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HomeMy WebLinkAbout014-1022-20-000 ST. CROIX COUNTY ZONING DEPAR AS BUILT SANITARY REPORT `t Owner roperty Ad ess P � ....�E City /State 7 12 a Legal Description: r - ; Lot Block Subdivision/CSM # / ' i,,'_,' = 0 /4 ' /4, Sec j�,�l , T7 v W, Town of >^e PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / Setback from: House Well P/L Pump manufacturer Model Alann location (HOLDING TANKS ONLY) 1 / Setbacks: Service road_ Vet to fresh air intake Water Line a Meter location !.c eV Alarm location SOIL ABSORPTION SYSTEM Type of system: Width Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS o e� Elevation �� Description of benchmark � Description of alternate benchmark Elevation o Building Sewer - ST/HT Inlet ST Outlet • 42— W Inlet ' PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) ( ) ( ) Bottom of System () () ( ) Final Grade () () ( ) Date of installation 14// ermit number ��4tate plan number Plumber's signature License number �o 3"a Date Inspector •Q�c C r` Complete plot plan Or N NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW a� n- U �o �l INDICATE NORTH ARROW r' Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit IX Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 3 Per rrti FL21SIQ[_s N me: El Cit rLn viii e Town of: State Plan ID No.: A VCWI ROSE t ff a4.13 CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: 014 - 1022 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark , W ffm # 't 1 r ti Bldg. Sewer ( 3/ C1T Holding St/ Ht Inlet o TANK SETBACK INFORMATION St/ Ht Outlet , TANK TO P/ L WELL BLDG. Ai Intake ROAD Inlet' Septic NA Dt Bottom Dosing NA Header / Man. flop 3� "-7-0 NA Dist. Pipe Holding 1 / 7'4-o Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand oo 0 Model Number GPM / TDH Lift P cti ea m TDH Ft Forcemai n Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT o. Of Pits Inside Dia. Liquid Depth DIMEN I N N 1 N SYSTEM TO LEACHING Manufacturer: SETBACK CHAMBER INFORMATION T Mo el Number: ystem: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 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 discrepancies, persons present, etc.) LOCATION: FOREST 10.31.15.146 NW E 2957 230TH AVENUE 8,6 r Ka 4 CAAA-ek C. ftuwal u f - �" l °�' �' Plan revision required? ❑ Yes KNo ` 1 �( Use other side for additional information. 10 99 / SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. , i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a e a € 4 ° p m,A L t 3 i � a m" ._ A a a a I „ .. e . s " a i € 1 a S n m w� ° a , C # e € " n " z t a.. e x s a e a E a i a r 3 F a � } a d h a t a e *i sconsin Safety and Buildings Division SAN ITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. p • See reverse side for instructions for completing this application State Sanitary Permit Nuum Personal information you provide may be used for secondary purposes ❑ Check if revision application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Na / Propert Location ��� / _e j—m at /4 / 1 /4, S l T , N, R (c'�Z =.Y/ Property Ow Mailing Address Lot Num Block Number o? G7 �I? Cit St to Zip Code Phone Number Subdivision Name or CSM Number tic r ,= � II. TYPE F BUILDING: (check one) ❑ State Owned !t ge Nearest Road �..� ublic 1 or 2 Family Dwelling Villa - No. of bedrooms Town or r III. ILDIN USE: (If building type is public, check all that apply) arcel Tax Number(s) t 3 I . 115. 1 Lf lo 1 ❑ Apartment/ Condo 5 IzI— `D-2–oZ —_2c 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Chec,Jr� only one box on line A. Check box on line B, if applicable) A ) 1 W1Vew 2 L`�J; placement 3, ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an 7 System _ Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 Tank 12 E] Seepage Trench 22 E] In-Ground Pressure 42 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation f'5_4v Feet — Feet VII. TANK Capacity Total # of Site )n gallons Prefab. Fiber- Exper. INFORMATION Manufacturers Name Con- Steel Plastic Gallons Tanks concrete glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank ���� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIIL RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name: (Print) Plu r'ssignature: ( Stamks) MP /MPRSW No.: BusinessPhon it / � l PlumbeiJif Address (Street, City, State, Zip Co ): _ GC.4 IX. COUNTY/ DEPARTMENT USE ONLY �� pp [] ❑Owner Given Initial Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued en Issuing ignature (No Stamps) LEA roved nz Surcharge Fee) J" r� Q Adverse Determination 300 � V /v ( X. CONDITIONS OF APPROVAL / REASONS FOR DI APPROVAL: A SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divisi , Owner, Plumber i INSTRUCTIONS �1 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 accurate this sanitary permit application must include: I. 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 information. 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.), s 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 81/2 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. t ; > Safety and Buildings 15837 USH 63 ' A HAYWARD Wl 54843 -8107 TDD #: (608) 264 -8777 \*Irsconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 24, 1999 CUST ID No.220527 ZONING OFFICE BYRON BIRD JR ST CROIX COUNTY SPIA 896 68TH AVE 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 05/24/2001 Idetification� Numbers_ Transaction ID No. 226239 Site ID No. 172765 SITE: pleas6lj refer to both i ­ 0 111 111 t,€rtt nurnbet% Site ID: 172765 above, in all co g a agency, ST CROIX County, Town of FOREST; 2957 230TH AVE, CLEAR LAKE 5400Cp]1 itiona NWl /4, NEIA, S10, T31N, R15W Facility: ROSE ALVERMAN 2957 230TH AVE, CLEAR LAKE 54005 A 3V E s 0 k FOR: DEPAFTMENT OF C0%1MFRCF Object Type: POWT System Regulated Object ID No.: 469319 p 6CN OF SAFETY AND 6UILUiNGS The submittal described above has been reviewed for conformance with applicables�o io�des� and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 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. 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 05/10/1999 FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 *CARL eRT. ASTEWATER SPECIALIST BALANCE DUE $ 0.00 Field Operations (715)634 -3484, CLIPPERT @COMMERCE.STATE.WI.USS „„ I PLOT PLAN PROJECT Rose Alverman ADDRESS 2957 230th Ave Clear Lake Wi 54005 NW 1/4 NE 1/4S 10 /T 31 N/R 15 W TOWN Forest COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 4/29/99 BEDROOM 3 CONVENTIONAL IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK XXX MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 2 -1200 LOAD RATE ABSORPTION AREA none # of chambers none BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION none Alternate Benchmark B ase of Siding @ 100.0 1320' Property Line 600' 550' B -5 B -4 00' Driveway is to serve as o the service road B -3 200' 1% Slope y C Tanks are to be properly bedded and provided with 0' .Well lockdown covers with 30' Driveway Alt. approved warning labels B.M. B .M. 500' B -6 0 25' ST H HT 5 Existing 3 South Half of property was found verflow Bedroom 0' to be a lower elevation ouse and natural vegitation indicated a saturated soil condition and Old System to be 25 , therefore was not tested pumped and buried Tanks are to be setback _ 1 <25' from driveway Note: Soils on site were consistent N and thus no further testing was ° 150' deemed needed by soil tester P.O.W.T.S. o Conditionally 200' 150' APPROVED DEPARTMENT OF COMMERCE B -2 DIVI 'JAN OF SAFETY AND BUILDINGS 125' SEE COR SPONDENCE 1320' Property Line � � cn /' /' 0 n- �rDO 's (D n (D (D 3 Di -1 (D n < v c m ! =- J W rD Z S - Q (D C .Z7 • • J• C7 N N C"'t' (D \ Cf w • . z (D o rri M r) t�-� � o• �, � rD Ljl CL N .. m j ro v r - M o C v (D C J. 0 O r+ f7 r + < a J• • �- E e H (D �� o (D rY J. r+ ? rr 0 v 1 1 0 0 J. C + x (D --- -- - - - - -- o C) N. 0 (v r 3 D D m " ( G) r co ;o C a w n z ; -n C) V) � ? z O fn m m cy Di (D (") rD O N W r+ (D C m m -+, cn ry O 0 0 =r a n z b 0 Z n N& (n O - 0 V (D Z • • (n m m (D - s m 3 -s -s x w =3 • • to • N J. ` 1 \ C • r+ C o- Cu rD � a �a cn o 0 c cn n r r a CL) W (D cr (n 0 rD c+ 0 w v �D .J 3 N � pr -• 'O rr � a ' —0Q =ro v= C+ rt m><o C-+ o C) (D N n v 0. =r a < 0 a < CL 3 0. 7 rD n r+ a J Y J - m 0 3 n � O C E3 (D C ;Wisconsin Department of Industry HOLDING TANK AGREEMENT Safety and Buildings Division Labor and Human Relations Bureau of Buildings and Water Systems Document No. / Plan Identification No. v(tl- 1432P 24 This space reserved for recordin data This agreement Is made between the p g governmental unit and holding tank Agreement Date owner(s) County or Local Gov6rnmental Unit Holding Tank Owner(s) 1J% G rp C X called Munic below We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property: (Provide legal land description) 3/ Al — JS' �- C /0 - r '4/ N >rP /S"cJ rG'RES 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 , C / 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), 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 bans 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 sha!l 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) Name(s) - Print Notri d Owners) Signatures) • •,• •.,� �, 20 , sworn to before me on this date: • p ;. Notary Public • B ;r • J ^` — 1 -- • •y lam' Municipal Official Name -Print Munici aI Off icaISignature F •• •�•�.• ;` C j r 1(r� t' r sion expires: � O r L .S Municipal Official Title - Print • c r The info mdtwn you provide may be used by other government agency programs [Privacy Law, s. 15.04 (1)(m)i SBD -6123 (R. 04194) it yogi 1432PAGE123 604441 KATHLEEN H. WALSH Tvt REGISTER OF DEEDS Document Number Documfnt Title ST. CROIX CO. � WI RECEIVED FOR RECORD 06 -07 -1999 9:00 AM AGREEMENT EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 12.00 PAGES: 2 Recording Area Name and Return Address �l/ro1JX� ✓�' p rs r ry /�eQ'.1 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 $2.00 to the recording fee Wisconsin Statutes, 59.43(2m) WRDA 2/99 215 -32 (2199) HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owner(s) Name(s) and I Pumper's Name /L) 6w � 1 013 AS'5� /i v S We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) c � o T _1 /Iq 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 C--IRO i.X 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the 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; ' f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain In effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the 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) I Owner's Signature(s) rTIl I I � � r nd sworn to before me on this date: .. I • u • s 0 Pumper's Name (Print) ( Pumper's Signature o 7 Notary Public "flhii xpires: P umper's Registration Number F Vy s 5 _mss 9 SSD -7574 (R. 09/88) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations Wisconsin Department of Commerce SOIL AND SIT UATION Division of Safety and Buildings p Page of Bura of Integrated Services in accordance wit jj , 1 8'x.0 Wis..Adm. Code '. County Attach complete site plan on paper not less than 8 1/2 x 11 inches in elan mu$�wr; ,. include, but not limited to: vertical and horizontal reference point (B ) tl♦fection and " 1`�l�l — G ✓`� l j( percent slope, scale or dimensions, north arrow, and location and d' tanne to.ftieerest road. Parcel -GD. # APPLICANT INFORMATION - Please print all infor ton. - 1 � �.'`'��� ' RevieH/e by Date Personal information you provide may be used for secondary purposes (Privacy -s�.15.Od Property Owner ` Property Location Gbv1. Lox ' Wh 1/4r�� 1/4,S T 3 IS Property Owner's Mailing Address Lot # Block# TS ubd. Name or CSM# d �y City State Zip Code Phone Number city ❑ Village [X Town Nearest Road / [l New Construction Use: Residential / Number of bedrooms Addition to existing building eplacement ❑ Public or commercial - Describe: Code derived daily flow gpd ,D Recommended design loading rate l! bed, gpd /ft gpd /ft Absorption area required _ bed, ft _ trench, ft e M ximum design loading rate gpd /ft gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark Additional design /site consider tions o: .�� . C* / A e L'C2 .S %.� /1 ll-?�c 2 Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system El S 11F'1* U 1:1 S U El S U El s U ❑ S ,.Ku 'S El SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. q Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground _y . � � Depth to limiting factor in. Remarks: Boring # 1 9 —12 /in Al f15 _ Ground 7 ft. Depth to limiting fac �� t ,9Q�r m in. Remarks: CST Name (Please Print) ignature Telephone No. 7 1 ` 1-� Addr ss Date CST Number PROPERTY OWNE /J '� /?/ SOIL DESCRIPTION REPORT Page of r a PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / Bed ,Trench r Ground Depth to limiting fac / Remarks: Boring # Ground �. ' ee f� - ft. ; Depth to limiting f� 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 # 12 U Ground l ft. Depth to limiting fac or ' Remarks: Boring # 77} G � round Depth to limiting f / ac �' r ` —in. Remarks: SBD -8330 (R. 07/96) Soil Test Plot Plan Project Name Rose Alverman Byro ird Jr. Address 2957 230th Ave Clear Lake Wi 54005 C #220527 Lot ------ Subdivision - ---- ------ Date 4/29/99 NW 1 /4 NE 1/4S10 T 31 N/R 1 5 W Township Forest Boring 0 Well PL Property Line County ST. CROIX k BM or VRP Assume Elevation 100 ft.Base of Siding System Elevation n *HRp as Benchmark Alternate Benchmark Base of Siding @ 100.0 1320' Prop Line 600' 550' B -5 B -4 00' N W O Ex B-3 200 ' 1% Slope C CD 0' . Well Alt. 30' 120' 0 5 ' *B.M B.M. 500' B -6 S 25' ST Existing 3 South Half of property was found Overflow , 0° to be a lower elevation /e2 ��� se and natural vegitation indicated a �'" << saturated soil condition and 25 , therefore was not tested Note: Soils on site were consistent N and thus no further testing was ° 150' deemed needed by soil tester. o b c� 200' 150' c� B -2 125' 1320' Property Line ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address S� 5 (Verification required from Planning Department for new construction) City /State I Parcel Identification Number LEGAL DESCRIPTION ek� p - Property Location /a, � /4, Sec. / , T�N R Town of o � Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes Vno Lot lines identifiable yes El 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 master plumber, j ourneyman plumber, restricted plumber or a licensed P umper 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. 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. S GNATURE OF APPLICANT 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. Aa E . 3 — l� SIGNATURE OF APPLICANT 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 GAVIC LAW OFFICES ATTORNEYS' BUILDING 114 E. AKERS Roben R. Gavic P.O. BOX 400 *Also licensed In Minnesota jory R. Gavic SPRING VALLEY, W1 54767 Area Code 715 Kenneth N. Sortedahl Il* Telephone 778 -5503 FAX 778 -5505 E -Mail gaviclaw0win.brotnet June 8, 1999 Rod Eslinger Zoning Office �3 Government Center �y ��" ' r� � 1101 Carmichael Road A Hudson, WI 54016' ` v ✓'D �' I RE: Palmer Alverman Estate S7-u of 1999 File No. 17,683 NTy Dear Mr. Eslinger: , c, This is in regard to my telephone conversation with you pertaining to the above referenced estate on June 2, 1999. I am probating the Estate of Palmer Alverman, a/k/a Palmer Alvermann with address of 2957 230' Avenue, Clear Lake, (St. Croix County), Wisconsin 54005. Mr. Alverman died on November 9, 1998. At the time of his death he was the owner of West One -Half of the Northeast Quarter and the Southeast Quarter of the Northwest Quarter of Section 10, Township 31, Range 15 West. His surviving wife is Rose Alverman. The Alvermans resided on the described premises at the date of Mr. Alverman's death. Mr. Alverman's estate is being probated in the St. Croix County Probate Court. The Probate Court Number is 99PR7. Rose E. Alverman is the Personal Representative in the estate. I am enclosing to you a copy of the Domiciliary Letters as issued by the Probate Court. The sewer system apparently has become defective on the Alverman premises which sewer systems services the residence on the property. It is the desire of Rose Alverman to rectify this situation as soon as possible and prior to the time that the Probate will be completed which is anticipated to be within 60 days from the date of this letter. She has arranged with the Byron Bird, Jr. Pluming, Inc. of Amery, Wisconsin to provide services for a new septic system which apparently will consist of a holding tank. By virtue of the Last Will and Testament admitted in the Probate Court for St. Croix County, Rose E. Alverman will be the sole owner of all the real estate described in this letter when the Probate is concluded. Rod Eslinger June 8, 1999 Page Two You had indicated to me in our telephone conversation that it would be proper for Rose Alverman to proceed with application to rectify the septic system on the premises on the condition that a letter explaining the situation would be filed with you and further certifying that a copy of the Final Judgment in the estate will be filed with your office setting out the ownership in Rose E. Alverman at conclusion of the estate. By this letter I am certifying that such a copy of Final Judgment will be filed with your office immediately upon it being issued by the Circuit Court in St. Croix County. I am enclosing a copy of this letter to Byron Bird, Jr. Pluming, Inc. so that he may proceed with the necessary application for permission to proceed with the rectifying the septic system on the Alverman property. Thank you. Very rs, 2 W.avic RRG /ja enc. cc: Byron Bird, Jr. Plumbing, Inc. Rose E. Alverman f � STATE OF WISCONSIN, CIRCUIT COURT, ;T- runrx COUNTY ® .. FILED DOMICILIARY H IN THE MATTER OF THE ESTATE OF ��R � 1998 �- PALMER C. ALVERMAN, a /k LETTERS 1-� \r ;'l REGISTER IN PROBATE i de - -- — - ST. CROIX COUNT r PALMER - ALVERMAN -- - - - - -- - -- Case No. To: ROSE E. ALVERMAN Names) The above named person died, domiciled in St. Croix County, Wisconsin, on November 9, 1998 Date You have been appointed personal representative and have fully qualified. These letters are issued to you, and you are ordered to administer this estate according to law. BY THE COURT: Seal Court official C Name Printed or Typed 'd I Date ^. S 74 A-U cgs 3 C C ` _r'swka I elson �4r Re ixisr In Probate PR -1303, 10/95 DOMICILIARY LETTERS § §856.21 and 865.08, Wisconsin Statutes / f GAVIC LAW OFFICES ATTORNEYS' BUILDING 114 E. AKERS Robert R. Gavic P.O. BOX 400 'Also licensed In Minnesota JorvR. Gavic SPRING VALLEY, WI 54767 Area Code 715 Kenneth N. Sortedahl U* Telephone 778 -5503 FAX 778 -5505 E -Mail gavk1aw@win.br*hrnet June 8, 1999 Rod Eslinger Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 RE: Palmer Alverman Estate File No. 17,683 Dear Mr. Eslinger: This is in regard to my telephone conversation with you pertaining to the above referenced estate on June 2, 1999. I am probating the Estate of Palmer Alverman, a/k/a Palmer Alvermann with address of 2957 230 Avenue, Clear Lake, (St. Croix County), Wisconsin 54005. Mr. Alverman died on November 9, 1998. At the time of his death he was the owner of West One -Half of the Northeast Quarter and the Southeast Quarter of the Northwest Quarter of Section 10, Township 31, Range 15 West. His surviving wife is Rose Alverman. The Alvermans resided on the described premises at the date of Mr. Alverman's death. Mr. Alverman's estate is being probated in the St. Croix County Probate Court. The Probate Court Number is 99PR7. Rose E. Alverman is the Personal Representative in the estate. I am enclosing to you a copy of the Domiciliary Letters as issued by the Probate Court. The sewer system apparently has become defective on the Alverman premises which sewer systems services the residence on the property. It is the desire of Rose Alverman to rectify this situation as soon as possible and prior to the time that the Probate will be completed which is anticipated to be within 60 days from the date of this letter. She has arranged with the Byron Bird, Jr. Pluming, Inc. of Amery, Wisconsin to provide services for a new septic system which apparently will consist of a holding tank. By virtue of the Last Will and Testament admitted in the Probate Court for St. Croix County, Rose E. Alverman will be the sole owner of all the real estate described in this letter when the Probate is concluded. Rod Eslinger June 8, 1999 Page Two You had indicated to me in our telephone conversation that it would be proper for Rose Alverman to proceed with application to rectify the septic system on the premises on the condition that a letter explaining the situation would be filed with you and further certifying that a copy of the Final Judgment in the estate will be filed with your office setting out the ownership in Rose E. Alverman at conclusion of the estate. By this letter I am certifying that such a copy of Final Judgment will be filed with your office immediately upon it being issued by the Circuit Court in St. Croix County. I am enclosing a copy of this letter to Byron Bird, Jr. Pluming, Inc. so that he may proceed with the necessary application for permission to proceed with the rectifying the septic system on the Alverman property. Thank you. Very truly yours, Robert R. Gavic RRG /ja enc. cc: Byron Bird, Jr. Plumbing, Inc. Rose E. Alverman STATE OF WISCONSIN, CIRCUIT COURT, ST- r-TZnTx COUNTY/,.,5 l4 ` FILED DOMICILIARY i IN THE MATTER OF THE ESTATE OF i= LETTERS MR 2 101 , PALMER C. ALVERMAN, a /k. a REGISTER IN PROBnTE ; ! ST. TE R Ct)t1NTY PALMER ALVERMAN Case No. To: ROSE E. ALVERMAN Name(s) The above named person died, domiciled in St. Croix County, Wisconsin, on November 9, 1998 Date You have been appointed personal representative and have fully qualified. These letters are issued to you, and you are ordered to administer this estate according to law. BY THE COURT: Sear _ C official Name Printed or Typed Date E:icka S, Nilsen Regi pr :n Probate PR -1303, 10/95 DOMICILIARY LETTERS § §858.27 and 865.08, Wisconsin statutes VO 1432 Es04441 KATHLEEN H. WALSH /�.� Tat if Q - cc.nc:. REGISTER OF DEEDS Document Number Docum�ntTitle ST. CROIX CO., WI RECEIVED FOR RECORD 06 -07 -1999 9:00 AM AGREEMENT EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 12.00 PAGES: 2 Recording Area Name and Return Address ,#. 4,-. Jee ` Y /awl ot b I4/- 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 $2.00 to the recording fee Wisconsin Statutes, 59.43(2m) WRDA 2/99 215 -32 (2/99) Wisconsin Department of Industry, HOLDING TANK AGREEMENT safet and Buildings Division Labor and Human Relations Bureau of Buildings and Water Systems 'Document No. /Plan Identification No. VL►(_ 1 432 PAGE 24 This space reserved for recording data This agreement is made between the governmental unit and holding tank Agreement Date owner(s) County or L ocal Go rnmental Unit Holding Tank Owner(s) -j% 4//l' C X, E E" AXE ( called Municipality below We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property: (Provide legal land description) � 5 ' K /0 i G'4 65 Return To I 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. 14S, Stats. As an inducement to the County of za , C "' / 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 a all char es and cost incurred b t m unicipality f r ins insp ection, pumping, hauling, or otherwise servicing and maintaining the 9 p ay 9 Y e o P • P P 9• 9• 0 9 9 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), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. A 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 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 certificationto 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. -14 no Owner(s) Name(s) - Print Not ri d Owner(s) Signature(s) • • ••, " t ,! V� •• �!i r1i sworn to before me on this date: �A7 f� y • N • Notary Public P 8 ! MuunicipalOfficialName - Print Muni ci aIOfficaISignature �a. Wion � expires: Municipal Official Title - Print The into mdtiun you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1)(m)) SBD -6123 (R. 04/94) STATE BAR OF WISCONSIN FORM 3 -1982 ✓ 60752 DEED KATHLEEN H. WALSH QUIT CLAIM 1 /A REGISTER OF DEEDS DOCUMENT NO. VOI. 5 GE 405 © /C/ _ ST1 2 - CO., WI 144 _ RECEIVED FOR RECORD /� Rose E. Alverman a /k /a Rose E. Alvermann 07- 30-1999 9:30 AN QUIT MAIN DEED Rose E. Alvermann, Wayne Alvermann, an EXEMPT N 08 quit- claims to CERT COPY FEE: Beverly A. Alvermann, as joint tenants wit hright Ot COPY FEE: survivorship TRANSFER' RECORDING FEE: 10.00 2 0 ( :ZS-'b _ PAGES: 1 --- -y- r Pct r L 0 ( S OD the following described real estate in St. Croix County, State of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA WEST ONE -HALF (W 1 /2) OF NORTHEAST QUARTER (NE 1/4) - -- - AND SOUTHEAST QUARTER (SE 1/4) OF NORTHWEST QUARTER NAME AND RETURN ADDRESS l T/ NW 1/4) 0 F S ECTION TEN , TOWN THIRTY -ONE (31), Robert R. Gavic RANGE FIFTEEN (15) WEST, ST. CROIX COUNTY, WISCONSIN. P.O. Box 400 Spring Valley, WI �Q 01410 22 90 000; 014102220000; and S 230 PARCEL IDENTIFICATION NUMBER 014- 1022 -30 -0 C� w I aJ- This _ is homestead property. (is) (is not) Dated this 28th day of July 19 (SEAL) c a l�ilt �.kii�/l �+-) (SEAL) . Rose E. Alverman (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Rose E. Alverman State of Wisconsin, ss. County. t to is 28th day Of July 19 Personally came before me this day of ' 19 - , the above named Robert R. Gavic TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Scats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ROBERT R. GAVIC Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) ,19 ) • Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN wisco aln lapel atw* Co.. Inc. QUIT CLAIM DEED Form No. 3 — 1982 LftvaukN• Vfle•