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HomeMy WebLinkAbout034-1086-80-200 I 3 (D 3 d h co � (D v � • d m rr w O (n A z m T v z w� T. z T� cn z O A S oo N O � �I • < 0 N < C < 0 N < O O s 1 N a N \ CD _ a O (D N N \ CD -' 7 a 7 (D U O y ��, t p (D _' R a ro ° p a €D ° p o° _� C) t -ti a A c a O(D c O a �-4 a c O m S O a ? m (n DD o CD @ @ n1 m a in °� p 5 0) g ° m m o si o p n m 3 ° w m nri w Cl) Q O C (D C (D C n O C 0 C (D C 0 C A) N °D 3 a o N w3 ° 0 3 N d g O N N O N O O C !V cn Z :r v D °U s Z to V D (D o c m D mm A IIn m D A to a n C IW .4. N 3 a O W N N 3 "d, i�' Q C O O D ' �y z� IQ N 0 0 0 0 � v z CD (D 00 �' 0 (D 00 ti 0 N N C � � CJ1 U1 , C C 0 3 O ° a 0 C C O C O = CC h • ( ((A CF N (A Cr O N (D Q Er 6 6 - Gt � v O) 0 CD CL m = m m _ `° N D D D o ° � � (o I h • m ro rn CD c c � m > CD A Z A C W O W CL z 3 a ° o cn cn 3 D A N_ O (D ° O Q N_ 0 CO p � Q 3 CD IQ c 7 • c a .O•. (D .. y 5 O (D Oi � T O O y I N CZ 7 ? CD N = -. O in — O O D p 3 O (D =O 0. O 7 OZ fl- 30 1 (D 30" p!� N O (Op N N p F N N N C m ° aQ m ID `° a°v (� -°O .° ° . ( o °° O .° a j< O a < a a °= F °= V c �° a o �v a ° wo 3(0 ° wo 3(0 = v = v o � (D : = C D my v x• m m x ti o� o -_C ti j j 3 3 O 3 b C c°n° M a° � a b CD C D dC ; fA 69 O I O O O1 O O CL August 18, 2003 Laura Johnson 291672 nd Ave. Wilson, WI 54027 RE: House remodeling project Dear Ms. Johnson: This letter confirms zoning approval according to the plans you have submitted. The plans reveal that you are replacing an exterior wall of your non - conforming structure because it's not insulated. This approval does not allow you to enlarge the present footprint unless you apply and successfully receive a variance from the St. Croix County Board of Adjustment. Any new construction must meet all minimum setback requirements, which are 133 feet from the centerline or 100 feet from road right - of -way (which ever is greater), 25 feet from the rear yard and a 25 -foot combination setback from the side yards. Clearly, ordinary maintenance is allowed on non - conforming structures. Property owners do have the ability to maintain their existing non - conforming structures. However, all "new" construction (expansions) is subject to the standards identified in the St. Croix County Zoning Ordinance. If the scope of the project changes, please contact the Zoning Office immediately so we can assess the project to ascertain if additional zoning approvals are necessary. Upon completion of the project, please submit photos to the Zoning Office of the finished construction. A copy of your information will remain on file in the Zoning Office. Please contact Vicki Benson, Clerk for the Town of Springfield, to obtain a town - building permit for the proposed construction project. If you have any questions, please do not hesitate to call. Sincerely, Rod Eslinger Zoning Specialist Cc: file Town Clerk Wisconsin Depa tment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildinge7ivision I INSPECTION REPORT Sanitary Permit No: 479300 0 GENERAL INFORMATION (ATTACH TO PERMIT) S)ste Plan ID No �: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). S Permit Holder's Name: City Village X Township Parc6l Tax No: Johnson, Laura i Springfield Town of 034 - 1086 -80 -200 CST BM Elev: Insp. BM Elev: I BM Descrip 9, : Section/Town /Range/Map No: c &>to I 28.29.15.563D20 TANK INFO MATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic Benchma D g Alt. B era t Bldg. Sewer Holden � am St/Ht Inlet St/Ht Outlet T rD.S TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt let eptic Dt Bot m � Do ' Heade I Man. eration Dist. Pi e Holding ! Bot. Sy-*- Final Gr e PUMP /SIPHON I F T I z Manufacturer Demand St Cover GPM Model Number TDH Lift Fric o9s System Head T Ft Forcemain Length Dia. Dist. to well SOIL ABSO SYSTEM BEDITRENCH Width ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO LDG IWELL LAKE /STREAM LEACHING ufacturer. INFORMATION CHAMBER Type Of System: U Model Num DISTRIBUTION EM Header /Manifold Distribution x Hole Size x Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems xx Moun t -Grade Systems Only Depth Over IDepth Over xx Depth of ed xx Mulched Bed/Trench Center Bed/T dges Topsoil Yes 0 No Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 [J�+s Inspection #2: Location: 2916 72nd Avenue Wilson, WI 54027 (NW 1/4 T29N R15W) Plat of Hersey Lot 8- BIk16 Parcel No: 28.29.15.563D20 1.) Alt BM Description = tV /A 1 ( w Q - {.� N J 2.) Bldg sewer length - 2 �� \ \\ - - amount of cover = « 3) A W—skk : ,n t �` —`- h -- - -- — - -- -- - - - - -- — -- — - Plan revision Required? FA Yes X No Use other side for additional information. e SBD -6710 (R.3/97) Insepctor's Signature Cart. No. ��� � � S Safety and Buildings Divisio W hington ve., ; ` o716 '' ' Sanitary ermit Number (to be filled in by Co.) I O�SI� n I 3 703151 Department of Commerce o t Sanitary Permit Appli n5.04(l)(i rate Pla I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal iprov *q (,RolX C O NI ` a. may he used for secondary purposes Privacy Law ZaNING QF4 ec n rrees s (if different than mailing address) / I. Application Information - Please Print All Information oC 1lo / dh d ` Property Owner's Name Parcel Zt 2 8' Property Own /'v/ ne er's Mailing Address Property Location 1 d fit) fit) A " 'p ' / <, ' /e, Section 43 jJ City, State Zip Code Phone Number id C r" !� �� circle one) II. Type of Building (check all that apply) / 9m N; R E o>Q T A 3 Subdivision Name CS _ l o r .�.��� _ ________ �Q El Public /Commercial - Describe Use '• r) ❑ State Owned - Describe Use ❑City_ ❑village &Township 4 �LI% IF �� III. Type of Permit: (Check only one box online A. Complete line B if applicable) A. ❑ New S stem y � Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Pen Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In- Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground 19 Holding Tan ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation VI. anit Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit s � Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) her's Signal re MP Number Business Phone Number I V 1 o/ Plumber's Address (Street, City, State, Code) VIII ounty /De artment Use nl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I uing Agen ign ure o t nps) Surcharge Fee) ❑Owner Given Reason for Denial �� �� Q Conditions of Approval/Reasons for Disapproval tach complete plans (to the Co6hty only) for the s m on paper not less th• r 112 x I I inches in size SBD -6398 (R. 01/03) • c� 3�} � \ � fib- �o -2`r'' � �h•• S :.� �• ���"- � Sd. 5 �- Ga 2 z9� 41� � i Safety and Buildings 4003 N KINNEY COULEE RD l' commerce LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 is cO n s' n www.coe.wi.gov/s / www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary June 23, 2005 CUST ID No.227548 ATTN.- POWTS Inspector TIMOTHY H MITTLESTADT ZONING OFFICE ABC SEWER ST CROIX COUNTY SPIA E742 HWY 12 W 1101 CARMICHAEL RD KNAPP WI 54749 -9074 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/23/2007 Transaction ID No. 1149421 SITE: Site ID No. 700461 Laura Johnson Please refer to both identification numbers, 2916 72ND Ave above, in all correspondence with the agency. Town of Springfield St Croix County NW1 /4, SW1 /4, S28, T29N, R15W Lot: 8, Block: 16, Subdivision: Hersey Plat FOR: Description: Three Bedroom Holding Tank System Object Type: POWTS Component Manual Regulated Object ID No.: 1024803 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: Approval Requirements: • This system is to be constructed and located in accordance with t Tans and with the "Holding Tank Com on anua T o - r Prrvafe Onsite Wastewater Systems" SBD 10571 - P (R.6 • A notarized Hol ing ' an c gree ��2 t ee the local governmental unit/Municipality and the property owner is required prior to the issuance of a sanitary permit. A Holding Tank Servicing Contract y also be required if no other service provider for the holding tank has been identified. ii o.'1d. s. • A service drive or road is to be provided to the service access opening or pump out port. The minimum "', "` measured distance required is 25 feet. � �' I EF R7MENT r j' • The well must be a minimum of 25 feet from any POWTS tank. chs. NR 811 & 812c OF i L` l �� • A Sanitary Permit must be obtained from the county where this project is located in accordance with the SEE CORRL 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. Stat it TIMOTHY H MITTLESTADT Page 2 6/23/2005 L • 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. prior to commencement of All permits required by the state or the local municipality shall be o p 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 1�G POWTS Reviewer Il , Integrated Services WiSMART code: 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 Henry F Grote , Certified Soil Testing Laura Johnson - 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: Lot 8, Block 16, Hersey Plat NW 1/4, SW 1/4, Sec. 28, T 29 N, R 15 W Town: Springfield RECEIVED County: St. Croix Da te: 1 7 2005 May 16, 2005 SgETY & BUILDINGS caner: Laura Johnson Address: 2916 n' Ave. Wilson, WI 54027 Plumber: Tim ittlestadt Signature: License # ✓ ✓✓ MPR 227548 Attachments: 6748 -Plan Approval Application SBD 8330 HT Agreement (copy pending) page 1: cover i AS 2: plot plan � 3: tank detail'' 4: maintenance information COMMERC S <?Y 'GS I �� EfVC NC 1= �J page 1 of 4 zT - zit 1Sw� cID \ ?b— TO Q Q �� Z -1 h� HOL'Di 'TANK CRuSS- S9'd ANU S p c:th'rCA1� Approved Approved Locking Vent Cap Weather Proof Manhole Cover Junction Box `^/ �•..•�� 1�La -� 4 12" Vent Pips Final Grade 4 i Approved Joint -- Water Tight ' ,seal High Water Alarm Svi tch, SPECIFICATIONS Approved Joint v/ 5.,k 0 TANK Manufacturer: �� w P"L pipe Tank Size: Gallons Extending 3' Onto ALARM Manufacturer: S S '���"� S ��� ""! Solid Soi' Model Number: Switch Type NUMBER OF BEDROOMS 1 La�.r nr -1O`� OWNER S NAME: � ADDRESS! 50L- GA DISCRIPTION: �' k S`^' k Sec 2� T z-°1 N ,R k�' W LEGAL / / / TOWNSHIP /MUNI�PALITY: S��<< COUNTY: Huffcutt 3000 LP holding tank Tank exterior = 1 61.5" x 92" x 73.5 " /(12" x 12" x 12 ") = 631.98 ft Tank weighs 22,000 lbs w/ cover Anchoring requires: 1.5 x 631.98 x 62.4 — 22,000 = 37,153.3 lbs Top tank surface = [165" x 92 "/(12" x 12 ")] = 1 05.42 ft2 3.25' soil backfill @ nominal 110 lb/ft' = 3.25 ft x 105.42 ft' x 110 lb/ft' = 37,687.6 lb anchor 4 Ii Holding Tank Maintenance Information As a condition of lan approval, a c f these plans must be given to the owner and this p pp copy o e e p an g information reviewed with the owner. The capacity of this system's holding tank is 3000 gallons. Under Wisconsin average use conditions of nominally 50 gallons per person per day, the tank will become full after about 30 days of use by two people. Water conservation measures including the use of low flow water fixtures will extend this time frame and are recommended. A water meter must be installed on the potable water service to this residence. The holding tank is equipped with an alarm which is installed 12 inches below the maximum water level of the tank. The alarm will function when about 630 gallons of capacity remain; this is about six days of average flow for two people. At this time a licensed septic pumper must be called to pump the tank before maximum capacity is reached. Septage disposal will be by approved methods according to the Holding Tank Servicing Agreement filed with the county permit application for this system. The licensed pumper is required to submit a report to the county within ten days of any servicing - such as pumping - of this system. Any questions regarding the performance of this system may be referred to the installing plumbing contractor, ABC Sewer, at 715- 665 -2112, or to the St. Croix County Zoning Office at 715- 386 -4680. Page 4 of 4 r + RECEIVED JUN 17 2005 SAFETY & BuiaNGS HOLDWC TANK SERVICING COMItACT ate q 1 os R made between the Tank Owners Natne(a) and Name b Z sepTrc W 46 ) unk s the (Provide dam:) -- • -- 1. The owner ageaa to Me a copy of this eatrhaet with die local gover=neul d trait tbd bas signed dw PUMP% tegnirW in Coma 8352(lxc)l. WIL Adto. Gods tad Wo sp MVW HOI&S Tads Cotppoaept Msaaat. This aS WMW lift"be Mod wIW Wa St Croix County 7,otft pV.Wpq, 2. The owner agrees to have die holding trmlgs) amviced by the PWW" and 8naemem to permit the pumper to have aaxss and to eater upon die ptapdety AN We purpose of aaviciag the b bft baw). lu owner agrees to equ aia die send or dtiMe w War We punpa ca aetvice the bokft Inks) with We p e9 t The owner Dam ogees eo MY We piper 1w all chwgft iaetazed In saviciag the hol6nE tact O as SUGUNHY agreed aeon by do owns and pumper, 3 do agrees to sttba�t b the local govt unit drat bad signed dw P womana sad to We" to mdad dra So afd�e b g&* OwdC(s) an a semiatmual basis. Tim pw%w tialhmr IL lU n=w and addmn of the =W= far b. The name ofWa owner of We bd ft n* a_ The Iodation of the ptapQty on which the bolding tank is kftH4- d. TW NOftl permit tmmbw issued t a the holding U* d. The data on which the holding talk was urAoW, £ The voluma is gaUons of the contents pmnped From the Larding tank fi w cub mmkiog S. The disposal sues to which Wo G0010a s Data We bolding book were delivered. 4. This amt will rein in drat twW the owner or pulWa Inmian= this ooa &wt. In toe arrest of a dWQV in dds contraM dm ownw agtaes to Ste a Copy of say cba S s to this spvioe conhad or a copy of a am service Conhact with torsi govoms x=W unit Mod We County asmtd above mfrs tea (10) buds m days !rain dw dale of chs w b d& swvice conical. 4a'w(s Narrre(S-) (Prw) Owner's Signatwre(s) Shed and svfpm to to on 0* dale. 91WAA 4d1f Todays lie Parapet's Name (PrtM) NO MARK D. STIGNANI Pub) sota PtartWS ReAistcation Number ► e s HOLDING TANK SERVICING CONTRACT Contract Date I � "v his Contract Is made between the Holding Tank Owner(s Name and per's Name w a the instafi�) hold tank {s the fo . (Provide legal deSC Towns:) ------------ ----------------- --rte- - -- ��1� - -" 1. The owner MMC$ to file a ropy of this contract with the local gover mcntsi unit that has signed the pumping agreement required in Comte 83.52(lxc)1. Wis. Adm. Code and the apluoved Holding Tank Component ManuaL This agreement will also be filed with the St. Croix County Zoning Department, the runper 2. The owner agrees to have the holding tanks) serviced by the pumper and'gua amass to to have access and to eater upon the property for the purpose of servicing the hoidigg mss), permit pWW agrees to maintain the ace= mad or drive so that the pu gWr Cut service the bolding tai(s) with the pwnpft equipment. The owner nether agrees to pay the pumper for all charges incurred in servicing the holding tanks) as mutually agreed upon by the owner and pumper, I The pumper agrees to submit to the local goven=ental unit that has signed the pumping agreement 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 rq)W: a. The name and address of the person respoosible for servicing the holding tank; er b. The name of the own 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 £ The volume 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 wil I remain in effect until the owner or pumper terminates this contract, In the event of change to this contract the owner agree to file a copy new service contract with local governmental unit and the County above idthin ten (10) business f a days from the date of change to this service contract, Owner(s) Name(s) (Print) 1 0fters Signature(s) Subscribed and aw to me on this date: Todays Date Pumpet's Name (Print) m `, �'� � � .,.��` • pets at No P W .„ MARK D. STIGNANI r• �� ( tary Pub is p r�esota per's Registration Number t$ es tr816ar0 Z001A 9996 Doe STL yva 20=90 NOS SO /eZ /SO i 798592 KATHLEEN H. WALSH ' c 8 3 0 P 0 0 1 REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 06/24/2005 11:30AN HOLDING TANK AGREEMENT EXOPT t St. CROIX COU REC FEE: 11.00 Holdfng Tar�c Aytear►ont COPY FEE: CC FEE: late P PAGES: 1 lAuaa To hrt�on mm ^ (�r) a baNq dally tatlota , Woo, under 9A, lhnft t. wrahe I: da omew, pant oweOr le v otdle � D000 et ba g .tom �. T+rblooaaif, raoorded ebafb o � Zap aaaet Cartbt co" Roll" of Demb Of�ax A In&#.IS gat gwR is i �, Spn T iF— W SLapplt 5gl(o �}vC� powwfy, Whomda, bdvS duly dmWb.d (Wade W wit. and i ISCt� 1 aabdlVWQWM of dam In dfaarlp 05 nor /00 - & -a?00 p�HERS Ac So E'3' Lbr 7Q. c 5 6 eMiil pvnadaaaa0ubattomm be �popaWM paep AMO,fapt/abr = caa aatrww aaaaaby.aaaWPalawwa ; aaa4roMrtypt apaab arfla wearwdarYaaaaant ayawa w imm� aaadar CA.OaMm fti Aft. Caaa.-rcklAIL w &W MwbaauamWbfaiwwey blaaa .dnai6ad POP arb waWeeladaMNbloadali< I . Ow wa ww b oaabna b el apploabb nquYntaar of Ck Qomm l% Wb. 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STIGNANI l� } • - � as Stafs of Minnesot i a: r L0.u,r'0. My'COr1 rMsslon Expl el Uwj tic s� ` � Y1cic 1. • n � � Ar» � W 0U / J . u.ae pmeoaaa mw nAO. w.AR,r o. utlf uo," oowaf" - 00 wr W r 7f�kAwbnarMarewarNea*AY /4' � IM�of pl 11 pMrlaAaarepnwRAMM afanfryabaraadafNNMa a1RaWyw awd011lha�l M dMa son stew flz TOOtjij 1101 M MTL IYd 70:10 NOR MO /a /10 y O RIGI NAL, n - 'w� OIL EVAL AT #2239 Departmentof Commerce c dance wit Com l e Page 1 of 2 Division of Safety and Buildings A �^v Certified Soil Testing, LLC Attach complete site plan on paper not less than 8 x U pf�ffMustl 3 �� County include, but not limited to: vertical and horizontal reference t direction and St. Croix percent slope, scale or dimensions, north arrow, and location a an 'P Parcel I ZONING 1 r 034 - 1086 -80 -2 0 Please print all information. OFFI eview d By Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). 13 OS Property Owner Property Location Johnson, Laura Govt. Lot NW1 /4, SW1 /4, S28, T29N, R15W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2916 72nd Ave. 8 16 Hersey Plat City _ State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Wilson I WI 1 54027 715 - 772 -3350 1 Springfield 72Nd Ave. ❑ New Construction Use: ® Residential ! Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA ft. General comments and recommendations: Limited Area, Well setback, & shallow, wet soils above seasonal saturation all indicate holding tank only Boring # ❑ Boring Pit Ground surface elev. — ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Cldrrtltaa t Redok Dsscirlptl( Texture 5trl rtttre orislsten Bbund'ary Roots GPD/W in. M_ e I Ctu rSz �;ont,`Golar Gr 31t,... 'Ett#1 'Etf#2 1 0 -5 10YR 2/1 - sil 2 m gr mvfr gs if m .6 .8 >Wv�� IF 1. U 2 5 -11 10YR 2 / sil 1 m sbk� I mvfr gs 1m .4 .6 3 11 -15 10YR 4/3 f2d 7.5YR 4/6 sil mvfr - - 4 6 horizons 1 & 2 are somewhat gritty w/ s & appear disturbed w/ pieces of broken glass & some gravels; lacks A +4" presumptive limit is 0" M Boring # El Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant C61or Redox ©ascription Tdktbre Strttctttre l;onslsten. , <Bouridary Roots` GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr, Sz Sh: 'Etf#1 'Eff#2 previous work in area indicates very poor soils; obvious wetlands to north adjacent to north lot line; poor site for interpretive determination " Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS _< 30 mgr CST Name (Please Print) ignat CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 1 5/4/2005 715- 233 -0398 SBD -8330 (R.07 /00) c � � Gt- �. � tti � � �, � s 0 �. - \ 1 o T C l a �., � `:: � '4' � U, t o c `G � �j 1"1 �"� � •-� kq 2" i Parcel #: 034 - 1086 -80 -200 06/24/2005 11:27 AM PAGE 1 OF 1 Alt. Parcel #: 28.29.15.563D -20 034 - TOWN OF SPRINGFIELD Current ,'X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " JOHNSON, LAURA J LAURA J JOHNSON 2916 72ND AVE WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 2916 72ND AVE SC 2198 GLENWOOD CITY SP 1700 WITC SP 7059 SPRINGFIELD SAN DIST #1 Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 28 T29N R15W LOT 8 BLK 16 VIL HERSEY Block/Condo Bldg: ALSO THE E S OF THE S1/2 OF LOT 7, BLOCK 16 EXC AS DESC 2013/576 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 28- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 10/16/2002 694496 2013/584 WD 10/16/2002 694494 2013/580 QC 10/16/2002 694492 2013/576 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/25/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 1,200 71,450 72,650 NO i Totals for 2005: General Property 0.000 1,200 71,450 72,650 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 1,200 71,450 72,650 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I i - Parcel #: 034 - 1086 -80 -200 07/08/2005 02:00 PM PAGE 1 OF 1 Alt. Parcel #: 28.29.15.563D -20 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner LAURA J JOHNSON * JOHNSON, LAURA J 2916 72ND AVE WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2916 72ND AVE SC 2198 GLENWOOD CITY SP 1700 WITC SP 7059 SPRINGFIELD SAN DIST #1 Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 28 T29N R15W LOT 8 BLK 16 VIL HERSEY Block/Condo Bldg: ALSO THE E T OF THE S1/2 OF LOT 7, BLOCK 16 EXC AS DESC 2013/576 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 28- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 10/16/2002 694496 2013/584 WD 10/16/2002 694494 2013/580 QC 10/1612002 694492 2013/576 QC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/25/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 1,200 71,450 72,650 NO Totals for 2005: General Property 0.000 1,200 71,450 72,650 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 1,200 71,450 72,650 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Document Number Document Title St. Croix County Holding Tank Agreement fate Plan Transaction Number - L &4,4 T ►-lt So 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 2 0 i Page S Document Number St. Croix County Register of Deeds Office: Recordina Area Name and Return Address A parcel of land loc4Wd in the %4 Of the3v- of Section a t tt f 64 :3 T.2 N — R 1 5 W, Town of S tP6 - F1 EU, . St. Croix a 1 t (e 7 �/7D �, County, Wisconsin, being duly described as follows (include lot no. and Wt Lsod ( - �Yb2 subdivision/CSM or detailed legal description): 1 67 - 9 8L4 C< f 6 V1 LL, Of ME A (-SL THEE 3 nor 3 — � 4 A . 06 3 reement Date: I 1 Parcel Identification Number (PIN) ' S /z 6f L6T , Qt zlcr 1(0, E1(C U,! 3' of N %L LoT 31ac1� l b We acknowledge that application is being made for the Installation of (a) holding tank(s) on the above described property or that c 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 property serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, 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, have &water meter installed in the structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to rKake such' instaiiations, 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. 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 property 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 ls.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: I Notarized Owner's Signature(s) Notary Public Governmental Unit Official Name, Title - Please Print My Commission Expires ST CROI i �CAr./�/J �' �iJ /•�/CT i11E�T Governmental Unit Official Signature Drafted by: Personal Information you provide may be used for secondary purposes [Privacy Law s. 15.04(1)(m)l "THIS PAGE 18 PART OF THIS LEGAL. DOCUMENT — DO NOT REMOVE" This information must be completed by submitter, document title. nam e 6 retum address. and EW (if required). Other lnfotmatlon such as the granting clauses, leagal description, etc. may be placed on this &d page of the document or may be placed on additional pages of the docuawnt NZL Use of this cover pe adds one peg to your document and JZQQ Ig UN jjj2= &Z Wisconsin Statutes, 55.517.