sectiCP, i 'Z r (I )� risccnsif! Stsif:i tcs, 4r-,(- 5. IU!E `. 4.0s (a') Gb) 1' 1sconslri
�.4,t i 1 1;t iSt1 RAF Code, i i i�r'!y t't;^ 6:d-ic_t �() i t:l t,gi 4;.t& 'q).,9) t l�evt for, a variance
CC ti?f' l r'isf:di l ri'ti u, f er i1- pv i v1e1 .(S {:4rK `.1C. !,tYri i f.:" ((x !'!jai S.cc en existing private
at c< t l"?RCS, is )dc';t ili fz;li toe sitir(cS
�z Irt;t1T(� 1lr Calf r..`.r.iljiS1Y`d%ive it,i<,. 'fir a? Y%I fiC:a1,Sr3 .inpf SE't; ShC13diCS
rWotec;t. tit' :'atet-o of the i,.f ti-, f cm, ccotctrin;itiori.' I SyStfsr.l beLumes a
f a. I 1 rir S',% it=f` or cont-, 1 Ptt�t::'s 46=t? rs CE:?' f i ? 'f:: �ic9tf: , V'A s vkxiai.,ce Chat I he
3 e sc i n(-'e6♦
The peti4ion f(�st° i, vet°iatict- reque� .tee to s. ILk ,, 0 of t4,e, Fis.
(x dc- 's.% corlsi eerec on UiEVIf V",, i'..r l. To's(' i ('f.i .R f )t K 5 e't E it
COS40 ti C€)iii i y dS i"C''YC%. Tili ( +,�VlC i ti c'r; i'( i i+ $ra:ri. it",
c-vont of failure, the
i!fC+tiraC `i>'�atEP) SS t')R i € 3"E'i?ii�C(°.(:e 411 l i I ('i:`3PeE 7sfr+i;, t:^t C'A'i'L'1' G`V�1'-i()t "aYst6'r .
Tl,f- a r 'i)°'i can ,, a 3 ","l i r,6F eb 0- sui tdbl e
Rc! varii rcc requ 'S .:0 was 1":( 1 ns*1i l 1 ca t1 �.Z e CL..lt:r7G l,.C.i.'.r',C : st.tli: C)` is site
,1tit i i irlc:i-ts f suitable )+r<�tur,,Al
Al i of f:.if; c (t.a and stalements ()f-, C,,; pr.,ti ti crust° re
f;tra$1Ctix'3° 'C`,. 13:TS 1'it"lain:t: 1s 'ti'C"Cif-c tp tii(, ';�f€'C�i t_�E'titic^n dTe(. canrint< tie
APSE'(` fE r, ilia : ts4il'!aiC)Vlw1i r,ocif'if: i 'iCris.
Si riccrely
,l
� r
�t
Ile 'i, t`€'if t'iC>I, Vii.
Jecti ol. o! Vri v� te Sc%.i,cc,
(C Le tow
I...i'?' ppe"4a Falls
Ncl s DPI, 4c-td n c ..,IV?1i"A S"i ral.ov - `it. r.r-o i:°:
i>+ lrllf PelCY£'Con,
DILHR-3BO-6423(N.04/81)
StItte of Wisconsin ` Department of Industry, Labor and Human Relations
I
SAFETY&BUILDINGS DIVISION
IM
��� t`t t'i!i� I it � �4 �ij�lir�.,; 1 jf,'. t 4j; •
. ,: I[.,t',-�.; rs� rft,..,. 6,•1(.tJ J tEO. I. .! };.!_ r, S}ij !',� - ;,1 -;d -
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itr
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. 9 t $!'t• 1' l r?�.'f7s ",t i�•i i', + i , � 4(ati 'h iJ !!: { :a , -) � F ', il) ,j fil"I .1:.l1,?t }t..�,1.
. i,ji � , r
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:+ill' J" � i •� t'. .. ?i i7 t.i.r 721r - li?I'i''F ,.i ... a
{ S s, ..J•{ r'.!'� I rG ,i,�:= i i! 'sir:; ,,I,' ' (:�-, ,. •..t,�,+
jet ttr:' f CJft ,'S.ti Il, I�'t' � ,at!.. s. a'1>t::r ;} :, i)� I �:! -• 1J'1`�t "tlSi;Yh'[frrJ
r.:f i'p l_ L r„iitI
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t•.ot' a ! ! r. •ai,^,. rj,. :'4 tj:� �, 7-:ti T,is;.`i
Mll r.P� 1 .,{�rl<;•{71;'.t. : '}t:1' r}c,.rL "�� I:t d. I. 4. 7 IBS I; �� •j4' + , f r �. ':9a .dr' r 1,1 l,1 [tT�:ij [, '
.. .., „ t i,..,, tt .. .: J. . . •-z s• 4iS ..�.r. si' !I hr: r r ;;t'r � ;.,}sr.:;t., i :;It;i.t��fR ittia4? �
.;,}Ir J , I)i,•rtl _ .r•� j e E;,' ;�, :e: j.. a i'1 � r`.. .it',I i , i�,� � tj� q':; 4,Ll7 t"<:lilr-lf�.
c 3r t ;l't,; I,'r 1i,=•err r,. a z,.x r';
t=:< n ;! kt� P'{ �iejtJii 'J
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if.ItI t i _ ur"1 r: j,1. Li (.i'1, .]dal IV,.. tii
DILHR-SBD-6423(N.04/81)
State Of Wisconsin ` Department of Industry, Labor and Human Relations
v'
SAFETY&BUILDINGS DIVISION
• A'
1 S'1 '.%irf a� � 4�rtJ;_: i,�'311'SLI� 1':r��t� �=1ii'"" ;i�,) �4�1 ilt _ 1' li,ll�il�;tl f'ICt l.t'ttt•,i� � i l#ij
t
i
i
i
I
DILHR-SBD-6423(N.04/81)
A ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
§%1' 796-2239 (HAMMOND)
W FT 425-8363 (RIVER FALLS)
-- - HAMMOND, WI 54015
June 1, 1987
Division of Safety and Buildings
Bureau of Plumbing
P. 0. Box 7969
Madison, WI 53707
Dear Sir :
An on site investigation for the Herbert Goble property located
in the SE 1/4 of the SE 1/4 of Section 9, T29N-R16W, Town of
Baldwin, revealed suitable soils at a depth of 1. 4 feet, below
which seasonable high ground water was noted .
This site should be suitable for a mound system.
Should you have any questions regarding this subject, please feel
free to contact this office .
Sincerely,
I�OMC,3 0-.
Thomas C. Nelson
Zoning Administrator
rc
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
P.O. BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. Croix
Location SE 1/4, SE 1/4, Sec. 9 T 29 N, R 16 EXRF4 W
Town Baldwin Street Address Route 1 , Box 60, Baldwin, WI 54002
Lot No. N/A Block N/A Subdivision N/A
Landowner's Name: Herbert Goble
The application for this site is for:
❑ new construction use.
E replacement system use.
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
❑ to have one of the first five approvals guaranteed for this year. This is
number - - of those applications. (Use one of the first five
quota numbers sued to you.)
one of the applications needing a quota number. The quota number assigned to
this application is - -
❑for one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
for an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by the
department.
❑for an application on file prior to February 1, 1980.
❑for a lot that meets the criteria for a conventional private sewage system.
If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is
replacing:
®a failing conventional soil absorption system.
❑ a holding tank that was installed and in use prior to February 1, 1980.
❑ a privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a
conventional private sewage system, check here.
I certify that the above information is true and accurate to the b_ t df my
knowledge.
Name Thomas C. Nelson Signature` C
County Official
Title St. Croix County Zoning Administrator Date June 1 , 1987
BILHR-SBD-6158 (R 12/82)
STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location: Township
SE 14 SE ;41S 9 IT 29 N/R 16 IKWW Baldwin
Street Address: Subdivision: County:
Route 1, Box 60, Baldwin, WI 54002 n/a St. Croix
Landowners Name: Mailing Address:
Herbert Goble Route 1, Box 60, Baldwin, WI 54002
I (We) , the undersigned , hereby make application for an alternative system on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree to have the system installed in conformance with the Bureau's approval
of plans and specifications.
I further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for the purpose
of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the
Bureau will send the applicant a letter of approval which authorizes
construction of the alternative system after all necessary permits have been
obtained.
I agree to give notice to any subsequent buyer that an application for an
alternative system has been made and if installed, that the premises are served
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
Signature of Applicant Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF This day of 19�
Notary Public, State of Wisconsin
DILHR-SBD-6413 (N. 05/81) My Commission Expires:
HELGESON TRUCKING INC.
Spring Valley, WI 54767
May z$, 1987
St. Croix County Zoning Office
Hammond, WI 54015
Dear Sirs:
Please send a letter of verification of onsite so that we
can forward this set of plans to the State.
Thank you.
Sincerely,
Chris Zignego
Office Aaministrator
RECEIVED
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