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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner STATE OF WIS CONSERV STATE OF WIS CONSERV X MADISON WI 53707 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 3135 CAMPGROUND LN SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 14 T29N R1 5W NE NW 40A Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 14- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/1989 Description Class Acres Land Improve Total State Reason STATE X2 40.000 0 0 0 NO Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 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 Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 s TDD #: (608) 264 -8777 isconsin FJ \lE1 www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov 2 6 202 Scott McCallum, Governor Philip Edw. Albert, Secretary X. CUUNT Y -; ��r -�c August 26, 2002 CUST ID No.222234 ATTN: POWTS Inspector GALE W SMITH ZONING OFFICE TUTTLE CONSTRUCTION ST CROIX COUNTY SPIA 316 E WALNUT ST 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/2612004 Identification Numbers Transaction ID No. 777595 SITE: Site ID No. 649303 Glen Hills Golf Club Please refer to both identification 3127 Campground Ln numbers, above, in all Town of Springfield, 54013 correspondence with the agency. St Croix County NW1 /4, NW1 /4, S14, T29N, R1 FOR: Holding tank, 2544 GPD. See key item(s) below Object Type: POWT System Regulated Object ID No.: 866620 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual, SBD- 10571 -P (R.6/99)" • In the event this holding tank malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described the Holding Tank Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. J • A Sanitary Permit must be obtained from the county where this project is located or other appropriate permit issuing agency in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for GALE W SMITH Page 2 8/26/02 inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. • Note: County regulations concerning the prohibition of holding tanks may vary. Check with the local permit issuing agency. • Note: The servicing of POWTS holding and treatment components, including septic tanks and holding tanks, is required to be performed by licensed pumpers under chs. NR 113 and NR 114. Key Item(s) • This approval is for the connection of a 3 bed room residence to an existing holding tank that currently serves a golf club /restaurant and bar. The existing holding tank must be inspected for structural soundness and size and must be brought into conformance with the requirements of COMM 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. • All joints and connections shall be made in accordance with Comm 84.40. Review Notes • Manhole cover or service port to be no more than 25' from service road or drive per Holding Tank Manual, Table 1. Reminders • A meter shall be installed by a properly licensed plumber on the water system that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • Materials shall conform to the requirements of COMM 84. • Abandon failing system per COMM 83.33. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Provide frost protection per COMM 83.43(8)(c). 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. GALE W SMITH Page 3 8/26/02 Sincerely, Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy Jansk Wastewater Specialist, 715 Y Y� p ,( ) 726 -2544 I r -- HOLDING TANK SERVICING CONTRACT% . Contract Date January 4, 2001 This contract is made between the t ` , C� Holding Tank Owner(s) Name(s) and I Pumpers Name i St. Croix County Parks Department Cassellius Sanitation Sj ; -'Jv�Cp We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) NE 1/4, NW 1/4, Section 14, T29N, R15W, Town of Springfield -------------------------------------------------- ------------------ 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of St. C r o i x 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; C. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owners Signature(s) Subscribed and sworn to me on this date: I St. Croix Count Parks Department i ( Today's Date I I V Pumpers Name (Print) I Pumpers Signature Notay Public Signature I Cassellius Sanitation I S ervic e i a� C O 3 Pumpers Registration Number mmission Expiration 559 Draftedby Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing Wisconsin Department of Comm RIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division .ter INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 383906 0 GENERAL INFORMATI State Plan ID No: Personal information you provide maybe used or secon ary purposes [Privacy Law, s.15.04 (1)(m)). Q �p Permit Holder's Name: City Village X Township Parcel Tax No: St. Croix County Parks Department I Springfield Townshi 034 - 1030 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: . TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Ic Benchmark V' , D 9 %e14- Bitft A tion Bldg. Sewer Holding 1WInlet TANK SETBACK INFORMATION 0 11*1Hf G*#eS TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt et Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding f t 35 Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Fr on Loss System Head J TDH Ft Forcemain ngth Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches FiTWI No. Of Pits Inside Dia. liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L LDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYW Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length is Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed(rrench Center Bed/Trench Edges Topsoil p 0 Yes 0 No �� Yes :[MN]o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 &(O / © o . / O Inspection # Location: 1049 Rustic Road # 3 Glenwood City, WI 54013 (NE 1/4 NW 1/4 14 T29N R15W) NA Lot Parcel No: 14.29.15.213 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 0 Yes [E No dCp Og D C Use other side for additional information. 10 SBD -6710 (R.3/97) Date � Insepc � to ignature Cert. No. -- __ Safety & Buildings Division I Sanitary Permit Application - - -- -� In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 IMSCOnSin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) I Attach complete plans (to the county copy only) for the sy t " , n r t than 8 -1/2 x 11 inches in size. a . uumy State Sanitary Number ❑ Check ' r o prevr6 0li 'on State Pl OL D ��Ium� c�LO l x 3 8 31 to %� !; � I. Applica Information - Please Print all Information. 't{ Location: Property Owner Name __..., t Property Location s ST. CROIX COUNTY PARKS DEPARTMENT — GLEN HJTT�S 1/4 1/4,S 1 72 N, RI w 1 _„ -- p m g T 4 c�v; ; Lot Number Block Number ,roe Owner's Mailing Address ; S 104 RU STIC RD # 3 '., C.��i1r) FICI_ r• ` N/A N/A 4 City' Mate Zip Code Ph ,e hftMber .� °� Subdivision Name or CSM Number GLENWOOD CITY WI 54013 ( 71� j� 4� N/A . H. Type of Building: (check one) ❑ City CJ 1 or 2 Family Dwelling -No. of Bedrooms : 0 Village X1 Fublic /Commercial (describe use):_ IlTOWn of SPRINGFIELD J State -Owned Nearest Road Parcel Tax Number(s) - J6 - D - 000 1 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. ❑ New 2. ❑ Replacement 3. ]£7 Replacement of 4. 5. Addition to System System Tank Only Existing System --B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground ound ❑ Sand Filter ❑ Constructed Wetland J Pressurized In- ground IA1 olding Tank ❑ Single Pass ❑ Drip Line D At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (GalsJday /sq. ft.) (Min. /inch) Elevation 2400 -- VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed T anks Tanks ❑ 12000 12000 1 WIESER CONCERET ❑ ❑ ❑ ❑ O ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plu Signature (no stain s): MP/MPRS No. Business Phone Number BENNIE HELGESON 220292 715/772 -3278 Plumber's Address (Street City, State, Zip Code) WI229 770TH AVENUE, SPRING VALLEY WI 547 7 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued . Iss ing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) I � Determination �j Cro . Z60 X. Conditi s of Approval easons for Disapproval: SBD -6398 (R. 07/00) • _ -. - . (C; lei, I - 1 � �l �Pa',,- � � a� }- �F�,_� - - - - -- s k� � o � PI — To e c � J { PL4 L 2 , -Pr t o ll �r G• 1- 1�01��:. 7�. - -era ;� p le �fOl.y�� � 1e., -OUeir �n go,./S. �, l r_ 4c -/cx)C3 �xt+ I + li c�� cr 1 cQhti I-C t Sfe�I FI��Q,� k, r,, ck ry �J C7I C ,�VC �5� 7ro rt: r0 y, y G / Ni1� f j w I re " 1 t \ rr NC -1 LV II� Y - r.a9 �j , R �s w .TocoVi 0 � J Cn �xtnc -e Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary January 11, 2001 CUST ID No.220292 ATTN: POWTS INSPECTOR ZONING OFFICE BENNIE W HELGESON ST CROIX COUNTY SPIA N7649 HWY 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 1/11/2003 Iderihfica>ionNumbers Transaction ID No. 606638 Site ID No. 625334 SITE: Please refer:to both identification numbers, Site ID: 625334, Glen Hills Park above, in alkcorces ondence.with the agenc St. Croix County, Town of Springfield NEIA, NW1 /4, S14, T29N, R15W FOR: Description: Commercial Holding Tank - 2,400 gpd Object Type: POWT System Regulated Object ID No.: 776195 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD- 10571 -P (R.6/99). • In the event this holding tank system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VI of the holding tank component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A meter, with remote reading device, shall be installed by a properly licensed plumber, on the water system, that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • This approval does not include fans for the general plumbing systems or sewer piping leading to the PP P g P g Y PP g g septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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 /instal lation/operation. ` BENNIE W HEL.GESON Page 2 1/11/01 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. Sincerely, ` DATE RECEIVED 12/28/2000 FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. to Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us X OEM INDEX SHEET PROPERTY OWNER: ST. CROIX COUNTY PARKS DEPARTMENT GLEN HILLS PARK JOE GRANT, PARKS DIRECTOR 1049 RUSTIC ROAD #3 GLENWOOD CITY WI 54013 RECEIVED PROJECT NAME: GLEN HILLS PARK DE (,' 2 8 2000 PROJECT LOCATION: NE 1/4, N 1/4, S 14, T29 N, R, 15 W BtDGS W DIV MUNICIPALITY: TOWNSHIP OF SPRING LAKE COUNTY: ST CROIX CONTENTS: Page 1: Plot Plan Page 2: Holding Tank Cross - Section and Specifications Page 3: Sizing Calculations Page 4: W12000 Tank Specifications Name: Bennie Helgeson Signed Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: December 27, 2000 p.O.W.T.S. Conditionally APP ROVED DEPARTMENT OF C0 B UI� NGS MASK* O SEE CORRESP ENCE I U.hn r 1 Y1 ► � e. O i1. � C� � � cJ ¢ 80 c i \ P,b Z . {'r 1 t � o Rew► 'L c v 6'rCL% -V (s �� Qtl. QU2N IC�h� 9 � p 1 f �r Olc f-J I E l'e V. Leo �L Is r _ a � F D L(iwiW) ;art ti '} S - Fe� I FIJI �''`5 `fie-• �'� r� s��z l I .� tS� i �� - rV\, l p I 1 i r"c Ll, CC I i CnNC s ►' HOLDING TANK CROSS- SECTION AND SPECIFICATIONS + Approved Approved Locking Vent Cap Weather Proof Manhole Cover Junction Box with Warning Label 4" C.I. 12" Min — 4" Min Final Grade Vent Pipe d 1 Approved Joint 18" Min A� Water Tight Seal High - Water Alarm Switch — Approved Joint w/ C.I. Pipe Extending 3' Onto Solid Soil SPECIFICATIONS TANK Manufacturer: w oe 5�e�r1 Tank Size: j mrn c-, Gallons ALARM Manufacturer: Model Number: I o i i-1 c,J Switch Type: M�e Vr , , NUMBER OF BEDROOMS OWNER'S NAME: 51 ('roT Cc)uJ, Pa, �' ADDRESS: LEGAL DESCRIPTION: Sec. l y T ai N, R /�W TOWNSHIP/ COUNTY: e + ( a T I SIGNED: LICENSE NU o DATE: s� OWNER: ST. CROIX COUNTY PARKS DEPARTMENT (GLEN HILLS PARK) SIZING CALCULATIONS CAMPGROUND SANITARY DUMP STATION 61 CAMPING UNITS x 25 GPD = 1525 ..................... ...........................1525 PUBLIC SHOWER FACILITY 80 SHOWERS TAKEN x10 GPD = 800 ................. ............................... 800 FLOOR DRAINS 3 FLOOR DRAINS x25 GPD 75 .................. ............................... 75 2400 GPD x 5 DAYS 12,000 GALLONS lIEC -05 {10 TUE1 1251 WIESER CONCRETE TEL:7156475181 p 002 s i 12�" i 144" ' i � r•' s i I G i � A °_+ I cg i �l s T lrri 104" i Q o o o z c Z Z M Tyf7m� Zo 0 r-i Mrn 003• p � O b O� x� = r N n 1X �m Z I'!1t0 ■ '� C� ~ r r 3 O r v r Z D a m��anaN 1 I O� =t OG Q o m r BOO G� F �1 O S 0 r � Z vy � O c 7C CO � � � � � Z LA Fn M n � HOLDING TANK SERVICING CONTRACT Contract Date January 4, 2001 This contract is made between the ---------------------------------------------- Holding Tank Owner(s) Name(s) and 1 Pumpers Name 1 I St. Croix County Parks Department i Cassellius Sanitation Service We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) NE 1/4, NW 1/4, Section 14, T29N, R15W, Town of Springfield -------------------------------------------------- ------------------ 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of St. C r o i x 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; C. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in eff ect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contractor a copy of a new service -contract with the local governmentai unit and the County named above within ten (10) business days from the date of change. to this service contract. Owner(s) Names) (Print) I Owners Stgnature(s) Subscribed and sworn to me on this date: 1 St. Croix County I 1f'r2�..� Parks Department I ( Todays Date I Pumpers Name (Print) I Pumpers Signature Notay Public Signature I 1 Cassellius Sanitation 1 I Service 1 C a /L2c Q 3 Pumpers Registration Number mmission Expiration 559 Drafted by Wisconsin Department of Industry Labor and Human Relations, Bureau of Plumbing CFA ST CROIX COUNTY PARKS DEPARTMENT GLEN HILLS PARK �Oy S o,- HOLDING TANK CONTINGENCY PLAN When tank alarm goes off, contact the pumper you have a servicing contract with. If holding tank leaks or overflows, contact licensed pumper, tank installer and St. Croix County Zoning Department. Licensed Pumper: Cassellius Sanitation Service 715/265 -4613 Tank Installer: Helgeson Excavation Inc. 715/772 -3278 St. Croix County Zoning Dept: 715/386 -4680 i HOLDING TANK SERVICING CONTRACT Contract Date January 4, 2001 This contract is made between the ---------------P------------------------------ Holding Tank Owner(s) Name(s) and 1 Pum er's Name I St. Croix County Parks Department Cassellius Sanitation Service We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) NE 1/4, NW 1/4, Section 14, T29N, R15W, Town of Springfield I 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of St. C r o i x 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract -or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date.of change to this servi ce contract. Owner(s) Name(s) (Print) : Owner's Signatures) Subscribed and sworn to me on this date: : St. Croix County i ',, I % "�M ao Parks Department I `F . Today's Date Pumpers Name (Print) : Pumpers Signature Notary Public Signature I Cassellius Sanitation I Service 1 ot� e, Q3 Pumpers Registration Number t ommission Expiration 559 Draftedby Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing HOLDING TANK AGREEMENT This agreement is made between the governmental unit and holding tank owner(s) Agreement Date Governmental Unit December 12, 2000 Town of Springfield Holding Tank Owner(s) Plan Transaction Number St. Croix County Parks Department We acknowledge that application is being made for the installation of (a) holding tank(s) on the following described property 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. Also, the property cannot now be served by a municipal sewer, or any other type Name and return address of private onsite wastewater treatment system as permitted under Ch. Comm 83 Wis. Attn: Joe Grant, Parks Director Adm. Code or Ch. 145, Wis. Stats. St. Croix County Parks Dept. 1049 Rustic Road # 3 NE 1/4, NW 1/4, Section 14, Glenwood City, WI 54013 Parcel identifier number T29N, R15W Town of Springfield 034 - 1030 -60 -000 As an inducement to the county to issue a sanitary permit for the above - described property, we agree to do the following: 1 . Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit 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. 66.60, Stats. 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis. Adm. Code, to have a water meter installed in the structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter the above- described property on a regular basis to read and /or inspect the water meter. 3. Uwner agrees to pay all charges and costs incurred by the govemmeniai unii or county for inspection, pumping, hauling, ur otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 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 by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) - Please Print Subscribed and sworn to before me on this date: St. Croix County Parks Department Dec. 12, 2000 Joseph G. Grant, Director Notarized Owner's Signature(s) Notary Public Kathleen Standaert J)ou� Lt'-Vi j dll-A-+-- Governmental Unit Official Name, Title - Please Print My Commission Expires Ray McCarthy, Town Chairman April 6, 2003 Governmental Unit Official Signature Drafted by: Per onal info bon you provide may be used for secondary purposes [Privacy law s. 15.04(1)(m)]