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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
u V4PECTION REPORT Sanitary Permit No:
453346 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N9r
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 1
Permit Holder's Name: City Village X Township Parcel Tax No:
Tor erson, John I Springfield Townshi 034 - 1046 -80 -000
CST BM Elev: Insp. BM Elev: BM Desc ' lion: Section(Town /Range /Map No:
v �- 20.29.15.3198
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM '- v
Aeration I ewer
y ,,
Holdin S Ht nlet
00 b (0-1 1 /.0 '0
sv
TANK SETBACK INFORMATION
TANK TO P/L WELL PLLDG. Vent to Air Intake ROAD Dt In
S c B�S.,.ri✓ .�
Septic PT O=— 2 �/ Dt Bottom
Dosing �/ > Header /Man.
Aeration S LO Dist. Pipe
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade
Manufactur o� Demand St Co ver _ S
Model Number "f l
TDH Lift Friction Loss System Head TDH Ft �
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Len th No. nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
9
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT
Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution 7 le Size x Hole Spacing Vent to Air Intake
Pipes)
Length Dia Length Dia Spacing
SOIL COVER x P Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bedrrrench Edges Topsoil �� Yes [M No 0 Yes x No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:__(�/ 2 j_/� Inspection #2: / /
Location: 2860 80th Ave. Woodville, WI 54028 (SW 1/4 SE 114 20 T29N R15W) NA Lot PQ Parcel No: 20.29.15.319B
1.) Alt BM Description = klLd W "" " y j��"
2.) Bldg sewer length = 3 ul' d V C yl , r r
- amount of cover
Plan revision Required? 0 Yes ^ +' No / q
Use other side for additional information. C - - - -- -- �'(i�! i!✓ —
SBD -6710 (R.3/97) Date IV1 i �� I ors Signature / Cert. No.
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Selfety and B;iildings Division County n r
m 201 W. Washington Ave., P.O. Box 7162 S7� ' fJ
aaff Madison, WI 53707 - 7162 Sanitary Permit (to be fil ed in by Co.)
(608) 266 -3151 1 3 3
J epa erc
' State Plan LD. Number �
Sanita Permit Application /� 1!�
k In,1ccofd with= 83.2 Wis. Adm. Code, personal information you provide
ma for ondary purposes Privacy Law, sl5.04(1 xm) Project Address (if different than mailing address)
1. ' pplic tioYr lrlfbfilukti6ie fleas Print All Information
Property Owner's Name U7� Parcel # Lot Block #
Property Owner's Mailing Address Property Location
/ 2/ 3 G 13egr k &� o
P . Q i %., �� ' /., Section 2
City, State / , n /� Zip Code Phone u q
E U CLk / RE �� 7U7i T Z ( I circle
N, R I C.
II. Type of Building (chec all that apply) �"7
Subdivision Name CSM Number
❑ 1 or 2 Family Dwelling - Number of Bedrooms
❑ Public/Commercial - Describe Use 3 — Sn G — W - (!y `
❑ State Owned - Describe Use ❑City _ ❑Village Vownship of
III. Type of Permit: (Check only one box on line A. Co plete line B if applicable)
A. ❑ New System ❑ Replacement System =Mfent/H Tank Repla O nly ❑ Other Modification to Existing System
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision hange of El Permit Transfer to New �) -2
Before Expiration lumber Owner �� D �a X 3 Z Q 3
1 % u
IV. Type of POWTS System: Check all that ap l
❑ Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable s tl ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Cham r ❑ Drip Line ❑ Gravel - less Pipe ❑ Other (explain)
V. Dis ersallTreatment Area Information:
Design Flow (gpd) Design Soil Application Rate( isp�Area quired (sf) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic !!ding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the unde ned, assume possibility for installation of the POWTS shown on the attached plans.
Plumber's Name Print) Plum 's Signature /MPRS Number �_ Business Phone Number
c, �t fin � 6
Pluri712er's Address (Street, M State, Zip e) C� p�
VIII. unt /De artment Use Onl
,Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Agent S gnature (No t s)
Surcharge Fee) �J � -C-/—'
❑ Owner Given Reason for Denial
IX. Conditions of Approval /Reasons for Disapproval ` 1
Aitach complete plans ( theounty ) f"A system on paper not less tharM12 z it inches in size (`
SBD -6398 (R. 01/03) ��y2��Q,QYl1L�l� `yZ2�yLU rc-�.
Safety and Buildings
4003 N KINNEY COULEE RD
commerce.Wi.gov * LA CROSSE Wl 54601 -1831
TDD * (608) 264 -8777
i sco n s i n www.commerce.state.wi.us /sb
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
June 29, 2004
CUST ID No.223475 ATTN: POWTS Inspector
JOE STANG ZONING OFFICE
STANG PLUMBING & ELECTRIC ST CROIX COUNTY SPIA
PO BOX 263 1101 CARMICHAEL RD
WOODVILLE WI 54028 HUDSON WI 54016
CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 06/29/2006
Transaction ID No. 1015899
SITE: Site ID No. 634292
John Torgerson Please refer to both identification numbers,
80TH Ave above, in all correspondence with the agency.
Town of Springfield, 54028
St Croix County
SW1 /4, SW1 /4, S20, T29N, R15W
FOR:
Description: Three Bedroom Holding Tank System
Object Type: POWTS Component Manual Regulated Object ID No.: 966661
Maintenance required; Replacement system; 450 GPD Flow rate;
System: Holding Tank Component Manual, SBD- 10571 -P (r.6/99)
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.
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:
General Approval Requirements:
• 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).
• The proposed tank maybe located in an area subjected to saturate conditions. If it is determined to be subject to
saturated soils at time of installation it must be anchored per Comm. 83.43(8)(8), Wis. Adm. Code to prevent
floatation of the tank.
• Per the Holding Tank manual sited above, a minimum of 3 inches of compacted bedding material must be COnd
provided under the tank. Bedding material is sand, gravel, lime rock or any unsaturated soil material of a sandy APPF
loam or coarser texture. 100% of the bedding material passes a '/2 inch screen.
EF RTMENT
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the CF
requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CORRE
• 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. Stat
' JOE STANG Page 2 6/29/04
• Comm 83.22(7) 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.
Owner Responsibilities:
• Comm 83.52 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).
• 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.
• Comm 83.55 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.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction/instal lation /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 $ 60.00
Fee Received $ 60.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@a commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
r
Y
Jdw Torn - 8ohbag Tonic
Traossdiee # `
Co en mutwhis a" Teduiques
All materialsmust car with Cmm 84 tend be insWW in accxadwee with man
specifcatiom Coosbr WOM methods must comply with the following Component Mm
Holding Tank SBD- 10571 -P (6199)
Location: SW 1 /4, SW 114, Sec. 20, T 29 N, R 1S W
Tom Spcingfield
County: St. Croix
Date: July 27, 2001
w ,
ownw. JobnTmg
Address: 2130 Brackett Ave. _.
Eau Claire;, WI 54701 '
f,
Plumber:
Signetm :
License #, -5•--
A�: 674&PIm App oval Ap131jes lion
SBD 8330
page 1: cover _
2: plot plan =' -
3: teoh detail
4: tail inf mmatim
Tonally .
- oVED
OF COMMERCE
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HOLDINU kDON
Approved Locking
,pjoved Weather Proof Manhole Covet
:nc CaP T Junction Box ` ",.••'";"�
P v L 40 12 '
it pips Final Grads 1
wq� T._
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1
Approved Joint
Ight
High Water
Alarm Switch . 1 _ - -
- 40 Approved
SPECIFICATIONS Joint w/ S L4t
? &j eA, Pvc Pipe
TANK Manufacturer: Extending
Tank Size: �''i° Gallons 3 1 Onto
t Solid Sot'
ALARM Manuf
Model Number.
Switch Type : `�•''� "`
NUMBER OF BEDROOMS: 3
-soh
5•�
OWNER 'S NAME:
A D D R E S S * N
'Z� S� � .�. .,'H 7Et d A�
- SM+ . . T a�t C R � 5--W
LEGAL pISCRIPTION. kr,�,,...... % S ac vs�
TOWNSHIP / MUNIC A ITY:
COUNTY. ,
wF x _ - 2- 2 5a D al
06/25/04 FRI 12:42 FAI 715 386 4686 ST CRX CO ZONING Q001
< 7 1 2683
J 2 1 6 6 p 4 `I 7 KATHLEEN H. W ALSH
REGISTER OF DEEDS
ST. CROIX CO., YI
RECEIYED FOR RECORD
Document Number Document Title 03/ 10/2003 11: 00AN
St. Croix County Exam x
Holding Tank Agreement TR 1 1 . 00
COPY FEE:
Es tate Plan Transaction Number - 6W / PA G COP FEE:
^ � re4__ f6 1 PAGEE S: I
ie0 QQ
Name — (Owner) Typed or pnnted
being duly swom , 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 J11 05 Page tj 57 Document
Number St. C County Register of Deeds Office Recording Area
A parcel of land located in the' /. of the Y. of Section Z0 Na" 'O ffle''9 Co.
W, Town of $t. Croix 2130 Brackett Avenue
County, Wisconsin, being duly described as follows (include lot no. and Eau Clair WI 54702 -1608
subdivision/CSM or detailed legal description): _5 VACR Er
5P171,11' Z4Rsor oP We9V_ 36 Roar o3y - /oy�- $D -avca
A g reement Date: are ldenp N leer (PIN)
3 5 03 of SN S�k S2o rt9N, /Z /51t/ z�yo d,A ,
We acknowledge that application Is being made for ft installation of (a) holding tanks) on the above described property or that continued use of
the wdsung premises requlres that a holding tank be Installed on ovat onse to wastewater purpos of p c ent of se u der Ch. Camm
cannot now be served by a municipal sewer, or any other type 0 i p
Wis. Adm. Coda, or Ch. 145, Wis. Stolz.
As an inducement to the county to Issue a sanitary permit for the above- dascribed property, we agree to do the following:
1. Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code reiadrtg to holding tanks. if the owner fails to have
the holding tank property serviced In response to orders Issued by the govemmertal unit or the Department of Commerce to prevent or abate
a human stealth hazard as described In s. 254.59, State., the governmental un@ (Tam) may enter upon the property and service the tank or
cause to have the tank to be serviced and charge ft owner by placing the charges on to tax bill as a special assessment for current
services tendered. The charges will be aeseasad as prescribed by S. 8fi -0703, state.
2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82A0(3)(e), Wis. Adm. Code, to have a water mater installed in the sWCture.
The water meter shot be Installed by a rdumber authorized by the Depart merit of Commerce to make such Installations, with said Installation
complying with State regulations and manufacturers apecifidotigns. The owner agrees to be llnanaally responsible for are purchase, i
instaltauon. mointunanos, and repair of'the water motor, bind s3raes iG W(Av Ira }nemmental unl: or the Depot: nant of Co- scarce yg :r••or
the above-deSpfbed property on a regular basis to read andior inspect the water motor.
3. Owner agrees to pay oil charges and costs Incurred by the governmental unit or county for inspection, pumping, hauling, or otherwise
servleing and maintaining the holding tank In such a manner as to prevent or abate any human health hazard caused by the holding tank.
The govemmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days (nom the data of notice. In
% even on the tax roll as owne special assessor nt far thwith batement of human health hazard, tat c
ha and the tax be collected as provided m a y be pled
4. The owner, agrees to contract with a person who Is licensed under Ch. NR 119, Wis. Adm. Code, to have the holding tank serviced and to
file a copy of the contract with Not governmental unit. The owner further agrees to Me a copy of array changes to the sense contract, or a
copy of a new seise contract, with the governmental unit within ten (10) business days from the date of change to the 5ervlce contract.
S . The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, wind shall submit to this county on a semlannnral
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 propany maintained.
0. This agreement will tematn in effect only until to County office responsible for the moulatlon Of private oeslta vraslaweter treatment systems
Certifies that the property Is served by either a municipal sewer or a pavers onslte wastewater treatment system that complies with Ch. Comm
83. Wis. Adm. Code. In eddlton, this agreement may be cancelled by axecuting 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 aselgneas 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
ag to be determined by reference to the property where the holding tank IS installed.
0v6ner(4 Nar.,efe±- e1aa:e Print Subscribed and sworn to Detoro ma on this dat�:.. tlrut rrrr+ ;
sSlgrnaaue(s) Notary Wile
en
G m NF P m My Commission E fez
i;nit;nt�d l it S
Govern to Oretted by:
>k�asds J Df:t
Personal Inflalmardan You provide may be used tar secondary purposes [Ptvacy Lew e. 1 (1 )(m
- THIS PAS is PART OF THIS LHGAI- DOCUMENT- DO NOT REMOVE"
This k0birmation must be ocinplated by subnitter: "Mot stile, got d retu
maddres and PIN {xrequirsd). Other Mtormetion Such es fine
graft" ciaug" 1*00 description, etC. may Ire plated Wi fh18 Ilyd( Page of the document w may bo �e Wisconsi statut�r� Of 59.51 T.
document. Note: Use Of this cover Page adds one Aage to document and 2
96 -25 -04 14;42 TO: FROM:715 386 4686 P61
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b• Tha1+�wlarMMlawrrrattll� 1MdC
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' �pWI1N1Iy11�tl11Na1W�M� • ,.a ....�.,..»�;••.. •,t..i.,�'. •. .. ..
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66 -45-04 14s42 TOs
FRONsT18 066 4666 Fat
HOLDING TANK MANAGEMENT PLAN
This Private Onsite Wastewater Treatment Sysfiem (POWTS) has been designed, and is to be installed and
maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBO- 10571 -P
611111999), and the Sr C ea& V County Sanitary Ordinance.
1. This POWTS is designed to accommodate all wastewater generated by a bedroom residence.
2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet
(at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to
empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code.
4. At each service event, the service provider should visually inspect the condition of the tank, risers and
manhole cover(s) and verify that the alarm eptern functions and manhole locking devices are present
Discrepancies are reported to the owner in a timely manner for corrective action. Al corrective actions
shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code.
5. All service events or inspections of this POWTS shall be reported to the county within 10 business days.
6. The owner may not remove any of the wastes from the holding tank's), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes
a failing POWTS and may result in issuance of correction orders or a citation by the county or state.
7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards
for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue
of a person from the interior of the tank may be difficult or ImpossloIe.
8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank
may be installed in the same location (a new sanitary permit is required for such a replacement). Con-
nection to municipal services would also be considered at this time if they are deemed available to the
property.
9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in
accordance with Comm 83.33 Wis. Adm. Code.
10. If there is a problem wdh, or question about this installation, the following persons should be contacted:
a. Installer...... S"t *:4, .� !'.� 6' � r— G of l! s j G
................... -Plane
b. Service ProOder... !ft 0':... e- e_ ?1S = 2j jjY Phone:
c. Co. Zoning or Health Dept..... � L. I
Phone:
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06-25-04 24:25 TO: FROM:6087859330 P93
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ST. CIIX CO�E�MI
RECEIVED FOR RtODRD
03ner2t lliO ltH
St. Croix County raw s
HoWng Tank Agrwftnf Mw e r 11."
COPY M:
Plert Tfltstsactiott IVurnbet - P A COPY Fes:
PALiBS s i
Ante - towner)I An
awom
stag, under OM-
DOOMIXt
biliiO dsdy ,
I. IUefcbas trite oasaedPut away of tits pu+cd of W lasted b St
Catalt Cam1)r. Wltooa>do, reaardad 1st Volam & � - �Z
NumbeI StCnwtCOudtyTtasiaterofbeddrOM-
Mama
A qa� l of bind loos to Mil — /. at t>te y of section ? 2130 ftekett AVG"
t N - R 16 W, Toted of �R,a �;r fyf t2 1 ,_,, $G Ctolx
C M."Y• WWOWAK boas duly dwaind as t WVA 0111c J4+CR(J� Eau C&titt3, WI 54702 -1608
SM or datelled kst! p
sitbdiviasort/C Rs�s" 03i�y
Z�leias' ov tom"
. , 5 3 S ao r"'O Awssv
A/teMeMrr f>t1e. t7f sw i4 St f� s , o
A medatortMlnNAaMo�a► h )hManptrdth)aathaaea awaalbadpa bor#*aominuadwed
a q wk bo i wind onto P�wNiYt r *0 """Of Pro" N aawaya At o ProPat1!
rcW
cannot now
M serves ry s mwWW react, cr ow other tips or P W" °� 1 wastwrosa weatfned system as frstmated under Ch C7amrrr 69
Wb. A*% COda, or Crr. lob, WW Stds.
As an hducaaat b Ore caurO' b bsw a saaLtY pairs for Or abov►dssdlbad prbrwrltr. we epee m do the faMeII
MIA.Adm.fbdeataWipmMatdr+ptinl�s 119feom+a hM
OaeMr J�eaa as Oolrfoatr b vi w I n fell rapidiarrwlde d o Comm 83. uds or fro Oaparbhed dCalMlwoe b Pra�nrt a a
the h01Rro ietdc ptopxy aavWad N balddR betrad by the poreR (T sir end t VIN the tads or
e human IsaMh Iwiand as daeaOred h a 2SS 0e, 1Mab, Ow 9�'aa d teiR tfatwd an be M a � """mot for arrant
Ocoee d haw on W* b be tM *W and dWW Ow amw by Ow v d�aa
mnownd. The dwpae W be atieeaded as praee,ibsd by a- Ban= lbb.
y The orwisr apnas. psrerant m a Comm WS Cl? aw Coma 62 A(3Ka1, WhL �� m 10 hum 4 VOW WAw make such jrMO . +A+ "M
ea�oft Itch $tah rd � a� SNOW Ths swot OF M► b be iwadeM htpe tar the purohMa. 111111 to
ihs .dMq paP� a Of b d b e�aq�a r kwpea ei or& or"De�at of Camn>etae a rnw�
I no* W e e
Ow tawr alAeea to Pay as d1arDM W4 wad rtaand by rw Y f a a WW ft for hspaoi sI p byft l
a ottwadaa
O nd mslnaWnp hddlrb sic In such a mama as b Pr at y sw MM hanraa IWaMt h0 d e A m a dMW of r WOW kv
Tile a
arargl ril W th et+aM' d any COW �r Mwa b• pdd by OM oaerr edOta Oft (� days fi
the wart On owswr dace not Pay fw Oeeb wMhh WAIF (1 days• ffie Mw apace go WX Orat W the msb and rapes bar w. Placed
on are tax roil as a tgpmKw asawment fur ON abeMnrart of a human hsWh heai, and OM taK sirs w caeaamod as pmNded by Mw
oonttad weh a Oaaast1"14 under Ch MR 11R W& Adis. Cale6 Iola* Ore *O e Acsd O r o
4. me s ew s b eer Ora udt The oeewt haOrr apraw b fee • arspT of arty d� b
�,y'� "nd *A v
r a wlM► �youatrtwANitaaalnas( C) a aMSa .dWSafdano.mriaaeMo.
L Itie arw sDr to o atYa et wfer a Farrar loeraed alder Ch. NR 113. Wk. Adm. COde. %ft do submk b the aaurdy at a 1140010101 Owe Or IM hd ft tit The QOMW Md V* W gouty M"
away ttpat the 0 ` P' b InwadbMa .
�mehd **jwkwlwtVuwOVrvpw%a^dsagerr WkW"YhwlMl Ouftbrow"91"WIlYWROW
b. This apreemsrA v,a rMrwh in e0ed odyy umi rig ows* dboe r tat Ore mptdetan or Prh<au OWA VMWAWr treeaaers aianms
peWks 0M
t pvpetty b ssrvsd by ewrar s mutddPM ariNr a a pdwb oraAe uasu+saMr waabwed •Y' 0a aeisaYart weh Ch. Can"
SS. m. Cc& In POONW-0 ara� M" be 091 by emu" awe osooedd+p seal o so p an'MU+ isferarraa b V" Wb. Ad
sgraansnthachawdwwMch cast orM,aOwWa bnisbedlbmYerdoir+ mMePraPNb.
7. Iles aprt »isertt ahMt be t btdes0 upol Ote Orwtar Ore twYs of the oww, sad a7aISwQ d M owner TM OWW Maul sulbet Ws apraarrwt
m 00 wp wr d deeft sad the apraelwert seal bs reoadad M the mg MW of deeds in a weamar vAadt ws PM* Ors askance d Ote
weawt in ddKffk dby rdaa noebOtafsapwNwheM0e"ship ttolwww.
M and anon bbelow meR " 40
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riot tJlPlll arMbd br.
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no PARR 15 PART OF TNIli { RBAL p000lIRMT- rM) IICR 1lEeA0tIE'
7NstrbnoeWnmueta aace NOM dhysubAlA . dad (rn9rdar0 pyer)ebrmeNonaashaarea
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doawwsc Vaa Of ft owar salda erM b daoument erM
86 -25-84 14:42 TOt FROM%715 386 4685 Pat
swr
i
Safety and Buildings
s 4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
www.commerce.state.wi.us/sb
www.wisconsin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
June 29, 2004
CUST ID No.223475 A7TN. POWTS Inspector
JOE STANG ZONING OFFICE
STANG PLUMBING & ELECTRIC ST CROIX COUNTY SPIA
PO BOX 263 1101 CARMICHAEL RD
WOODVILLE WI 54028 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/29/2006 Identification N umbers
Transaction ID No. 1015899
SITE: Site ID No. 634292
John Torgerson Please refer to both identification numbers,
80TH Ave above, in all correspondence with the agency.
Town of Springfield, 54028
St Croix County
SW1/4, SW1 /4, S20, T29N, R15W
FOR:
Description: Three Bedroom Holding Tank System
Object Type: POWTS Component Manual Regulated Object ID No.: 966661
Maintenance required; Replacement system; 450 GPD Flow rate;
System: Holding Tank Component Manual, SBD- 10571 -P (r.6/99)
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.
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:
General Approval Requirements:
• 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).
• The proposed tank maybe located in an area subjected to saturate conditions. If it is determined to be subject to
saturated soils at time of installation it must be anchored per Comm. 83.43(8)(g), Wis. Adm. Code to prevent
floatation of the tank.
Per the Holding Tank manual sited above, a minimum of 3 inches of compacted bedding material must be
provided under the tank. Bedding material is sand, gravel, lime rock or any unsaturated soil material of a sandy
loam or coarser texture. o o e •
• 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.
�j'� • 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 See. 145.20(2)(d), Wis. Stat
JOE STANG t Page 2 6/29/04
• Comm 83.22(7) 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.
Owner Responsibilities:
• Comm 83.52 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).
• 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.
• Comm 83.55 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.
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 $ 60.00
Fee Received $ 60.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMART coder 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz @commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Wisconsin Department of Commerce a PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and Building Divisior
'V INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 420728 0
GENERAL INFORMATION 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:
Tor erson, John I Springfield Townshi 034- 1046 -80 -000
CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range/Map No:
CST BM E(ev: Insp. BM Elev:
20.29.15.3198
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
I� E Coy A�"
Dosing � Alt. BM
Aeration B �- O's t 3 dg. Sewer C
'G c
HOiding S t Inlet
- 7 St/Ht Outlet
TANK SETBACK INFORMATION YbuT�h c
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ?^ ) 4 Dt Bottom
Dosing Header /Man.
Aeration VT Dist. Pipe
olding B t. System
65 l 2r/
� Final Grade
PUMP/ PHON INFORMATION. o�w P V K
Vrff u — facturer Demand St
GPM
Model Number Led
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM '
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO J P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Type Of System:
Model Number:
DISTRIBUTION SYSTEM A 11 4
Header /Manifold Distribu ' n x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacin
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx SeededJSodded xx Mulched
Edges Bed/Trench Center Bed/Trench Ed Topsoil g p F Yes Ej No (-] Yes
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ Inspection #2: / !
Location: 2860 80th Ave. Woodville, WI 54028 (SW 114 SE 114 20 T29N R15 ) NA L t / - Parcel No: 20.29.15.319B
1.) Alt BM Description �G
2.) Bldg sewer length
- amount of cover = u
Plan revision Required? r
q �_ _, Yes [] No
Use other side for additional information. _�_
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
1
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Sanitary Permit Application Safety & Buildings Division
+ In accord with Comm 83'21, Wis. Adm. Code 201 W. Washington Ave.
PO Box 7302
See reverse side for instructions for completing this application
`�SCOnSfr Madison, WI 53707 -7302
Personal information you provide may be used for secondary purpo .
Department of Commerce p p (Submit completed form to county if no;
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach com lete plans (to the count) cop) only) f r the sRfiGEF&iU less t ian 8 - 1/2 x 1 1 inches in size.
County 5T. CP O f Staley ' ita rmit Number ❑ heck if revision to previous applica ion State PI 1. D.1 e� _ / O
I. Application Information - Please Print all Information JAN 2 9 7 1 JU 3 Location:
Property Owner Name Property Locatiop -�
ST. CROIX COUNTY J �p �—
GG T C_ w� OFFICE Q/4 A. S C) TC r,N. CE or
.R j2L Property Owner's Mailing Address Lot Minter Block `�
Nr
I� O. X605 S- Z`/Mo PS v �r
GWtS
ISO �R 14GK� -T — f - 3t: Rots
City, State Zip Code Phone Number Subdivision Name or CSM Number
� 4u C LW 12�� 54 -70- 2 ( - 7 t5 )gas} — 555 1 N / A
II Type of Building: (check one) ❑ City
I or 2 Family Dwelling - No. of Bedrooms: 5 S - h u rl J vj It t,� °r ❑ { •own of
• Public /Commercial (describe use): '��� ��� I/ Jf r
• State - owned
III Type of Permit: (Check only on box on line A. Check box on line B if applicable) Nearest Road fid lr<4 St
A) 1. ❑ New System 2. Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) +
stem Tank Onlv Existing System 0 34 In 4, c,
$) 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
❑ Pressurized In ground ) aIiolding Tank ❑ Single Pass ❑ Drip Line
❑ At - grade O Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
0j, f �QrS�'' Required Proposed Rate (Gals./day/sq. ft.) (Min. /inch) Elevation
qC
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑ ❑
VII Responsibility Statement 2 p3 /N PAS `� - %h / hex /� roC�55
I, the undersigned, assume responsibility for installation of the PO`AITS shown on t a a^1 Tans.
Pl%ibces Name (print) PI nature (no st s : MP /MPRS No. Business Phone Number
715- T
Plumber's Address (Street, City, State, Zip Codey
KJ
32 2D, D E AU �-A � -6 -7 3
VIII C unty/Department Lge Only Ct-e.k- In p a
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 1 uin gent Signatur stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee) $ - �,o 0, Q 7 -3 / 12 '-
Determination a3 �21�
IX. Conditions of Approval /Reasons for Disapproval:
� -� � wi � a?ODI.
l�r46�`v —1 o��.v,`. — t�t^'Ic., way ` �,� d `�Aac,� e d f6 �G�—
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ej_0 -to o - �.-tiV ,�,r�. Wits L4 a Zdd f�-
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�� SBD -6398 (R. 07/00) eq �4-a eOA Q (,t ae �-
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Coard
Pam Quinn
From: Jansky, Leroy [Ijansky @commerce.state.wi.us]
Sent: Monday, June 16, 2003 3:33 PM
To: 'Pam Quinn'
Subject: RE: Missing mail
The plumbing does not sound correct to me. I could go out to look at it
or
have the state plumbing consultant take a look when he's around there
next ��
time. �_4 U Cc `7� O
• - - - -- Original Message - - - --
• From: Pam Quinn /
• Sent: Monday, June 16, 2003 8:03 AM
• To: ' Jansky, Leroy'
• Subject: RE: Missing mail
> Thanks for your phone message Friday p.m. - I didn't get back until
5:00
• either, so didn't return your call. I let the builder know that we'd
• found
• the information and fee, so he could enjoy his weekend!
• Separate topic: I went out to inspect a holding tank that Tom Fisher
• installed a year or so ago without a permit issued by our office.
[Sent
> him
> a warning letter, etc.] Anyway, the tank location is OK, but am
concerned
> that the wastewater is routed from a sump in the house that exits via
a 2"
> forcemain out the basement window and is above ground for approx. 15
ft.
• before pipe goes underground to tank inlet. Don't know for sure, but
• likely
• the 2" is coupled to 4" inlet at the tank. Is it OK to have exposed
SCH
> 40
> pipe like that, or is it going to be subject to freezing? Even with
> pressure from pump, I would be concerned about making sure void volume
> moving too slow when it drains back into house and building up ice.
Maybe
> I'm full of caca ... hazard of working in our business! Let me know if
we
> need to take any action, since no one is living in the house yet.
• - - - -- Original Message - - - --
• From: Jansky, Leroy [mailto:ljansky @commerce.state.wi.us]
• Sent: Thursday, June 12, 2003 6:43 PM
• To: 'Pam Quinn '
• Subject: RE: Missing mail
> As of 5/16/03 their letterhead said PO Box 1645, Madison, WI
53701 -1645.
• Plat review takes our fees and then sends them on to DComm. The other
• paperwork stays at DOA and is sent to me directly from DOA.
> - - - -- Original Message---- -
> From: Pam Quinn
> To: 'ljansky @commerce.state.wi.us'
> Sent: 6/12/03 4:42 PM
1
I
> Subject: Missing mail
• Just a follow -up; I am trying to locate a phone number for the central
• mail
• office in Madison via the dept. directory. I can't find a specific
• listing
• for Land Info Services, nor do any of the DOA offices have a PO Box
like
> 1645 ... most are 7000 series numbers. I can start a trace with the
> Hudson
> post office as of tomorrow, since we have metered outgoing mail, but
it
> may
• take awhile. What are the options for getting the release at this
• point? I
• understand Plat review is the clearing house for fees, etc. but we've
• sent
• this twice into some void in the post office boxes! Glad it's not my
• tax
• return: -)
• Pam Quinn, Zoning Technician
• St. Croix Co. Zoning Dept.
• pamq @co.saint - croix.wi.us
2
Pam Quinn
From: Kevin Grabau
Sent: Thursday, May 01, 2003 8:12 AM
To: Pam Quinn; Rod Eslinger; Jon Sonnentag
Subject: FW: FORCEMAIN COVER DEPTH
- - - -- Original Message---- -
From: Jansky, Leroy [ mailto :ljansky @commerce.state.wi.us]
Sent: Wednesday, April 30, 2003 7:44 PM
To: 'Kevin Grabau '
Subject: RE: FORCEMAIN COVER DEPTH
That's a good one. It is my understanding that a forcemain is
equivalent to
a pressurized buiding sewer and thus the minimum depth for use in an
onsite
system is 18 inches. Areas were snow cover will be removed must be
insulated. I don't believe that you'll find any specific reference to
forcemain bury depth. There is also a general statement in Comm 83
about
protecting compoments from freezing. n
- - - -- Original Message - - - --
From: Kevin Grabau
To: Leroy Jansky (E -mail)
Sent: 4130/03 4:44 PM
Subject: FORCEMAIN COVER DEPTH /
Leroy, -t
Maybe I need to go home .... I cannot 1113U Illy dtl�swers ....... minimum depth
for
buried forcemain is...?
Kevin Grabau
St. Croix County Zoning Department
1101 Carmichael Rd
Hudson, WI 54016
715.386.4680 n
keving @co.saint - croix.wi.us Lj 7Z5 — - 7 - 7—
1
Pam Quinn
From: Rod Eslinger
Sent: Monday, May 19, 2003 12:16 PM
To: Pam Quinn
Subject: RE: Preferred Acceptance Company (Holding tank permit)
Has this been handled?
- - - -- Original Message---- -
From: Pam Quinn
Sent: Tuesday, February 25, 2003 2:43 PM
To: Rod Eslinger
Subject: RE: Preferred Acceptance Company (Holding tank permit)
Hey Rod,
I double- checked with the owner and confirmed that Tom Fisher did install the tank. Have to find his mailing address;
seems to be an out -of -county plumber. Listed status with DCOMM is "renewal" as of 12/31/02, but they don't list
addresses. Anyway, do you want to be on the cc: list for the attached letter? Kevin found the violations report booklet
you were looking for. << File: Preferred Acceptance.doc >>
Thanks!
- - - -- Original Message - - - -- [ Pam Quinn]
From: Rod Eslinger
Sent: Tuesday, February 25, 2003 9:31 AM
To: Pam Quinn
Subject: Preferred Acceptance Company (Holding tank permit)
Pam,
I need to have a few questions answered b-4 taking a position with regards to the permit you asked me to review.
When was the HT installed (actual install date)?
Was installed before we rec'd the pumping contract in 2001?
Who installed the tank? Was it Tom Fisher, who's obtaining the permit?
When did the zoning office rec'd the permit fee and application? The permit application was not date stamped.
I'm kind of thinking that we should issue Tom Fisher a citation for installing a tank w /out a permit. Or issue him an
official warning. I believe the warnings we write may get published in the WI Construction Codes Report for all to
see. (See Kevin)
The ordinance number violated here is 17.70 (3) (a) 2. Installing a any tank w /out a permit is not acceptable,
except when its an emergency, Tom should know better, if in fact he installed the tank.
Rod
Rod Eslinger
Zoning Specialist
St. Croix County Zoning
1101 Carmichael Road
Hudson, WI 54016
Ph. 715 - 386 -4680
Fax 715 - 386 -4686
1
ST. CROIX COUNTY
WISCONSIN
, ZONING DEPARTMENT
ST. CROIX COUNTY GOVERNMENT CENT
N N N / / N ■ N ■ •����. 1101 Carmichael Road
Hudson, Wl 54016 -7710
Phone: (715) 386 -4680 Fax (715) 386 -4686
r .
March 21, 2003
Mr. Tom Fisher
N324 County Rd. D
Eau Galle, WI 54737
RE: Holding Tank at 2860 8& Ave., Springfield Township
Dear Tom:
Subsequent to our telephone conversation last month, s tank at the Preferre h oping to get a
written response from you regarding the installation o f a holding
Acceptance Company rehab project in Springfield. an of
However, I haven't received the promised letter and am to i gu ars a of n danit a f pelt an
regarding the installation of a POWTS component prio
without an inspection by our staff. The Zoning Department will not tolerate this type of oversight
on the part of our plumbers.
or
Comm 83.21(1) states that "the installation or co nstruc ti o n l he owner of the property on
continue unless all of the following have been fu lfilled: Subsection (8) requires the
the POWTS is to be installed possesses a valid sanitary permit."
P
ermit card to be posted in plain view and must remain postd until the m in sta ll ation s
POWTS re q u ired under s
c ompleted and inspected. Per Comm 83.26(2)(x) When a sanitary P covered nor any POWTS component
Comm 83.21 (1), no part of a POWTS component may b unit or department has had an opportunity o inspect the
put into service until the governmental (b also re quires the master plumber to
system in accordance with this subsection. Subsection ) q
notify the zoning department when the work will be ready for inspection.
Regardless of your assumption that John Torgerson was responsible to submit the application
and fee for permit issuance, it was your responsibility to mak d w ation. pro perly
posted and contact the zoning department for an inspection of the tank prior to in
You have installed other systems in St. Croix County with no apparent problem following
required procedure dure and this particular case may be no more than someone "dropping the ball" on
q permit. The house has not been occupied due to the extensive renovations
obtaining a sanitary p livable, but it will be for sale or rent in the near future•
needed to make the foreclosed property
Luckily, we have obtained the necessary holding tank servicing contract and holding tank
A
agreement from the owner, who has made arrangements to give a zoning inspector access to take
elevations and measurements to verify the system matches the state - approved plans.
In the future, you will need to track all of your applications for sanitary permits and make sure
the permit card is issued and posted before you schedule any POWTS installations. Always call
us for an inspection before installing any components; we can check our records and make sure
all the paperwork is in order. If you have any questions regarding this particular permit or St.
Croix County procedures, do not hesitate to contact the zoning office.
S'
Pam Quinn, Zoning Technician
Cc: Steve Fisher, St. Croix County Zoning Administrator
Leroy Jansky, Wastewater Specialist, Dept. of Commerce
John Torgerson, Preferred Acceptance Company
unn County Zoning Dept.
ile
F s
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
M / P N N M ■ — value ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
��• �- - —®— Hudson, WI 54016 -7710
(715) 386 -4680 FAX (715) 386 -4684
February 25, 2003
Mr. John Torgerson, President
Preferred Acceptance Company
2130 Brackett Ave.
P.O. Box 1605
Eau Claire, WI 54702
RE: 2860 80 Ave. Holding Tank Permit Application
Dear Mr. Torgerson,
Enclosed are the Holding Tank Agreement and Holding Tank Servicing Contract as
promised in our telephone conversation yesterday. You will need to have both notarized
and the Agreement recorded as part of the deed for the property through the Register of
Deeds office here at the government center.
The permit application submitted to our office on January 29, 2003 did not include the
$300 sanitary fee and arrived after- the -fact; it should have been processed and a permit
issued before the holding tank was installed back in 2001. The plumber, Tom Fisher,
should not have installed the tank before receiving an approved application and state
permit card. Per WI Admin. Code Comm 83.21(1)(b) "the modification of an existing
POWTS may not commence or continue unless the owner of the property on which the
POWTS is located possesses a valid sanitary permit and has obtained plan approval for
the modification under s. Comm 83.22, if the modification involves the addition or
replacement of any of the following: 1. a POWTS holding component." Although the
project received conditional approval by the state (letter dated 8/14/01), that paperwork
and the permit application is required to be submitted to our office for review and permit
issuance.
Tom Fisher will be cited for violating Wisconsin State Statute 145.19 Sanitary Permit (1),
Wisconsin Administrative Code COMM 83.21 (1) (b) and Article 17.70 (3) (a) of St. Croix
County Zoning Ordinance.
I
3 f (a16 3
y
4 - 4 �
I'�
Torgerson — Page 2
After we receive the notarized and recorded documents, along with the sanitary fee, we
will process the application. An inspection will be scheduled to verify as much
information as we can on the holding tank connection, its location, sizing, etc. for
documentation in our files.
Thanks for your cooperation with regard to submitting the necessary documents to
complete the sanitary permit process for this property. If you have any questions or
concerns that I can address, please feel free to contact me at the zoning office.
Sin
R;-L
am Quinn
Encl. Holding Tank Servicing Contract
St. Croix County Holding Tank Agreement
Cc: Tom Fisher, Plumber #231491
ile
Safety and Buildings
' 4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
iscons n www.w
www.commerce.state.wi.us/sb
v
isconin.gv
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
August 14, 2001
CUST ID No.231491 A7TN.• POWTS Inspector
ZONING OFFICE
THOMAS C FISHER ST CROIX COUNTY SPIA
N324 CTY RD D 1101 CARMIC14AEL RD
EAU GALLE WI 54737 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/14/2003 Identification Numbers
Transaction ID No. 668183
SITE: Site ID No. 634292
JOHN TORGERSON Please refer to both identification numbers,
80TH AV above, in all correspondence with the gSnc
TOWN OF SPRINGFIELD
ST CROIX COUNTY
SWIA, SW1 /4, S20, T29N, R15W
FOR:
DESCRIPTION: THREE BEDROOM HOLDING TANK SYSTEM
OBJECT TYPE: OWl' - T SYSTEM REGULATED OBJECT ID NO.: 806638
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 letter including instructions and information relating to
proper use and maintenance of the system must be given to the owner and each subsequent owner upon
completion of the project.
• A meter, wi remote reading d exice, shall be installed by a properly licensed plumber, on the water system, that
adequate y measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do
not discharge into the sanitary system.
�A notarized Holding Tank Agreement between the local governmental unit/Municipality and the property owner
is required prior to the issuance of a sanitary permit. A Holding Tank Servicing Contract may also be required
if no other service provider for the holding tank has been identified.
• The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code.
• The proposed tank appears to be located in an area subjected to saturated conditions. Therefore, it must be
anchored per Comm. 83.43(8)(g), Wis. Adm. Code to prevent floatation of the tank. Doc tTie`
method of anchoring and calculations to p floatation are to be attache to the plan prior to issuing of the
sanitai�"riT1n:
1
THOMAS C FISHER Page 2 8/14/01
• When this tank is no component, longer used as a POWTS it shall be abandoned by complying with Comm
g P
83.33.
• Comm 83.52 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). In addition, 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.
• 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.
• 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.
• 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 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.
Sincerely, FEE REQUIRED $ 60.00
,�- FEE RECEIVED $ 60.00
BALANCE DUE $ 0.00
Charles L Bratz
POWTS Plan reviewer II- Integrated Services WiSMART code: 7633
(608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM
cbratz @commerce.state.wi.us
cc: JOHN TORGERSON
4 .
I
John Torgerson - Holding Tank
Transaction #
Construction Materials and Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manual:
Holding Tank, SBD- 10571 -P (6/99)
Location: SW 1/4, SW 1/4, Sec. 20, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: July 27, 2001
Owner: John Torgerson RECEIVED
Address: 2130 Brackett Ave.
Eau Claire, WI 54701 AUG - 3 2001
Plumber: Tom Fisher & BLDGS DW
Signature:
77
License # MPRS 231491
Attachments: 6748 -Plan Approval Application
SBD 8330
Conditionally
page l: cover APPROVED
2; plot plan
3: tank detail KENT of COMMERCE
4: maintenance information
am CORRESPONDEN
page 1 of 4
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HOLD1Nr, fANK•CRUSS- ,sfrCT1- ON -ANU SPj'C1h'TCA1LU?fb
Approved Approved roved Locking
Vent Cap Weather Proof Manhole Cover \ L
Junction Box �^� r•a.�...� w e
4 v L c, 40 12"
Vent Pipe y 4 „
Final Grade �
Approved Joint
�w
Weser Tight
Seal High Water
Alarm Switch 1 Dr _..1
SPECIPICATIONS Ca�v Approved
Joint w / s�4o
TANK Manufacturer: QA PvC- Pipe
Tank Size: 3wr.a Gal long Extending
1 3' Onto
ALARM Manufacturer: SS ��Q•�i"° S ""s Solid Soi'
Model Number:
Switch Type -
NUMBER OF BEDROOMS 3
G l a. d 6.
1 ,
OWNER'S NAME:
ADDRESS: 2�3a S �w• et�, 1+'r C%st.k U11-01 STO Z1if.o �d (�••• WS tw
LEGAL DISCRIPTION: S 1 41 SZ k,Sec. to ,T It N +5' W
TOWNS HIP /MUNICIIALITY:
COUNTY: S�• Gve ;�
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P "-�X ° -
gc(� ;?-a S
ORIGINAL ,
1360
Wisconsin Department of Commerce SOIL EVALUATION REPORT Pag e 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing
ounty
Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 034- 1046 -80
Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
P rope rt y owner Prope L
Torgerson, John PR,9F45f2,9D Govt. Lot SW 114 SW 114 S „4U 15 W
roperty Owner's Mailing Address Lot # Block # Subd. Name or C M -i
2130 Brackett Ave.
City State Zip Code Phone Number Cit Village Town Neliit _fit Roll__
Eau Claire WI 1 54701 715 - 834 -5551 Springfield 2860 80 !ARL;�
New Construction Use: H Residential / Number of bedrooms 3 Code derived design flow rat t GP
.
i \
Replacement Public or commercial - Describe ri rti
Parent material l over till Flood plain elevation, if applicable —/
General comments
and recommendations: Soils lack A +4 "; holding ta nk only
F f I Boring # Boring ]a Pit Ground Surface elev. — 89.5 ft. Depth to limiting factor 8 in. Soil Application Rate
Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0 -8 10YR 3/2 - sl 2 m gr ds cs 2flm .5 .9
2 8 -16 10YR 5/4 c2p 7.5YR 5/8,4/6 sl 0 m mvfr - if .3 .4
I
P -1 Boring # Boring IN Pit Ground Surface elev. —90.0 ft. Depth to limiting factor 4 in. Soil Application Rate
Horizon i Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0 -4 10YR 3/2 - sl 3 m gr ds cs 2flm 5 9
2 4 10 10YR 312 fl 7.5YR 4/6 sl 2 m sbk dsh cs if .5 .9
3 10 -19 10Yr 5/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - .3 .4
' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Number
Henry F. Grote , 222774
Address Certified Soil Testing ate Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 7/14/2001 715- 233 -0398
I
Property Owner Torgerson, John Parcel ID # 034 - 1046 -80 Page 2 of 3
Fil Boring # Boring
Pit Ground Surface elev, 98.2 ft. Depth to limiting factor g in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh.
1 0 -4 10YR 3/2 - sl 3 m gr ds cs 2f1m .5 .9
2 4 -8 10YR 3/2 - sl 2 m sbk dsh cs if .5 .9
3 8 -16 10Yr 5/4 c2p 7.5YR 5/8,5/3 sl 0 m mfr - - .3 .4
acs +4
❑Boring it Boring
Pit Ground Surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
' I
' I
I
I
I
❑Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Eff#7
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
ii
I
i
I
Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
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.
SBD -9330 (R. 07/00) Certified Soil Testing
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Ibcumant 654690
Number KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
08 -24 -2001 9:30 AM
SHERMF'S DEED SHERIFFS DEED
EXEIPT # 14
CERT COPY FEE:
COPY FEE:
TRANSFER FEE:
RECOR ING FEE: 34.00
RETURN TO:
Garvey, Anderson, Johnson,
Oeraci & Mirr, S.C.
Attu: John D. Leary
P.O. Box 187
Eau Claire. 54702 -0187
Parcel Identification Number:034- 1046 -80
I
VOL 4 00 PAG1,4J8
t
Document r ' F jl E D
Number
GL
�' 5t Gj & Y
SHERIFF'S DEED
RETURN TO:
Oarvey, Anderson, Johnson,
Oeraci a Min, S.C.
Attn: John D. Leary
P.O. Box 187
Eau Claire WI 54702 -0187
Parcel Identification Number: 034 - 1046 -80
WHEREAS, pursuant to an Judgment rendered in the Circuit Court of St. Croix County,
Wisconsin, on April 2, 2001, in an action between
PREFERRED ACCEPTANCE COMPANY,
Plaintiff(s),
V. Can No. 00 CV S18
CHERI L. SCHIMMEL,
PAT SMITH,
Defendant(s).
and, after due advertisement, the premises hereinafter described were sold on July 24, 2001, to
Preferred Acceptance Company, the highest bidder therefore, for the sum of $73,000.00,
AND, WHEREAS, said purchasers are now entitled to a conveyance according to law,
NOW, THEREFORE, the undersigned in consideration of the payment to him of the
aforementioned amount, receipt of which is hereby acknowledged, hereby conveys to Preferred
Acceptance Company, the following property in St. Croix County, Wisconsin:
South 24 rods of West 36 rods of SW 1/4 of SE 1/4 of Section 20, Township 29
North of Range 15 West, St. Croix County, Wisconsin.
This conveyance is subject to all unpaid real estate taxes and special assessments.
T
VOL 1 05 PAGE 459
Dated this q" day of w , 2001.
Dennis D. Hillstead, Sheriff
St. Croix County, Wisconsin
ACKNOWLEDGMENT
STATE OF WISCONSIN )
)ss:
ST. CROIX COUNTY )
Personally came before me this / da y of GG� W �
, 2001, Dennis D. 1illstead,
known to me to be the individual and officer described he in, and who executed the foregoing
conveyance and acknowledged that he executed the same as such Sheriff, for the uses and
purposes therein set forth. yy, � �,.
iJ. 6 ('eupA/ ,Notary Public
IIOTA#y PUBIC ST
MkRy J. w omm State of Wisconsin
1E
o O f f
My Commission is pe;mment (if not, O 3
This instrument was drafted by John D. Leary, Garvey, Anderson, Johnson, Geraci & Min, S.C.
• • r w ti
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SPRINGFIELD
COMPUTER NUMBER 034 - 1046 -70 -000 Parcel Number 20.29.15.319A
OWNER NAME: First MITCHELL Last BLOOM
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
2617 90TH AVE
SECTION 20 TOWN 29N RANGE 15W %160 '/440
Line Description Line Description
TOTAL ACREAGE 34.600 PLAT LOT BLK
01 SEC 20 R1 4.6A INS 15
02 SE SW 5E E XCS24RDSOFW 16
03 36 RDS (EZ -U- 1125/499) 17
04 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
@W u ram Sank era Asaoclaeon 1967
6728Sa
DOCUMENTNO, U 0 1 8 H 8 P G 5 5 0 KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX Co., YI
REAL ESTATE MORTGAGE RECEIVED FOR RECORD
(For Consumer or Business Mortgage Transactions) 03 -07 -2002 9:00 AM
PRRFRRRRD ACCEPTANCE rQMPANY
(`Mortgagor," EX�t?PT�t
whether one or more) mortgages, conveys and warrants to CHARTER BANK EAU
CT,ATRR 1_ni_n_ w_ Clairernont Avenue Rau Claire. WT REC FEE: 13.00
54701 ("Lender') TRANS FEEL
inoonsiderationofthesumof THIRTY-FIVE THOUSAND AND NO 1100 CERT COPY FEE:
PAGES: 2
Do llars
($ 35,000.00 J, loaned or to be loaned to PREFERRED ACCEPTANCE Recording Area
COMPANY -
('Borrower," whether one or more), Name and Return Address
evidenced by Borrower's nots(s) or agreement dated FEBRUARY 25, 2002
CHARTER BANK EAU CLAIRE
the real estate described below, together with all privileges, hefeditaments, easements and 1010 W. CLAIRENDNT AVE.
appurtenances, all rents, leases, issues and profits, all claims, awards and payments made EAU CLAIRE, NI 54701
as a result of the exercise of the right of eminent domain, and all existing and future
improvements and fixtures (all called the "Property" to secure the Obligations described In J RITCHIE
paragraph 5 on the reverse side, including but not Ilmited to repayment of the sum stated
above plus certain future advances made by Lender.
1. Description of Property. (This Property i5 nOt the homestead of Mortgagor.) 0 t 4 - 1 04 6 - A 0
(ls not) Faroe en er o. ., / TT
n C �
THE SOUTH 24 RODS OF THE WEST 36 RODS OF THE SW 1/4 OF THE SE 1/4 OF 7
SECTION 20, TOWNSHIP 29 NORTH, RANGE 15 WEST, ST CROIX COUNTY,
WISCONSIN.
If checked here, description continues or appears on attached sheet.
D It checked here, this Mortgage is a construction mortgage.
7 If checked here, Condominium Rder Is attached.
2. Title. Mortgagor warrants title to the Property, excepting only restrictions and easements of record, municipal and zoning ordinances, current taxes and
assessments not yet due and n/a
3. Escrow. Interest wi 11 be paid on escrowed funds if an escrow is required under paragraph 8(a) on the reverse side.
hwm hvie nott
4. Additional Provisions. Mortgagor agrees to the Additional Provisions on the reverse side, which are incorporated herein.
The undersigned acknowledges receipt of an exact copy of this Mortgage.
NOTICE TO CUSTOMER IN A TRANSACTION GOVERNED BY THE WISCONSIN CONSUMER ACT
I s DO NOT SIGN THIS BEFORE YOU READ THE WRITING ON THE REVERSE SIDE, EVEN IF OTHERWISE ADVISED.
DO NOT SIGN THIS IF IT CONTAINS ANY BLANK SPACES.
c YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN.
d YOU HAVE THE RIGHT AT ANY TIME TO PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS AGREEMENT AND YOU MAY BE
ENTITLED TO A PARTIAL REFUND OF THE FINANCE CHARGE.
SignedandSealed FEBRUARY 25, 2002
PREFERRED ACCEPTANCE COMPANY (SEAL)
WISCO CORP PATION
! (Type of Organization)
By:� VV r L) (SEAL)
JOHN T ERSON PRES ENT
By: 1 (SEAL) (SEAL)
By: (SEAL) (SEAL)
By: (SEAL) (SEAL)
AUTHENTICATION aaaa,aiOR ACKNOWLEDGEMENT
STATE OF WISCONSIN
1 ss.
Signatures of County of EAU CLAIRfi f
This instrument was acknowiedged before moon FEBRUARY 5 2002
by JOHN W TORGERSON
authenticated this day of
me(s) of perwna(s))
as PRESIDENT
yps aLa r y; e.g., Deice,, Iruatae, etc.. any)
a
Title: Member State Bar of Wisconsin or I !1 ,
� C PTANCE COM ANT sme p Me who fns umeni was executao, if any)
authorized under 6706.08, Wis. Stats. 1
This instrument was drafted by
J
7�RTTCHIE /CBfiC y ! u L i ^"=- PAUL D KOHLER
"Notary Public, Wisconsin
-Type or print name signed above. O r y/ (ti CC My Commission (Expires)(Is) MARCH 3 2002
I "ee ry ...........
%,���%�
���
_�
�_
of ��
Preferred Acceptance Compan
p p Y
2130 Brackett Avenue • P.O. Box 1605 • Eau Claire, WI 54702 -1605 (715) 834 -5551
Fax (715) 834 -7151
RECEIVED
March 6, 2003
MAR 1 0 2003
ST. CROIX COUNTY
ZONING OFFICE
St. Croix County Government Center
Zoning Office
Attn: Pam Quinn
1101 Carmichael Road
Hudson, WI 54016 -7710
RE: 2860 80th Ave. Holding Tank Permit Application
Dear Pam:
Please find enclosed the Holding Tank Agreement and Service Contract you requested.
Also enclosed is a check for $11.00 for recording fees and a check for $300.00 for a
sanitary fee.
Feel free to call if you have any questions.
Sincerely,
Af � — \
ff D
Of ice Manager
enclosure
712683
!j 2 1 6 ` P ` `I `! 7 KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
Document Number Document Title
03/10/2003 11:00AM1
St. C r oix County EXEMPT #
Holding Tank Agreement REC FEE 11.00
TRANS FEE:
COPY FEE:
tate Plan Transaction Number - / CERT COPY FEE:
PAGES: 1
t're�eue Ace-rdcthce n w t�a►��!
Name — (Owner) Typed or printed
being duly 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 )705 Page 4 /5 - 7 Document
Number % St. Croix County Register of Deeds Office: Recording Area
A parcel of land located in the '/• of thesE' /< of Section Z a Name ) *RM Mortgage Co .
T�-9_ N — R _5 W, Town of St. Croix 2130 Brackett Avenue
County, Wisconsin, being duly described as follows (include lot no. and Eau Claus, WI 54702 -1605
subdivision/CSM or detailed legal description): S 1 1ACRZa -
5 I Z #, PDS of Wev 36 Rom 03 N-- / `/b - FO-000
3j 6 Agreement Date: 3 Of sw �y SE- %y S2o rZ9 Al� 2 /5 -KJ Parcel Identi c (PIN)
Zff4 D A /ivrl
We acknowledge that application is being made for the installation of (a) holding tank(s) on the above 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 of private onsite wastewater treatment system as permitted under Ch. Comm 83,
Wis. Adm. Code, or Ch. 145, Wis. Stats.
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 (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, 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 sped ications. The owner agrees to be financially responsible for the purchase,
lnsta; ;ation, maintenance, and repair or the water meter, end a to aiiow the govemrrmen;a; uni: cr the Department of Comr„eme to cr =
the above - described property on a regular basis to read and /or inspect the water meter.
3. Owner agrees to pay all charges and costs incurred by the governmental unit or county for inspection, pumping, hauling, or 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/c) Namers! - D1sase Print I Subscribed and sworn to before me on this dal$:
- T o �. a �' '� V1 3
Notariz nets Signature(s) Notary Public _ t
Gov mebtal film i� P se Pri nt My Commission E pipes <3�
I i 01 CARl11OMM y a 1 5 +, ++
Govern atur Drafted by:
= -A,(. &5o sy J e d
Personal inforlmation you provide may be used for secondary purposes [Privacy Law s. 1 04(1)(m)j
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE"
This information must be completed by submitter: document title. name & return address. and PIN (if required). Other information such as the
granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed on additional pages of the
document. Note: Use of this cover page adds one page to your document and $2.00 to the recordinv fee. Wisconsin Statutes, 59.517.
10/16/01 TUE 08:35 FAX 715 386 4686 1pJ005
HOLDING TANK SERVICING CONTRACT
Contract Date
/o -16 -vl
This contract is made between the
A ----------------------------------------------
'P I 8
t�12�L�-v & 'P 71)t-)Lt
TGG e- I Pumpers Name
S"--k U ce - -To C.
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptlons:)
l,U , 3 L fiz Y/ z
4j 17-
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. II-HR 83.18(4) (b), Wis. Adm. Code and with the County of
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 agr�ernert will remain in Effect until the owner or pulnpe; terminates this contract. In *.he event of a chan fr. this contract,
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract wltir the local
governmental unit and the County named above within ten :(1:0) business days from the date of change to this service contrack:.
Owners) NamA(s).'(Rrtnt) .. I Owners Sighature(s) "' ' ' ' ' ' Sirb96nb Arid swum to'rne on this date:.
Arnc- G I � � -� � � / 7od� s llatt�
I
M ?*-� y I
Bit ..
,- piffiPwai M"1 Note Fume Slnan ce
t
1
I
Nil
7, i J 71/1 — 61 5 3 Commission Expiration
Drafted by
10/16/01 TUE =08:35 FAX 715 386 4686 004
ST CROIX C�"1UN'1`Y
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSH P CERTIFICATION FORM
Owner/Buyer
Mailing Address
property Address
(Verification required fmm planning Department for new coustructiou)
fate � Parcel Identification Number 'o l
Q
City /S
LEGAL DESCRIPTION SovTK 2q RoDs or7 7we 3 (o R-0 o
Town of
property Location 5 Vj V4, -: 4, Sec. • fit. TIN R��W, g
Lot #
Subdivision y 1 f °'
Pa e
Certified Survey Map # �� Volume g #
Page C
Warren Deed # �O ' 6 Volume g Z
Spec house O yes ❑ no Lot lines identifiable Q yes ❑ no
STE 1VI NANCE
ailure to handle
Improper use and n�aitttenanceof your septic system could result in its preum=c f t yon PutP � te main
consists of pumping out the septic tank every tluee years or sooner, if n,,ddb a licensed punnpe
cc au affect the function of tho septic tank as a treatment stage in the waste disposal system
owner agrees to submit to St. Croix Zoning Department a certification form, sighed by the owner and by a
The property owner r ve that (1) the on -site wastewater disposal system
Waster plumber, journeyman plumber, restrictedplumber or a licensed puMpe ver �j the septic tank is less than er full sa sludge.
is in proper operating condition and/or (Z) after inspection and pumping ('
Uwe, the undersigned have read the above requirements and agree m maintain the private sewage disposal system with the standards
leted and returned to the St. Croix County Zoning Office wttWn 30
le
set forth, herein, as set by the Department of Commerce and the Depatimcnt of 'L' .tu:�t Rrsou-+,�.P, Stave of VTisco ^Sin. Cxm )- n
Ming t your septic system has been maintained must be comp
Y ye a 'ration date.
DATE
URE On APPLI �'�. �- 'S'
R CERTIFICATION our knowledge. I (we) am (are) tae owner(s) of
I (we) certify that all statements on this form are true to the best of my ( Our)
? P d escrn d bove, by virtue of a warranty deed recorded>n� e, of Deeds OtYce. /D DA'I'S
01 APPLI y information that is mis- represented may result in the sanitary permit being revoked by the Zoning UeParnuent.
is Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey neap if reference is trade in the warranty deed
I
o� mt✓ L(p- ACRE Pkpca 4 d 3 y -1086` 7a --00 ,`
20. — ?,q. 15 31qA