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Cs n 0 c 3 a `< A Cm > n > m o o m 0 'm 0 o o A y m 'D ro �.ro � n c �-0 7 ro CS ro 7c ro y ^ = N 0 n N �� m o l< @ 5' m e �`< °c w l< a ^ 0 0 A .. lo =• C n m N d 3 C1 ri m m 3 '� - C J 3 CD (n .� `< -s - 0 a = n lo (D ro g CD -,m pro .<< 7CC N m Cn. ro CD -� N N X �< m 0 N m . 0 3 n C n. O 3 m m ( lo D 0 0- c ro0 0 0 m p o �;� (D C0 d� 3nm 0 N ° w cra,< g ron C1lo Co 0 c 3 w o m � i � c 3 3 vN m w an d v,'m m in m N C c 23 o y o �° n c m a —0 ( O m j ro .O C ro (D N t= Q. (D T CD lo _ �> m O 3� N m n "N H -ff u o ( o ° m m o a O a 6 - N (� N 3 3 I t , m �. O 0 s rn w .� m m c N .< P INSPECTION AGREEMENT hT e correct operation of the below equipment significantly influences the life of the wastewater system. Periodic inspections will help extend the life of the system and prevent the need for costly repairs. This agreement authorizes access to your POWTS equipment by a trained and authorized technician during daylight hours to provide regular inspections and routine maintenance to help assure e equipment's properly. It is hereby agreed by and between Purchaser and &A*:�L (Service Provider) that in consideration of the payments provided for herein, Service Provider will provide the services of a factory- trained representative to perform periodic inspections of the equipment described below. Service Provider will prepare a written report after each inspection and provide a copy of the report to the Purchaser. This report will contain recommendations for any operation and maintenance deemed appropriate by the inspector. This agreement does not assume any responsibilities or obligations that are normally the responsibilities of Purchaser and does not extend to cover any costs that may be associated with any recommendations made under this agreement. In no event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of time, injury to person or property or incidental economic loss due to equipment failure or for any other reason whatsoever. Service Provider may supply additional services, parts of k of only after aufhorization by Pu rdYai - -- This agreement shall remain in force for a period of years, beginning f .20 and will automatically renew each year thereafter for one year unless canceled by eithilif party ith at least 30 days written notice. This agreement may be canceled by the Purchaser only if replaced by a service agreement with an authorized service provider for the equipment listed below. Service Provider may delay or cancel future inspections if payment becomes at least 15 days past due. as Periodic Inspections: The Purchaser agrees to pay Service Provider $ /.2 5 per inspection for four (4) inspections for the first two years at six month intervals and one (1) inspection each year thereafter. Payment for the first two years of inspections is due at the time of installation; additional payments are due upon inspection. Any additional testing or services required by Purchaser will be billed based on time and mat rial am nts. !O _ -7- - D$' Date 10-12 - 0 9 Service Provider L-'> aS1bt Signature 0 o.AX -- Y) Phone -`71 1 ? - 330 Address q City A A4,t4 State W: Zip <l ©, E ui ment Covered Under This AC reemen Description Model No. Serial No. Install Date i Location if different from System Owner Bio- Microbics FAST Microfast 0.5 29868 J May 16, 2008 8 726143rd Ave S stem Owner: Company Name: note' Signature: d '� Print Name: Robert SI Verman Phone: 1 street:726143rd Ave Fax: City, state, zip: Somerset, W 154025 E -Mail: Payment Type: VLCheck Ll Cash ❑ American Express E Visa D MasterCard ❑ Other Credit Card No. Exp. Date Security Code Amount $ Name on Credit Card (print) Signature: PS POW TS SERVICE AGREEAENrSERVICE PROVIDER Mln BeW.Dm AUGOB REC EIVED This document prepared by -. Tel: 888- 455 -6864, 262- 692 -2416 Petersen Management Co., LLC i � ` .f.�U Fax: 800 -669 -1232, 262 -692 -2418 PO Box 340, 421 Wheeler Ave., Fredonia, WI 53021 -0340 USA < C LT E -Mail service@petersen.cc WE LOVE TO SERVE Our Customers O E QUALITY PRODUCTS SINCE 1916 __] Wisconsir, Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506362 0 GCNERR, INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Silverman, Suzanne I St. Joseph, Town of 030- 1060 -50 -050 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �( L T� ti� 23.30.19.211 A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION FS ELEV. •7.BSS 96 q-7; H 7 Septic I ' ,� � ` � I _-� Z � Benchmark ' 76'- 0 L5 Dosi V lJ�/�y_L JzJ Alt. BMA �/ b l V lu� All, t /Q eratio Bldg. Sewer r. 4gay1� Holding ` St/ t Ie \ � •3.5� ci�l �' p ��j tOutlet ABU 1 �� 12 �� l 31 TANK SET ACK INFORMATION v „ i TANK TO P/L WELL BLDG. Vent to Ai Intake ROAD Dt Inle eptic 25 ♦ / _ Dt Bottom g 2 7• `� p Headedp(13n � . 4 b`f'S • � A6—ratio Dist. Pipe C� ow C... N: 7) O Ina Bot. System >L T, s 1179 . V 40 Fin Grade �, C�e f 4 �5 $97 •9 PUMP /SIPHON INFORMATION Manufacturer G P Viand St Ye Z•6 >1� L p Model Number /3 A _ . D/ OX (� TDH L' I Fricti � Lo System F ad TDH� t Z3 Forcemain Length Dia., jj Dist. to Well 1 �►d SOIL ABSORPTION SYSTEM B ED /TRENCH Width p1 Lengttkl No. Of Trenches PIT DIMEIONS No, Of Pits Inside Di� Tu i d D` DIMENSIONS 4 �„ 3 �"'� -�'� SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: CHAMBER OR A INFORMATION Type Of Syste e L � i o I � UNIT Model Number: O� ✓C4'ON°�,JL D G� DISTRIBUTION SYSTEM So I✓ r. Header /Manifold ,. Distribution 1 i/ x Hole Size I x Hole Spacing Vent to Air Innttaake � - Pipe(s) �t 5 /�I Z Length Dia Length 3 4 Dia �� Spacing_ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded t x Mulched Bed/Trench Center �` Bed /Trench Edges` Topsoil \11 � N ` + Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / Inspection #2: !� / Z. / 0 W�� Location: 726 143rd Avenue Hudson, WI 54016 (SE 1/4 SW 1/4 23 T30N R19W) NA Lot 1 IQ/h�l2O O�' 'r Parcel No: 23.30.19.211A 1.) Alt BM Description = S ,<<' dc ~6— CqL V -*l / ` ' " + Y 2.) Bldg sewer length amount of cover = / P'� • -''� Plan revision Required? Yes > J G� fi e/ & 3 Use other side for additional information. 1O ` O Cert. No. Date Insep is Sign e SBD -6710 (R.3/97) - I r� COt71meCCe.Wl.gov Safety and Buildin ivisi County c1 201 W. Washington Av O. 71 i sco ns Dtl „ Madison, WI 53707 -71 anitary Permit Number (to be filled in by Co.) of Comxerce State � � i Transaction Number Sanitary Permit Application /3Z 948 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this to to thep QQPP�����q'�+nta unit is required prior to obtaining a sanitary permit. Note: Application f rms to�,t 4teA M(31T/#$ are Iroject Address (if different than mailing address) submitted to the Department of Commerce. Personal information you pri vide may be used for secondary ur poses in accordance with the Privacy Law, s. 15.04(1) m , Stats. '72Co /43 J 19be 1. Application Information - Please Pri t All Information Property Owner's Nam6' :j. ^, c�, V y _ arcel # ► } . r j/ Q, ST. CROIX COUNTY 30 y-4�60 0 Property Owner's Mailing`Address roperty Location Govt. Lot City, State Zip Code Phone Number / <, Section /� 9 412— .g — 1�-�- circle one) IL T of Building check all that apply) ✓' _�' r Lott ! T �? Q N; R E ofL�. 1 or 2 Family Dwelling -Number of Bedroom 3 .:. Subdivision Name ❑ Public /Commercial - Describe Use ❑City of ❑ State Owned - Describe Use y CSM Number ❑ Village of LK Q� I own of III. Type of Permit: (Check tin k onetbox on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Othe Modification to Existing System (explain) i j Lit Previous Permit umber and D72su ed B. El Permit Renewal El Permit Revision ❑Change of Plumber ❑ Permit Transfer to Newt,, 1 Before Expiration Owner ° { _ f., t z ' I V. Type of POWTS System/Component/Device: Check all that appl ❑ Non- Pressurized In- Ground Pressurized In-Ground ❑ At -Grade ❑ Mound ? 24 in. unable soil ❑Mound <24 irr of — ' ~ -J El Holding Tank El Other Dispersal Component (explain) Pretreatment Device (explain) O EV _946E V. Dis ersal/IYeatment Area Information: - Design Flow (gpd) J ' Design Soil Applicati n Rate(gpdst), Dispersal Area Required (sY) Dispersal Area Proposed (s(f System Elevation O L- VI. Tank Info Capacity in Total # of an Gallons Gallons Units o New Tanks Existing Tanks 7 a U Cn Septic or Holding Tank Dosing Chamber f � AA P VII. VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number iV h Aey(y ;,• .2 Z Z8/ Z!S - umber's Address (Street, City, State, Zip Code) VIII. County /De artmen se Onl Permit Fee Date Iss� ed 1 Issuing #gent Signature R proved ❑ Nsapproved- f y ❑ Owner (liven Reason for Denial (j't -' ' �" / J " t c ,. .,.\ ; IX. Condit' asons for Disapproval ��1rS8WNER: ,� i � ...:�'` r> v` v� .a/ i �• "1..., ,1 ' � - � - � ��� 1�tJ r.J 1: Septie tank, effluent filter and ( 1 diepereal cell must all he servk:ee / melntakutd ae per management plan provided bypiymbef, r l 2. AN srfbacft tigWentenh mtnt be rrglMrtairlld � A ,�- s 1 + r omp a ns a system and submit to the County only on p per not less than 8 vi x l I inches in size SBD -6398 (R. 01/07) Valid thru 01/09 I 9 M3TZYZ . 'i�.:: •F ?14C121Q .4sailfAi to 9boo okw-04* *4 8A v-e R Joe- MW _ - e- 2q Q cit _ poca vm cs to -Q Zkj ral J P fli ocb lab ca �-- I N b = (S N d0 e Q e -°g ti A qR > s . A31 UN N �, a ICA WL iLn o7� n �t 0 mo 3 - ``w d co ci- to t - - • ULBRICHT &ASSOCIATES CO. 281210th Ave. • Spring Valley, WI 54767 Reg. Designers of EVneedng Systems 71 5- 772 -3442 Private sewage consultants Fc Fi PROJECT NDFZ,,p Plan I.D. ¢a�06 Date �j��,� Owner l si /U '�l one r'1a-- 52-3 -!5-377 Address Le Description P / A) D 3 - /o&O-so- 3 0 A;. Iz �9w Town of S �- 30 S c- P County S T C R-0 t K C.S.T. W- Z1 1hXiCl4 T 2-Z4?3 75- �,g/� 3 f A""7 2 Zc��'7 y Installer Local Authority/ Supervision sr• C Po i c cT y, ,� ; ,J G ' j&p 7' . PROJECT DESCRIPTION 3 ' R - G . � - & � s • 1 , � E *YF. ,g- /7�o r I A ) k - - ` A A r w i l l 13E n � r �C�iP i!- 400 U �-0 T j'0 4 A L I ' m - 9�2ov�fl F'0-0-T tHOOEOE '�- Q j'(A (.s sA Z-0 7 - -- Wa o,J c. y su / TA R I E Ale & A - D V�TZ9eM i AJ W 0. 14, W, M . 14 {�.p �r oD�ir� r� Tio v V4kei O w /// & x ee&ss_+R y rpip s /7 &/ sy -774e! � -, /4f P QU & o r- / . P ��c�.y.�- �E.ti�>� T io,�., s 0" .5. 44ts "'= ,45Z08 t c </s 7 - ,57M Wt I A) - ftN MP eau ED 1316- M 1'C t Iii sT / o. 5 0 i Ulbricht & Associates Private Sewage Consultants �° �F _` ULBMCHT 2812 1 Oth Ave. 'p b HuD80N, WI Spring Valley, WI 54767 'I'p� w � The attached plans and specifications are based on the following approved manuals p� SSti12' 171 ;�� ®�U /t'l�itJ�JL VERSr' Z • 0 S:(3 D 1070 (o P 6 N ovo/ r r ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultants TN D c -5 et - r P�. { Ptor P14AJ s P �. Z — C405 5& - cr/ o ti De i ( S c �t oss sue- C71'oN o f pa tip c # M �, S. POM SpLrcs 1 1 &W 4 13 -"c T3f o 1� � c & lu c ��FAS T ' �. 5 sysr&wm specs. CtfDSS .S&C 1 oN 'D i (S OP W t e,Ep e co x>c,t A Co. A E 2 i s 5 Y ST �(ANS 7 o j k r • p 1 O d C 3 0 d COON o i C7 y .' C � rQ Nc N V1 O- , � �/ �--- C D%STPi pi usrtsoR k T YR i CA L_ Fo (Z A L c_ 3 "T'R L ,�J c t4 - TOTAI- V(g o f= LArL Aj EirTw PL eRa . , TiVE NEAP OF EAcA R �ssO RE 01,A "C Vhl M,5 f Y Pvc �oacE /J / ,4 SST Amff M /fit' x1 i f N&c i T o .6/I3Ow d2 LAST tAole 5 HA 11 (3E Nt✓�.1' To tRNp cAP . VoiD VvtuME FO . 6 FT 7oT,q• L VD I1� 11 /U � O e t d F 2 - 1 1 F-O RCE MA PERFvRATED PIPE DETAi Holes IvcATEV ow G OTtOM sH All 13E I " Y `) VARiABL E y 1i Gj u h {1�� S pA cED . olsr�NCE P Y r Hol WAKI=Tr- R -3z/& R L ATE L Z- MANi F °LD X -2 rcRcf; MAiN 4f iuc��s ° F lFolE p i P E. F° R D i srR i Q o +i'o N p A7E o� t✓ . to � �,w,,vr+. • p, �,L DISTRi i3u'rtoiV Dty�I�,ARGte RACE p�� LA T ER/lt,. /�• OO T O TAL "DISGr1AR vE R ATE NE�'WO(� iC 35 Ga �, M ,•, , � T E G / �UUERr �' I�"U�7 �a�1S t �• R ,� � St y! 9r� l o w 're eA3 c R w"F- ` PLIMP CHAMBER CROSS S£CTIOU ARID SPECIFICATIOMS y „ 3 > S G VELIT CAP I pipe VENT PIPE WEATHER PROOF APPROVED LOCKING JUUCTIOM BOX MAUHOLE COVER w [ri �.00- IAMI O t � • O f2 "MtU. .... .. _ � rGG� 11��D� 1C&- t�,tT /ON GRADE i y 21 I i8 ° MIU. COMOUIT ` -- - 3 �t1 � 897'0 , PROVIDE .y INLET AIRTIGHT SEAL ( f g (QG f ( APPROVED .POINT APPROVED JO A ,( %J/ PIPE Wf PIPE !XTENDING 3` .�p "� ' ( 1 1 1 ALARM I T SOLI S OMTO SOLID SOIL OIJD Olt B 3. , � � fir. 15 SOLI sa.go� 6 a 40 p °G �� 3.3 ! i 0IJ C f t ELEV. �" FT. t - -� OFF a 1 PUMP � ?,SSE .3 O D , LJ 1410�PE 040M 'g�o� / B SilrvA 4- 0 It tf jO,J RISER EXIT PERMIWED OQLH IF TAIJK MANUFACTURER HAS SUCH APPROVAL .jr, SEPTIC a Tf OAJ S DOSE — �N�( LUMBER OFD E PER TALIKS MA UUFACTURF- TAIJK SIZ : ' GA S DOSE VOLU E 9 ALARM MANUFACTURER: /►ti INCLUDIN % A G LLOAIS MODEL IJUMBER: D • L " r,a CAPACITIES: = RICH R � G LLOwtS SWITCH TYPE: E ✓fyl���, _ 1 HES O G LLOAIS anal �� ®�° © _ INCHES OR " 2 - ALLOUS PUMP MANUFACTURER: l � ,. MODEL NUMBER: ' F / Yy � �// D IMCHES OR ALLOMS M TO BE SWITC4 TYPE: �Iy G ' K //AA �A � MOTE IBS AL EO ON SEPARATE CIRCUITS MIAIlMUM DISCHARGE RATE -30 GPM VERTICAL DIFFEKEAICE BETWEEU PUMP OFF AND DISTRIBUTION PIPE.. 1 3-5 FEET - AA. 1k Sr1ECS + MIIJIMUM NETWORK SUPPLY PRE SURE.. .. 3r� Z� FEET EACt :, � P1 + FEET OF FORCE MAIN X ? .9 F /1OOFLFRICTIOW FACTOR. •' FEET Z -40A L ` �r — TOTAL DYNAMIC HEAD = I � FEET fUTERUAL DIMENSIOUS OF TAIJK: LENGTH ;WIDTH ;LIQUID DEPTH TDT1 L THIS POWT SYSTEM SHALL l INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # h - � d fj V - SEPTIC TANK, per Comm.83.44 - (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fllter). Tank shall have an approved above � Q � ground locking manhole cover for regular (every • / v r © 12 months or less) inspection & servicing by a Q 1 i r�ran�edd !�'PYV1 P!P num »pr. . HEAD/ 115 CA PACITY �;� CURVE ,00 � 65 95- N_ .l I EFFLUENT •MODEL - and 0 75 MODEL 189 DEWATER/NG = �` 70 185 V 20 65 Q Z 16 G 55 F 16 MODEL So- e 183 MODEL t- 14 166 12 � 35 10 MODEL MODEL 30 137, 138 165 SEWAGE and e DEWATER/NG 6 28 _ MODEL 15 L 161 4 I 7 10 a 2 MODEL �u 5 53, 55, u� 4 S7,59 i 1 0 GALLONS 10 20 30 44 SO 60 70 60 90 100 110 LITERS 0 60 160 240 320 400 75 22 FLOW PER MINUTE 7O 20 C 10 60- MODEL W = t8 � . 55 2M5 V Iso 14 MODEL Z 294 )N- 12-- - J 35 MODEL O --� t0 •}-- 299 , MODEL '- 30 6 � MODEL 6 20 282 - - - i � 4 15 1-0 MODEL OELLE/� i.I i 2 5 267, 268 — ° 3280 Old X Mrs Lane GALLONS 10 20 30 40 50 60 70 s0 90 too 110 120 i30 140. 150 150 170 180 190 P.O. BOX 16347 LoubtrNe, Kentucky 80216 LITERS 0 so 160 240 320 400 480 560 640 720 (�A?)_778�2Z31 FLOW PER MINUTE "137" Cast Iron Series "139" Bronze Series HEAD U S/M N Feet Meters Gal Ltrs. 5 1.52 104 394 • Automatic or Nora- Automatic. 10 3.04 74 300 • 1 /1 H.P., 1 Ph., 115V, 200 -208V or 230V. 1s 4.57 64 242 • 1 h H.P., 3 Ph., 200 -208V or 230V. 26 6.10 36 t36 25 7.69 a 30 • Non - clogging vortex impeller design. Lock Valve: 26' • Passes % inch solids (sphere). is 1 NPT discharge. Canadian Standards • av ail. Float operated, submersible (NEMA 6) 2 pole listed Approval available mechanical switch. • Automatic reset thermal overload protection. l(era�eQ 137 sari" SC-2225 • Stainless steel screws, bolts, guard, handle and 139 Series SO-1115 arm and seal assembly. 'Bronze motor and pump housing, switch NOTE: No UL listing for 200- 208Vl1 Ph. case, base and impeller. pumps. Mercury float switches are available for non - automatic models. I N C O R P O R A T E D 8450 Cole Parkway . Shawnee, KS 66227 ■ Phone: 913 -0707 ■ Fax: 913 - 422 -0808 E -mail: onsite@biomicrobics.com ■ www.biomicrobics.com ■ 800 - 753 -FAST (3278) FAST® Wastewater Treatment Systems with SFR® Models and Treatment Capacities* Retrofit Applications Maximum Treatment Capacity Blower Minimum Tank Volume per Module Persons per Module*' Capacity Dimensions 250GPD 1/8 HP 36" L (91.4cm) x 28"W (71c m) RetroFAST® 0.25 (9471-131) 1 to 4 persons 5-17 cfm x 36" H (91.4cm) 18 " (45.7cm) diameter opening 375GPD 1 /4HP 36" L (91 Acm) x 40" W (101.6cm) x RetroFAST® 0.375 142oLPD 1 to 5 persons 9-24 cfm " 36" H (91.4cm) ( ) 18 (45.7cm) diameter opening Residential Application Maximum Treatment Capacity Blower Minimum Tank Modules Volume per Module. Persons per Nodule Capacity Volume*** 500GPD 11/31-111P MicroFASTe 0.5 (18931-131)) 1 to 8 persons 11 -25cfm 450GAL (17031-) MicroFAST® 0.75 750GPD 1 to 11 persons WHIP 750GAL (2839L) (2839 PD) 17 -25cf n MicroFAST 60.9 900GPD 1 to 14 persons 1/31-11P 750GAL (2839L) (3407LPD) 17 -25cfm MicroFASTe 1.5 15000PD 6 to 21 persons 1/2 -3 /4HP 1125GAL (4259L) (5678LPD) 25 -40cfm MicroFASTe3.0 3000GPD 10 to 42 persons 1 -1.5HP 2250GAL (8517L) (11356LPD) 44 -80cfm MicroFASTe4.5 4500GPD 18 to 63 persons 2 -2.5HP 4219GAL (15971 L) (17034LPD) �90- 135cfm MicroFAST 69.0 9000GPD 30 to 126 .persons 3 8438GAL (31941 L) 34068LPD - 140 226cfm Highstrength/ Maximum Treatment Capacity Blower Minimum Tank Commercial Modules Capacity Volume*** HighStrengthFASTO 1.0 Consult Factory 1/2HP 750GAL (2839L) 32 - 36cfm HighStrengthFASTe 1.5 Consult Factory 3/4 - 1.5HP 1125GAL (4259L) 50 - 60cfm HighStrengthFASTe 3.0 Consult Factory 2 - 2'51 - 11P 2250GAL (8517L) 80- 100cfm HighStrengthFASTe4.5 Consult Factory 165- 185cfm 4219GAL (15971 L) HighStrengthFASTe 9.0 Consult Factory 5 - 7.51 - 11? 8438GAL (31941 L) -x275- 310cfm *IMPORTANT: The BOD loading of each individual application, along with the above flow parameters, are the major determining factors in the design for each FAST wastewater treatment application. **Please note that only residential applications or those applications requiring treatment for only sanitary wastewater, may be designed from the number of persons per module. Actual capacity may vary with local conditions and performance goals. **'Minimum Tank Volumes: Settling tank(s) equalling 1/2 to one times daily flow should be used prior to FASTe . Updated by Bio- Microbics, Inc. on 7/7/2004. G.-WaW Cwftn1 Caftb i a ' I ......... 1 —L t 3 La> "0 N - Op m :zrr ri -i D -C3 O - -i i 7o r z Zr ND - - m z �D 3 ci nx P �z -C < r U. F ..... ............ i 114:,, r3l L, Z 3 iN " r D � r C z� l_ D 3 v I nmfu 1 y ^ 3 o£C ~•.0 Nu A t' . rZ-zi n n rn i i -• o H ..... oro Nm ( \ \�� v V 1 1 1 � td rm-o ' • m) .C% I � m< �® a rom VI rn 8 a • 08 i n T ' 3 N ,p fJ tV H Z N 'O tr/ - i D r'1 - 1 --r N -1 -1 td D ° D • '1 ""� t' CO (/1 �= M o -I m��n�° "m - ��c'jM Ll r" o c O r ^ d c, D r <o% Y „N„pr) --1 Z 0O.'tJ vmt�*I�O ti �7 0 2CN 3? M y p r C ° �y r) C1 N -4 Z m m M ID > •O ca e w �y ° � M NC"."..'Glf*1 r�mrl XC1O -1� O P9 - rq -4 4 - D q n t*) V) byf*1n�7� owrr, ri ° D - 'a n i� r N Z °-< $ °dMXC3 M>m -0 = r tx N p A N rl SN , on Z N Z = Z M X C) m A r A o N ° t7 X x Ca ` A _ D TI 3 v D� "9 "DZ D � ZZ � O•'ry � m � f*1 mm ru ~ c) lJl m° r NZCZ= ")rq Z ZVC)vV)0 -t 9 9 A < f'1 r) d...� -1rn m - i N 00,400 r) n ° a o s a az V r Zrl N ..r fns D^ Z t7�Z - t A ol 3 -4 rzA . C l) i� � --4 °z� (Ano � -n Na vies ° v � r (� z� £ D. m N-- — ri,oa r, � = O mH Z cl r O -a•m� arm fi r, Cl Ll G1® N oMd ri M = ci yd Z3 N rC - U C-) ZaN SDON r� ra�ro O c0 y L)m�£ N �r � rt M .Z) ° rl r A D �I rrn ` Safety and Buildings PO BOX 7162 commerceml.gov MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www•commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 22, 2006 CUST ID No. 226375 ATTN.• POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers SITE: Transaction ID No. 1321990 Robert Silverman - Dwelling Site ID No. 718353 726 143RD Ave Please refer to both identification numbers, Town of Saint Joseph, 54017 above, in all correspondence with the agency. St Croix County SE1 /4, SW1 /4, S23, T30N, R19W FOR: Description: Petition For Variance To Code Section Comm 83.43(8)(i)., Wisconsin Administrative Code. p The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Based on the precedent established by the previous petitions, this petition for variance is being processed as permitted by Wisconsin Statute s. 101.02(6)(g), and Comm 3. All of the statements and supporting documentation included with the petition were considered. Since your request is similar to other petitions approved by the Department the petition is approved. 'I he petitioner requested permission to have a replacement pressurized dispersal cell installed as close as 35 feet to the high water mark of a lake. This petition approval is granted conditionally with the understanding that all of the petitioner's statements included on the variance application form (SBD -9890) and any other documents submitted to the Department will be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 0- RIG J 11 ALr ROBERT W ULBRICHT Page 2 9/22/2006 Sincerely., - ) ; r' Fee Required $ 225.00 Fee Received $ 225.00 Balance Due $ 0.00 C (, Peter E Pagel Private Sewage Plan Rw' wer , Integrated Services WiSMART code: 7633 (608)266 -2889 , M - F, 630 - 1500 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer t t z cc h rti e_ F S (y e - r m a- n _ Mailing Address 13 0 W i YL cV"a Pk w Ai a h e_ Ls Lk N S s 4 1 c l Property Address 72- J 1 �AVevuxA�e - -~ - (' Jv ific4dou Lcyi.iiicd from i'la a rig & Zoning Depaz fez new Consuucaon.) City /State 5h Jo 3 Qw n �T, W1 Parcel Identification Number _ © — 3e 14 Poo LEGAL DESCRIPTION C l Property Location i/4 , _ 1 /4, Sec. T 3� NR/? W, Town of Subdivision , Lot # Certified Survey Map # 9� D 3 S� 3 , Volume a Page # Warranty Deed # " / l 2 3 2 '2— Volume Page # 3 3 , -- Spec house yes no Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specked in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restiicied plumber or a licensed puirper veri�y'ing that (1) the . site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of'Natutal Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms < �'Z -.� /5. 9/3 /OZ SIGNATURE 6F APPLICANTS) DATE ent. ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning ng p Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mar, if reference is made in the warranty deed. (REV. 08/05) r Safety and Buildings = PO BOX 7162 commerce.Wl.gov MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www.w www.coe.wi.gov/s / isconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 22, 2006 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/22/2008 Identification Numbers Transaction ID No. 1321987 SITE: Site ID No. 718353 Robert Silverman - Dwelling Please refer to both identification numbers, 726 143RD Ave above, in all correspondence with the agency. Town of Saint Joseph, 54017 St Croix County SE1 /4, SW1/4, S23, T30N, R19W FOR: Description: Pressurized In- Ground / ATU Object Type: POWTS Component Manual Regulated Object ID No.: 1097879 Maintenance required; Replacement system; 450 GPD Flow rate; 60 in Soil minimum depth to limiting factor from original grade; System(s): In- ground POWTS Component Manual, SBD- 10705 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); Aerobic Treatment Unit The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. On page 4, the dose tank specifications are incorrect. As listed in the Wisconsin Plumbing Products Register, the approved specifications as well as the adjusted pump switch settings are as follows: Tank manufacturer: Weiser Concrete Products, Inc. pl Tank model number: WLP 750 -MR CAS Liquid depth = 37.5 inches Vertical capacity = 20.28gpi AP Minimum required dose volume = 56.6 gallons p Maximum dose volume = 99.79 gallons A =15 inches, or 304 gallons B = 2 inches, or 40 gallons, . C = 4 inches, or 81 gallons L+ D =16.5 inches, or 334 gallons $r 2. This system is to be located and installed in accordance with chs. Comm 82, 83, and 84, Wisconsin Administrative Code, except where the approved plans grant exception to these rules. I ` ROBERT W ULBRICHT Page 2 9/22/2006 3. Comm 83.21(2)(c)4. The application for a sanitary permit to the governmental unit shall be accompanied with documentation that the master plumber or master plumber- restricted who is to be responsible for the installation or modification of the POWTS has completed approved training or has documentation that approved training will be provided during the installation of the POWTS, if the application for the sanitary permit involves one or more of the technologies or methods specified in s. Comm 83.04(1). 4. Comm 83.52(1)(a). Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). 5. Comm 83.52(2). A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 6. Comm 83.52(3). The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. 7. The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and /or owner's manual for the POWTS described in this approval. 8. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, —; Fee Required $ 175.00 ' Fee Received $ 175.00 Balance Due $ 0.00 ., C l.' r of Page Private Sewage Plan Review r , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 06 - 1500 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Wisconsin Department of Cornn w ,,.we IL EVALUATION REPORT Page I of 5 Division of Set* and Buildings m accordance with rorrm 85, M. Arks. Code Co+* St .Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but rat bnrted to: vertical and horizontal reference point (BM), direction and Poll ID. percent slope, sole or dimensions, north arrow, and location and distance to nearest road. Please print all inromation. RevW#ed by Dale k Personal information you provide may be used for secardary rposes (P s. 15.04 (T) (m)). � i Property Owner � G `v Properly Location Robert Sily v v R ' . Lot 8 S E 1/4 SW 1 S 23 T 30 N R 19 E W Property Owner's Mailing Address opt # Block # Subd. Name or CSME 3� 306 Minnehaha P �UL 1 &6 1 Steven and Shirley's Plat on Bass Lake City State Zip Code Phone Idurr CUNT El~ ■ own Nearest Road Minneapolis MN 55419 ( S*"*fi - -1557 private drive 143rd Av. ❑ New Construction U.E) Residential / of bedroom 3 Code derived design flow rate 450 GPD E] Replacernent Pubic or commercial - Describe: Parent material r4 a " C Rood Plan elevation if appicable Rol o " ft. General commits SEE ATTACHED COMMENTS and Boring ❑ Boring a Pd Ground surtaoe elev. 93'8" R Depth to knilirg factor 23 n. Sol Application Rate Horizon Depth Dominant Color Redox Description Texlure Structure Consistence Boundary Roofs GPDff n. Mu►sell Qu. Sz. Cont. Color Gr. Sz. Sh. -BM - EfW2 1 0-7 10YR4/3 FR SL 2 M GR hm CW 3F .6 1.0 2 7 -11 7.5YR4/6 FILL CB S 0 SG ML CW 2 M .7 1.6 3 11 -16 10YR4/3 L 2 C PL AM CW 3 CO .0 .2 4 16-23 10YR5 /4 LFS O SG MI- CW .5 1.0 5 23-40 10YR5 /4 C3D 5M/8 S 0 SG ML .7 1.6 ® &Wing n 0 2 F Bourg # 0 Pit Ground surface elev. 93'2 ft. Depth to knitting factor in. Sol Application Rats Horizon Depth DontinanR Color Redox Description Texture Structure Consisfencie Boundary Roots GPDW n. Murnsei Qu. Sz. Cont Color Gr. Sz. Sh. - FM - EfN2 1 0-6 10YR4/4 FILL SL 2 M GR MF1 CW 3 F .6 1.0 2 6-29 10YR5/4 FH.1. FS 0 SG ML CW I F .5 1.0 3 29-44 10YR3/2 C 2 P 73YR5/8 SL 2 M SBK MF1 CW 2 F .6 1.0 4 44-45 10YR5 /4 streak M 3P 7.5YR6B SCL 0 M MF1 CS .0 .0 5 45 -52 10YR2/2 SL 2 M SBK WIN CW 1 F .6 1.0 6 52-64 7.5YR4/6 M 2 P 15YR5/8 COS 0 SG ML .7 1.6 Eflluert #1 = BOD > 30 220 nxdL and TSS >30 < 150 rnglL < 30 nglL and TSS < 30 mgfL CST Name (Please PrB* Signature CST Nariber Dale R. Stewart 220879 Address Date EialuationCoriducled Teleplane Nurilm 757107th St. Roberts, W154023 6101/ 2006 and 6/93F OW 715 749-0145 0 1 , 1 ia /Z606 Property Owner Silverman, Robert Parcel ID # Page 2 of 5 Boring # [] Boring E] Pit Ground surface elev. 98'8" R Depth to limiting factor 0 in. Soil Application Rye Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF n. Mansell Qu. Sz. Cord. Color Gr. Sz Sh. 'Etr#1 '01112 1 0-4 IOYR4/4 FELL SL 2 M GR MFI Cw 3 F .6 1.0 2 4-11 7 5YR3 /4 FILL SL 1 F GR MVFR Cw IF .4 .7 3 11 -39 7.5YR4/6 C 2 D 5YR5/8 SCL 2 C PL MFI ,0 .2 F 4 Boring Bong # R Pit Ground surface elev. 4 R Depth to iriln9 factor O n 1 7 Soi Rate Horizon Depth Dw*vut Color Redox Description Texture Structure Consistence Boundary Rods GPDW n. Wad Qu. Sz. Cont. Color Gr. Sz Sh. 'FM1 - 01112 1 0 10YR4/3 FILL SL 2 M GR MFI CS 2F .6 1.0 2 6-12 S 0 SG ML CS .7 1.6 3 12 -22 10YR5 /8 C 2 D SYR5/8 SCL 2 C SBK MFI CS . 4 .6 4 22 -26 10YR6/4 M 3 P 7.5YR5/8 SU 2 C SBK MFI .4 •6 � n Boring # • Pit � Ground surface elev. 9410 fL Depth th to � tea 20 in. Sol Applicalion Rate Hor¢on Depth Dominant Color Redox Description Texture Shucture Consistence Boundary Rods GPDW n. Wed Qu. Si Cont. Color Gr. Sz. Sh. •EW1 711112 1 0-12 10YR3/2 FILL SL 2 M GR MFI CS 3F .6 1.0 2 12 -20 S 0 SG ML CS 1 F .7 1.6 3 20-31 7.5YR4/6 M 3 D 75YR618 FSL I M BK MFR .2 .6 Etlluent f1 = BOD > W:5 220 mg& and MS >30 < 150 mgll ' EflMient a = WM, < M mg& and M 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SB"Wre OLOIM) i Property Owner Silverman, Robert Parcel ID # Page 3 of 5 Boring Boring # E] Pit Ground surface elev. l Ol'9 ft. Depth to �9 factor >63 LO 3 Soil Application Rate Mormon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPOW in. Munsel Qu. Sz Cont. Color Gr. Sz. Sh. TOM `Etf62 1 0-9 IOYR3/2 FILL SL 2 M GR MFI CS 3F .6 1.0 2 9-63 7,4/6 S 0 SG ML l F .7 1.6 F7 ❑� # Pit Ground surface elev. 979 R X60 Depth to irnitin9 factor m Soi Rate Horizon Depth Dornirran Color Redox Description Texture Structure Consistence Boundary Rods GPOW in. Morsel Qu. Sz. Con. Color Gr. Sz. Sh. 'E#1 •0102 1 0-8 10YR3 /3 SL 2 M GR MFI CS 3F .6 1.0 2 8 -18 1 loyg5L4 SL 2 M GR MFI CS CS .6 1.0 3 18-60 7.5YR4/6 S 0 SG ML . 7 1.6 Boring # g Grand face el 97�M ft. Depth to knifing factor > sur elev. Out Pit S - Rafe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDff in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. - 8M '0111 1 0-8 10YR3/3 SL 2 M GR MFI CS 3F .6 1.0 2 8-15 S 0 SG ML CS 2 F .7 1.6 3 15 -27 7.5YR4/4 S 0 SG ML CS .7 1.6 4 27-60 7.5YR5/6 S 0 SG ML .7 1.6 Etluent 0 = WD,, > 30 < 220 r g& and TSS >30 < 150 rng& EflMnnnt 92 = KO, : 5 30 r g& end TSS < 30 ngll_ The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. sec- as�►rx.mioo� 13A TU R N r- NU P W ,5 - L.L A K wM , �r 9 ��. F s 7 -T V I, LL. T N 6 7 , 3 �l a 43'2 •, 6 3 98 ., q $ vc Pm PE (3 5 9 �f � /a •, BAS 45 of n o JZ�A/4 y C (� ►oi�9 P- n/6' 1. S 97 47'9 -, 13s Z ' C , 98 . 9 „ SC R LE PO W ___.S 13 PL 8. Y 9 * 9 toil9�� X15+1; -\PL Oqw�A -�{ 300' �/ g9 „ I k � �t3 X� T PLAY HO LA5 E RoS RT s L E Al .� GOVT Lof �t� STcvCAI + ��iz�L y .5' PLC / odn L 455 Lo?' $ S 23 T 36 R l 9 W S T - :5oSE P Toc,<1NS¢ i7- P ST. is 8 z, k C7 - Y VJT CroixValley Soil Testing 757107' Street Roberts, Wisconsin 54023 Dale R. Stewart Page 5 of 5 June 14, 2006 Soil Evaluation Report: CST comments Robert Silverman St Joseph Township St. Croix County, WI Date of soil evaluation June 1, 2006, and June 12, 2006. This is a site located on Bass Lake government lot 8 SE % SW % S 23 T30 R19 W Lots 5 and 6 of Steven and Shirley's Plat on Bass Lake. Current POWTS is a holding tank south of current dwelling. Property owner Silverman would like to locate a POWTS system on this property that would include the dispersal component. It ism understanding that Henry echville of Nechville Excavating has had a Y g � rY g number of exchanges with Waste Water Specialist Leroy Janske, about the possibility of accommodating Mr. Silverman's request. Mr. Nechville shared that there is a possibility that a dispersal component could be located in the fill where the current dwelling is located. With that information, along with several on site meetings with Mr. Silverman and Mr. Nechville, I did perform a soil evaluation at this property in two locations. The current well and POWTS need to be abandoned according Wisconsin Department of Natural Resources and Department of Commerce codes and regulations, if the replacement POWTS is located where current dwelling sits. Assuming the current dwelling will be removed. If the site south of the current dwelling is used, only the holding tank would need to be abandoned. The soil evaluation report shows that there is a lot of fdl type material on this site. The in situ soil has redox features almost immediately under the fill material. There is fill material under the current dwelling that appears to be sand to fine sand. The site south of the current dwelling, has soils ,upslope of borings 4 and 5, that pending design approval, have the capability of accepting highly treated effluent. It is anticipated that Mr. Silverman will need a variance for the set back requirements from the OHWM. Based on that information, CST located borings at 35 feet from OHWM with this anticipation. There likely will be other variance requirements for the new dwelling. During an exchange with Waste Water Specialist Leroy Janske, on June 9, 2006, it was suggested by Mr. Janske, that the site located south of the current dwelling may, with additional borings upslope midway between borings 4,5 and 6, work for an in- ground pressure distribution system. It was suggested that a St. Croix County Zoning representative be on site to review the soils at these additional borings. On June 12, 2006, Ryan Yarrington and Pam Quinn, St. Croix County Zoning Department, where both present and did review the soils at borings 7 and 8. Their initial opinion, at this point, is that this site would work for in- ground pressure, subject to any County variance requirements, design requirements, set back requirements and relocating electrical and telephone utilities. Dale R Stewart CST220879 i I I r� ST. CROIX COUNTY WISCONSIN ZONING OFFICE { 10 11 N ■ N a via rr� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 _- (715) 386 -4680 FAX (715) 386 -4686 COUNTY ON —SITE VERIFICATION FORM Z3 ro ppe wnar rope ocaton Govt. Lot 6 19 114 8 T .70 N R J 9 E (cr Property0w er's Mailing Address Loot I Block# 91d. Name or Cigr state Zip Cos Phone Number ❑City ❑Village Nearest Rood n ❑ New Construction Use: ❑ Residential /Number of bedrooms —_ _ _ —_ Code derived design flow rate---- _-- - - - - -_ GPD P le placament ❑ Publicor commercial - Describe: -- - - -._. —_.----------..---- - - - - -- Parent material _ -- „_._. --- — _._ - - - - -- __ _.. -- Flood Plaiin� elevation if ap licable �--- - - - - -- ft. Gen comments G vrI"C, LL Sy6ft,� �Q•^ -�� and racommendations: v J 4 Ot+LjM ao 36 7 ❑ Baring Baring # ❑ Pit Ground surface e4ay. __.________ft. Depth to limiting factor___ -- in. gat Application Rate Horizon Depth Dominant Color Rsdox Description Texture Structure Consistence Boundary Roots GPQ1W in. k4unsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Efr#1 "Effff2 / a -1 /t,Y4.3 z L5 L G w 2 F o •7 / Z 1S4 7 M 1 5 5 M L_ G I M b•? 1• �. Boring # ❑ Boring ❑ Pit Ground surface elev. _ -- - -_ ft. Depth to limiting factor _ - - -_ in. gal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'E 0 -7 0 Y A 3L -- S L q r at 0.7 1- z Z 1 1 yj -t 5 dr,' I -5 7 e r...� A— 0. J Go 1 y4w (A�� O�� ST. CROIX COUNTY ON -SITE VERIFICATION FORM Property Owner _ _ _ - - - - -- Parcel ID # -- _ - - -, _ _ —__ Page ____ of 1-1 Boring # El Boring ❑ Pit Ground surface elev. ______ ft. Depth to limiting factor - - -__ in. al Application Rate Horizon Depth Dominant Color RedoxDescription Teodure Structure Consistence Boundary Roots GPDlft' in. Wnse0 Cm. Sz. Cont. Color Gr. Sz. Sh. F-1 Boring # ❑ Boring ❑Pit Ground surfaceelev ._ ..... _.__......___.ft. Depth to limiting factor __.__.__..........._.in. _SdIApWIcatbn Rate Horizon Depth Dominant Cobr Redox Description Teodure Structure Consistence Boundary Roots GPDRI in. Munsall Cu. Sz. Cad. Color Gr. Sz. Sh. 'Eff#1 "Elf#2 Boring # ❑ Boring ❑ Pit Ground surface elev. _. — h. Depth to limiting factor - -_ —_ in. Sal Application Rate Horizon Depth Dominant Color RedoxDesciption ToMwe Structure Consistence Boundary Rods GPDtff in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh 'EI'M '0#2 Effluent 91 BOD, > 30 :220 mgA. and TSS a30,1 150 mgrt ` Effluerd #2 = BOD 30 nVL and TSS 130 mg!L y , 1 111111 11111 111[1 1 ll![ 6 1111 Illll 1111 Illilf 1111 1111 Document Number Document Tltle 861609 09 KATHLEEN H. WASH St. Croix Count REGISTER OF DEEDS County ST. CROIX CO., WI AEROBIC TREATMENT UNIT (ATU) RECEIVED FOR RECORD SERVICING AGREEMENT 10/02/2007 02:45PM AGREEMENT EXEMPT N State Plan Transaction Number - REC FEE: 13.00 PAGES: 2 t.)t a F3. sIL VE1 Name — (Owner) Typed or printed Being duty sworn, states, under oath, that: 1. He /she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume ! I/ (a Q .� Page 3 3 5 Document Number /Z Croix County Register of Deeds Office: Recording Area t Name and Retum Address A parcel of land located in the SF /4 o�theS_� /, of Section PL3 T N —R I _ )Town 30(, L.>e-t.4- 1yl,� �Grk St. Croix County, Wisconsin, being A" A 1 � � M K.1 duly described asPollows (include lot no. and subdivision/CSM or detailed legal description): .03D ntO(cfl - �� _ 000 C S � Parcel Identification Number (PIN) Agreement Date: Q I6 177 �Jee— Q.G- j As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above - described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Comm 83, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System) technology. If the owner fails to have the POWTS and ATU property serviced in response to orders Issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Slats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be 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. 66.0703, Slats. 2. The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the .°ystem. The POWTS maintainer will perform periodic Inspections and maintenance as required by the manufacturer and the Department, including, but not limited to: the blower, electrical controls, and treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two years of operation and yearly thereafter. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit so as to not create a human health hazard as described in s. 254.59, Stats. 4. The owner recognizes that the county, Department of Commerce, or POWTS maintainer may make periodic inspections of the components to complete performance monitoring of the unit. 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection, maintenance or servicing event in a manner specified by the department or designated agent within 10 business days from the date of Inspection, maintenance or servicing. 6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment unit no longer serves the property. 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. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit Is installed. Owner(s) Name(s) - Please Print Subscribed and swom to before me on this date: .S U z,-- f.t N r✓ F3 . -S/ LV E YZA A O,' ((J Notari d Owner's Signature(s) Notary Public _IA 941E 6EA EpIlei(SE114 oyern tal Unit Official Name, Ti lease Print My Commission Ex 5 E` NOTARY PUBLIC - MINNESOTA (K) A.1 / "n, 4 My Commission Expires Jan. 31, 2010 Governments it Official Si oat Drafted by:p ersonal formats y vide may be used for secondary purp s (Privacy Law s. 15.04(1)(m)) "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" 1 of 2 This information must be completed by submitter. document Utle. name & atum address and PIN (!!required). Other information such as the granting clauses, legal description, etc. may be placed on this rust page orthe document or may be placed on addldons1 pages of the document. Note: Use of this cover page adds one pope to your document and S2. to the rscordino fee. Wisconsin Statutes, 59.517. Robert J. Silverman 306 West Minnehaha Parkway Minneapolis MN 55419 612 823 1557• II robertj silverman @hotmail.com November 8, 2006 Henry Nechville 967 Highway 65 so Roberts WI 54023 as RE: Silverman —Bass Lake Dear Henry: I enclose a check for your fees to date. Please note my address is " West " Minnehaha Parkway. I am not returning e other form because we are going to delay proceeding with the g g g P g current septic plan. We are having difficulty with the County approving an acceptable new cabin on the property which will remain after using the available land for septic system and preserving the 75 foot set back from the Lake. We need to continue to work with the Architects and County to see if something can be worked out. Alternatively, we are considering going back to the original plan of putting a more conventional system across the road. If you do not already have it, I enclose the report on soil conditions across the road. I have sent a copy to Bob Ulbricht. The problem with building in that location that is we may not have clear title to the land. We are committed to doing something on the septic but it will probably not be until fall of 2007 by which time we hope to have a workable plan. At that time we would like you to do the construction. In the interim we think it best to slow down the process for creation of the approved system not only to avoid the fees with the County but also to avoid a belief by the County that we are committed to a particular solution. I believe you told me that we have two years to build, so this delay should not create a problem. If that is not correct please let me know. We do appreciate your assistance in reaching the point where there is at least one possible solution. Thanks for all your help and we will be in touch. Very truly Robert J. Silverman I �ff�ll lfllf =�r ff IIIfI fllff Villa f�f�l1 llli 1111 3 5 3 2 360353 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI ' %o a c o m z RECEIVED FOR RECORD rn y3 'z 09/12/2007 03:30PM ° CERTIFIED SURVEY MAP � �m� n °a Q0 a $0 �NO C ' ; 5 VOL: 22 PAGE: 5455 -� � m r rx � `• � 2 �� n czi c�,04X (A w aa rn REC FEE: 13.00 '' =o a - N i - COPY FEE: 3.00 N od o �', ":.�„ '" g� zv N g wE Z , a "M�• �'', 0 • g c.'•''v O PAGES: 2 00 rn m h�nrncmtn�nr`��o m -a x n� cn cam+ m r 6v — — N00'53'24 "W 2593.77'— — a o R, ;a C z m m Z ' M*0 m o J WEST UNE OF THE SW 1 /4 o � g m o r- v 721.24 1872.53 �• R v m '< N i V m \ � O 4 �z 1 z �z- rrnnM an z � g ao THE WEST LINE OF THE SW 1/4 OF SECTION �� 1 23 BEARS N00'53'24 "W AS REFERENCED TO ►� z THE ST. CROIX LINTY COORDINATE SYSTEM w X • gSESS 0 oczo m� I *, p v 02 N < � �� 00/ �m �� Oa >Az GJ � � Z Z p C � J� m I = I ( D Q mDv W - 10 m M v cn p l. I �I -4 o � 9 I I —�v,� m I wok (W �' o o M'� z r Z9 1" IaIic z�o� I I x'00 4 FIFA u , N ,,® a/� I m -upa zO� C z o II F �z �� NmN c � z m.� �J I �� �� I I z m ��� W o I J A nm� �_ j I �/ 2 CA N cn I � / mo o I .o� o v °��'' i o I I AP i N e �c') z i �� � >v cgg m 02 'm @ I/ v : z v v/ / �?v a I N 0 Z zZ -z 2 0 O mN mm on I m aZ / SHEET 1 OF 2 4� I Vol. 22 Paves SASS � • I CERTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOT 8 OF SECTION 23, T30N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN, BEING LOTS 5 & THE NORTH HALF OF LOT 6 OF THE PLAT OF STEVENS & SHIRLEY. I SURVEYOR'S CERTIFICATE: I, Ty R. Dodge, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Bob Silverman, I have surveyed, divided and mapped part of the Government Lot 8 of Section 23, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, being Lot 5 & the north half of Lot 6 of the plat of Stevens & Shirley, described as follows: Commencing at the Southwest corner of said Section 23; thence, along the west line of the SW 1/4 of said Section 23, N00 °53'24 "W a distance of 721.24 feet; thence N89° 15'36 "E a distance of 1317.53 feet to the point of beginning; thence N01 ° 18'52 "E a distance of 9.38 feet; thence N09 0 04'52 "E a distance of 142.60 feet; thence N89 ° 07'30 "E a distance of 104.50 feet to the beginning of a meander line along the shore of Bass Lake; thence, along said meander line, S49 ° 01'16 "E a distance of 225.59 feet to the end of said meander line; thence S89 ° 15'36 "W a distance of 297.55 feet to the point of beginning. Including all land lying between said meander line and the ordinary high water mark of Bass Lake between a line bearing N89 °07'30 "E from the beginning of said meander line and a line bearing N89° 15'36 "E from the end of said meander line. Containing 0.76 acres (33,353 Sq. Ft.) more or less, to the ordinary high water mark. Subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin statutes and the land subdivision ordinance of St. Croix County and the Town of St. Joseph in surveying and mapping the same. y R. D and Surveying 84 Date �\\\\`\ppW`�CO V/, 2920 Enloe St. ��� •••'••• 1N '% Hudson, WI 54016 * :' ••• T�( R, �c DODGE S -2464 CLEAR LAKE, A a I: < Approved on I by ��L ✓ , Zoning Department LOT 1: This map shows the combining of the North Half (NI/2) of Lot Six (6), and all of Lot Five (5) in Stevens & Shirley Addition to the Town St. Joseph, located in Section Twenty-three (23), Township Thirty (30), North, of Range Nineteen (19) West, St. Crioix County, Wisconsin. No additional lots are created by this map, therefore it is exempt from subdivision review per 13.1(B)(3). THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB NO. 6571 -03 DATE: 08/16/2007 SHEET 2 OF 2 Vol. 22 Page 5455 C-5. 1 2 822 KATHLEEN H. WALSH VOL 1466PAGE335 REGISTER OF DEED ST. CROIX CO-, W QUIT CLAJM DEED RECEIVED FOR RECORD oactirricni Nurnbcr 9:30 A" QUIT CLAIM DEED EXEMPT 0 CERT copy FEE Daniel H w Brown and Ruth Brown, husband and wife COPY FEE: . . ................ . ........... . ..................................................................... . .............. . .. . ................ TRANM * .. RECM ING F FEES: 10-00 ................................................................. . ................................................. I-— ........................... PAM. ................... ................... I ........................ ...................... . ................................................... clull-ClAims to ........ Suzanne ... ......... .. ... ... B .. ..... Silverman known as ..................... .. . .. - ..... .. B Va D ................................................................ .............................. Suzanne I ...................... R y ... . k) ......................... I ............................................................... I ................... .............. __._ ......... R c co r4l rt I; Area ......................................................... I .......................... ....................... 1 . 11 , ........... ............ r4sma and Rt%urn ^Ad,,— the (oilo-Ig d.seribed real cstata In. .............. .. C roix . .. . .. . .. . ... ...................... county, Suzanne B. Van Dyk Dorsey & Whitney slag at Wl :ccn.ln: 220 South 6th Street The North Half (N J) of Lot Six (6), and all of Lot Minneapolis, MN 55402 'rive (5) in Stevens and Shirley Addition to the Town of St. Joseph, located in Section Twenty—three (23), Township Thircy (30) North, of Range Nineteen (19) 030-1060 West, St. Croix County, Wisconsin. 030-1060 (rxrccl lacnilri—lion Nucntcr) Together with an easement for roadway purposes over and across all designated roadways on the Stevens & Shirley.Plat to the Town of St. Joseph, dated April 3, 1940, and filed for record an April 3. 1940 in Plat Book "3", page 12. in r.he office of the Register of Deeds in and for St. Croix County, Wisconsin. Tids-.1-P nPt h----'--d P—Fc Rated 004 ............ ........... day t Octob ............................. er 99 .................. .......... (it) or (it not) .................. ................. I ............................ ........... I .......... ...... ........... .... ....... .. IiSLA .................................................. I ........... ............. . .......... ......................... I ....................................... ........................................................................... ... . ............................... ........................... I ................. .............. ........................................................................ . ........... I ..................... .. Ruth ............ . . Brown .. ........................................ ..................... I ..................... AUTHENTICATION ACKNOWLEDGMENT ovK*R,4U WISCONSIN PI ERCE ............ ....................... ........................ Pz.-rcnally "ma ■ uthcntIc*jcd thli .............day of ................. ...... ........................ 19 ............... L�rore me Ihij.1,5.r_bj.y.r ... Qf ................. 19,29 t'.,c &bnc ngmvd ....................... ....... I ...... ............... '�M ... And ... Am.�.h a .. ......_ ...................... 9. : an w1f,! ..................................... ..... ........... .. ...................... ............................ I....., ....................... ... ........ ........ typ< or prim n.arnc . .......................... - ................... ...................................................... Tm-& mr-immi srATra nAR OV V/1-SCONS17N (it ..('_ ........................ ........................................................................ .... ------- ........ ...... ...... . ....... I ......... % ..%h.ri%td by SS 706.06, W4. S-lut") to me knoym to be 11'r. Pc"Qn.!� ........ who ".Culc 4 %CIA A Iniirumcm and ccknowicasa thc aamc• TA . ... . ..... _a ..... ... Z ......... Names of personi signing in sny cApacity should In typed N rylx: or prim ..."A ��A > N _6 30 arriated bcjow Suzanne . B thc$ 0 NOtArj ?U S. afpTyrv. a ........ ... .............. coun(y,wi 220 South 6th Street My Commiulon I& perm2ricni. (If no, stale cxpl"ilan MiW% . . ......... 2 of dratted by (Iyp4 or print name) _2 v_' X.0 ...... ...... ...19......................... RECEIVED I�llli l!!!I' J IIIII IIII VIII! ill Illl S EP 2 6 2007 860353 8 TY KATHLEEN H. WALSH T. CROIX COUN REGISTER OF DEEDS guRVEYOR'Sv `R ST. CROIX CO., WI RECEIVED FOR RECORD Z � v' s ` .ti a ..• '� '' m c� � N � � 09/12/2007 03:30PH ""y_ sc�ic� o���� CERTIFIED SURVEY MAP ° o c1 'I x o z y c -� s VOL: 22 PAGE: 5455 z: 2 '$�` p? c�S C -) N REC FEE: 13.00 Fn •': '� "` ��"'�zn�m t„= Azc�yN COPY FEE: 3.00 gwE� z O ' :' ? sz�� � o PAGES: 2 rq m QO -- N00'53'24 "W 2593.77' -- v a 50 C z °� WEST LINE OF THE SW 1/4 o ^� S � * p a 721.24' 1872.53' n v 4 z D L m 0 2 THE WEST UNE OF THE SW 1/4 OF SECTION -2 " 23 BEARS NOO'53'24 "W AS REFERENCED TO N �' z c'= THE ST. CROIX COUNTY COORDINATE SYSTEM p m rn f- EA SEMEJ'j ACCE ER rn P p xz f �� �� v jr'� 1 4 1 , 05 �� a�Z 11 4 �9 Ir� to CR `�U u11 m C r ��� I I y $�� m .4 Fr, ZW N C Z V / � A�` g�,a� to Of .gym to W rn CID 0 i > Q„ sg g nri X sa I . co • L a� Z SHEET 1 OF 2 L 1 of 2 I Vol. 22 Page 5455 c ti p c cn it O 11 o O T d m m e O C fA 0 O Co rn < o N N C s CD Co 7 7r (D N 7 y 0 tD O C N � fl. u+ N N to CA O S j 0 .Z v cn 7 O CD c o o N ° C e oi m �° c ro o D o ao Vi i _ _ 7 rL c (° cn 7 N CD N Nis. _ c o O w D a m �, Z D m OD CD a m m G U) D OD tp N 3 cn K3 N cn 00 00 N O C) .p cn W N 0 0 0 d 0 0 0 < o p * ** D m e W U) U) J CO) N U) CD m m v g C < v v g cn y C CD N CD - CD N CD N O y _ cn Dpi O < d CD 3 3 d m 2: 4. rr °\p o Z Z 2 D o O Q cn C 1 v ° O D D ° o O C N °' O O w N rn C ( a c d C N o. m C/) ,< a CD tD O 5 -' --I Cl) CD 7 N C d ,`p Z n U3 ., A Z O W w N O O W <-' a 3 c C :: O 3 OD (.0 a 'O N p> W N O D O C C D CD - 0 cn S' D 3 D 3 X C C Q N d CD N N CD d CD CD .- ON �_ � a D to � - C . O Cn G �• 7 CD O -� O O c �° D CD N v c C CD a T J N C CD om °° z c ° m z CD c 3 'oOa w3 a 3 3 d N m v f O 5 d S 3� D 7 CD3 CL CD CD 2 O n CD N y p •o 4 C CD CD dC �D 3 T CD CD 3o t CD CL 4 Cn CD Q y O O A CD Q `L CD 7 to W O 0 N . to d pj 3 O 7 p O O +� (D CD N C oc n < Cn N O CD CD O ` N 0 O H) O v oot o m o CD o ■. ° CL �, a w � o a a � Z � W � F O C N O � � x 4 x " w I J, z N M 4 kj� r oo POWERS LIQUID WASTE MANAGEMENT 5 6 March 11, 1991 James K. Thompson. Asst. Zoning Administrator St. Croix Co. Zoning Administrator St. Croix County Courthouse 911 Fourth Street Hudson, WI 54017 _ Dear Mr. Thonpson: Below is the information you requested regarding gardzng holding tanks we currently service. 1, Adada Rental Rental property in Houlton Box 37 County E on Hwy 35 across from liquor store Houlton, WI 54082 Owner: Don Peters Capacity: 3000 gals 2. Brown, Dan SQ;9/n VA" �0 West side of Bass Lake. 129 South 9th 726 143rd Ave. River Falls, WI 54022 Capacity: 2000 gals 3. Charland, Flora trailerhouse 2233 90th New Richmond, WI 54017 Capacity: 2000 gals 4. Hartigan, Terrence Bass Lake 4 1394 Frog Pond Lane New Richmond, WI 54017 Capacity: 2000 gals 5. Kiekhoefer, Sherman trailerhouse 1669 220th St. Emerald, WI 54012 Capacity: 2000 gals 6. Kingdom Hall Jehovah Witness Hall west of c/o Michael Faust New Richmond on Hwy 64. 408 Sunrise Somerset, WI 54025 Capacity: 3000 gals To my knowledge, this is a complete list. If you have any questions Please feel free to contact me. Sincerely, 7 Tammy Powers manager (715) 246 -5738 550 RILEY AVE. NEW RICHMOND, WI 54017 � . / 0 2 . V � f f $ � � 14) e s e 2 �£ R U S 0 d k m g 2 - £ 0 f ■ � 0 o / \ § _0 @ =r § I \ 6 o 3 ■ ) § 8 E o £ § d1 ° ` @ > E 0 E o m U) A" 2 i = #: ° 0 o � ® § ƒ . . C w ' 0 r ca a e e 0 ■© c 2 CT ( o o o � 7 0 0 0 0 @ � 7 2[ ■ ■■ 7 i E § 7 2 k § ' n E @ 9 ■ m \ 3 & � / � . � 0 � / 0 § § 2 ƒ / CD 2 { ( z 9 e � o / # § $ 0 .. Q 9 © C 0 \ § co 7 � c CL § =o_ / /(D / �a � aE�g � §s z ( 00 R 0 cn \ c« ESQ » 7Z§ Cl) ® q b ; * CD i cn � CD \ `�, a � � § � � K � / _o �§ 0 \ �2 Parcel #: 030 - 1060 -50 -000 03/17/2005 01:03 PM PAGE 1 OF 1 Alt. Parcel #: 23.30.19.211 030 - TOWN OF SAINT JOSEPH Current Xi ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner SUZANNE B SILVERMAN * SILVERMAN, SUZANNE B 306 W MINNEHAHA PKWY MINNEAPOLIS MN 55419 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 726 143RD AVE o SC 5432 D OF SOMERSET BAS SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.660 Plat: 2508 - STEVENS & SHIRLEY'S SEC 23 T30N R1 9N LOT 5 OF STEVENS & Block/Condo Bldg: LOT 5 SHIRLEY'S PLAT IN Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 10/28/1999 612822 QC 07/23/1997 f 830/350` 07/23/1997 (f 457/447 \ / ( 4-t - R 6-- of s V J 2004 SUMMARY Bill #: Fair Market Value: Assesse with: 5233 254,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.660 180,400 70,100 250,500 NO Totals for 2004: General Property 0.660 180,400 70,100 250,500 Woodland 0.000 0 0 Totals for 2003: General Property 0.660 90,500 59,900 150,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount 040 -OTHER ASSM'T SPECIAL ASSESSMENT 492.42 Special Assessments Special Charges Delinquent Charges Total 492.42 0.00 0.00 . 1 379476 a D�'a ,MONUMENTED NORTH LINE CERTIFIED SURVEY MAP SEP 11982 OF GOVERNMENT LOT LOCATED IN GOVERNMENT LOTS OF SECTION 23, T30N, R19W, a w Ip CERTI_FIE_D SURVEY TOWN OF ST. JOSEPH , ST. CROIX COUNTY , WISCONSIN of D"& _ - I- - - — — - N 89 ° 30'51 "E 13.00' wbono S 89 ° 16'15 "E W 91.40 t - LEGEND 3.28' _ 1 MAP - 49 . n - - -�o VOLUME 3, PAGE 644_ SECTION CORNER MONUMENT a N O(A 1� t. wc IG 2" IRON PIPE FOUND mmm .m a $ 3 F �—" — — -.';) • I" IRON PIPE FOUND 10 mmm ,n 11i 'm '`'' • 1/2 "IRON PIPE FOUND 'co a D Z m 1 W O I "X 24 "IRON PIPE WEIGHING �m7OD W zoom ',�' , 1.68 LBS. /LIN.FT. SET = `" i i ,n I 1 ( R.) PREVIOUSLY RECORDED AS oN ,O az' n _ i PREVIOUSLY PLATTED { O _ a S 1 37'45 "W 1 1.56' : - -- (n ..._ m �n IC N89 030'51 "E =LLi 20 z z IZ i \ MEANDER LINE I 12001 a 297.76 Z , z'' Ir .�, 9os4' ; ::i \ \ S S SHORELINE 0 6 90 In 3 Ate= �0 1 Wd_ 4 ;`::' _POND_ r , O m - \ 2 1 m y o 1 L?'T o 2.38 ACRES s, tq ' 1' � o Z m W '� NOOSE esyr n N 1 4 � � y � — w N47 92.00' V1 N 7 0 ,30 r r, w o o 9cc� °y g0 0 4 g8" o o/ 0 o \ \ 3 0- o - ; -_' - -- --- - - - - -- - . 1.38ACRES re't N \ /( � v � may ;•!� I r N -' �F� ���' w 0 m z n F z s , \ N 9) v�D °� N II7�ae ��4 ? tiff �� G) z = 0 .4 01 my N CD 2 � D C $ � ,' �, n N < 2' * Z C 'It It Z Z 00 ? N m �G 201, < w� N O 0 o D z r'� 1.03ACRES ° { mo OD (A .4 W O N D p o 3 n -4 O N - n Z O W N O_u .1, 1 A m o Lw_ M (D N O :0 ;a r*i m m v 0 w /(q APPROVED o rn N >40 -1 g6 z F I v z rn W W SEP 01 1982 - o 0 2. o o v /. 0 0 1 M 7 v 1ST .1 0 ST, CROIXC COUNTY < ° GOA NEHFNSIVE PARKS FLANNWO C = /c, AND ZOMNG COIAAMTTU m > cQ v 0 POINT OF BEGINNING / / V �+ N89 ° 41'08 'E 6 awn 1288.13' 90 V. / � (1289.4R.) 30.54 177,15 4 6* ` 39't SCALE IN FEET I "= 100' t S 89 ° 41'08 "W 207.70' 0 100' 20d 300' SW CORNER SECTION 23, MONUMENTED SOUTH LINE OF THE SWI /4 T3ON, R 19 OF SECTION 23, BEING ALSO THE SOUTH Volume 5 Page 1203 LINE OF GOVERNMENT LOT 8 �v 9 UNPLATTED LANDS_ Tulc IN4TQIIUFNT nRAFTFD RYT� 482 - 374 � V s R o R w row• �� ♦ I / /_/ l/ +� ^ Q O CA w 1 � O O Q� Q, p P t V , • . ° 4 C 4. �` l : `4. ° is • � 4� A 1 0 p N ~` �. mo t. ■,� \ J 4 4 0 CA it J� o a 4N Vet ; • � � � P `. P a � to \ P � �. � p P n IA AS BUILT SANITARY SYSTEM REPORT OWNER �1r?►ift�� (fi4 -n i�✓1 +�F�f, �r�a�r�r� TOWNSHIP -{ S eph. SEC TN -R ADDRESS ST. CROIX COUNTY, WISCONSIN. �?0 SUBDIVISION ��cs�� /Etl LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63' E$yTHING WITHIN 1 FEET OF SYSTEM b0� It V V I di a e o th Arrow SC L _ BENCHMARK: (Permanent reference Point) Describe: �� t o o - werr Elevation of vertical reference point: jam' Slope at site: SEPTIC TANK: nufacturer: Liquid Capacity: Number of ri s on cover Tan manhole cover elevation: Tank I et Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufactur r: Number of gallons Number of gal. pump set or a cyc e gallons; total capacity o distribu ion lines gallon: size o pump head; gallon er minute horsepower ran name of pump and m el number ; Type of warning ev ce HOLDING TANK: Manufacturer 4.m.0. Number of gallons o - � Qzl? Elevation of manhole cover ./ Type of warning device' b SEEPAGE PIT IZE: - umer o pits eet diameter ye feet li id depth seepage pit in t pipe- elevation bottom of seepage p t elevation feet. SEEPAGE D SIZE: number of lines width length tile depth SEEPAGE RENCH: width length PERCO ION RATE AREA REQUIRED AREA AS BUILT INSPECTOR / DATED F �� - PLUMBER ON J LICENSE NUMBER �6 REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM 30 . .� .^ . Sanitary yermiL _ . ` State Septic Sel � 0AM OWN SHIy 8t' Croix County L0CA?I0 Sectio Lot # Subdivision SEPTIC 7&0K Size---­­'­­- gallons Number of compartments Distance from: Well Building 12% slope Btgbwater PUM CHAMBER Size �_ gallons Pump Manufacturer -Model 0um6er________ 80LU14C TANK Slze/ 9 ulloua Number of Compartments Pumyer_ Alarm System Distance from: Well Building _ I2% olope_______________ Bigbvvuter ABSO RPTION SITE Bed Trench Distance from: Well Build 1 slope______ Highwater L^~ of each +^~ ft Depth of - ^- `---- ----________-''' Number of line D epth of ock over �ile in, Len gth / D epth of tile below grade in. / lo pc of treucb_____iu' per 100 tt. Total absort area ft Type of Cover:�_________ _ I'll' DIMENSIONS Number of pits Gravel around picoyca no Outside Depth below iulet [c Total absorpti Area required lNSP8CIED Tl?L� ~, APPROVED D�?8 lq8/ �� - .�� KDJEC?8D D&?D 1YU ---- -- --------- KDA300 FOR KEJ8CTl0N -_____-______--___ | - --- � - DEPARTMENT OF APPLICATION SAFETY &BUILDINGS 'INDU S ''RY FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: City, Village or Ne County: J ug % S iyx's T p Ni R 12 "or) W _ o -12- 'L ot Number: Blk No.: Subdivision Name: Nearest oad, Lake or Landmark: / State Plan I.D. Number: c11- o� /1 l '► 4 r i/ r5 F 7$d (If assignedl8 /o S/ 73 TYPE OF BUILDING Number of ❑ Public* ❑ Variance ❑ Other (specify)* Bedrooms: 1 or 2 Family * State Approval Required. 2, TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: 4 M. EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New EA Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private El Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name f Plumber: Signature: M MPRSW o.: Phone Number: a Plumber's Add ess: I Name of Designer: - a'A ord) COUNTY /DEPARTMENT USE ONLY ignat a of Issuing Ogent Fee: Date: Sanitary Permit Number: APPROVED ❑ DISAPPROVED 114 eason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. I► DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (N.03/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDWSTRY_ DIVISION LAB AND PERCOLATION TESTS (115) P.O, BOX 7969 HUMAN RELATIONS MADISON, WI 53707 LO CATION: SECTION: TOWNSHIP /AM1kfP1W.Jl?A1l•;~Y: rOT NO.:BLK. NO.: SUBDIVISION NA C �/ �� 4X� N/R /?I (or) W s ME: �! COUNTY VNEFU BUYER'S NAME: M ILI ADDRESS: USE DATES OBSERVATIONS MADE FN NO. B DRMS.: COMMERCIAL D R ION: A Residence ❑New �Re lace P RATING: S= Site suitable for system U- Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND T TEM -IN -FILL OLDING TANK: RECO MENDED SYSTti,nal ZO) DS �Y1u OS Ou as ®u _�U �S ❑U /a/ �'" io If Percolation Tests are NOT required DESIGN RATE: If any portion of the lot is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain ele n: ACT 21 19 PROFILE DESCRIPTIONS NING BORING TOTAL DEPTH T ROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNE OL R, TUBE, DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGFrE TO BEDROCK IF OBSERVED (SEE ABBR BACK.) s, S✓ re "S. 3J 11 5,V, pia t 5'. Z GG L7 i 1 B- / C r (� Il �/ is h`j 1 , OZe ". 5, 26 . m1 . 5, �o � B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DRO IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD3 PER INCH P P- P- i P-. P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION _ E , E 4 7 I Imo. 1 /0 . ._,... .............. ..�„,...... die ... {'i' .._ ........ € € .. I • CL _ ��� _ t I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): rrti& -rNd W Z zC� - Z - Z o CST SIG RE: DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester. DILHR -SBD -6395 (N. 03/81) t' WON 12/78 r z S tate j '' u DIV180l4,:Q+:<1EALT 4Z - n iS F#�i - 1AFi h a;: SECT tart el *140 FIRE -01#0 *$o{.l�t'SYS �'sk3#7 1t s lAkMSt, I?lE l!► : sox is 5370 DATE: October 2, 1981 l or, 1 r9� PROJECT: IpN 8� 1 ' QFf/ E Suzanne Van Dyk & Dwdij' Residence ' Holding Tank NF}s. SW , Sic. 23, ,:' 119W, Steel's Soil Service Town of St. Joseph,' 988 North Shore St. Croix County, Vi .fi Richmond, WI 54017 PLAN ID. # 81 -05193 DETACH HERE Suzanne Y-an D k & Daniel Brown 81 -0519 f ; .. PftQJF -OT NAME 3r PLAN ID: .t• ,� F , Tft is to acknowiedge m*pt of your. p18us and apecifi for the above - indicated prcx t. F wry" ,•el)eninary review Indicates the pion review fee required is.$' „ r F Plan accepted for review. fee received is $ .:fee is being returned becaOsg of Q Overpayment ❑ Underpayment. 4 � � orb• r Providing one of the two cpstagories above -is checked, remit correct fee in one payment. , f r Y ii , No fee has been remitted. Plans submitted with no fees will be held in abeyance. r ; j 0 Plans being returned: i` ' 0 -Additional information required. SEE BELOW. 1, Plan S u bm ission ❑ Additional informatiorrshall be submitted in triplicate unless specifically noted.' ❑ Plans not.clear, legible or permanent. z , E All information submitted 'shall be signed, sealed or, stamped in accord with Section H 62.25(Z lMlu� � � It�e. ❑ Affidavit enclosed. U. Alternate sewage Disposal Systems (Mound Systems) E3 PLB 108 (Application for.use of analternate system). ' County onsite requireOl copy). ❑ Design calculations for pressurized distribution F Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. III. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on,all sides. Elevation of permanent reference point (benchmark). E Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines „well; watercourse,. etc. Construction detail of ieptic, holding or lift pump tank if site constructed or tank manufacturer if. #precast. Construction detail Ond ;cross- section,of soil absorption syste Soil boring -mad percolation test on EH•115 corn pleted by certified so i I tester, (1 copy Complete data relativa to anticipated use of bldg, ❑ 3 copies of PLB 60 enclosed. x , Deed restriction required (1- copy). w : IV Holding Tanks . •�. � ° aftofile• � #�l�lr>g <4aak� . ,. ,..- ..: _ ,. , . , _ _.. .: •, _. � ; .. , .. 0 Holding tank agreement by -owner and local unit of government (sample enclosed).. Q Reason for installing holding -tank soil test or statement from county (1,copy). � ¢ V -L ift � P Calculations for tot* lift pump discharge, d and gallons pumped per cycle. head _ �•, �. '= g. y length & depth offorca main. , del,of pBmp :or automatic siphon0ncluding size; pump curves, drawdown and aver lift.outtxp tank::showing pumps) or- siphon(s). 1 L' c x d prior to plan sgbmission•) . - ) yond of trench before side slope begin) r isor, tr V l `E �`� "'a e�x � ���' x . �•.r F ° r "+l.Y YTl k ,(� 1 P '2 x � C fi� s k � Ynti 3 $ L- " .7, _ } ���� � • .:;gyp � k� � '�`� °, � �` . i '� a Mwop i ,&,' � �m�`� - �� - . ` • -.. o r Ff � y 4 �. � s • 4Y.( ? irtr r � � �'a r` "3Cwi R4 ��� ,t � k „ $� .� �r f • r *`� � 4 #its. "�� p f �7 F .. '� r �.�r,E � ':� x f�a�J �-t� E i � •z3 mac' „ `" �� r § Nr� �t z� I. VW k4.fi 944�.�a'� � °�d l �g+ t"� • Gk-pCY 4,� ,. • � u�. _ x r 1� j � n 3 p v. � } � p •},�' �h 4 .. IIii t, _ Department of Industry, Labor & Human Relations q - r Division of Safety & Bldgs. S tate O Wisconsin Bureau of Plumbing Platting & Fire Protection �* PLO. Box7969 Madison WI. 53707 Tel. 608- 266 -3815 INALL CORRESPONDENCE " L S r L C REFER TO PLAN IDENTIFICATION NO. NAME OF PROJECT e J °y TYPE OF APPROVAL STREET AND NO. CITY OR TOWN CO NTY STATE ZIP , I / C t/ry . `-� / OWNER f e\ --- Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, James Sargent - Bureau ID for � PLANS REVIEWED BY: DATE'/ cc: D OWS Owner DI LHR p Plumber H & R (2) County Mfg. Rep. Bur. of Health Fac. & Services DI LH R S813-6099 (N, 06/80) Rec. & Env. Services 7 ,11 8 1 , 0 , 51 /I..S�J 1" 17 he 7 Wit" A' 0 ra /i ate' Ay i Ooe 4, ST. CROI X COUNTY *, ,•: r W1 S C O N S I N ►i iii :: :: ` ,:;, � .t;4i Z O N I N G O F F I C E 796- 2239 Poet 0666i Box 227 PAM Hammond, WI 54015 RECEIVED P O U W M N P E R R SEP301981 A Q R E E M E N T P i ia�., LU , cr . PLEASE BE ADVISED, chat unt.it you ate again not.i6.ied, Alto5l , cont-aact with (" c�L 06 l "0 Vii con4in, (Pumpet , 6ot the punpoa e o6 temov.ing ,a.t.t waAte 6tom the aan.itaty ayatem to be Located on the ptopet.ty and 6utute home e.ite Located in St. Cto.ix County, (0i.6cona.in, Townah.ip o6 31 ,A being in the C % 06 the 501 4 06 See. 2S , T. 3,0 N.- R. _�W. (Oa mote 6 utty d ea et.ib ed as 6 ottowa : ) L o S` ai., Dated th" /! i j/, day o 4 a 5f 19�. (OWNER) State o6 W.iaconAin) (Dlc✓N AA County o6 St. CCo.ix) Peneonnattyappeaxed beJote me. th.id o day o6 the above named 3u2dn V�� �,.,c1 to me own to �fk� p e�c aon w execated the otego�n cna.t4umen.t and a h 6a)p-z VOLA W oZaAy u cc, t. toix un y, - My Comm. l i.e petma n,t) Kxpi*e -)- I, �` %r•s,?/' hete.inbe6ote xe6 e&ted to as Pumper, join in -t e a ove agteement to the extent that I have a contract with Ownet as above stated. ec�f K (PUMPER) 0 r� NOTE: As spedified in H63.18 ( A) Wisconsin Administrative Code this document is to be recorded in the Tract Index, lo- �.� cated at the Cqunty Register of Deeds. At the time of Sani- 3 e 3444 tar.y Perwit Application, a copy o this a47reement , with t he recording dates and numl — Ar should be submitted to this office. VOL 6.35 i ; ' 502 RECEIVED HOLDING TANK AGREEMENT SEP 3 01981 PLU!UH!NG SECT!QN d entered into this 'day of 1s Ag ement is mad n u S� 19, by and between the hereinafter called an ^► '1 q- here Wafter ca e the "Owner. 105 1 9 3 We hereby acknowledge that application has ,been made for a building permit on the following described property, to wit: Hof S An J, NX, or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. we also acknowledge that said property cannot now be served by a municipal sewer or septic tank — soil absorption system. Therefore, as an inducement to the County of 4 to issue a sanitary permit for the above described pram ses, we eh reby agree. and bind ourselves as follows., 1. Owner agrees to conform to all applicable requirements of the Plumbing Code relating to bolding tanks. Any Lime one down or Munn. ipa o ; #. of through its Plumbing Inspector or Health Offi- cer, deems t n essary pump out the subject holding tai, the shall have same pumped out in twenty -four (24) hours, orl will have said work done and charge same back to Owner and pl ace fame on the tax bill as a special charge he Owner further agrees that the Town or Municipality of ^„�,, may enter upon the property des- cribed above at any reasonable tilne, to inspect, or pump and haul wastes from the subject 2'. Owner agre to pay 1 charges and costs incurred by the Town or Municipality of for inspection, pumping, hauling or otherwise servicing and ma a n ng a subject hol ding tank in such a man- r�er as to prevent or abat uisan a or health hazard caused by such holding tank. r o shall notify the Owner of any such cost *which shat pa1d the Owftr within thirty (30) days from the date of notice and in the event that the Owner does not pay said cost within thirty (30) days,.Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the - abatement of nuisance, and said tax shall be collected as 7f,` "1RSOFPl%-_E Wisconsin Statute. vI C'_-ii' Co., wIS. °r 'd. fcr 18th DILHR - SBO - 6123 (R.3/81) d ® of Sent. A.D. l9 81 at 1:00 P , M. James 0 !Connell #. F R.ahr.r of DNdg `..•.Jt. deputy RECEIVED Page 2 SEP 3 01981 3. Owner agrees to have a quarterly pumping report su8ib .,p S 90 local verrment and the county which will state the Owner's name, M w of the property on which the holding tank is located, the pumper's name, the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted to the Department of Industry, Labor and Human Relations by the governmental unit responsible, per section 145.01 (15), Wisconsin Statutes. 4 We guarantee that the holding tank contents will be disposed of at a site meeting the requirements ,of chapter NR 113, Wisconsin dmi a ive Code. $ ® �7 5. This agreement w 11 remain in affect only until the sanitary permit issuing 9 a ent in County certifies that the subject pro- r party is served bye r a pu c sewer or a septic tank --- soil absorption system that complies with ch. H 63, Wis. Adm. Code in addition, this An"p- ment may be cancelled by executing and recording said certification with re- ference to this Agreement, in the Tract Index indicated above. 6. This agreement shall be binding upon the indicated governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this day of cc , TOWN OR MUNICIPALITY OF OWNERS b y by STA OF W CONSIN Personally came befo re me this day of 1�.. 19 L the above named YI La-0 N to me known to be the persons who execute t e f oregoi ng instrument an acknowledged the same. v THIS INSTRUMENT Y L C DRAFTED BY: + '" .e' My commi scion- expires:.!' �1 M 810 RECEI VED CEP 3 t P« MBt �����Tl3� xi L t s� 7 . Q ttyy , i t� t 9 (101% 9 DIV REC SAP � ld � F � P i -A 1+ . -/.0 4, r}.AYh(Y� cilA }�?•t r 2,' 1 �.�5�1>�x �� ST. CROI X COUNTY t Y WI SC0 NSI N ZONING OFFICE CF -� 796 -2239 (HAMMOND) Of 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 QUARTERLY PUMPING REPORT SST. CROIX COUNTY NAME: / ,J RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 HAMMOND, WI 54015 715 - 796 - 2239 or 715 - 425 - 8363 TOWNSHIP: PLEASE PROV E THE FO LLOWING INFOR MATION ACCOMPANIED B RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL V (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 198 T OWNERS SIGNATURE mj :12 -83 ST. CROIX COUNTY W I S C O N S I N a�, ZONING OFFICE 96 -2239 (HAMMOND) 5 -8363 (RIVER FALLS) r� HAMMOND, WI 54015 UARTERLY PUMPING REPORT S T. C R OI X COUNTY NAME '5 n n , () - ay x RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 .r- 115- 796 -2239 an 115- 425 -8363 TOWNSHIP �� , �1(� S� {'j PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: f O (,ueF•S �Q.,���• o LOCATION OF DISPOSAL SITE: k i EK / c 11 �2i d G!1 �Sf►�Sct,l NUMBER OF PERSONS LIVING IN RESIDENCE: 73 USE: a)aZe YEAR ROUND SEASONAL �� (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED gib loco THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1985 OWNERS SIGNATURE ST. CROI X COUNTY W I S C O N S I N VU �= ZONING OFFICE Y ' p lea ' 796 -2239 (HAMMOND) '¢�. �s �'ti 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 �I 2UARTERLV P U M P I N G R E P 0 R T ST. CR01X COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. SOX 98 fugal 7 HAMMOND, W I 54015 715 -796 -2239 an 715- 425 -8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL W / ' (CHECK ONE) APRIL MAV JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30, 1985 OWNERS SIGNATURE I r T. CROIX COUNTY ` 7 > 1 ,�� 6 1 SC0 NSI N I N G OFFICE _ 4%1y6 .9 - 39 (HAMMOND) 63 (RIVER FALLS) t MMOND, WI 54015 QUARTERLY PUMPING REPORT --- - - - - -- - - - - - -- - - - - -- ST. CROIX COUNTY NAME .'GCZA-tj N C V 'N RETURN COMPLETED FORM TO: ADDRESS F A s S LA < (5 ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 CwecST - HAMMOND, WI 54015 715 -796 -2239 0n 715 - 425 -8363 TOWNSHIP S a Z-,epL4 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER NAME OF PUMPER: A r LOCATION OF DISPOSAL SITE: A NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL ( (CHECK ONE) JANUARY FEBRUAR MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN MAY 15 1985. OWNERS SIGNATU ST. C R O I X COUNTY WI SCO NSI N ZONING OFFICE Ai 19 796 -2239 (HAMMOND) �, cn 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY �t NAME: ,..? Z A M N � { �� �� A N'� RETURN COMPLETED FORM TO: ADDRESS: 1/U'E SI S{I1kL� ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 HAMMOND, WI 54015 715- 796 -2239 or 715 - 425 -8363 TOWNSHIP: �T. J 0 S L I I PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: �j ivy w USE: YEAR ROUND SEASONAL V� (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1985 OWNERS SIGNATURE. _ z mj :12 -83 �`. '7 8 ST. CROI X COUNTY WI SC0 NSI N ZONING OFFICE ` 796 -2239 (HAMMOND) �. 425 -8363 (RIVER FALLS) T HAMMOND, WI 54015 Q UARTER L V P U M P I N G R E P O R T ST. CR01X COUNTY ;7 g / NAME ? ETURN COMPLETED FORM TO: ADDRESS ;�..� � �' - �! /L 5 , y' ;� ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715- 796 -2239 on 715 - 425 -8363 TOWNSHIP L� i PLEASE P'kOVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: J E NAME OF PUMPER: C -r L LOCATION OF DISPOSAL SITE: w NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL X _ (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED �� ZE'JD6 THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 1 1984. OWNERS SIGNATURE ST. CR X COUNTY Xr W I S C 0 N S I N y t - "� ' �r��i 5' '�t t t )�` •� � { �!r� ZONING OFFICE ��✓ �% /� 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) t HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CR01X COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS 'S, ST. CROIX COUNTY ZONING OFFICE P.O. SOX 98 HAMMOND, WI 54015 715 -1'96 -2239 an 715- 425 -8363 TOWNSHIP PLEASE PRO IDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: r NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL_ (CHECK ONE) JANUARY FEBRUAR MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED. . a THIS REPORT MUST BE RETURNED NO LATER THAN APRIL 15, 1984 OWNERS SIGNATURE ST. CROIX COUNTY w a a ems Wi SC0 NSI N ZONING OFFICE y�'93"r 425 363 F �. 8 ( S) HAMMOND, W 1 54015 T U A R T E R L Y PUMP I N G REPORT ST. CROIX COUNTY NAME ; RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 E t l / C" N /l{ 0 Al a J 0/ ; HAMMOND , WI 54 015 _ 715- 796 -2239 or 715 -425 -8363 TOWNSHIP. S / . `/ Q.S t. P14 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION O& DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE :Y (p 1 L -( w. t{, v ' D) t to - t> USE: YEAR ROUND SEASONAL V o"'A (CHECK ONE OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED Gua,S plc 1jq 141. %d s'f i THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 15, 1984 OWNERS SIGNATURK L ° - z Z' L' % y mj:12 -83 J - ST. CROI X COUNTY ; W I S C O N S I N ZONING OFFICE I �>"9 O,c�C 425-8363 796-223 25 8363 FALLS) D T HAMMOND, WI 54015 U A R T E R L V P U M P I N G R E P O R T ST. CR01X COUNTY NAME SuZaniJe- V -)✓1 &jk RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 rS YYt �'J HAMMOND, WI 54015 / 715 -796 -2239 an 715- 425 -8363 f s TOWNSHIP Y z7 S P r_' PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: — USE: YEAR ROUND SEASONAL X ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JULY 15, 1984 OWNERS SIGNATUR V CIO \r N O e too' ue• iee' io✓ gee ieo' �� V 41- jq Nk � v o o v � � ` ` „ • , I D C O O 0 0 ` P f` t V � P 1• � `' � � C � o � 2 1 , ^ p' b c, R : I ?. T J O 0 'z i° cm QA J .,- �.�.�w.....y}. ,. .... �,.F:... a.... �—. m-. w•.:.,..... rs-..+ �-, .- .,:rs+F...:�,- :a..:s.w+ -S�'�, �r' rat \ .. 4' 00 l 4' oi e R a I r 14 0 cU C .� .'"l o• � D Q A � � )' �. '1. a R O �' o � G ;, Q /�J p �� O-