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7-.n,~~ epartme nt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
uilding Division
INSPECTION REPORT Sanitary Permit No:
479395 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j.
Permit Holder's Name: City Village X Township Parcel Tax No:
Brendemihl, Gale Star Prairie, Town of 038-1017-95-000
CST BM Elev: Insp. BM Elev: BM Desc ' Section/Town/Range/Map No:
100-1) (7 40V % 0( S_ I I h Y AAJ 03.31.16.63
TANK INFORMATION ELEV ION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septi Benchmark to O
3 CSC ~ 3. to 3 - j ~ .
D ng
Alt. BM c n 3. 6 Jv. v
erati Bldg. Sewer (Itj 6
`"I Opp
Holding S Ht I let ~ .7Z to- 1~
TANK SETBACK INFORMATION "D 0,
TANK TO P WELL BLDG. Vent to Air Int ROAD Dt Inlet
Septic Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe f Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer De
3.
mand P~o er I DD
GPM t4F
'S
; 6kaA
Model Number C•~
TDH Lift Friction Loss tem Head TDH Ft
Forcemain Length ia. Dist. eII
SOIL ABSORPT N SYSTEM JJIA BED/TRENCH Width Length No. 10f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAK REAM EA HIN Manufacturer.
INFORMATION C OR
Type Of System: IT Model Number.
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole x Hole Spacing Vent to Air Intake
Pipe(s) \ 5Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil = Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1174 County R,o-ajd(HH New Richmond, WI 54017 (NW 1/4 SE 1/4 3 T31N R16)W)) NA Lot goojv~tt 5 Parcel No: 203.31~~Q~ (/L~ +
V( F&I c3 7
1.) Alt BM Description /I
/
2.) Bldg sewer length s4e_4 N ~GU to a
- amount of cover = y _ + 1~ql
WW
r--en revision Required? Yes /No Q b~
other side for additional information.
n~ ~ e/ Date sepctor's ignature ,1•, J ,J \ ,Y,Ce!t No
C~ GG~~% tv"~{+T- ~i(//1~ f-r ~2~ c
'10 (R.3/97) out' v 4-C,
Safety and Buildings Division County ~r G
201 W. Washington Ave. P.O. Box 7162 / d X
1*1 M adison, W' 162 Sanitary Permit Nuumber (to be filled in by Co.)
scor~sirn ON) 2 q: T/ 3`j s
Department of Commerce
State Plan I.D. Number
Sanitary Permit Application Q o~35 = 2s. ~p#
In accord with Comm 8321, Wis. Adm. Code, personal information you provide Project Address (if different than mailing address)
may be used for secondary purposes Privacy
1. Application Information - Please Print All Information T 3 g'^ 1,p17-,13° 5' ocro ((0 3)
Property Oz's Name 0'? P reel N Lot N Block N
AK7 `1,'
~ mot. ~ 6
Property Owner's Mailing Address 51.CROIXCOIJNT? operty lion
ZONING OFFICE
-7 41 Y.,S~ Section
City, State Zip Code ;]Phone Number
'-le one)
+ l ~irr ® ® TS-f- N; V-ZE or W
IL Type of Building (check all that apply) Subdivision Name CSM Number
Pf I or 2 Family Dwelling - Number of Bedrooms
❑ PubliclCommercial - Describe Use
❑ State Owned -Describe Use ❑City ❑Yilla ce ownsh' f
Gt C
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System fi4.plaeement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modirwation to Existing System
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New
Owner
Before Expiration Plumber
IV. fy-pe of POW'I'S S enr: Check all that apply)
❑ Non -Pressurized In-Ground ❑ Mound > 24 in o soil ❑ Mound <24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- round Holding T ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain)
V. Dis rsalfrreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (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 4T- • g~ G
Aerobic Twounent Unit
Dosing Chamber
VII. Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS shown on fhe- attached plans.
Plum 'Name (Print) + Plum ignature MP/MP RS Number Business Phone Number
P um s Address (Street, City, S Zip CodcV loop'
VIII. Count y/De artment Use Only
ov Sanitary PerFee (i ;rGEroundwate,, Date Issued Issui Agent Signature (No Stamps)
Approved ❑=mit L. ed
Surcharge Fce)~1-
❑ r ~ en ial
IX. Conditions of Approval/Reasons for Disapproval 0,2
SYSTEM OWNER: f
1 Septic tank, e#6eM4Hter and 5 t s r'O /
dispersal cell must all be serviced / maintained `
_ p„ s
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances.
Atach complete plum (to the County only) for the system on paper not less than 9112 x 11 toehes in size
SBD-6398 (R. 01/03)
Zrendehihl PLOT PLAN
ADDRESS 1174 Ctv Rd H NewRichmond WL 54017
SSE 1/4S 3 _ /T 31 N/R 18 W TOWN StarPraide COUNTY ST. CROIX
✓AS Byron Bird Jr. 220527 DATE 7-20-05 BEDROOM 3
,dONVENTIONAL IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK XXX
MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 3000 gal LOAD RATE ABSORPTION AREA
# of chambers
BENCHMARK V.R.P. Top of well
ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H.R.P. Same as BM
SYSTEM ELEVATION to be determined
Cedar lake
10, 75'
D
15',~b vw~ o,
PL
S
N 45' Access Rd.
5'
20' 0 ~r
t
75' 1
PL ,4(~•
20' 3 bed house 75
15' " ,
6 45' 5'
P.O.W.T.S.
Conditionally
APPROVED
36' DEPARTMENT' OF COMMERCE
DIV N OF SAFETY A BUILDINGS
ONDENCE
Co. Rd H SEE C
C OPY
Safety and Buildings
10541 N RANCH ROAD
commerce.wi.gov HAYWARD WI 54843
i ■ TDD (608) 264-8777
S C O n S www.commerce.wi.gov/sb/
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
August 05, 2005
CUST ID No.220527 ATTIC- PO WTS Inspector
BYRON BIRD ZONING OFFICE
BYRON BIRD JR. PLUMBING, INC ST CROIX COUNTY SPIA
896 68TH AVE 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/05/2007 Identification Numbers
Transaction ID No. 1160735
SITE: Site ID No. 702297
Gale Brendehihl Please refer, to both identification numbers,
Cth H above, in all correspondence with the agency.
Town of Star Prairie
St Croix County
NW1/4, SETA, S3, T31N, R18W
FOR: 300 gpd holding tank
Object Type: POWTS Component Manual Regulated Object ID No.: 1031399
Maintenance required; 300 GPD Flow rate; System(s): 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:
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 60.00
1 Fee Received $ 60.00
Balance Due $ 0.00
Carl J Li
pp~
Wastewater Specialist, Integrated Services WiSMART code: 7633
(715)634-3484,
clippert@commerce.state.wi.us
PLOT PLAN
PROJECT ale Brendehihl ADDRESS 1174 Ctv Rd H NewRichmond Wi. 54017
NW 1/4 SE ~ 1/4S 3 /T 31 N/R 18 W TOWN StarPrairie COUNTY ST. CROIX
MPRS Byron Bird Jr. 220527 ~ DATE 7"20'05 BEDROOM 3
CONVENTIONAL IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK XXX
MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 3000 gal LOAD RATE ABSORPTION AREA # of chambers
BENCHMARK V.R.P. Top of well ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *g,A,p, Same as BM
sYSTEM ELEVATION to be determined
Cedar lake
75'
10'
D
15' 0'
PL
S
45' Access Rd.
O 5'
20' o
75' ~ 10'
PL ~ 5
75'
20' 3 bed house
u~
15' 6' 4~~ ~ q
~5'
~3.V`~~.T.
CC~'~~f~l~lO72~r~t~
~~D
DEPARTMENT OF CbMMERCE
36' HIV ~ 1N flF SAFETY A BUILDINGS
SEC` CO ONDENCE
Co. Rd H
Page Of
SITE CONSTRUCTED
HOLDING TANK CROSS-SECTION
4" C. I. Vent Pipe
wNent Cap weatherproof
or
2" C.I. w/Retum Junction Box
Approved Locking Manhole Cover
Bend with With Warning Label Attached
Audible/Illuminated
225 From Door, Alarm
Window or Fresh Minimum 12"
Air Intake Final Grade UAi
4" MlnlmumXw~ ght
nng
18" Minimum
~ I
Watertight
Seal High Water I
Tank Dimensions: Alai rn Switch R
Length: ; 13 ~ • \
Width. ( Approved Joint
Working Heighi. 7 Exteerdlrog Pie
(all dimensions inside) Beyond Tank
Number of bedrooms: Excavation
Wall: es6: 3y <r Gallons per day: At t t~
Wall:
Base:
Cover: Water stop
GALLON CAPACITY
3" of Bedding Under Tank Keyway
PLUMBER/DESIGNER
~M: Manufacturer: at! 1 74
Model Number: Signature:
Switch Type: A- License Number: O S a~
Tank Specifications: Date:_ ~ ~;XD o 5!
Concrete mixed to withstand 3,000 psi min., and shall be of monolithic pour
Tank cover and manhole riser joints to be tongue and groove or shiplap
All joints to be sealed watertight with approved sealants
Keyway width to be approx. 30% thickness of sidewall
Water stop shall be copper, neoprene, rubber, or PVC, at least 6 inches wide, and continuous
Provide adequate anchoring
Include all wall tie specifications (See attachment)
Manufacturer spkifications for sealent and hydraulic cement meeting ASTM C 595 must be
included in submittal. The sealant must be specified as compatible with both concrete and sewage.
s . j6 T k
aa 4 '
[
it,
awl
~xt L.,..Sw P
Inc.
Plumbing
Byron Bird Jr.
I
B F"r tG
User Manual: 5
r
r
Owner=u
w }
2 5
W
n N/R
14 1/4 S T-
Location
I
1
' Township s :/`OtfriLSubd name or CSM
_4 W_
F
County- e~ie r sC,_.
I
The owner is responsible for operation and maintenance of the systr~
alarm, and must maintain an access road. The'county is responsible for 'n"s fry
the site before; during, and after construction. The holding tank mL sib e.
licensed pumper. An alarm system is installecto activate wren thai",5 V
the time of the servicin` g ,the service provider fibs a report`wIa thy{ a~r
1, designated agent. A remote reading water mefer must be installec~"on th a ly`,
of the facility that discharges into the holding tank.
;Phone Number Installer
Pumper r r - No.- 7
Health Authoriy _ jar a '+f x / No `
Contingency Plan:
P
d
~ he ,
k ~ .pumpe and pro erl ed
d,
If the tank were to fail, the owner, shall have t
by license provider. The'.tank than must be replaced tank by a licensed Master F,i . r
g Restricted Master Plumber:
44 T
1
r
Vie.
Jf'ti
4.
~W
i 4=
~e .
3
Al,`' ors
f
7
wS.
~t
I
P
I
s
HOLDING TANK SERVICING CONTRACT
Contract Date
, ® This contract is made between the
Holding Tank Owner(s) Name(s) and Pumper's Name
e' ,-Ile 11'7,,
We acknowledge the instaon of (a) holding tank(s) on the following property: (Provide legal escriptions:)
7-3//1-1/7-1,94 & CC~~ r L« f~ &fl
V G G.
O
Q rC
- -~d
1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the
pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank
Component Manual. This agreement will also be filed with the St. Croix County Zoning Department.
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 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 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 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 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 local governmental unit and the County named above within ten (10) business
days from the date of change to this service contract.
Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date:
CDs
Today s Date
t.
Pumper's Name (Print) Pumper's Signature Notary Public Sign re
Jjew~
Pumper's Registration Number Expiration
5. NOTA R V ; ~
61530
CA Ab
F W `SCO
iS -7 -7
2 8 6 4 E 1 KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX Co., WI
RECEIVED FOR RECORD
08/10/2085 03:00PH
Document Number Document Title HOLDING TANK AGREEMENT
EXEPPT #
St. Croix County REC FEE: 11.08
Holding Tank Agreement TRANS FEE:
COPY FEE:
CC FEE:
tate Plan Transaction Number - PAGES: 1
GALE 3ec)V0 M ( N L, p ia- zC~~~
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 ~0 Page / 70 Document
Number 321-9'0 St. Croix County Register of Deeds Office: 6,) L/ Zrf Recording Area
A parcel of land located in the '/4 of the '/4 of Section -3 5 Name and Return Address r
T ' / N - R Z,,gr, W, Town of :0,, ~r f Croix
County, Wisconsin, being duly described as follows (include lot no. and
T3//L/l~w ~t
subdivision/CSM or detailed legal description): 33
o ~r w ~ a 5- ~ ~ ~•~l •t R ~r ~o~L.ij 73~ %f,`~°~ G 3~$ -/I/7 Z(PIN
Parcel Identification Number We acknowledge app icatioY 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 falls 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 amater meter installed in the structure.
The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations, with said installation
complying with State regulations and manufacturers specifications. The owner agrees tombe financially msponsible for the purchase,
installation, maintenance, and repair of the water meter, and agrees to allow the govemment6l 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 fol.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.
1
Owner(s) Name(s) - Please Print Subscribed and sworn to before me on this date:
ell, en /,e rr/• li t op- 0 oS A.o QIA 18
Notarized Owner's Signature(s) Notary Public '
Governmental Unit Official Name, Title - Please Print My Commission Expir s J'• ~y
Govemmen nit Official STgnature Drafted by:
JC2 5' c
Personal information you provide may be used for secondary pure s (Privacy Law s. 15.04(1)(m)]
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE"
This information must be completed by submitter document ft 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. Use of this cover page adds one page to your document and SZQQ to the ree2aft-&L Wisconsin Statutes, 59.517.
DOCUMENT NO. n STATE 13AR OF WISCONSIN- FORM 2
IEC
DEED
f••' 529 mi 1"70 ' watVED 1
' yQt THIS SPACE RESERVED FOR RECOROtNG DATA
329493 _
t _
BY THIS DEED, Leona G. Schilling, as personal REG.:aTERS OFFICE
- ST. CROIX CO.. WIS. i
Renregentati7e of the Estate of Frl r
deceased Recd for R?ccrd t. is_ 1sL
Gale Bzsidemihl sin le day of___Qctober q D. 19- 75
Grantor conveys and warrants to r g tl j0_;j5__ A M,
i'
Re¢istar of De•-ts
_ Grantee- I
for a valuable qo sideratipn of 03~ Ot-r1@r Va lla Te RETURN TO
!i consideration _ L. R. Reinstra
is the following described real estate in Ct Crni County, State of Wisconsin: 127 West 2nd Str-et
Rlehfnend, -:rl---~4A k7
Tax Key K
Th.~ is homestead property.
Part of Government Lot "r5", Section 3, Township 31, Range 18
describedas follows:
Commencing 733.1 feet W of a line N and S, through the center
of Government Lot "r6", Section 3, Township 31, Range 18; which
is the point of beginning; thence W along the IN line of County
Highway "H" as now travelled about 75 feet; thence N to Cedar
Lake; thence E along said Cedar Lake to a place directly N
of the point of beginning; thence S to beginning. Intending
to convey a parcel of land extending from said Highway "H"
to Cedar Lake, and 75 feet wide, E and W.
T7. S'i ti f. l_'R
Exception to warranties:
Executed at_New t.ch ond,-Wisc_onsin___--thi 29th. _day of _September--_-_.__-. 1975-
SIGNED AND SEALED IN PRESENCE OF (SEAL)
Leona G. Schilling
(SEAL)
(SEAL)
III
i
(SEAL)
Signatures of _ Leona G. Schilling, _as -personal representative of tthe.
Estate of Edna R. Fenner,- deceased
authenticated this ?9thL` day of September--- 75 .
Title: Member State Bar of Wi%consinV4Xl) XXWrrfY,
STATE OF WISCONSIN
County.
Personally came before me, this-_------- day of 14....__,
the above named _ - = - _ -
to me known to be the person.-...- who executed the foregoing instrument and acknowledged the same.
This instrument was drafted by
L. R. Reinstra, Attorney
New_Richmond,---W__5491? Notary Public.------ County, Wis-
The use of witnesses is optional. M,• ~ nmmission (Expires)
Names of persons signing in any capacity should be typed or printed below their signatures.
_ MC1MMrCano~~
WARRANTY DEED-STATE BAR Or WISCONSIN, FORM NO. 2 - 1971 ~L7 -
Parcel 038-1017-95-000 09/13/2005 08:20 AM
PAGE 1 OF 1
Alt. Parcel M 3.31.18.63 038 - 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
GALE BRENDEMIHL O - BRENDEMIHL, GALE
1174CTYRDH
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1174 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 PT GI-5 N OF HWY S OF Block/Condo Bldg:
CEDAR LK W OF LN 733.1 _FT W OF C OF GI-6
& E OF LN 808.1 FT W OF C OF GI-6 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
03-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 529/170
St~l~s
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 82,100 56,100 138,200 NO
Totals for 2005:
General Property 0.000 82,100 56,100 138,200
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 82,100 56,100 138,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 215
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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80307-7
4 2 8 6 9 P 12.3
KATHLEEN H. iiALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
08/10/2005 03:00PM
Document Number Document Title HOLDING TANK AGREEMENT
EXEMPT #
St. Croix County REC FEE: 11.00
Holding Tank Agreement TRANS FEE:
COPY FEE:
CC FEE:
tate Plan Transaction Number - PAGES: 1
i
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 Sol Page / 70 Document
Number 3 2-'WO St. Croix County Register of Deeds Office: 6.j Lst' Recording Area
Name and Return Address
A parcel of land located in the of the of Section
T~_~ N - R 1,~C W, Town of Croix
County, Wisconsin, being duly described as follows (include lot no. and
subdivision/CSM or detailed legal description): -5.,4 7"j// 0451 O't
/r/ 0 5rl ~u/y,~~ e G c<~ R ~e Hof L 733
'
6eement~a~e:o~~`rc .3Parcel ldentificationNumber (PIN)
We acknowledg that app ica60 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 faits 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 awater meter installed in the structure.
r The water meter shall be Installed by a Plumber authorized by the Department of Commerce to make such installations, with said installation
complying with State regulations and manufacturers specifications. Tho owner agrees to-be financiaiiy responsible for the purcnase,
installation, maintenance, and repair of the water meter, and agrees to allow the govemment&I unit or the Department of Commence 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 properly maintained.
6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems
certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm
83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this
agreement In such manner which will permit the existence of the certification to be determined by reference to the property.
7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement
to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the
agreement to be determined by reference to the property where the holding tank is installed.
Owner(s) Name(s) - Please Print Subscribed and sworn to before me on this date: Q~~EY F.
~cle< ghch cle 'W1 t;- D oS y~~.•••.....,• '0.0
Notarized Owner's Signature(s) Notary Public
~1 K . i
Governmental Unit Official Name, Title - Please Print My Commiss'.on Expir s ~5
t _ a, o o "1 of WIS a
Govemmen nit Official nature Drafted by:
r
Personal information you provide may be used for secondary pure s (Privacy Law s. 15.04(1)(m)]
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE"
This information must be completed by submitter. document title. name 8 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. Use of this cover page adds one page to our document and $Z 0 to the recording fee. Wisconsin Statutes, 59.517. -tift