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c m d (#1 Z W -i z C d C4 Q `� O = m N o N n o v o �D 4° CD ._.. N A � Ov 3 N CD A 7 C O N p OD D A N a fG C y O N_ fD N C Z O 0 1 N N N O CA Q �' O I°o3 _ C J 3 cn -f D un Z D �� co • �. CD y CL c, (D O N C oo w O �y c CL a c V 3 D w+ Wt _ O N o C O o = O o = _ O t " p ' C a N s c y 00 Oo G O C CD W� T w • ?O 000 OOO- N N_ tp 3 N N co ca (A D a v v v (Dy v v I O O O � � O M ( OD CL cu `° I Z o ZZ O 0 D D D D o fl; O O o =r o. =r g CD N x I C C a 3 3 O rn N A 2 CD I A z 0 co c rn CL z o g�: Z, 3 3 m � w a m A may 5 D CL o y a3 n �(D o m Div m � o ao CO o � m mn o a o =y=°.., o a _ 3 �� 3 is o O CL co Z (D J a y co 7 fD f.J co 0 3 ti I c„ I o o fD m w O to O o 'r e cQ �C p a � ST. CROIX COUNTY WI SC0 NSI N ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 QUARTERLY PUMPING REPORT ST. CROIX COUNTY NAME: ,� rn�/0 c'-2 11- RETURN COMPLETED FORM TO: ADDRESS: �g , ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 Y 7 HAMMOND WI 54015 715- 796 -2239 or 715 -425 -8363 TOWNSHIP: Lc�.� ��_� �-� PLEASE PROVIDE THE FDLLOWING INFORMATION ACCOMPANIED BY CEIPTS ROM Y OUR PUMPE . NAME OF PUMPER: cT LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: v �t�lt yLu USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER "7 8 DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. 'D ,O THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 198 OWNERS SIGNATURE mj :12 -83 ' f y ST. CROIX COUNTY P .. §5 : sF do WI SC NSI N 3' " #��'��� .,'•� a' t � F 00% � �� j , ZONING OFFICE P - 21 r 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) T HAMMOND, W 154015 UARTERL REPORT ST. CROIX COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS �f� C7�t c, ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 115- 796 -2239 on 715- 425 -8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: P o n elf- LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: oc-c '14 y c USE: YEAR ROUND SEASONAL (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1985 OWNERS SIGNATURE i • r ' ~ ST. C R O I X C O U N L s y � ZONING O C EQ,t� / J` 796 -2239 (HA ON �•; j ^, 425 -8363 (R IV \ F A HAMMOND, W1" QUARTERLY PUMPING REPORT ST. CR01X COUNTY NAME Le 4r, c bt ��f �� b-� RETURN COMPLETED FORM T0: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715- 796 -2239 ah 715- 425 -8363 TOWNSHIP ��, c��..Q.Q�. PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE:�� Z'nct NUMBER OF PERSONS LIVING IN RESIDENCE: r' " USE: YEAR ROUND SEASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED i THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30, 1985 OWNERS SIGNATURE �. 7L S` CROI X COUNTY ` �k ,t ooNi � W I S C O N S I N n rte. ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 QUARTERLY PUMP I N G REP O R T ST. CR01X COUNTY NAME: �/ / f G -�, c �Z � .e (/` RETURN COMPLETED FORM TO: ADDRESS: G[ /l �` �� y C cP- C� -C�� ST. CROIX COUNTY ZONING OFFICE. —�� P. 0. BOX 98 HAMMOND, WI 54015 715- 796 -2239 or 715- 425 -8363 TOWNSHIP: PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: 1 USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED i THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1985 OWNERS SIGNATURE mj :12 -83 i ST. CROI X COUNTY WI SC0 NSI N ZONING OFFICE 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 1,9G UARTERL PUMPING REPORT ,\\ — R T E R — V - - — — — — — — — — — — — �' ` ST. CR01X COUNTY it(S� -- -- — — — — — — — — — NAME RETURN COMPLETED FORM TO: ADDRESS �s� 11c� ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715 -796 -2239 on 715- 425 -8363 TOWNSHI �W4 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: C cc ` < <k Y, r LOCATION OF DISPOSAL SITE: �bcw F not wt eJ cvC o rccr NUMBER OF PERSONS LIVING IN RESIDENCE: !1i'c^ ►1 F: USE: YEAR ROUND SEASONAL (CHECK ONE) JULY AUGUS SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1984 OWNERS SIGNATURE ST. CROI X COUNTY `� WI SC NSI N Y o S e , u } 1a l9 G f- ZONING OFFICE Y � ; , � 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME: RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 7 HAMMOND, WI 54 015 715 - 796 -2239 or 715 - 425 -8363 TOWNSHIP: PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION O,&.DISPOSAL SITE: tt� NUMBER OF PERSONS LIVING IN RESIDENCE: ""—�� �� USE: YEAR ROUND SEASONAL (CHECK ONE) �5 - 7 � as OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 15, 1984 OWNERS SIGNATUttE mj :12 -8.3 I DEPATMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HbMAN RELATIONS DIVISION P.O. B()X 7969 PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING MAD40N, WI 53707 El CONVENTIONAL 1:1 ALTERNATIVE State Plan I.D. Number: (if assigned) El Holding Tank ❑ In- Ground Pressure ❑ Mound ' NAME OF PERMIT HOLDER: ADOR S OF PERMIT HOLDER: INSPECTION DATE: T BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM LAN: REF. PT. ELEV.: CST REF, PT ELEV.: n - -P j Na of Plumber: JMP/MPRSW N. County: Sanitary Permit Number: > G 3�� SEPTIC TANK /HOLDING ANK: MANUFACTURER: - y' LIQUID CAPACITY: T INLET ELE V. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER /{Q 7 OV ED: PR VI D'. 2 11,S `�,� /V �(/ YES V 1 - 1 NO EVES ❑NO BEDDING: VENT CIA .: VENT. JJATL . HIG WATER -ROAD: 13)PERTY WELL BUILDI G: IVENTTOFRESH 3 a A ARM : AIR IjyLET� ❑YES ❑NO YES ❑NO 7C � DOSING CHAMBER: MANUFACTURER BEDDING: J LIOUIDCAPA ITY I PUMPMODEL. / U P /SIPHON MA TUBER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO IE]YES ONO GALLONS PER CYCLE: PUMP AND CONTRO LS OP ATION L - PROPERTY WELL. BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN LINE AIR INLET: PUMP ON AND OFF) ❑YES , SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth plowm ,w �E vGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shat cease ntll the soil is dry enough to continue.) CONVENTIONAL SYSTEM: "?a WIDTH: LENGTH . NO. OF DISTR IPE S CI COVER °! INSIUE DIA #PITS- LIQUID a _ TRENCHES MATE AL: .,Sh I DEPTH. h GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE 7-7 RIAL: N ( DISTR PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END. PE S. LINE: AIR INLET: ' b MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. IONS MEASURED. , ❑YES 1:1 NO SOIL .`OVER TEXTURE PERM7NT RKERS OBSERVATION WELLS / NO DYES ❑NO DEPTH OVER TRENCHBED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDE S MU LCHED. CENTER EDGES. ES NO DYES ONO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: .T �`" " �s; WIDTH. LENGTH. NO OF LATER L SP ING: GRA DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER. r.*n. TRENCHES: kre MANIFOLD PUMP MANIFOLD CIS R P E M NO_ DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. # ELEV.. ELEV- DIA, EL V. PIPES. DIA.: HOLE SIZE HOLE SPACING. DRILLED CORREC COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED q � PLANS. ` ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE: OYES 1:1 NO El YES El NO Sketch System on R in c my file for audit. Reverse Side. � TITLE: v,s✓�.,,xs?' DILHR SBD 6710 (R. 01/82) ' '+ r, 1 DEPARTMIzNT OF APPLICATION SAFETY &BUILDINGS INDI�iSTRIf ' FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the sy ;tem on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner. j Mailing Address: C� 17 mar. ..J 11, ^ (/✓ �,, l.� � (O Property Location: City, Village r Tow )sh : County: t /4 )/IJ' /aS 34, / T,� ?'N/ R 16 -c4{ ) W &* &V 6! a . � r Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State P -an I.D. Number: e -1 H c� `r (If assigned) TYPE OF BUILDING o / Number of El Public F-1 Variance El Other (specify) * _�,� / y`„ �, S Bedrooms: Q-1"or 2 Family * State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER AS GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY i/ ✓ LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ew ❑ Replacement ❑ ExperinLental ❑ Seepage Bed ❑ Seepage Pit �+ ❑Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): 94rivate ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na7; e-4,22 f Plumber: Signature: MP /MPRSW No.: Ph9ne Number: (t 2< ( PI bar's ddress: E. NameAf Designer: COUNTY /DEPARTMENT USE ONLY Si nature o Is uing Ag t: Fee: Date: p El APPROVED Sanitary Permit Number: QO — Q - S ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHRSBD -6398 (R.07/81) a � s e SEP 1 5 1982 �- v R 1 00 . 0 4 t� 'n Ica. 66 P�r►t Tree 7-4 �• b� Now V*6 Its afell ?I►�. h at�1p R To w u a � C- a v bade ST- U6 ;►r T �f 5 L `` /v NE /� s 3b Z N f X ! �y r j F t s t o {"i 01 +t' �' Pd ?. �:_s P^'. ,S� j Q Vi i' -� � �. �, 1� ,fi� ��.. �YYp +� -tcr ';• .J QERART,MENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION BOX 76 LA 4 AND N RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 FiU "�'A LOCATION: SECTION: TOWNSHIP OT NO.:BLK. NO.: SUBDIVISION NAME: s uJ �/ 0 3r6 ADUl /�� M► G'4 'e- COUNTY: OWNE 'S Bki�P�R=6-P MAILING ADDR S t 5 4, cz �'( S �-� n c WL S. S USE DATES QbSERVATIONS MADE r NO. BEDRMS.: COMMERCIAL DESCRIPTION: ISROFILE DESCRIPTIONS: ERCPLATION TESTS: esidence 2 ew ❑Replace 17010F RATING: S= Site suitable for system U= Site unsuitable for system (4 Cz-- �� (L C e r ONVENTIONAL: M / IN -G S KA RE: S�STEM -IN -FIB OLD TANK: RECOM 1 D SYSTEM tional) If Percolation Tests are NOT required DESIGN RATE: SYSTE �J� If any portion of the lot is in the / under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- �f �u �� �, /-"I 3 „a/ S; fs ��� Si /3” - n i ! 4 � R - . �� 3,i Al ; �s //„ �S,• / � y „ „ 5:/ Roof ptrd 7 93 B--) 1 . o n s6 C . B -3 Q „ ter y,yo ,. B- C13 nog �• S el !� �S S./ � "fin s�•��� Os�a- B -s �� D -1 � s„ � /S % /�s �i,� ,•/ / >..;8•t SQL e B- orl A- d: p PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 jVgRI0D 3 PER INCH P- P- P- P-_ P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION f�kc Other ' � _ _ t/�R� P �>° r�k� •d°+'� fib«,;= _ � F • p /OQ• 1A e 0. gyoP` � ... 1 >star AOL o b C i r e 4 __. 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pri )): / TESTS WERE COMPLETED ON: 14e — e.) ADD S: C TIF NUMBER: I PHONE NUMBER optional): e, / CST SIG TUBE: DISTRIBUTION: Original -Local Authority, 2nd page - Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester. R -SBD -6395 (N. 03/81) ' �! '°,b �:.�'Yd+� "iii �' , •,} r � _ �j y� •' ,�y� �i at'�` �i ,�pY.'a' �Ay .' '�& ,��L t'�b t � (' x? $ � Y . �t 'i` , 4TH^ � n�H� • �� JR ot y ? j }a N T4 i hhPP t j ^ � r , [ i u + tt f � d f 'a , k i . l 3 -S'o Ali a' t x 4 • 38D 8678 (9/81) (Plb 100a)':. ` STATE ©F =�,�OILHR Oetaa -And Re�ttirn `lfpinr � � Df � BuIWINGS Portion Thb Form Mth tau olF: Ilk 111fASH #hli #t ' WAVE. RM 178 lny Return Corres#ndence P.d. =Y615 -3815 DATE: 10/15/82 PROJECT: Dean, Nelson Residue 2 SW t NE, 36, 28,164f Tn Eau Galle Helgeson Truckin%, nc. St. Croix WI f Route 2 ,ri ng Valley, WI 54757 - PLAN ID. # $2- 05678 DETACH HERE Dean, Bels - Residency 82- 05678.. , PROJECT NAME PLAN ID. # - his is to acknowledge r8ilAipt of your plans and ins for the above - indicated pirojW.' Preliminary - review indicates the required fee is $ Fee Received is Underpayment — Please.submk the additional fee. ❑ Overpayment — Refund Plan accepted for reylew: © Plans being returned: w x No fee has been rerhitte&,.Pf sutx dted with no fees will be ❑ Additional information 1`00*e414. d held in abeyance., = 1: Plan Submission ❑ Complete data rel1tt111e d3t1 aiiltl [] Additiornal. irilatm ltion shall be. submitted in duplicate un- (] 2 copies of PL8 6Cf eneiaMSel � " less - specifically noted. El Deed restriction requigld k ❑ Plans notclear, legible or permanent. ❑ Condominium declaratro+t'4 .: All information submitted shiall be signed, dated and sealed or4tomped in accord with Section H 63.08(2)(x) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks El Profile of holding tank showing wept, manhole alarm and manufacturer if precast. Completo ;construction details if I #: Pressurize Distribution Systems (Mound or In Ground Pressure) ` site constructed. Anplication for use of an alternative system signed by owner ❑ Holding tank agreement signed by trY rt M )Deal unk of and rsotarzed. (1 copy) government (sample enclosed). ❑ County onsite. re4uired (1 Dopy). ❑Design calculations ❑ Reason for installing holding tank. §oil test or statement for pressurize distribution. ❑ Soil boring& percolation from county (1 copy). . test data ❑ Plot plan showing location of holding tank sltitlt lateral - it ❑ Cross section of System. ❑Pipe lateral layout. ances to any, building, Wells, wader serves 1pinp� ulster ❑ Plan view_of.system. ❑Plot plan. copy) Et course, lot lines, swimming pools, all..w` servrce th%pad ❑ Verification of Exception Status Form by County. (1 c. Provide benchmark with -ai palm Ill. Private'Sir~ Disposal s V. Lift Pump ❑ Ground- slope with 2' contours in entire area of soil absorp ❑Calculations for total lift um di p p si# „del and moons Lion system extending 25' on all sides.< ❑ ❑ Size, length depth of force m iii Elevation of permanent reference point (benchmark). pumped per cycle, w x ❑ Location of area suitable for replacement system - provide ❑ Detail & model' of pump' or a6Rlo LL ` s Including soil data.' size, pump curves,.drowdown and a rate GPM. ❑ Plot plan' showing lot size and, all lateral distances from verage ` ❑ Cross section of lift pump tank showing pfp3) or sewage disposal system to , lot limes well water siphon(s). 4' Course,; swimming pools. water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site txit rucl d.t tam V1. i# preeast V1. Systems In Fill (Fill must be placed pri#r� � ` miswor ❑ oonstruction detail •and cross section of ..soil absorption ❑Total area; filled . (fill to extend 24' r e: a�f Cinch it system. before side slope be9in).. ❑ Soil boring and` lartion test on 115 completed by Der- ❑ Depth and type AID lifted soil` y). 0 nCopy of onslte r� s 4 ^•k* -. r { •, ..., ,3v�e:. -s:::_ .. . ..,. _. _ ., :,. _ - ' '`' -. ::. s - S: k. Via. �u •r `� *�,r. , � � ; G rp y � t * 644 +�, it �. ' >K�:� Yi. �yy� °£ „�i } ¢ c ,� ) ma %f ^( j'it� 4 -. yy�tg qt'Y. `, N 2 e• ':'Mf 5' ¢ }' ,.M" rt kw* 11�'' 4+ - �rr �g o � b p sY,4 n t! k t fin � xsan a 4s 11 � 9► � f [ FS.J I i ^ , N�' � at 'w i ? 2 l i +s., rt,,� i r! -t A ` A .+ 4r "��Ir is tR ?'� + �'#N s 3 Y` . •+a N x ', t a a t � £ T.i 3.•r ��� �" ;5 �t�'x�'�. a b� ,' ,.� ,;�. s: >; � £,¢; f - r"+T• � �� r'-- f �1j � ""`� `�' _�. ��� 4 �'� "�,�,�'�.d¢,rrT ; a �f .:g �' �( `; � � �.J'� � ' � � '# �( � �� � '�SY, * " . 'z'+�.. 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'.. ,.. ., "x +� S,'o4€£..:ao-" � " R f}"•T... vl .i � -1 24 ,.` da` �rin�� a— a ` A 2 t Department of Industry, Labor & Human Relations SState Division of Safety & Bldgs. tate of Wisconsin „` I Bureau of Plumbing Platting & Fire Protection 00 <<` f � P.O. Box 7969 R CC v �82 Madison W1. 53707 Tel. 608 - 266 -3815 N > NpV 6 IN ALL CORRESPONDENCE --t:' /�(� -sue REFER TO PLAN J IDENTIFICATION NO. NAME OF PROJECT TYPE OF APPROVAL STREET AND NO. CITY,OR TOWN / S E� ZIP OWNER -- Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, �td>✓ James Sargent- Bureau Dire or PLANS REVIEWED BY: t DATE: cc: DP<OWS Owner DILHR Local PI Plumber H & R (2) ounty Mfg. Rep. Bur. of Health Fac. & Services DILHR SSD -6099 (N. 06/80) Rec. & Env. Services yam• R Wisconsin Department of Industr PLB -1 INSPECTION REPORT Labor . & Human Relatio S #fety & Buildings Divisio Bureau of Plumbing' PTattin A Fire Protection Mme o remises a e an o. 8- 8 c +r + oun y Sanitary ermi se 0 MU s3b T. W,R W w . C A - ST•c ?0 m aster Plumber cs: Addr F SP 4 VAII_' �4 W 7 ourne FIU MD er Address O wner ddress N %ia VALLE W s 7G, i LOCAM( S 4PP Y, i NO � rZ r � r o Icr CoA7itn65 6N fAc.£S 0- Z > G { 1 <T cC4 d% " a " u `� ) rr �: c Q - -5% L.QV F L_ 6 F is 1 i s ' �o T - ,r V. ). 6 q 13 A d - Y 5 AL�- rb L E LQWt $A) y 5; .53 r EST EST, Lf ve. ( v � 534 . I 2 (� n o �- T 7 I—e gna tur )See Attached. DILHR- M - 6192(N.09180) Signature of is Pl umbing 5u -S e a pec s White Inspector Yellow -Local Inspector Pink - Plumber or Responsible arty Green -Owner • Department of Industry, Labor & Human Relations p Division of Safety & Bldgs. S tate O 1'y Wisconsin Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608 - 266 -3815 INALL CORRESPONDENCE 14 c4--4,47 y '�Nc, REFER TO PLAN Y IDENTIFICATION NO. 4 \�14 66e/ Lc..) Sy76 7 NAME OF PROJECT ( �1. 4el_ SI) TYPE OF APPROVAL Imoo STREET AND N0, S)d' , C �/�J CIT OR TOWN I OU STA E ZIP OW E Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, llJ James Sargent- Bureau Dire or PLANS REVIEWED BY: / _ DATE: cc: WS Owner DILHR Local PI Plumber H & R (2) ounty Mfg. Rep. Bur. of Health Fac. & Services DILHR S8D -6099 (N. 06/80) Rec.& Env. Services st Wisconsin Department of ! n du n PLB -1 INSPECTION REPORT Labor & Human Relatioq; Safety &Buildings Di visi Bureau of Plumbing, Platting & Fire Protectio N ame of remises Date an o. - Count anitary ermit 5 a N ! W - Two, F� 6 A LLB ' . C l o Q )C 3 L/ 7Lt m aster um a me ess I E7 we s U 32 5(i �lA! -r_r J ourneyman ,um er ress O wner Address - �► 1.j _ T) EAtJ S LLC k1 S �7 1f &Z T r i k D iscussea w1tK 7 ( ) See Attached. DILHR- SBD- 6192(N. 09180) Si gnature of is . n te : . w aSxe Specia 14hite- Inspector Yellow -Local Inspector Pink - Plumber or'Responsibl Party Gree - ner yr 4 OTE: As specified in 1163.18 (4 A) Wisconsin AdminlsLraLiVe 0dethis document is to be recorded in the Tract Index, lo- cated at the County Register of Deeds. At the time of Saili tary Permit ApYlication, a copy of this a-recmenL, with the r ewording date and_numb should be su bmItted to this office. YW _ 653 �� HOLDING TANK AGREEMENT This Agreement is made and entered into this _ day of n V A p - 19 y% z , by and between the v cc ;/ c r fiereinafter called '"C`4 il_ [L C ' an , le /_' f t iC , DC. ,' v, her called the "Owner. We hereby acknowledge that application has been made for a building permit on the following described property, to wit: 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. We also, acknowledge that said property cannot now be served by a municipal sewer or septic tank — soil absorption system. Therefore, as an inducement to the County of Cr to issue a sanitary permit for the above described premises, we hereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbing Code relating to holding tanks. Any time the Town or Municipality of Z� t 12e_ , through its Plumbing Inspector or Health Offi- cer, deems i t necessary to pump out the subject holding tank, the (�me.r shall have same pumped out in twenty -four (24) hours, or E 2C - (.2 c will have said Work done and charge same back to Owner and place same on the tax bill as a special charge. The Owner further agrees that the Town or Municipality of r r (V -� J - 1, may enter upon the property des - cribed above at any reaso able time, to inspect, or pump and haul wastes from the subject holding tank, t� _r�► 2. -Owner agrees to pay all charges and costs incu%(2 0 56iaf 4r Municipality of ' Ed b 41' LY_ for inspection, pumping, hauling or otherwise servicing an ma nta n ng Fie subject holding tank in such a man ner as to prevent or abate any nuisance or health hazard caused by such holding tank. ,fib cv j zz shall notify the Owner of any such cost which shall b e paid by the er w thin thirty (30) days from the date of notice and in the event that the Owner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Wisconsin Statute. RECr GFFICE VED 5T. C;t`O A CO., DILHR -SBD -6123 (R. 3/81) 5 t9�2 R�'d• ¢o' Record ts''s_ 12th OCT 1 day of October A.D. 1982 ON s 2: 2 5 P a �+ d , h p �Ve,��IN James 0 Conne Re 9 I.Tr of Deeds � o a J ul� VUL r1J ka�r Page 2 3. Owner agrees to have a quarterly pumping report submitted to the local government and the county which will state the Owner's name, location of the property on which the holding tank is located, the pumper's name, the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted to the Department of Industry, Labor and Human Relations by the governmental unit responsible, per section 145.01 (15), Wisconsin Statutes. 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code. 5. This agreement will remain in affect only until the sanitary permit issuing agent in S t C County certifies that the subject pro - perty is served byeither a public sewer or a septic tank -- soil absorption system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agree- meet may be canceled by executing and recording said certification with re- ference to this Agreement, in the Tract Index indicated above. 6. This.agreement shall be binding upon the indicated governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this day of cNb Y 19 g� TOWN OR MUNICIPALITY OF OWNERS y 0 g . t� STATE OF WISCONSIN �;GU5678 Personally came before me this /L. day of 067- 19 8z, - the above named >,� � 6 o Al " �r N 44-7 to , me known to be the persons who executed the foregoing instrument an acknowledged the same. THIS INSTRUMENT .BLIC DRAFTED BY: Al :M,y,�;onti s�•i .expi.res : „�lr ' �, 5198 �� © VD OCR ' pLUW1�INQ' SOON I ST. CROI X COUNTY WI SC 0 N S I N ZONING OFFICE 796 2239 y Post Os66ice Bax 227 TE RS OFFICE t REGISIC Hammond, WI 54015 5 St. CrOIX CO., �Vjs. (:ec d. for :z-ccrci h,'s 12th 0 w N E R day of October A 1982 P U M P E R ".__� : 25 p , A G R E E M E N T James O'Connell - PLEASE BE ADVISED, chat unt.it you are again not.i6.ied, I Witt deputy 3 93() contract with z 9 C i-� r' ('�' <<'� o ,'•�C)l �'t �� �S - Wi.b eon.sin, (Pumper) , Jot the purpos e o6 removing att waste from the .sanitary system to be Z-acated on the pxoperty and future home site .located in St. Cno.ix County, Wisconsin, Township oD being in the S` % oS the % of Sec. 3 T. N. - R. ` W. (On mo Gutty des c , %ibed as 60ttows: ) Dated this. t(_ day o5 � e 19 (OWNER) State o6 Wisconsi $ County o6 St. Croix) ,�' • �v'�'. Personnattyappeared be6ore me this /fihday os C�, ''�. �'`a ^' se the above named to me naivi,�; tf�e: .in and acknowZ&N ed�' s¢°ne pennon who executed the �oxego.ing . �., . t , otary Pu t,x c, St. Croix Count•y, wI My Comm. (.is pexmant) (Expi/..e•s) L r3 T, hexe.inbe� ore xe'exxed to as Pumpex, join in the above agreement to the extent that I have a contract with Owner as above stated. )P U MPER). OCT 151982 �,n�►r�a sECn ST. CROIX COUNTY ZONING DEPARTME _ AS BUILT SANITARY REPORT V. Owner Property Address t .; City /State Sk 6 mmtz Z22L Legal Description: ,✓f r "r 'M'��e Lot Block Subdivision/CSM # 4i- - l5'C 4 L)L'/4, Sec- IL-, TAN -RAW, Town of o vo SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC Setback from: House Well .,;�5 P/L -Q0 � Pump manufacturer Model 8 7 / Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width �' Length y `7 Number of Trenches Setback from: House - Well X 122 P/L Vent to fresh air intake ELEVATIONS Description of benchmark lb r b c C6,, c e ^� �S X I UJ j Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom L7 7 Header/Manifold q S' Top of ST/PC Manhole Cover Distribution Lines () ZZ 3 �._ () ( ) Bottom of System () 2 7 () ( ) Final Grade Date of installation 0/:) /9 ermit number�-� o State plan number Plumber's signature, icense number Dated 10 Inspector - -�� 4 Complete plot plan T \ N 1 NOTICE: Pie #se pjovi the foiow o `� • A plan view k tc sy g�ev ng ` 't1 100 feet of the system. 1 • Two horiz�nt, l re erence p it t+q centef f s9ptic tank manhole cover. • Show #ltern�e b cark applicable. --� L L _ PLAN VIEW J � �tt N iL ti 0 T rA Q 0 i1 C. q V C �J' U J � J 1'� v 'U y INDICATE NORTH ARROW v i W Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y Safety and Buildings Division Count ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary ArrlitJ _: Personal information you provice may be used for secondary purposes (Privacy L , s.15.04 (1)(m Permit Holder's Name: p Ot Villa %T Town of: State Plan ID No.: CDONNELL, PATRICK U �ALL CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax Alo.:2000-50 -000 00 1 � C s;k w � lJ U t5 TANK INFORMATION U ELEVATION DATA A9800558 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 5e 'c 135 Ben hm r j1 16d -42, DO D i n g wt 1 7 i 51) i Z ti /�/ l vO Aeration — Bldg. Sewer Holding `-- _ St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic ILf NA Dt Bottom JZ•3� �/ 7 Dosin - I NA Header/ Man. Aeration NA Dist. Pipe �,&Z Gf'Gf•4 Holding -- — Bot. System q9, 7 r PUMP/ SIPHON INFORMATION $ Final Grade Manufacturer o va C Dern nd Model Number � GPM TDH Lift7,-7a- Lriction System 5- TDI�3. �t H ead Forcemain Length / Dia. � � Dist.Towell SOIL ABSORPTION SYSTEM S EDLXRENCH Width Length No. Of Trenches PIT No. Of Pits_ Inside Dia. Liquid Depth E I N �� I DIMEN I SETBACK SYSTEM TO P/ L I BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER � v Mod Number: System: ovn tt OR UNIT DISTRIBUTION SYSTEM Header / Ma 'fold � Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 1 Dia. Length Dia. Spacing t � 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 Ia Bed /Trench Edges 1 6 Topsoil ( c Yes ❑ No LR-Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE 36.28.16.539B,SW,NE 2658 BOSTON ROAD effVleA— Plan revision required? ❑ Yes No Use other side for additional inform'oa n. IZ 22.- ° f!Pj `7 7 4 1 SBD -6710 (R.3/97) Date Inspector' Signature Cert. No. SANITARY PERMIT APPLICATION 201E Washiin v ev i sion NOscons In d with act o r 83 .05 Wis. Adm. Code P.O. Box 7969 Department of Commerce t ILHR Madison, WI 53707 -7969 • 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. ST CROIX • See reverse side for instructions for completing this application State Sanitary Perm Number The information you provide may be used by other government agency programs ❑ Check if vision / o�Jl— Zpplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION TRANS ID# 184656 Property Owner Name Property Location PATRICK MC DONNELL SW 1/4 NE 1/4, S 36 T28 , N, R 16 VW W Property Owner's Mailing Address Lot Number Block Number 2658 BOSTON ROAD N/A I N/A City, State Zip Code Phone Number Subdivision Ame or CSM Number WOODVILLE WI 54028 1 (715) 778 -4438 / II. TYPE OF BUILDING: (check one) ❑ State Owned ' Nearest Road p village EAU GALLE BOSTON ROAD Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 008- 2000 -50 -000 1 ❑ Apartment / Condo 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: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. ® Replacement 3_ Q Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ______System ________ System_________ __ __Tank Only______________ Existing System _________ExlstingSystem 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 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ 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 450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 375 375 .4 N/A 98.78 Feetl 100.53 Feet Cap acit y VII. I NFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. Gallons Tanks Concrete lass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank 1350 1350 1 WIESER CONCRETE ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1350 1 1350 1 1 IWIESER CONCRETE ® ❑ I El El ❑ 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum er's Signature: (N tamps) MP /MPRSW No.: Business Phone Number: BENNIE HELGESON 220292 715/772 -3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY Q Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing A t Si nature (No Stamps) surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination 0 Ifo X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6M (R 11196) DISTRIBUTION: Original to County, One copy To: safety 8 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: 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.), 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. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 *isconsin , Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Dep of Commerce November 03, 1998 CUST ID No.268093 ATTN: POWTS INSPECTOR ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/03/2000 Identification Numbers Transaction ID No. 184656 SITE: Site ID No. 162925 Site ID: 162925 Please refer to both identification numbers, St. Croix County, Town of Eau Galle above, in all correspondence with the agency.' SW1 /4, NE1 /4, S36, T28N, R16W Patrick McDonnell FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 433475 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: • 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(d), Wis. Stats. • The existing holding tanks must be inspected for structural soundness, size and baffles where required, and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If either tank does not conform a state approved tank must be installed. 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, t DATE RECEIVED 10/22/1998 fir~ FEE REQUIRED $ 190.00 6rard M. Swim FEE RECEIVED $ 190.00 POWTS Plan reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us I INDEX SHEET PROPERTY OWNER: PATRICK MC DONNELL 2658 BOSTON ROAD WOODVILLE WI 54028 SAFETY & dLvb5 4)t V. PROJECT NAME: PATRICK MC DONNELL PROJECT LOCATION: SW 1/4, NE 114, S 36, T 28, N, R, 16 W MUNICIPALITY: TOWNSHIP OF EAU GALLE COUNTY: ST CROIX CONTENTS Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Pump Chamber Cross Section & Specifications Page 5: Pump Specifications Name: Bennie Helgeson Signed Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: October 20, 1998 Coll d i t i o na ly 1 .0 . E r �dN , DEp ��.� ME q�3 O4 ND UYI.DtiN 1pty ov S r b aO � g Q m CTJ A h cn s C 1' C z \ . W (N _ i a j 1 1Ti CORRESPONDENC a r S Vo age — Of _ Straw, Marsh Hay, Or Synthetic Covering Distribution Pip Medium Sand CF 1C,, , oo• 573 H G 9 Topsoil ___ =_= =- F —J 1 D 3 E u • 41 %Slope Bed Of 2�— 2 i Force Main Plc red Aggregate From Pump L :r D /- 83 Ft. �,� Cross Section Of A Mound System Using E Ft. 7S Ft. A Bed For The Absorption Area F F Ft. A Ft. H _� 5 Ft. Signed: B y7 Ft. License Number: K %a.Ja Ft. L 72. yy Ft. Date: j_ Ft. Ft . Force Main W Ft. L 1 Observation Pipe —,,, K �r--------------- - - - - -- ------------------- - - -- " 1 A -- -------- - - - - -- ----------------------- Distribution Bed Of Z 2 % Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area I Perforated Pipe Deloll 0 End View )Pstforoled End Cop 1. b ;�. Pvc P. °` Permanent End Markers Jas �c `o �c s Holes Loc ated on Bottom are Equally Spaced X Q • A PVC Force -Main * From Pump /P PVC ' E Manifold Pipe C.4 pislrlbvllon..• Pipe Lost Hole Should Oe Next To End Cap Distribution Pipe Layout_ P R S / x 3 Y 3� Signed: Hole Diameter Inch License Number: Lateral �_ Inch (es) Date: Manifold " �_ Inches Force Main " Inches XhU <rT E l-vo. `�9• a S PUV%P CHA.MP,ER Cfiu55 ANG JPlCIFIC:l.IIU "J`: VENT CAP r i C.1 � E `�T PIPE. WEATHERPKCOF _ APFROVE D LOC• < •'• %i JUIIJCTIOW BOX MAtJHOLE CQVEF WINDOW OR FRESH I AIR INTAKE I GRADE i 4" MIIJ. � �• le"Mlu. COWDUIT -- �` -- -- ---__- PROVIDE INLET T EAL AIRTIGHT 5 I I I 1 I I APPROVED JO ►J % II APPROVED JOIW'f A I II W /C.I. PIPE W /C.I. PIPE I II EXTEWDJUG 3' ALARM EXTENDIU6. 3' OMTO SOLID SOIL I II ONTO SOLID SOIL B I I I OM c I I I ELEV. 9y31 FT.. PUMP - OFF D COMCKETE BLOCK XAA � RISER EXIT PERMITTED OIJUS IF TAWK MAIJUFACTURER HAS SUCH APPROVAL 35-(--� SPEGIFI'GATIOAJS EPTIC E DOSE 1 A (JLIMBER OF DOSES: A �� PER DAB TAUKS MAUUFACTURER' " ''��~ TAWK SIZE' GALLONS DOSE VOLUME ,L,�. y 1 IN LUDIMG BACI�FLOW: GALLONS ALARM MAUUFACTURER: S.v ` lc5 C•.Ll, aacL: �ou MODEL NUMBER: /n� NC� CAPACITIES: A= �y IUCHES OR � GALLOWS SWITCH TYPE: `l/3' B= IUCHES OR GALLOU5 aa ! // '' ,�Y CALLOUS GO<T S C : IUCHES OR ( Ill " PUMP MANUFACTURER: g 3 2 — .7 �,/8 MODEL NUMBER: J� ' - Ds,L INCHES OR .�— GALLONS SWITCH T`JPE: McV.,L `f MOTE: PUMP AUD ALARM ARE TO BE 37 GPM INSTALLED OW SEPARATE CIRCUITS MINIMUM DISCHARGE RATE u VERTICAL DIFFEREMCE DETWEEW PUMP OFF AUD DISTRIBUTION PIPE.. y 9y FEE7 + MIIJIMUM NETWORK SUPPLY PRESSUR,, //. . . . . . . . . . 2.5 FEET + AQ FEET OF FORCE MAIM X - 3L_ F/Ioorr.FRICTIoM FACYOR.. X 1 - 72 FEET / TOTAL DyWAMIC HEAD = Z. -- FEET ii IIJTERUAL DIMEWSIOWS OF TANK: •i-LE`•+UTH (Iilrsa ✓•• WIDTH �uv , �na_ ;LIQUID DEPTH_ y/I is vs S iir 7,t k IS cl t A o,1 a .- .ti1ac1� C'r cc r. ~r SIG ►JED: DATE: LICEIJSE' DUMBER: __ T MODEL: 3871 Submersible SIZE: 3/4" SOLIDS RPM: 1550 Effluent Pum p HP 0.4 METERS FEET — 8 ' 25 7 w 6 20 z 15 4 p 3 1 n 2 1 -- — 0 0 10 20 30 40 50 GPM 0 0 2 4 6 8 10 12 M3 /h CAPACITY MENEM �, GOULD����,�0 8 Effective October, 1988 . ne m in wr r rn CNeNGH WITHOUT NOTICE PRINTED IN U.S.A. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK r j4 - raw L This is to certif that I have inspected the presently serving the P h�� 1 residence located at: S c- ±, )r Section � , T,'A N, R _L�,_ W, Town of fE:i 6 Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. 4�bl-� ` ,, t- 4° b °� "�- Sti�� << 74Nk/� A, G�G"�....�c,-� , Last time serviced: 7 Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: T-- 13 G -f , T� s Construction: Prefab Concrete [i Steel Other Manufacturer: (If known) Age of Tank (If known) : 8 x/ -eS o �L� (Signature) (Name) Please print _ (Title) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name &"'11-e ��1 e So c� o Signature MP RS Wiscoisin Department of Commerce SOIL AND SITE EVALUATION DivWQrfof Safety and Buildings Page of -� Bureau of Inte Services In accord �' eg R& with s: tLOR3 ; 09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x "s in Coun include, but not limited to: vertical and horizontal refere7c7ap6int (B ^ !{t percent slope, scale or dimensions, north arrow, and I* tiofh and distance to nearest roa� parcel I.D. # Piro , . 1998 ©b8 — "P000 — :5 0 -006 APPLICANT INFORMATION - Please print #H gWOIX 1`� Rev wed by Date COUNTY Personal information you provide inay be used for secondary pu + riva &~ (m X- I I to l Property er t, ; . _ _ P lion c� �I! t O C t °t s U) 1/4 N �1/4,S 3� T� 0 �N,R E (o W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# a61(9 B 0 ". f i _U1 o �) 4 1 0 1 A14 [City . State Zip Code Phone Number 1:1 City ❑ Village [E Town Nearest Road ,�� � � �/' �_) ' � • ��c c-c_ � � �cSTb s1 I� ❑ New Construction Use: L24esidential / Number of bedrooms 3 Addition to existing building [Replacement ❑ Public or commercial - Describe: Code derived daily flow 4 "50 gpd Recommended design loading rate y bed, gpd/fF = trench, gpd/ft Absorption area required gi bed, ft 3 7 S trench, ft Maximum design loading rate _ _ bed, gpd/ft S__ trench, gpd/ft Recommended infiltration surface elevation(s) . 79� P &>f ate. ©� (L k 1W ft (as referred to site plan benchmark) Additional design/site considerations -2 �o / K San u. �rr CL�oe� �� �� (3rc� k Y7 4 �?c Parent material �f� GSC�eY fi Flood plain elevation, if applicable f)'tl ft S Suitable for system Conventional ,_M,_ouunnd -f Y In-Ground Pressure AT-Grade System System in Fill Hold' Tank U = Unsuitable for system El Q L'3 s El El L1 ❑ S [B El L=� ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fi2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground - s YX 5 S elev. %.s Depth to limiting factor n. Remarks: C nJs o'1 So: ( �e ��r I n 4 S Boring # � �`y p a ry, L3 -/ 3 Y- o K %B c I C Lk) 1,) s Ground , -R /o S c elev ft. Depth to limiting factor /qin. Remarks: U U) CST Name (Please Print) S' ture Telephone No. 4d(� 77, Address r ` R Date CST Number lam' 7 _/L1 v' �' W 1 . c Dn9)9.) /' SOI � DESCRIPTION REPORT PROPERTY OWNER ` C k �6► t� � Page . -,) bf r f/ . PARCEL I.D.# 663 — 07 d QD — �56 " Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 4 s d s , s Ground _ ( C 3 S k ck elev. (f 3 Depth to limiting ; factor in. Remarks: n A co &� C vX S." ked�c — Tn F C, -3 Boring # 13 Ground elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # E3 Ground elev. ft. Depth to limiting factor in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -6330 (R. 07/96) o � b ^ Cj �l 'p V S n �iL7 3 � � A r ' o r XK e^ Vi Q —CA_ � A � F r f Wisconsin Department of Commerce � rINQ. SITE EVALUATION Division of Safety and Buildings % Page of Bureau of Integrated Services ` C�cerdilinCe with s.''14HR 83.09, Wis. Adm. Code Attach complete site plan on paper not less thoir8,1 /2 x 11 P ' "G. Plan ' It County ' Include, but not limited to: vertical and horizoq"ference point (BM), direction S 7 percent slope, scale or dimensions, north arrow, and lotion to n road. Parcel I.D. # cao x �_ "� 008 — dodo APPLICANT INFORMATION - Please p#nf all lFt ; �`r Re wed Date Personal information you provide may be used for seconder y purposes Property er Pr�dy Location a / �1r' . Govt. Lot L�J 1/4 N E,1 /4,S 3� T� 0 N,R t0 E (o W Property Owners Mailing Address t � Lot # I Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village �Town Nearest Road R ❑ New Construction Use: ErResidential / Number of bedrooms 3 Addition to existing building [Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate • Y bed, gpd/ft trench, gpd/ft Absorption area required 3 7 s bed, fl 3 7 '3 7 trench, n2 Maximum design loading rate bed, gpd/ft , s trench, gWt Recommended infiltration surface ele vation(s) 9. 79 1&6 arc, o� a� K l�cc� it (as referred to site plan benchmark) Additional design/site considerations cW " o r 1, 83" -5d- ,- u_w d rr �!- dr. �� f3c� S x Y 7 c Parent material �� GYa�Y fi l Rood plain elevation, if applicable A),47 ft S = Suitable for system Conventional , Mou / nd _�( In- Ground - res / sure de Fill System Fill Holdi Tank U = Unsuitable for system ❑ S [J L'_7 s ❑ U ❑ S l� u ❑ S L`1 U ❑ S L7U '-' " ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 E3 in. Munsell (,u. Sz. Cont Color Gr. Sz. Sh. Bed , Trench 2 -�6 f a �. slob � �-- 1(1p jb Ground elev. Depth to limiting factor J.(- - in. w 4 f Remarks. � i l� r5�5 0 � So ( �ecQ �-�� r � Boring # C p a '� .� S rh Li y O f ( v2 c k krkt m- w r J t 5 Ground - v 6 7 tk 4- ✓ 6 C- M 5 ,r- I J , 3 elev ` - ft. , , Depth to limiting factor Lain. Remarks: U CST Name (Please Print) Si lure Telephone No. Address Date CST Number &411 A 1 SOIL, DESCRIPTION REPORT PROPERTY OWNER C `� �C � 0 t [ / Page - _;� of a PARCEL I.D.#I Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench sal ��s s a .s 0 51 w. S b W !co Ground 3 p C c s L J elev. 3 Depth to limiting factor in. Remarks: ' SA C 6c cs o —3 Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to . limiting MGM in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/86) � a �o , N e l b Q . 0 ' V r a m p o . I A 1 � V e t N LIV n p 0 F r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer PATRICK MC DONNELL Mailing Address 2648 BOSTON ROAD, WOODVILLE, WI 54028 Property Address SAME (Verification required from Planning Department for new construction) City /State WOODVTLLE, WT 54028 Parcel Identification Number oo8- 2000_5n_nnn LEGAL DESCRIPTION Property Location SW 1 /4, NE I /4, Sec. 36 , T 28 N -R 16 W Town of EAU GALLE Subdivision r' , Lot # Certified Survey Map # �� Volume , Page # Warranty Deed # ��o� �� , Volume Dl Q Page # Spec house ❑ yes N no Lot lines identifiable ® 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 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. 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 exrdra ti on date. SI ATURE OF AP ICANT 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 escribed above, by virtue of a warranty deed recorded in Register of Deeds Office. IV ,e-- /0 SICAATURE OF AP LICANT DATE * * * * ** An information th i sanitar p ermit being revoked b the Zoni Department. * * * * ** Any i s mis -re resented may result in the sa ry p g y g p P Y ** 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 is oQ State Bar of Wisconsin Form 2 1982 �I Air 566868 I WARRANTY DEED n DOCUMENT NO. VOL " PACE V cuMeNTS ta __ REG153ER'S OFFICE i T1tte Company 0 l Z 0 J l ST, CROIX C0 WI i� S_psu MN 5 Ave nue W — R�dtl for 1 _I — _F� izab eth . L. C orr -ig a singlp Per son OCT 13 1997 +a /k /a El izabeth I. Cor —an 1:30 0", L. P� — conveys and warrants to —-- —_Ed r ick J. Me Donne 7 1 a n R. — __,S_t,&CeyL_F,,Mcnnnn 11 . as n± tenan,___� to ! THIS SPACE RESERVED FOR RECORDtNO DATA � - _- -- - -- — -- NAME AND RETURN ADDRESS the following described real estate in S t. Cro i x County, State of Wisconsin: i All that part of the West Half of the -- - -' Northeast Quarter (W 1/2 of NE 1/4) of 008- 2000 -50 Section Thirty -six (36) , Township Twenty- (Par,-1 Identification Number) eight North (T28N), Range Sixteen West (R16W), St. Croix County, Wisconsin lying Northerly of Highway EXCEPT the North Sixty (60) acres thereof and EXCEPT part to LaMont Ducklow in flume 11 290 11 , page 3. 3 aaroo.Lfa A IC This homestead property. (is) (is not) } Exception to warranties: s Dated this ? — ______ _,_ day of (SEAL) - BAL) a • - - -- - - -- - -- - - - -- - - -- E1' abeth L. C orri gan --- - - - -- - — - ---- - - - - -- _ (SEAL) - — - - -- (SEAL) AUTHENTICATION ACKNOWLEDGMENT S TATE OF Signaturr(s) ___ ____ S V09fiZ1M CALIF NIA SS. - - - — - - -- -- County. authenticated this day of -------- __— , 19 -_ _ Personally came before me this ____ day of -- 19_ 3- the above named - - -- - - - -- - -- -- - -- Eliz L. Cor a sin gle pers TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ____-- .__.._ __— _______ _ —_ *a�la Elizabe I. Co authorized by §706.06, Wis. Scats.) to me i to be the person _ — _ _ who executed the foregoing ins.rument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Notary Public 7 County, Wis ISignatur;s may he authenticated or acknowledged. Both are not My cominissior is permanent. (If not, stare expiration date ne ,I •Nmot I Ivr — n> vrnmp in en" - paale .Mould ha• t or printed houw their %ienamrco WARR A%f % DEED STATE BAP ell WISCONSIN Wisconsw Lergal Blank Co In, Vt)k \I Nu ! — 14X2 M:I W;I:ha.' W••. Vat 1 ) 70 PACE P 7 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT *; State of y County of On �l`� ? before me, Date Name and Tgla of Officer ;e g.. 'Jane Due Notary PuEtic") personalty appeared �l aL.bc� ., h Names «sgrwr,s, r j: personally known to me 6 Xproved to me on the basis of satisfactory evidence to be the rson whose name pe (�. (>�&a)ksubscribed to the within instrument and acknowledged to me that n � executed the same in ell authorized capacity(i4, r " and that by er t)44 signature(4 on the instrument the w 2=1 - person*, or the entity upon behalf of which the personA bvft &a is IV acted, executed the instrument. r ' WITNESS my hand and official seal. >` Signature of Notary PLA*c r OPTIONAL Though the information below is not required by law, it may prove valuable to persons retying on the document and could prevent '( fraudulent removal and reattachment of this form to another document. fi Description of Attached Document Title or Type of Document: r Document Date: � L Ict - 7 Number of Pages: t Signer(s) Other Than Named Above: r Capacity(les) Claimed by Signer(s) Signer's Name: Signer's Name: _ r Individual Individual r Corporate Officer Corporate Officer Title(s): _ Title(s): Partner — _ Limited `_= General _ Partner — Limited __ General t j Attorney -in -Fact Attorney -in -Fact Trustee Trustee 1 h =: Guardian or Conservator � 5 ` Guardian or Conservator Other: I Tap �t rhumb here Other: Top iDf thumb ne• Signer Is Representing: Signer Is Representing: 1996 Naoorai Notary Assoc~ . 8235 m2rrerlet Ave.. PO. Box 7164 . Carxga Park. CA 91309 -718.1 Prod No 5907 Reorder CN'a. -Free 1 000 87S -i RV �2 r T r' -'{ A {�'Ys:�1%` t ,� a t jy` ,.' A � a.. A��'� r�4:,, .,fir,. "k "',. v : r ,.- f �t , 8'..... `, •4},,. !�" ,M•i; " vi s Se `:mot N t'"�t x'� i p .� 1 'T',, � ��.-{ n ,,, , .�. r'~�..#ay, ,,,�,.,R,y, ..5.ri R c y y *s' e'y* S i x. TAY j`'., .. i , ux t • j l� y� '}/� uM�r� d u s �r ljS 7A+r rya � e�tR-,frS.uc '7d rys 1 (] fs c �.. MW }i�l� \ ,��� }� d� - DI V n &yFirie4P otectton r r• 0. t ae'y..�{, ,. "w 2j � ,,r '� ,£ � {. ,� F' ��'�'}�> za NS• �A4 ��, �z-* , i� I ��; �• V:. , k �i :,'1 R;�_ 6 R X 4 p a w . + . T * 1f 3r 4 {': ,b k *�T � • i ,u!Y ` r a l 'N -.y� •,A :."u 1 un I1 f ; Q,iU Grmi 't ,� �• Le�r�} ?Ht'� �$��' tea., '. ;,�� ��,��� r K x ss` �, gln:,. .. 3' Fly * I '.e , t '. — �..� 3^�'k y 'y f i f T frt p ..�l..w � � x � �,.! ,d .�2�..� � •. e �' t�� r � ��a. f n.. t - �,,.. A.� ak �•�+ +.,, ri 'ds s �rw >r �k a St +, a!,f a ..� r ti - ",ai w ne� tk� t i •^'" 1 Nsy�i tiri � .r ar +e < � 'y � ra�;. r � �' � k' r ' -+ r "r � "''s �' �ga44� sx 1 �, ""•°r - ° - �z Ya f `" Tv' r S 1 xxr~ 7.. � , ;. .•' L * xa� •k`r;Y �.� v � fl ., r " �` 7s �# t Y� N ,. Via i4& .+ >>ttr #.r.. ,. ur. ,� •. ` w i.i"1` ryf A k .dp '7 _ l..:C •� ] ' f1 {} 7 •i. �.xva r.'�. �F i u. . -a•, � i++ 4� c� -c'.y a rx � � � I .: v QQ..`` V N '" af✓>I r 4. •till.. C. .��' + , ,. arty ^ een - Owner mi APPLICAT ION RRA�VITARY sgFS U1LDiNt fir y 1., 13. J7 YD,�/,iSiC r. ` * 1QADISON Vlil537( * t } ►tteci►Iplans`; OUthe sysl� urn paper of , max, h ze,Ipiude plaMet is Klir ensioned•ora g ale YForazom � a d,p.e tical elsvatlo r" pe:points.must dyvrY q separating, `'*T and slcal cMaractertstl z t: P g,. i�Y pecjfle...... pt f��3'�I it Admr l@ 1ie shown..An Index a P 4a9e must be sign and'dated by the designer,'esigped #y ?Mast �cerise:nurnbers �eglb�e reprod "Af the. test. report arYthe; Copy `e �;ust, I ?t' +v � +.y.. r Y - *t w df _ • 7a f $` �:. 4 rry x � - l4 � r � � a -r t.n� a �..q.. r , . ,,. s Property tion , �+ r a ?, ; City, Village r Townsh Coun c t { �k L.andlria � � � E � '` {+,� , � �► mbs of �`�. ,r r � #�• '" �el @ 4'1 � ' f � t �` '���'' � " , n't;.,,.: �' `a ` '^✓T5':93 �, by � ' pia ��� _i�:Y^� =. '",MY T � Jr � . 4 .9 MS AMR Y 4r SEP p 4 Mr ti iis.TA fYl - 0 r T . RCQ ITO ,10 Mi via Y �Pu >.-e �' ��. S11 ° �eF�+ r� r.'�+ ,,�, � � MPJMP�SW,�110 •PI'i' r `%.. W .: '�� ... •"f �. .-: � -:¢ � �' � ,� if',.�, .,,�._ , a" - �` � � ! � may, ,n'. ! 1 "�'� �- ' � � Y i� x ' ARTMENT US <ONLY� ; } , APPR Q'�( umber; '* �' '� r ' ❑ DISAP OVfDi s ti �easonforasapproval 10 '�' �. '' "����'• x f �4 R 3 � t�'!"� r,� ; F , �i x'�'y"i. aJ°` 5 .T ` + y N r. .r Y'— `. " Alxe" ►' at'e � rs .au. CM>itnge own f ty t 3. yE h r r j3r-^ "� `�` i p o be { y p�In a rr e w t i t t tk } C11 _ #111th COUnt Tk tallatlon Fallltre m pl `tFte salilta 4 4 `> L, ti,�- i,J ,+ T� . ( P ��� ` `o4gx nar�/1gUr @a.U� Y f , �� Vl►n "er � .I�t� r,� w =..... vr� e �.. .a f . ,s is ,y, r W i le 4 M . ZONING OFFICE HAMMOND, W1 540 October 12, 1982 State of Wisconsin, DILHR Bureau of Plumbing P.O. Box 7969 201 East Washington Avenue Madison, WI 53707 Gentlemen: The property located in the SE of the NW Section 36, T28N- R16W, Eau GA1le Township, owned by Nelson Dean has received approval fo r a Holding Tank from St. Croix County. Numerous site evaluations have shown depth to high ground water, slope of land and slow pert rates being the limiting factors 41 which_ dictate this type of system. If you have any questions on this matter, please feel free to` contact this office. Yours truly THOMAS C. NELSON �y Assistant Zoning Administrator wjo y z z l ' r U� ay C ?r','��,", JI '��.1 '�. f � � v�L. J � y � f' }t � a�l I � �I �� T i t f, � � .r ,'- � ) S hIG���� ..T � T � � � �,..w�• � 4.�P,k f � t s : a• y� fir^ x I � , j `c � kl OF ila a, . ��� SF —r v f �n ,1.0 r. o • ,j F .. ST. C R 0 I X COUNTY A y - r�r pu A [ W l :S N N • ♦t r. 111 iii t r ra• Q c 1 ,'a b i 'L ATV - - _ �,j-- Z O N I N G O F F I C E 795-2234 � � i�:y�il III[I Ili, `a;«1 •:.� : Pabt Osssice Box 227 REGISTERS OFFICE Hammond, WI 54015 S T. CROIX CO., WIS. Rec'd. for Record i,;s 12t O W N E R dcy of October ,q, p 198; PUMPBR =�. 2:25 P ,h1. A G .R- E E M E N T James O _ per fit+ —` er of DeodM n PLEASE BE ADVISED, That unt.it you axe again not.i6 ied, I w.itZ (dJuu- ep P l � 1 con tact with 1'C(1h �' �< <.� --x� - o� , �)�cl�t�(yl W.i.b eon.6 in, (PumpeA) , Son the puxpos e o S xem ov.ing att wa,ate 6x om the &anitaxy b yatem to be tueated on the pxopexty and Sutuxe home site notated in St. Cnoaix County, Wi,6 con,6in, Townah.ip of . being in the S ; o 6 the IVC % os Sec. T. N. -R. Al W. (Ox moxe Gutty deac as 60.!?tow.6: ) Dated th.ia . day o C��J e - 14 (OWNER) 8 "� � State' o W.ia eo n . 0 6,6 .b :.:., 4 County o 6 St. C ,��• ; v>�, Pex.6onnattyappeaxed be6oxe me th.i4 y 6 fih da: o C r , _ • � '`'�� f .2. the above named !x'i_ o./ ,a? ,� �,4recc „� S,OrAN to me nocur,�ti tfe; pexbon who executed the Soxegotng .LnAttument and acknowtc-Nged e:. ly otaxy u .tic, St. Cxotix County, W My Comm. (.is petmant) (Expires) z F3_ I, hexeinbe6oxe xe6exxed to as Pumpex, joain in the above agreement to the extent that 1 have a eonixact with Owner as above btated. / s (r PUM PER). OCT 151982 ... _. _ e111t,A$I Spa-- °. _ _ —_--_ __-- •_._ -- ..._ - - ---- --- ._ 0 a VUL 3 Page 2 c, 3. Owner agrees to Have a quarterly pumping report submitted to the local government and the county which will state the Owner's name, location of the property on which the holding tank is located, the pumper's name, the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted to the Department of Industry, Labor and Human Relations by the governmental unit responsi - ble - , per section -14 -5.01 (15), Wisconsin Statutes. 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code. 5. This agreement will remain in affect only until the sanitary permit issuing agent in - S T (VeIX County certifies that the subject pro - perty is served by eitheF a public sewer or a septic tank — soil absorption system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agree - ment may be cancelled by executing and recording said certification with re- ference to this Agreement, in the Tract Index indicated above. 6. This.agreement shall be binding upon the indicated governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this day of c, L = V TOWN OR MUNICIPALITY OF 6,q L l e OWNERS by Al r. byO STATE OF WISCONSIN 8 2 0 5 7 fil Personally came before me this day of OGT �/ 4" 19 qz- - the above named ,cs o �y IN ,4- Ai w 4-v'lfl C i T D ^� to me known to be the persons who executed the foregoing instrument an acknowledged the same. THIS INSTRUMENT aLIC DRAFTED BY: � •My s91 t n Sexpi.res : OCT 151982 numalmo MMON NOTE: As specified in H63.18 (4 A) Wisconsin Administrative • Code this document is to be recorded in the Tract Index, lo- cated at the Cqunty Register of Deeds. At the time of Sakli- tqr Perinit A p p lication, a co o -f this - a ^reemen -t _with the Y Pi- PY _ . , r &cordinz date s.and numbp.r should be submitted to this office. 'CUL 653 0 7 HOLDING TANK AGREEMENT This Agreement is made and entered into - this day -of - n"t r A p - 19 �� , by and between the o ct w ;/ ch ...; fiereinafter called LJ • [L an Pt 04t ,�! ' `" Uc �v, hereinafter called the "Owner.�� We hereby acknowledge that application has been made for a building permit on the following described property, to wit / /b 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. We also , acknowledge that said property cannot now be served by a municipal sewer.or septic tank - soil absorption system. Therefore, as an inducement to the County of S ��eI to issue a sanitary permit for the above described premises, we hereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbing Code relating to holding tanks. Any time the Town or Municipality of Fl� V - �-d ZLe through its Plumbing Inspector or Health Offi- cer, deems it necessary to pump out the subject holding tank, the Owner shall have same pumped out in twenty -four (24) hours, or F� L• ((, J1I C will have said *w ork done and charge same back to Owner a r an ce same on the tax bill as a special cha ge. The Owner further agrees that the Town or Municipality of 7C, r may enter upon.the property des- cribed above at any reasonabl time, to inspect, or pump and haul wastes from the subject holding tank. 8 Q 2. -Owner agrees to pay all charges and costs incurred by the Town or Municipality of 'EdLti (, -11-C inspection, pumping, hauling or otherwise maintaining a subject holding tank in such a man ner as to' prevent or abate any.nuisance or health hazard caused by such % holding tank. jb CdZIC shall notify the Owner of any such cost which shat a paid by the Owner w thin thirty (30) days from the date of notice and in the event that the Owner not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs 1 assessment for the 1 ed n the tax roll as a s and charges may be ac ecia o p 9 Y P abatement of nuisance, and said tax shall be collected as provided by Wisconsin Statute. REG4 RS OFFICE ST. CX01 AX CO., NV IS, DILHR -SBD -6123 {R. 3/81) ��( Read• fe. 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