HomeMy WebLinkAbout002-1091-70-200 °o ° 0
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Parcel #: 002-1091-70-200 02/15/2006 09:38 AM
PAGE 1 OF 1
Alt. Parcel#: 36.29.16.521 B 002-TOWN OF BALDWIN
Current LX ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
12/22/2004 00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
GARY G &DEBRA J HILLSTEAD O-HILLSTEAD, GARY G & DEBRA J
2628 60TH AVE
WOODVILLE WI 54028
Districts: SC=School SP=Special Property Address(es): '=Primary
Type Dist# Description '2628 60TH AVE
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description. Acres. 15.000 Plat. 4896-CSM 19-4896 002-04
SEC 36 T29N R16W SE SW CSM 19-4896 LOT 1 Block/Condo Bldg: LOT 01
( 15.00 AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-29N-16W SE SW
Notes: Parcel History:
Date Doc# Vol/Page Type
12/22/2004 783271 19/4896 CSM
07/28/2000 627217 1530/146 WD
07/12/1999 606638 1441/170 LC
07/23/1997 1089/238 QC
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
87369 Use Value Assessment
Valuations: Last Changed: 05/19/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 9,000 52,000 61,000 NO
AGRICULTURAL G4 5.000 400 0 400 NO
UNDEVELOPED G5 8.000 3,100 0 3,100 NO
Totals for 2005:
General Property 15.000 12,500 52,000 64,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
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
Parcel #: 002-1091-70-100 01/08/2008 05:04 PM
PAGE 1 OF 1
Alt. Parcel#: 36.29.16.521A 002-TOWN OF BALDWIN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type
12/22/2004 00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
PAUL R&JANIS NELSON O- NELSON, PAUL R&JANIS
2693 60TH AVE
WOODVILLE WI 54028
Districts: SC = School SP=Special Property Address(es): =Primary
Type Dist# Description
SC 0231 BALDWIN-WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 36 T29N R16W SE SW EXC CSM 19-4896 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
36-29N-16W SE SW
Notes: Parcel History:
4-3-05 IS IN SEC35 NOT 36-SC Date Doc# Vol/Page Type
07/22/2005 801188 2849/413 WD
03/29/2005 790761 2773/129 WD
12/22/2004 783271 19/4896 CSM
07/28/2000 627217 1530/146 WD
more...
2007 SUMMARY Bill#: Fair Market Value: Assessed with:
230626 Use Value Assessment
Valuations: Last Changed: 10/25/2006
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 14.000 1,500 0 1,500 NO
UNDEVELOPED G5 11.000 14,700 0 14,700 NO
Totals for 2007:
General Property 25.000 16,200 0 16,200
Woodland 0.000 0 0
Totals for 2006:
General Property 25.000 16,200 0 16,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch#:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
1
��lR pp '� rffAG MAL�896
REGISTER OF DEEDS
- RECEIVEDxFOR•hECORD
f.> 12/22/2004 04:00PH
CERTIFIED SURVEY HAP
CERTIFIED S URA%E Y I�1
COPY s.Oe
LOCATED IN PART OF THE SOUTHEAST 1/4 CF THE SOUTHWEST 1/41/OOF►
SECTION 36, TOWNSHIP 29 NORTH, RANGE 16 WEST, TOWN OF BfALOW(N, ST.
CROIX COUNTY, WISCONSIN.
OWNER:
GARY & DEBRA HILLSTEAD { 'e
2628 60TH AVENUE UNPLATTED LANDS ROOERLYNN 'i S.
WOODVILLE, WI 54028 I — — ` — —— HAP ��
N 88'22'01 e W
596.02' MLL j.•
...........
cn LOT 1 0
= INC. R-O-W /
0 653429 S.F.
V)
u i 15.00 Ac.
o EXC. R-O-W N
V)
I � rn 633865 S.F. M cn
zI (D
r— W a 1 4.55 Ac. "r� J
01 ¢ N °
CD :Z
N `_i�BARN �I A f ,yl
o �I�GARAGE t`O 6 (�
SCALE. I' 200' LJ L J H SE �J d I
o so ioo zoo F-
tn
o�v
3
0
--- —
7323.50' 3 ------,p--- --------
Q 33.04'
SW COR SEC 36- — —S 87'121-41-- E 592 89' 730.72'
FOUND P.K. NAIL CO 592.76- —r7 , /� — — — — — _,,._
� � `- -�- - - - - �_ _ S 1/4 COR SEC 36
--S 87'12'41" E 2647.00'-- FOUND 3/4"
SOUTH LINE OF THE SOUTHWEST 1/4 / �EROD
LEGEND:
• SET 3/4" BY 18' IRON UNPLATTED_LA_NDS
PIN WT. 1.50 LBS./FT,
COUNTY SECTION MONUMENT
(FOUND AS NOTED)
�w WELL LOCATION NOTE..
BEARINGS ARE REFERENCED TO THE SOUTH LINE
QS SEPTIC LOCATION OF THE SOUTHWEST 1/4 OF SECTION 36, ASSUMED '
------- 100' BUILDING SETBACK LINE FROM R—O—W 10 BEAR S87'12'41"E.
THIS INSTRUMENT DRAFTED BY KEVIN SAMUEL
HUMPHREY ENGINEERING SHEET 1 OF 2
Vol 19 Page 4896
1
t Form - STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER �'�c�� TOWNSHIP tBJ Lj)/ SEC. 31 T N-R�(�W
T I
ADDRESS �a,�} ,� ST. CROIX COUNTY, WISCONSIN
SUBDIVISION �) LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of I1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTE
�y clot
s..
�1_I
t- •� ,jam
t�
IS 110 L)
�a
NDICATE NORTH ARROW
BEN C RK: Describe the vertical reference point used
Elevation of vertical reference point: Irjo Lk,, Proposed slope at site:
SEPTIC TANK: Manufacturer: / �u,tc�lr.-, Qcd3quid Capacity•
Number of rings used: I ,.L Tank manhole cover elevation: 9E1=
Tank Inlet Elevation: Tank
9 Outlet Elevation:
Number of feet from nearest Road: Front,O Side 0 Rear, _/50-- feet
From nearest property line Front 10 Side 10 Rear,0 feet
Number of feet from: well building:
(Include this information of the above plot plan) ( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
1
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump ff switch elevation: Gallons per 1
p p cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: rj ' Length: Number of Lines:.— Area Built: -�
Fill depth to top of pipe: Qp
Number of feet from nearest property line: Front, O Side, Rear,0 P't .
Number of feet from well: //0 r
Number of feet from building: �0 /
-o—
(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 N�
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, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector• °k"^ A e o'^
Dated• Plumber on job:
c 4 •�
License Number: 2
3/84:mj
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%,SW-14,S36,T29N-R16W VCONVENTIONAL ❑ALTERNATIVE State Plan II.D.Number:
Town of Baldwin ED Holding Tank El In-Ground Pressure El Mound (If
Cty Trunk B
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO D TE:
Albert Hillstead Route 1, Woodville, WI 54028 -3 �? 3 �• �
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:
Bennie Hel eson I3215 St. Croix 92564
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: jWA.FtV1 IN G LAB LOCKING COVER
1 O P DED: PROVIDED:
g 7 a ) YES ONO ❑YES NO
BEDDING: =NT DIA.: VENT MATL.: f"OYES GH WATER NUMBER O�F ROAD: PROPERTY WELL: BUILDING'. VE TO RESH
ALARM: FEET FRO Q� LJ LINE: 1 ? Q AI INLET.
OYES l ONO NEAREST v l d l �u + `� v
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY'. PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ONO
E:]YES ❑NO 10YES ONO
GALLONS PER CYCLE: PUMP ANO CONTROLS OPERATIONAL'. NUMBER OF PROPERTY WELL BUILDING. AIR INLET
(DIFFERENCE BETWEEN FEET FROM LINE
PUMP ON AND OFF) ❑YES 0 N NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
FORCE
or excavation. (If soil can be rolled into a wire,construction shall cease until
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH. NO.OF JDISTR.PIPE SPACING: COVER INSIUE DIA. SPITS LIQUID
BED/TRENCH TRENCHES / I M RIAL PIT DEPTH
DIMENSIONS ^ �f
GRAVEL DEPTH FILL DEPTH IDISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DI TR. NUMBER OF PROPERTY WELL. BUILDING4VIENT TO FRESH
BELOW PIPE�'.t ABOV OVER ELEV.INLET.ELEV.END'. —7�/ PIPES: FEET FROM LINE: / AIR INLET.
6 Z /,2 NEAREST--►
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
DYES 1:1 NO
OIL COVER TEXTURE: PERMANENT MARKERS OBSERVATION WELLS
DYES ONO ❑YES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED
CENTER: EDGES:
❑
DYES NO OYES ONO DYES 1:1 NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH: LENGTH'. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. DISTR. DISTR.PIPE DISTHIBUTION PIPE MATERIAL&MARKING
ELEV.'. ELEV.: DIA.'. ELEV.'. IP"Iop ES DIA.'.
ELEVATION AND
DISTRIBUTION
HOLE SIZE HOLE SPACING'. DRILLED CORRECTLY JCOVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS.
❑YES NO DYES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE.
OYES 1:1 NO DYES 1:1 NO NEAREST
�I
Sketch System on Retain n county file for audit.
Reverse Side.
SIGNATURE. TITLE
Tim Zoning Administrator
DILHR SBD 6710(R.01/82)
SANITARY PERMIT APPLICATION COUNTY
=LTDW1L,,1H, R 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 PLAN I.D.NUMBER
8%x 11 inches in size.
—See reverse side for instructions for completing this application.
PETITION
1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES IZO
PROPERTY OWNER PROPERTY LOCATION
Albert Hiilstead' SE '/4 SW '/a, S 3 6 T N, R 16 ; r)W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
Route 1
CITY,STATE ZIP CODE PHONE NUMBER CITY . NEAREST ROAD,LAKE OR LANDMARK
Woodville Tipil 5402$ 15 69$-2+61 ° VILLAGE: Baldwin ¢ounty Trunk B
II. TYPE OF BUILDING OR USE SERVED: #44-cl O
Number of Bedrooms if 1 or 2 Family 7! OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable)
1. a. ❑ New b. ❑X Replacement c. El Replacement of d.El Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a. ®Conventional b. ❑Alternative C. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. ❑ Seepage Bed b. ®Seepage Trench c. ❑See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. EVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): U pj�`er'
.0 ail F et e ❑X private ❑Joint ❑ Public
60 334 ��0 Feet
VI. TANK CAPACITY Site
in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xisting Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank 100' 1000 1 Midwestern Pre Fil F-1
Lift Pump Tank/Siphon Chamber
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Sta s) MP/MPRSW No.: Business Phone Number:
Bennie Relgeson 3215 1 (715 77$-4425
Plumber's Address(Street,City,State,Zip Cod ): Name of Designer:
Spring Valley, 1I 54767 Rennie Helgeson
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
Bennie Helgeson
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
Spring Valley, Wisconsin 54767 715 77$-4425
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved S nitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps)
Lp Approved ❑ Owner Given initial ���✓ Sur argre Fee '
Adverse Determination )
X. COMMENTS/REA ONS FOR DISAPPROVAL: ,� k
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
f
G ,
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 ro this permit must be approved by the permit issuing authority. A new permit may be needed
if there ls 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; I , - 1., -
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, contactyour 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:
1. Property owner's name and mailing address. Provide the legal description where the system is to be
installed;
11. 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;
0
VIII. Soil test information: Certified soi# 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'/z 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) soihtestt data on a 115 form. -
GROUNDWATER SURCHARGE
On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is 7 ore
commonly known as the groundwater protection law. This change in statutes was the -
f
result of over 2 years of steady.nego. ation and public dabate. The groundwater bii, (.1rJUnljv+tater
included the creation of urcharges fug' a number c e i ,'a d ,iractices 'which J!'lSC0 lints
can effect groundwater ne surcha, -)nk effect on JuIv 1, t"Y of the w.a.er tha td eas,dr£' !
is used io your 0,:'r , Po .t f ndwa?et ti,
system or the tank purnob _
i
rho-; P lOi �
t+;re(j f)y
worth p oterJ,m_,
si;_`398 jR.03!86)
r
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 kLt 101116 -
Location of Property SE 14 S U) 14, Section S(o W
n
Township a ,p ,-)I .
Mailing Address �� �T �� ®�� y; II -e
Address of Site
SA rbz!:,
Subdivision Name 4jA
Lot Number .,414
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 O 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.
PROPFRTV OWNER CERTIFICATION
I (We) cvW6y that att statements on this Sotcm atce true to the but o6 my (ouA)
knowledge; that I (we) am (cute) the owner(s) o6 the pnopeAt y des ctr ib ed in this
.inboAmation boAm, by vi tue ob a watvcanty deed %eco&ded in the 066i,ce o6 the
County Reg-ustetc o6 Deeds as Document No. P 4 • 7/ and that I (we) ptces entt y
own the ptcopos ed site bolt the sewage dizpozaz s ys em (atc I (we) have obtained an
easement, to nun with the above deco ibed pnopehty, 6otc the consttcuc ion ab said
.sybtem, and the .same has been duty tcecotcded in the 066.ice o6 the County Regi.6teA o6
Deeds, as Document No. ) .
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED-----` " DATE SIGNED
3/S
V"
NUMBER This Indenture�Made this 4th day of June A.D.,1955 .
',
between Roy C. Larson and Ernestine R. Larson, his wife
parties of the first part,and
Albert G. Hillstead and Alvina K. Hillstead, husband and wife and as joint tenants
parties of the second part.
i
WITNESSETH,That the said part ieS of the first part,for and In consideration of the sum of
Six Thousand Five Hundred and no/100 ( $6500.00) Dollars
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to them In hand paid by the said part ieS of the second part,the receipt whereof is hereby confessed and acknowledged,ha ve
given,granted,bargained,sold,remised,released,aliened,conveyed and confirmed,and by those presents do give,grant,bargain,sell,remiso,release,
alien,convey and confirm unto the said parties of the second part, their heirs and assigns forever,the following described real estate,
situated in the County of St. Croix ,and State of Wisconsin,to-wit:
Northeast Quarter (NEn) of the Southwest Quarter (SWq) and the South three—
fourths (S3/4) of the Southeast 4uarter (SEq) of the Northwest quarter (NW4)
I
and the Southeast Quarter (SE4) of the Southwest Quarter (SW4) all in Section
I
36 Township 29 North of Range 16 West.
07.15)
(R. S.)
(Can. )
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TOGETHER 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 part ieS of the first part,either in law or equity,either In possession or expectancy of,in and to the
above bargained premises,and their hereditaments and appurtenances.
TO HAVE AND TO IIOLD the said premises as above described with the hereditaments and appurtenances,unto the said parties of the second
part,and to their heirs and assigns FOREVER.
AND THE SAID Roy C. Larson and Ernestine R. Larson
i
I
I for their heirs,executors and administrators,do covenant,grant,bargain and agree to and with the said
part ICS of the second part, their heirs and assigns,that at the time of the ensealing and delivery of these presents
are well seized of the premises above described,as of a good,sure,perfect,absolute and
indefeasible estate of inheritance in the law,in feo::ample,and that the same are free and clear from all Incumbrances whatever,No Exceptions.
and that the above bargained premises in the quiet and peaceable possession of the said part ].e5 of the second part, their heirs and
assigns,against all and every person or persons lawfully claiming the whole or any part thereof, they will forever WARRANT AND DEFEND.
IN WITNESS WHEREOF, the said part ieS of the first part ha ve hereunto set their hand sand seals this 4th
day of June A.D.,1955
Signed and Sealed in Presence of Roy C. Larson (SEAL)
'Robert R. Gavic Roy C. Larsen
!Robert R. Gavic (SEAL)
Violet Gavic Ernestine R. Larson
Violet Gavic Ernestine R. Larson (SEAT.)
(SEAL)
S'T'ATE OF WISCONSIN,
s.
Pierce County.
Personally came before me,this 4th day-of June A.D.,19 55 ,
the above named Roy C. Larson and Ernestine R. Larson
to me known to be the person S who executed the foregoing instrument and acknowledged the same.
Received for Record this 9th day of
Robert R. Gavic
June A.D.,19 55 ,at 9 o'clock AM. Robert R. Gavic
Notary Public, Pierce County,Wis.
David Hope Register of Deeds. (Seal)
My Commission expires 10-26 A.D.,19 58
nepttt.v.
ICI
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a
ST C - 105 rr-
a
H
SEPTIC TANK MAINTENANCE AGREEMENT
0
St . Croix County z
OWNER/BUYER1 /
e r to
ROUTE/BOX NUMBER R+ 1 Fire Number
CITY/STATE Woad U , tje_, ZIP
PROPERTY LOCATION : ` , SQ) 14, Section� T Q N , R _W,
Town of & "3" St . Croix County ,
Subdivision 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 I+
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.
( ertification, form will be sent .3^prOXi ^at?1! 3C raj prior tv^
three year expiration. H
te
0
• F.
I/WE, the undersigned , have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth , herein , as set by the Wisconsin Depart- b
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
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
INDUSTRY, DIVISION
LABOR AND CC P.O. BOX 7969
HUMAN'RELATIONS PERCOLATION TESTS (1�J� MADISON,WI 53707
(H63.09(1)&Chapter 145.045)
LOCATION: SECTION: WNSHIP UNICIPALITY: LOT NO.:BLK.NO.: SUBDI ISION NAME:
'/450/ 3 Ar HIN E (o W I A Lot-b\ AM
COUNTY: OWNER' E: 11VIARNG ADDR SS:
A 1A
USE DATES OBSERVATIONS MADE
IND.BEDRMS.: COMMERCIAL DESCRIPTION: I PROFID ES R PTI0NS:IP ER A I 0 N TESTS:
*Residence vA ❑New RReplace
`7` So(-( SS rue. Show :�a.r%f,CTL90
RATING:S=Site suitable for system U=Site unsuitable for system 9�n,,
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:rYSTEIVI-I N- LLHOLDING TANK: RECOMMENDED S STEM:(optional)
NS ❑U ❑s ❑U ❑S ❑u ❑S u ❑S Ru
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: NA Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST O BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
I d �$ S T-5 8'61,6L ab e 6' MS 3 k% FS
B- / Sr 3 6n MS 3 Dk 5 �
FS �,7' 8�• MS
A4 S
B-3 $,-3" �.�' �l S;/ r3 :a ! g, �i 1•D ' ,hn t1 S
B- 4j y ,,� 8
,L
B- CO /Q r
PERCOLATION TESTS �✓ ✓✓✓C
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RA MINUT
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PER LOD 3 PERINC
P_ d
P- IND �� ►� Y
P- L
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 horn
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,T"l, M`a, r �o �
SYSTEM ELEVATION $9.2 A., .L $y.
17- 1
---' _ -
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fi �� .oP
Q� P .. . 1s..., ,. _
_I_ _. . � ---- --� E _-
_.
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I,the undersigned,hereby certify that the soil tests reported on this forfn 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 'nt): TESTS WERE COMPLETED ON:
ehrJ/e e So.1
i3
ADDRESS: CER I ICATION NUMBER: PHONE NUMBER(optional):
Ut/-,e4 U1 67Y26 7 —7'?F—q qeaS-
CST SIGNATURE:
Ole
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 IB - 5395 "
To be a complete and accurate soil test,your rel ort must include;
I, Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercial project,
3, MAXIMUM number of bedrooms or cornrriercial use planned;
4. Is this a new or replacernent 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;
0. PLEASE ras the abbreviations shown here for writing profile descriptions an(] completing the Mot plan;
?. MAKE A LEGIBLE diaaagrarrt accurately locating your test locations, Drawing to scale is preferred. A
separate sheet may be used if desired;
S. Maf<e sur;~>your benchmark and vertical elevation reference point are clearly shown,and are permanent;
9 Co mpleie all appi opriate Boxes as to dates, names,addresses, flood plain data, percolation test exemp-
ion if appropriate;
lr If ,!w, ii?forrnaiion (such as good plain, elevation)does not apply, place N.A.in the apprormiate, box;
I'I, Sire: the form and place yor.it, current address and your certific Lion number;
2, ,NIal<e legihle copies a€ d distribute as required, ALL. SOIL TESTS MUST BE FILED VVITH THE
LXDC,AL AUTHORITY ORITY VVITHIN 30 DAYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil awpirratcs and Textures Other Symbols
— str m lover 10"i BR — Bt dro(A
col) collhi£w (13 - 10") SS - Sand"storre
ql Car ays l (under,3,.) LS LialesLone
�s HCiW — High Caroni€1dwwe,r
co-n-'-'e S;;ild I etc. PzJcolahoor, rat:
_ r tie S;ar?d t3salc7 3 a?r"hng
t
� .7dY Lt a;tr <
�
- Loam Bit - B .='o f
-? — It Loam Li sa _,;'
ci S,l.
Y -- Y l :rat
Clay L_tsurrr R — `a
s l r ,i...`3! L)cat( (not a t
551:.f->;<
C,Say %, Li..
f{t
ay cc cron�ncw,
i
p
HVvL — I il) , iw toi level,
VRP V ri :jai Itrft>rrrr= t; Pv ,,ti
TO THE Ot NER:
sr�.
ten' report rS 't),: 'fit St yiloo in.secirrir,ol a sariitary p0rrzlit. The county of tine Department may request
B ! ' oo ), tci p,,rrnit issuancrl: se! for the private
ai tJ='rmo .3p)p31cmi")n must 13£; ti the aarwropiiaie local tuft€orit`rt in Order is
tl3. bi ofjtatt .sa £i!'d r)ost€;d p.l€r to ,,f t' start .z ar)y .�E)E,St€"UCtiC�n.
J
t
ANUS ANU. �, v DIVISION
AN D PERCOLATION TESTS (115)
LABOR P.O. BOX 7969
LABOR AN
HUMAN RELATIONS MADISON,WI 53707
r; (1-163.09011&Chapter 145.045)
UNICIPALITY: L NO.:B O.: SUBD/ .3 �T 2q N/R*E (o eFWNSHIP
jAD AM 42A
COUNTY: OWNER'S E: MAI N R S S:
USE DATES OBSERVATIONS MADE
NO. _ TESTS:
R S:BFDRMS.: COMMER
Residence ❑
A/� New Replace, //3197 $Z4 &�
�.Y
� 7 so�•t rU�.
RATING:S-Site suitable for system U-Site unsuitable for system S `.
r ONVENTIO AL:. MOUND: „ IN-GROUND-PR UR. : S S EM-1N- LL HOLDING TANK:RECOMMENDED SYSTEM:(optional)
sou osou osou os u [IS RU .
t:
I L2 If Percolation Tests.are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: N Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GR UNDWATER CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH jy. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
s .$ � cab . MS .3 k37 FS
B- / 5,3 �d.5 /70 n'� �S� 3 0 ' 6n /,4S .3'ak 8n FS ,,-�' 6, MS
131- Si s Ad ',D „ 5L �u►b i.sl'� Fs.
.
s $5
4�
B-
B-
•,' PERCOLATION TESTS
EST DEPTH- WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES, AFTERSWELLING INTERVAL-MIN. p PER INCH
P- I 15'14
P_ !) tao
P-
P•.
P-
P_
PLOT PLAN: Show IQcations 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. ( e>r M►��!�( L.Ow��
SYSTEM ELEVATION ��•a R�.r� $4• �rl�e
J .
TI
--- __-. 01 •
s
IN
t. o '
LL �J=.
s Saiwo, CR��a``'')�
I,the undersigned,hereby certify that the soil tests reported on this for(n 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 'nt : TESTS WERE COMPLETED ON:
s o : /,5" 46 7.
AD RESS: CER I ICATION NUMBER: PHONE NUMBER(optional):
S r -e ,• 309 X 78-51`�e.1
CST SIGN TUBE:
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) OVER —
Fj6 f plate
B.M 4r v.R,P too.00
&AofK OT
,l"
Scwa.-
1000 G�1
/h�i�wc5�'erw
�r2 CaS�"
• n�
17R
�Ue•�fJ
63
br A- �_=1 .
2aresT LLfppr"rrtlu 6 8.07
fp •the �otsJeir t-t sq ck
�5 ti S+�PcyrroV
Sic o�
,� rooe4Q SVIA leoverr 04-
�y�z.z- •—,
/hIh
over p�S�rol per �- '�- i'I,. BCC,
y„
(�►� V QKl C co-
-re
��lo�s Ptpc o
rresl.. r4�� I„l<fs cr..c� U'�.5�rvaTtoY. >Pj�c,L
T"Jckoxter aeon", 17e.1 3a's�
AS BUILT SANITARY SYSTEM REPORT
OWNER / TOWNSHIPS
SEC. �fo T�N, R /(o W
ST. CROIX COUNTY
P,O, ADDRESS • WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100FEET OF SYSTEM
1978 �
Cb
c9
O
't
SEPTIC- TANK CONCRETE `" STEEL
KS) MFGR.
NO. o7 rings on cover Depth DRY WELL
i TRENCHES No. of width length area _
' BED no. of dines width length G area
depth to top of pipe
AGGREGATE
PERK RATE AREA REQUIRED AREA AS BUILT
DISCLAIMER: The inspection of this system by St , Croix County 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 SYSTEM.
INS PECTO .. 7: ; --
DATED 9- '' • ' PLUMBER ON JOB
` LICENSE #Lj d
z '
!g REPORT OF INSPECTION—INDIVIDUAL SEWAGE SYSTEM
San.itany Penm:i , �,SJ
State Septic
NAME � � `�� -Township y/_��z
St. Cnoix County
Locat.ion,")C^% o�S�y�%, Sect.ion3GTWN, R /6w
SEPTIC TANK
Size /d'd"O gattonz . Numbers 96 CompantmentA
D.idtance Fnam: We. t_,e! 'b it. 12% on greaten stope --- it
Building /Z it. Wettands — it.
DISPOSAL SYSTEM Highwaten
Distance Fnam: Wett 4c-' v ''! it. 12% an greaten stope
Bu.itding__ Vix. Wettandd Ft.
H.ighwaten it. Z
3G
FIELD DIMENSIONS:
Width aj trench it. Depth a6 etow t.ite_,t 2- .in.
Length o6 each tine 9(0 iit. Depth of hock oven ti Z" kn.
Numb en: a4 tinez Depth of t.ite below gnade_j0 _in.
Totat .length aj tines I0Lf it. Stope a6 trench r-- in pen 100 it.
Distance between tines �! it. Depth to b edno ck
Totat abbonbtion anea-..S&46t2 Depth to gnoundwaten it.
Requined area it 2
PIT DIMENSIONS:
Numbers o6 pit-6 Gnavet around pitz yu no
Outside d a n it. Depth betow .inlet it.
2
Totat abdonbt.ion area it a
' A
Area nequ.i it
2 rn
INSPECTED, Z l
E ED ;7�E
APPROVED, MC A,/ , DATE 197(S.
REJECTED ,DATE 197
fff
State and County State Permit
PLB67 #
Permit Application County Permit# 5
for Private Domestic Sewage Systems County 0A. %—
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
Albert Sillstad ZU Woodville. Wise
B. LOCATION: 3$ % 3 %, Section _36, T29 N, R 16 E (or) t# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township BaldViA
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify)TJrailOr*Variance
Single family Z Duplex No. of Bedrooms 3 No. of Persons 2
D. TYPE OF APPLIANCES: Dishwasher YES Z NO Food Waste GrinderYES Z NO # of Bathrooms L
Automatic Washer Z YES NO Other (specify)
E. SEPTIC TANK CAPACITY 1000 Total gallons No. of tanks 1
*Holding tank capacity Total gallons No. of tanks
New Installation = Addition_ Replacement_ Prefab Concrete z
*Poured in Place Steel Other (specify)
F. EFFLUENT ISPOSAL SYSTEM: Percolation Rate 1) 8 2) 8 3) 10Total Absorb Area_ sq. ft.
New ddition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No, of Trenches
Seepage Bed: Length 36 Width 16 Depth 31 Tile Depth 21 No. of Lines 3
Seepage Pit: Inside diam4ter Liquid Depth Tile Size 48
Percent slope of land 5% Distance from critical slope
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME t'OU Sadth C.S.T. # 1768 and other information
obtained from (owner/builder).
Plumber's Signatur MP/MPRSW# 5184 Phone # 6"- 2407
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
A FRn -A
®a_
p IT
fotAd
W
Do Not Write in Spac Below IjOR DEPARTMENT USE ONLY
Date of Application C1— Fees Paid: State U County , C C� Dat —
Permit Issued/8eimosvg-(date) _Issuing Agent Name
Inspection Yes No Valid# Date Recd
1. county ( it 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 6/1/76
EH .115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON,WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION:SAEY4,5 114,Section.(,T.9fN, R 41100 W,Township or-IMarpO ;
Lot No. , Block No. County „�j` C RO/X
Owner's Name:
GA_7
LuJ'��A Ne
Mailing Address: �� jyGa if CL li.�i
TYPE OF OCCUPANCY: Residence X No.of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT
DATES OBSERVATION MAD : SOIL BORINGS 7-17— 7&PERCOLATION TESTS 7-100-70
SOIL MAP SHEET SOIL TYPE
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-s .�6 0 /►/ d D l l / /D
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
' S l /al"G''L M
, 4V ! " e o'S'
B r'Z 7� e } �� $`.rs AeedS
B— I t O } �� .� 9"t-Cj )7"e-i .7 MCdS
2.
B_ .r I's �p F�s L j 4,17" M edS
PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.)
Indicate on the plan the locationand square feet of suitable areas. Indicate nu ber f square feet of absorption area
needed for building type and occupancy. 12 �-�+/ Indicate scale
or distances. Give horizontal and vertical reference points. Indicate lope.
eL
NL
E ls
tae
o• tN
y
441
Vol
N I H i F
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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 location of test holes are correct
to the best of my knowledge and belief.
Name (print) 6_4�8, -51M/f Certification No._ / Z 46
li Address �� �Y I—& d 1`✓ 1y
Name of installer if known
COPY A—LOCAL AUTHORITY CST Signature u/