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KATHLEEN H. WALSH
Document Number Document Title REGISTER OF DEEDS
ST. CROIX CO., WI
rr
I ova e lm ert RECEIVED FOR RECORD
C~
05_12-2000 3:45 PM
r~
HOLDING TANK AGREEMENT
EXEMPT N
CERT COPY FEE:
COPY FEE: 5.00
TRANSFER FEE:
RECORDING FEE: 16.00
PAGES: 4
Recording Area
Nams and Return Address
~ CC',1 ~VI-'Sft SS
0 ~'3 lc){ ! 00oo
G C)
Parcel Identification Number (PIN)
This information must be completed by submitter: document title name & return address. and PIN (if required). Other information such as the
granting clauses, legal 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 $2.0 to the recording feerecording fee. Wisconsin Statutes, 59.43(2m) WRDA 1/99
215-32 (2A98)
xM con`^'' cousin Department of Industr '
Labor a nd Duman Relations y HOLDIIYG TANK AGREEMENT Safety and Buildings Division
~ Bureau of Buildings and Water Systems
41•I rJZOPACE 34J
Document NO. /planldentification NO. This agreement is made between the 7e7~served for recording data
governmental unit and holding tank
Agreeme t Date - owner(s)
1~0.
County or Lot5~al ore mental u it N -ink O Her(s)
call M n! r !i b ! w
We acknowledge that application is being made for the installation of (a) holding
tank(s) on the following property: (provide legal land description)
w t~ S S LJ
~(Y •
Return To
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
Code, or Ch. 145, Stats. private sewage system as permitted under Ch. ILHR 83. Wis. Adm.
As an inducement to the County of T- 0 ~C s
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. ILHR 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 municipality to prevent or abate a human health hazard as described in s. 254.59.
Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing
the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60. Slats.
2. The owner agrees, pursuant to s. ILHR 83.18 (10). Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by
the County and State. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation
complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation,
maintenance. and repair of the water meter, and agrees to allow the municipality 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 cost incurred by the municipality 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 municipality 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 hearth hazard, and the tax shall be collected as provided by law.
4. The owner, except as provided by s. 146.20 (3) (d), Stats., 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 or the owner's registration with the municipality. 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 municipality 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 municipality on a semiannual basis a
report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3)
(d), Stats., the owner shall submit the report to the municipality. The municipality 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 unvl the local governmental unit responsible for the regulation of private sewage systems certifies that the
property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 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 the 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 -Print Notrized Owner(s) Signature(s)
t' - L• ( y` Subscribed and sworn to before me on this date:
Notary Public
Municipal Official Namfe - Print unicipar officaI Signature
Wn, expirLft #A
mu rCln l Official Title - Print 1
The information you provide may be used by other goner ent agency programs (Privacy Law, s. 15.04 (1)(m)I
SOD-6123 (R. 04/94)
V11 151 Q PAG[ 3 4 5
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer tT SS
Mailing Address
C'- taLe.
Property Address /
(Verification required from Planning Department for now construction)
City/State
Parcel Identification Number
LEGAL DESCRIPTION
Property Location NLO SC Sec. T3
L-N-R ~W, Town of cz.^ V)r,, rr.
Subdivision , Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # , Volume , Page #
Spec house O yes ~d no Lot lines identifiableP yes O no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance'
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
SIGNATURE OF LICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIPsATURE OF ICANT DATE
Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
HOLDING TANK SERVICING CONTRACT
Contract Date 1510 PAGE 3 46
This contract is made between the
Holdinin Ta(+k Ownar(s1 NamA(et - and -I Pumper's Name - - - - j--1- -jQ- - - - - - - - - - -
JUQ, t L7 t~ L Pin ~ "t'USS n W Q.S'!L
to S LccK¢.~v{Z: ~
y e-
~d 4 MN SS i 3~1c Grna~r~rl ~u 1k.)r~fhr,/, Ld- Ss<~~ 7
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:)
tv ~o 'A I T sue'/ S T;3 ~v 1
U
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has
signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and
with the County of
s
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 all-weather 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 municipality 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;
t. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g_ The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract,
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality
and the County named above within ten (10) business days from the date of change to this service contract.
Owner(s) Name(s) (Print) Owner's Signature(s)
C-11 S +nss Subscribed and sworn to before me on this date:
RIc k-•1 /3 -7 tr2 s (V `Vt
Pumper's Name (Print) f 1 J ~h 11 Pumper's Signature Y- C- Notary Public
PA;•evS Li.fwd WrISJl° I~ ►LI I ' t7
z~ My commiss••'~_
1 L1 V►'1 M o o- p ~ 1.ny12 ~ ~ 7
Pumper's R istration Number J~•, ?
,,~•AF•,Y~a^~a
SOD-7574 (R. 09/88) This instrument was drafted by the State of Wisconsin Department
of Industry, Labor and Human Relations
10/23/2006 11:10 AM
Parcel 038-1017-60-000 PAGE 1 OF 1
Alt. Parcel 3.31.18.60 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
- BURTON,
JEFFREY L BURTON OC - NAUEN VARDA KEY L
NAUEN VARDA K
1544 MS RIVER BLVD
ST PAUL MN 55116
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ` 1158 CTY RD H
SC 3962 NEW RICHMOND
SP 1700 WITC
SP 8055 CEDAR LAKE/N R
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 3 T31 N R1 8W COM C HWY 799FT E OF W Block/Condo Bldg:
LN WLY ON C HWY 55FT N TO SHORE CEDAR
LAKE SELY ON LK TO PT N OF POB S TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
03-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
01/04/2002 667230 1807/597 WD
04112/2000 621053 1501/624 WD
11/02/1999 613142 1467/609 WD
07/23/1997 811/251
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
i
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 60,200 48,000 108,200 NO
Totals for 2006:
General Property 0.000 60,200 48,000 108,200
Woodland 0.000 0 0
~ Totals for 2005:
General Property 0.000 60,200 48,000 108,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
I
i
1<
Wsconsin'Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryP7edT t~ o.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. S
Permit Holder's Name: Cit E) Village Prairie n of: State Plan ID No.:
Baggenstoss, Rick & Jodi y Star Prairie Township 3 I $ 9 I -r
11b
CST BM Elev.:- Insp. BM Elev.: iBM;D~ Isption- Parcel Tax No.:
~i CST- %1&4 038-1017-60-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION B5 HI FS ELEV.
Septic Benchmark , LL O
Dosing Alt. BM 1000,
Aeration Bldg. Sewer 6.3 Z' `la.`1D
Holding W e,, St Ht inlet 6.(05 5-f
TANK SETBACK INFORMATION St/ t utlet-------
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding v r f y6 o' f Bot. System
PUMP / SIPHON INFORMATION Final Grade
M nufact r Dema St cover
M del N m r A P
TD ift F Iction Syste TD Ft
For main Length Dia. Fi Dist. Towel
SOIL ABSORPTION SYSTEM
ED / THE H Width Length N . Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
IMEN I DIM EN N
S S EM TO P/ L BL G LL LAKE TREA LEA I Ma act er:
TBA C MBE
1 FO ATI N Ty e Ofili, b~ o e Number:
stem: R UNIT
DISTRIBUTION SYSTEM
Header/Manifold ibution Pipe x x HV
Len i Len C Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
DO;WLQ ver Depth xx Depth Of x Seeded / Sodded xx Mulched
Bed /Trench Center -/Trench E Topsoi ❑ Yes ❑ No
#1 1T70D
CQMMNTS: (I Jude co a d1's~r~RancLes, ersogsA~PS of etc) nspection : ort Inspection 2:
Location: 1151 ~ounty Road H, New Klc inonct, W 1 ~4U1 % NNW 1/4 SE 1/4 5 T3 IN R18w) - 03.31.18.60 -I,ot 5
1.) Alt BM Description= 41A ~
2.) Bldg sewer length= 2-0 -amount of cover = 15
3) ~rvti y, ~~5 w~s'E' Sho~G
Plan revision required? ❑ Yes l$[ No
Use other side for additional information. 1611011-5 Cb To,u~
4K SBD-6710 (R.3197) Date Inspector's Signature Cert. No.
t
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
,
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Ifisconsin Safety and Buildings Division
SANITARY PERMIT APPLICATION 2 1 B. W shingtonAvenue
Department of Commerce In accord with Comm 83.06, Wis. Adm. Code Madison, WI 53707-7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size. C re) *Z0K
• See reverse side for instructions for completing this application State Sanittaary-PLermit Number
Personal information you provide may be used for secondary purposes ❑ Check if revision previous 'application
[Privacy Law, s. 15.04 (1) (m)).
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION C& (0 C1 Prope wn r ame Property Location ~--&d2iL5
(~Jt,rr7/a _S C'1/4, S 3 T 3 , N, R EJM W
ot Number Block Numb r
Property Owner's Mailing ilkddr s Acrwp L
V1,95 L City, Sta Ef\ TZ:,i ode Phone Number Subdivision Name or QM Nu ber
N ( o
. TYPE F BUILDING: (check one) ❑ State Owned ❑ city p Village Nearest Road
t
Public 1 or 2 Family Dwelling - No. of bedrooms own OF pr-r, r" C CL
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) :3r x/ Q e, 0
1 ❑ Apartment/Condo 10 1 7toOo 0 CJ . 039 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recre_ I aci)ity,
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service S Car }ash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: sec 13 rf%
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 _ New 2. >3J Replacement 3. E] Replacement of 4. ❑ Rec innectio o 1 jQtepX9 an
------System --------System Tank Only______________ --i _ _ _gTf Ipi4lq Sys ,
B) ❑ A Sanitary Permit was previously issued. Permit Number ssu i
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental
11 ❑.Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 421D Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
~BO Required (sq_ ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
A) A- N A- JI) - Feet A )/A TANK C aclt
VII. INFORMATION in gallons Total # of Manufacturer's Name f Site
Prefab. Con- Steel Fiber- Plastic Exper.
New Existing Gallons Tanks Concrete strutted glass App.
T nks Tanks
Saptie*amkee oldin Tank t r-rj ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for in 11ation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Pri P mbe 's Si natu : ( o Stamps) MP/MPRSW No.: Business Phone Number:
PtLll~rj~ber's Address (Street, it fateG ip Code):
C.{I ~ ~C3 kA Q 1
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps)
PApproved ❑OwnerGivenInitial Surcharge Fee)
Adverse Determination 36D. cu 6-5`2
X. CONDITIQN$ OF APPROVAL ~/_REASONS SAPPROVAL: * Cak-
tV ° A~
~o ~j2 dtiti~ ~ w c nn
SBD-6398 (R. 4199) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division,--608-266-3151.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank iriformation. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement- Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County / Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross,section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601-1831
TDD (608) 264-8777
Visconsin www•commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
May 30, 2000
CUST ID No.220537 ATTN.• POWTS INSPECTOR
ZONING OFFICE
CALVIN W POWERS JR ST CROIX COUNTY SPIA
1969 185TH AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/30/2002 Identificatio ers
Transaction ID Nq-S18691
Site ID No. 19290
SITE: Please refer to both identification numbers,
Site ID: 192902, Rick Baggenstoss Residence above, in all correspondence with the agency.
St. Croix County, Town of Star Prairie
NW1/4, SE1/4, S3, T3 1N, R1 8W
FOR:
Description: Two Bedroom Holding Tank
Object Type: POWT System Regulated Object ID No.: 665307
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:
• The well must be a minimum of 25 feet from any POWTS tank.
• The existing POWTS must be properly abandoned.
• 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.
CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force
on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000.
Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary
permit approval if submitted to the issuing agency on or after July 1, 2000.
Note: There is a potential for a law suit that may delay the effective date of the code so this status may or may not
change.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection Y authorized representatives of the Department, which may include local inspectors. All permits
b
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
CALVIN W POWERS JR Page 2 5/30/00
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 05/22/2000
FEE REQUIRED $ 60.00
FEE RECEIVED $ 60.00
erard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)-785-9348, Mon. - Fri. 7:15 AM to 4:00 PM
jswim@commerce.state.wi.us WSMART code: 7633
PAGE_LOF(P
HOLDING TANK
FOR
A. Q BEDROOM RESIDENCE
LOCATED IN THE tJq/4 OF THE Sr- 1/4 OF SECTION_3,T3 LN, ,
TOWN OF Ska r roc, : -V. Q ro ; ~C COUNTY, WIS~( lOn
V MERCE S
j of IoM
RUMEN Y N
DEpA PE
INDEX pN~s4
pENGE
PAGE 1 OF 6 TITLE SHEET SEE GORREgP
PAGE 2 OF 6 PLOT PLAN
PAGE 3 OF 6 CROSS SECTION
PAGE 4 OF 6 RECORDED DOCUMENT
PAGE 5 OF 6 HOLDING TANK AGREEMENT
PAGE 6 OF 6 HOLDING TANK SERVICING
AGREEMENT
PREPARED FOR
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POWERS EXCAVATING INC.
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1969 185TH AVE. o
NEW RICHMOND, WISCONSIN 54017 0
715-246-5135
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110I.nINC TANK CROSS-SECTION ANn SPECIFICATIONS
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Approved. Approved Locking
Vent Cap Weather Proof Manhole.Cgver
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Vent Pipe 4" Min
Final Grade
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SPECIFICATIONS Approved;
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NUMBt;R_OF REpRQOMS:.
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T.F;GAL DISCRIPTION: Lij_W k, eC•_.1__+.?~N*R-l
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4r~. 1510PAGE34lz KATHLEEN 622945 H
REGISTER OF DEEDS
Document Number Document Title ST. CROIX CO., WI
~ RECEIVED FOR RECORD
m C 1/ rL:~ 05-12-2000 3:45 PM
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HOLDING TANK AGREEMENT
EXEMPT N
CERT COPY FEE:
COPY FEE: 5.00
TRANSFER FEE:
RECORDING FEE: 16.00
PAGES: 4
Recording Area
Nam and Return Address
7- j a,~fy stt S S
BbS ~.uyle ~ -~{~Q (~V
55 a 9
$ I (~I ~i (cf~o0
Parcel Identification Number (PIN)
This information must be completed by submitter: document title name & return address, and PM (if required). Other information such as the
granting clauses, legal description, etc. may be placed on this first page of the document or maybe placed on additional pages of the document.
ote: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.43(2m) WRDA 1/99
215.32 (2/99)
;onsin Department of Industry,*
ndust,
v HOLDI~G TANK AGREEMENT Safety and 8uildin Division
' Lpbor and Human Relations qq510PAGE3 r~ 4 c d Bureau of Buildings and Water Systems
~
Document No. /Plan Identification No. Vf.'i .1 This space reserved for recording data
This agreement is made between the
governmental unit and holding tank
Agreement Date Owner(s)
0~.
County or Lo al oYe mental U it ink O~qner(s)
ST Q_f,a,
P``"~Y
rCL r
~
called Muni i ali elow
We acknowledge that application is being made for the installation of (a) holding
tank(s) on the following property: (Provide legal land description)
S N w
R6c
SA C r®r Ca`~ Return To
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 sewage system as permitted under Ch. ILHR 83, Wis. Adm.
Code, or Ch. 145, Stats.
As an inducement to the County of S~ t`O 1 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. ILHR 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 municipality to prevent or abate a human health hazard as described in s. 254.59.
Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing
the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats.
2. The owner agrees, pursuant to s. ILHR 83.18 (10), Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by
the County and State. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation
complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation,
maintenance, and repair of the water meter, and agrees to allow the municipality 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 cost incurred by the municipality 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 municipality 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, except as provided by s. 146.20 (3) (d), Slats., 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 or the owner's registration with the municipality. 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 municipality 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 municipality on a semiannual basis a
report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3)
(d), Scats., the owner shall submit the report to the municipality. The municipality 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 local governmental unit responsible for the regulation of private sewage systems certifies that the
property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 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 the 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) Names - Print Notrized Owner(s) Si nature(s)
S
r Subscribed and sworn to before me on this date:
13 Zfh S 1~DS S
Notary Public
rtQtflMC(/I D~ ~~4r ~rrlr jolcl14
11
Municipal Official Nam/e/- Print Municipal Offical Signature
~G(4/~S f7i I' Y n expirLWKIOW
Muniu I Official Title -Print Paw
woavaft~
The information you provide may be used by other gave, " went agency programs (Privacy Law, s. 15.04 (1)(m)I
SBO.6123 (R. 04/94)
HOLDING TANK SERVICING CONTRACT
Contract Date Y( 1..1513PAGE 346
This contract is made between the
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Holdinn Ta k Owner(s) Nam,-10 and I Pumper's Name
Jcc~ i F~a erg _10ss I U,, , L;~t -►'t~-m~', tic
d
30& C
_~do ~~rv M N SS! I 01
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:)
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1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which hz
signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and
with the County of S1_ c [tea ;
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and
enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather acce:
road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pi
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 municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wi
Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agre,
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;
I. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contra
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipal
and the County named above within ten (10) business days from the date of change to this service contract.
Owner(s) Name(s) (Print) I Owner's Signature(s)
- Subscribed and sworn to before me on this date:
R)/3 0%, 41d~' I
Pumper's Na a (Print) I Pumper's Signature olary u
Pw,ev-S ~JttU l,Jas ~i
My commission expires:
" I u V► fY\ o tit`' 5
Pumper's R / istration Number
SBD-7574 (R. 09/88) This instrument was drafted by the State of Wisconsin Department
of Industry, Labor and Humart Relations
Wiscongin.DePartment of Commerce SOIL AND SITE EVALUATION
Divrsion of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
r
59 C~ County
Attach complete site Ian on paper not less than 8 1 /2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
D .3'.S/o1-7
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Prope w r Property Location
Ck~ 2) Q Q 0 'iP rN Govt. Lot 1/4 1/4,S 3T N,R g-=)r) W
°3~ e
ss Nw . 3 l
Property Owner's Npilin Ad t Lot # Block# Subd. Name or CSM#
_2 (_CLS ~_qkQ It L_ ~ 3 1 1 G a J. L~~
City State Code Phone Number ❑ City village Town Nearest Road
Lo lv .sm "R I C-4. Ff, c ) < < C l Rd N
❑ New Construction Use: Residential / Number of bedrooms Addition to existing building
Replacement I Public or commercial - Describe:
Code derived daily flow 3()(.N gpd Recommended design loading rate bed, gpd/ft2b}3trench, gpd/112
Absorption area required t~Pr bed, 112N_.trench, ft2 Maximum design loading rate bed, gpd/ft2~_trench, gpd/ft2
Recommended infiltration surface elevation(s) _ N ra. ft (as referred to site Dian benchmark)
Additional design/site considerations _ u C, 1V\ o. } ,,q sii ft,, ds S
13
Parent material Flood plain elev lion, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S M U ❑ S ®U ❑ S [Y~ U ❑ S I,S,.U ❑ S 0 U XS [I U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
3
f o_~ 0 .y .I. I S~14- rh S .21r,
Ground 16 r r fo S'* $
elev.
Depth to
limiting ;
ctor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
C T Name (Please t) Sign Telephone No.
kit- Po ~Qd!ZS --I
Address Date CST Numbbr'
to -1i~ S N ~ U_.~! 1. s-i- o0
If 11
PROPERTY OWNER ~r~57oIL DESCRIPTION REPORT Page _,:a_ of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground ,
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
'n' Remarks:
SBD-8330 (R. 07/96)
N ~o S Y S 3 j 3 N
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m ~ - _ - - _ afQ&~.fl o 3 ~ 101710 00 a
9)A II-X
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•Wtdonsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code /159 0, ` County
Attach complete site lan on paper not less than 8 112 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
D 3~~ Inl7(o ID
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). _ 7gr,l
Prope w r Property Location
Govt. Lot N W 1/4 1/4,S 3 T _3 N,R -=Sr) W
Property Owner's ailin Ad Lot # Block# Subd. Name or CSM#
~t r
city State 29 Code Phone Number
{ I j ( ) El City Village Town Nearest Road
C l J)
~Lt ["!4 1 sloe, ~f"t X
-1 y
❑ New Construction Use: Residential / Number of bedrooms Addition to existing building
Replacement I Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate W ft bed, gpd/ft2.trench, gpd/ft2
Absorption area required ~Pr bed, ft2 trench, ft2 Maximum design loading rate 6r gybed, gpd/ft2kLA _trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations cv C, \ v\ Q. r a S
Parent material Flood plain elev tion, if applicable AIA
ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S 5Q U ❑ S NU ❑ S [is, U ❑ S VS,U ❑ S 0 U S❑ U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
0- 4/2. 2
.6 L
Ground st; /6 r Y P ' A S'aF t) L
5
elev.
14A -eft. M nwt~ - e Y'
Depth to
limiting
~ctor
Remarks:
Boring # Tnvto
Y
f i
tY
\J '1
Ground S GI"X
Y
elev.
ft. *f
f y
Depth to
limiting
factor
in. Remarks:
C T Name (Please t) Sign Telephone No.
o - L5 Q.
Address Date CST Number
~o - t cl~ t S~/- 00
DESCRIPTION REPORT
PROPERTY OWNER ` IL Page _CI_ of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
i Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
elev.
ft.
I
Depth to
limiting
factor
in.
F-t-
Remarks:
Boring #
i
Ground
elev.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD-8330 (R. 07/96)
r-
eu~s~~ss N w`/~{ sIE s 3T 31 lu R
m ~vvI j c+'~~ 0 3 J o i 7lo 0. a
B N A TDB e-~
5ca_~C_ I~ /a r
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vi. t5lOPAGE 345
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer t'. tT Rct-0 e # SS
Mailing Address 14
Jul S Sl~~
Pro erty Add dress 14
,5 8
(Verification required om Planning Department for new construction)
City/State l~ 1 PLk »-t aw~ l~ Parcel Identification Number $ D ` 000
LEGAL DESCRIPTION
Property Location NU '/4, SC y4, Sec. , T2LN-R J W, Town of cz r~ `r ~.'2
Subdivision Lot # _ r
Certified Survey Map Volume , Page #
Warranty Deed C)S , Volume SG , Page # CO
Spec house ❑ yes 19 no Lot lines identifiableP yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance'
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restricted plumber or a Iicensedpumperverifying that (1) the on-site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
SIG 'fi1RE OF LICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIPsF ATURB OF ICANT DATE
Any information that is mis-represented may result:in the sanitary permit being revoked by the Zoning Department.
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
~ Y
Ji , VJUPAA24
STATE BAR OF WISCONSIN FORM 2 - 1999 621 ~~3
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Gary H. Baillargeon and Bonnie F. RECEIVED FOR RECORD
Baillargeon, husband and wife, 04-12-2000 9:30 AN
WARRANTY DEED
Grantor, and Ricky S. Baggenstow and Jodi L. Baggenstoss, husband EXEMPT #
and wife, CERT COPY FEE:
COPT' FEE:
TRANSFER FEE: 225.00
RECORDING FEE: 10.00
PAGES: I
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Part of Government Lot "5" of Section 3-31-18 described as follows: Recording Area
Commencing at a point in the center of highway, as now located, cunning Name and Return Addre
East and West through the W I/2 of Lot 6 in Section 3-31-18, said point [
being the southwestem corner of that certain piece of land deeded to James
Thompson, which deed is recorded in Vol. 177, Page 599; running thence
Wly along the center of said highway for a distance of 55 feet; thence Nly to
the shore of Cedar Lake; thence Ely along the shore of said Cedar Lake to a
point directly N of the place of beginning; thence Sly to the place of
beginning, St. Croix County, Wisconsin. 038-1017-60
Parcel Identification Number (PIN)
This is not homestead property.
00 (is not)
Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this ~b day of _ April 2000
' f Gary aillargeon
Bonnie F. Baillargeon
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Gary H. Baillargeon and Bonnie F. Baillargeon, STATE OF WISCONSIN )
husband and wife, ) ss.
County )
authenticated this 6eday of April 2000
Personally camc before me this _ day of
the above named
e Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not,
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristian _gland Notary Public, State of Wisconsin
Hudson, Wl 54016 My Commission is permanent. (If not, state expiration date:
(Signatures maybe authenticated or acknowledged. Both are not necessary.)
a Names of persons signing in any capacity must be typed or printed below their signature. Information PrareNlonWe coopao➢. Faro a, Lao. W
STATE BAR OF WISCONSIN 900455"2021
WARRANTY DEED FORM No. 2 - 1999
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