Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
028-1001-20-000
9 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Or ri 1 'kL L 9 1:1,70 Address 5 City/State 13 ft ILI T of# ZONING Z0N1N(i0FF1CrE Legal Description: Lot Block — Subdivi§ion/CSM # V4 Sec. -R _L, T_R(N IZV, Town of 1 W t ve. Y ?_ PIN # SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer e C ,, n, Size ST/PC /6 4 4ZS 17 Setback from: House Well P/L Pump manufacturer 2 e, & rz Model L 10 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: Nil 41,n Width Length Number of Trenches Setback from: House Well PAL Vent to fresh air intake E Description of benchmark to Pat 0 • I A 100 Elevation 0 Description of alternate benchmark Elevation Building Sewer Le ST/HT Inlet ST Outlet ; ' - PC Inlet 3 PC Bottom -Oaq Header/Manifold b TOP Of ST/PC Manhole Cover Distribution Lines q ) . & L Bottom of System O 16 i4l_( Final Grade ALL-1— Do Date of installation /;Yj 7,f Permit number _ao State plan number I A 2 Plumber's signature License number 2 2 3 Y7 Date Inspector jfod complete plot plan Wisconsin Department of Commerce 1 OIL t n Division PRIVATE SEWA YSTeM County: Sa fe ty a nd Buildi 9 INSPECTION REPORT - ST . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. 307652 N at'l . ❑ W'II�e Town of: State Plan ID No.: P�rf kl m CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TcL�IQ._1001 -20 -000 D O o ,o UZ23 TANK INFORMATION ELEVATION DATA A9800041 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sep Ic m,e /wr /000 r 1 d 2-5 /oZ /on , osing UN��1w�S`f ��ccc�s'C� ' 75 1 7 �3 16(. /C)6 Aeration Bldg. Sewer 10256 /0 0 I7 ' .28 Holding Dw Inlet K?L5;9 / f.o' 9/ TANK SETBACK INFORMATION Outlet /�., / /.cl' 9 /. /g' TANK TO P/L WELL BLDG. Aeintake ROAD Dt Inlet /oZ / /.� 0///-S, e tic F p' 16' — NA Dt Bottom loZs% /S SA 97.2,q osin fl� u�/ �� 3`r NA Header /Man. 16� z Y •2 7 o Aeration NA Dist. Pipe 101,3 (,�.7- $7 C) C.. Holdin Bot.System I C 1 q 01 PUMP/ SIPHON INFORMATION Vhf ) M Y Final Grade Manufacturer __r Demand a 5G S� r�. -f�.. (2�Sfl Model Number 20.0%PM TDH Lift f� Lriction��S Systema TDH�'� Ft Forcemain Length - 1 i Dia. Dist. To Well SOIL AB ORPTION SYSTEM BED / TRIE19Ce Width Length f No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHIN nufacturer: SETBACK INFORMATION Type O t , CHAMB R Mode er. System 0%__1_1 OR UNIT DISTRIBUTION SYSTEM Ob Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To,Rirhrinke Length _F Dia. Length : �� 1 Dia. Imo, Spacing 111 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: RUSH RIVER 1.28.17.4B,SE,NE 570 HIGHWAY 63 s `� .bawd 6 -G -cwn C oAw�r wk4 mil, trS 14 -zinc r, s r,\ cA ,c -1 Plan revisio� g%Ldes [A No Use other side for additional information. L`1 ° l S 1 7 � 5 SBD -6710 (R.3/97) Date Inspector's Signature Wiscons''in Department of Commerce � W o o Safety and Buildings Division PRIVATE SE IGMM EM County: INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitaryae�rjL.: Personal information you provice may be used for secondary purposes [Privacy s.15.04 (1)(m)]. Permit Holder's Name: ❑ Cit n Vill Town of: State Plan ID No.: HIELKEMA, HARVEY RUSH —RI — 7I aag CST BM Elev.: Insp. BM Elev.: BM Description: Parcel lax !L1001 -20 -000 00 t �k. o� c,i to UL TANK INFORMATION ELEVATION DATA A9800106 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchma%h .3S I ot - too Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air l to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe cj 2°( 97 .0�. Holding Bot. System PUMP/ SIPHON INFORMATION /,} Final Grade Manufacturer I :?o . I �" Demand Model Number I 2J5c%pM TDH Lift a3 Lriction System TDH I Forcemain Length 195/ Dia. f )` Dist. To well SOIL ABSORPTION SYSTEM BEDT Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME N S ?� I DIMENSION 7:�� SYSTEM TO P / L BLDG WELL LAKE/STREAM LEICHING Manufa SETBACK CHAMBER INFORMATION Type O �l/ _ Mo el Number: System:'(V 0V ,, f GI [�� OR DISTRIBUTION SYSTEM Obae man Header /Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Airfitd C' Length Dia. Z Length 3� Dia. r Spacing A/y �J� _75 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded _ T x Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No [] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) s35 c� 33 LOCATION: RUSH RIVER 1.28.17.4B,SE,NE 570 HI I' WAY 63 �.I )r 19 Su i[ �/e I` q +535 �ISI7 9S 0Z_ gSzS 4s Luis LI Z�1 �.Z$ 4'Z� r� s. f q 4 y.q Plan revision required? ❑Yes ❑ No Use other side for additional information. I F SBD -6710 (R.3/97) Date Inspector's Signature Cert No VL ons in Safety and Buildings Division S ANITARY PERMIT APPLICATION 201 B Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) for the system, on paper not less County,,r e than 8 1/2 x 11 inches in size. � • See reverse side for instructions for completing this application State Sanitary Permit Number :?�©_ I Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 0/ q O + y i / / C r rS / sly State PI I.D. Num 1. APPLICATION INFORMATION -PLEASE PRINT ALL IIN RMATI N / 2 Z' Pro rty Owner Name Property Location l {4 r (r e- 1 "c- I( k e :+. ti 1/4 pf G 1/4, 5 T �� , N, R I ? -15 W Property Owner' Mailing Address S Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 134 ld". ,, w, s– ? - 10(, 'L I ( ?lam 1, II. TYPE OF (check one) ❑ State Owned cit Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Io w a n OF /Z 4 S `2 �' ��'� �.S �w t. j Ill. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo �' a g. �_ 2 6 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 Q 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, Q New 2. g Replacement 3. ❑ Replacement of 4. Q Reconnection of 5. Q Repair of an - - - ___ System________ System _ _____ _______Tank Only_____ ________ Existing System ___ -____ Ex- 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 ❑ 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 3 ? ) ? S" ! • Z Feet '?k s_ Feet VII. TANK Cap acit in gal Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted steel glass Plastic App T n Tanks Septic Tank I AVi d c re i ❑/` ❑ ❑ ❑ ❑ ❑ Lift Pump Tank b 5 ti ` ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility or installati9p of the onsite sewage system shown on the attached plans. Plumber's Name: Print) Plu er's Signature: mps) MP /MPRSW No.: Business Phone Number: J-G� Name: Print) � 1 2Z 3 612 c - ?l Z4 Plum Address (� rQet, Ci t�3 Code) `� v �� , ,/ f 5 _� G S ' G 41, d ti. !mot/ l IX. COUNTY/ DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuin Agent Signaturg(NoStamps) [Approved E] Owner Fee) 2O , / / l g , I Owner Given Initial 7 Q / Adverse Determ d X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (8.17197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 Visconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary April 02, 1998 CUST ID No.267341 ATTIC• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 RE: CONDITIONAL APPROVAL Transaction ID No. 71228 APPROVAL EXPIRES: 04/02/2000 7 SITE: Site ID: 4877 �"' ������� ST CROIX County, Town of RUSH RIVER A,�Q SETA, NE1/4, S1, T28N, R17W 1 4 St ��9� HARVEY HIELKEMA — CPO, f FOR: ��,` zo� Description: MOUND c` j SCE Object Type: POWT System Regulated Object ID No.: 11537 / L The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes listed in the regarding line above. 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 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. Adm. Code. • 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. 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. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincerely, ~ DATE RECEIVED 03/30/1998 EPOWTS FE E REQUIRED $ 180.00 6 RD M SWIM , AN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JS WIM @COMMERCE. STATE. WI.US R Page 1 of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE SE 1/4 OF THE 1/4 OF SECTION ,T Z% N, R 11 W, TOWN OF S 1V ka1Z COUNTY, WISCONSIN. INDE% RECEIVED PAGE l 'of 6 TITLE SHEET MAR 3 O 1998 PAGE 2 of 6 PLOT PLAN SAFETY & BLDGS. DIV. PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR 1-F A R v E Y 1} l Er L 1c E Yet A S�10 SvMMtT C11Z eL E k 1,1?j 1AvI SqooZ PREPARED BY WEC -sERER SO I - - TEST I j,4 (a AND. 4N DES I (SM SERA! I CE I P.O. B01 74 421 K. KAIK ST. '` ,•»••»•~� /� P.O.W.T.S. RIVE. FAILS. YI 54022 Conditionally F�CHE ER j D -915 P APPROVED DEPARTMENT OF COMMERCE "►® •••••„•••• IVISIO A TY UILDINGS Lo 6 ®K SEE CORRE ONDENCE JOB NO. g8 ' 37 PLOT PLAN Page ?- of Scale 1 "= 4p ' - :Q��.__ -� w �w r ESM "l 3 BDR.wt � # s�o .9 �'co VS� �z 96 L►''pv� @.3 r 1 - I 301, 100' OF P 4S' S m Z'pvC F.N. S r 2 � N 9S• i a huts rcR.gA . lOU.p' OW WC Or }ivuSC Stw"6. NOTES - 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. tank to be` 16So gallon capacity manufactured by 5. Bench Marks sew EYSpvE 6. Divert surface water around systek to prevent ponding at the uphill side. ti Page 3 Uf Approved Synthetic Covering rysTr�► c 33 Distribution Pipe Medium Sand Topsoil H � Elev. °t`t• 0 3 E - b 3 % Slope . ( Force Main Plowed - Trench of 4"-2k" From Pump Layer Aggregate Undisturbed D V Ft. Soil E Ft. Cross Section Of A Mound System Using F a -a Ft. 1 Trench For The Absorption Area G Ft. A S Ft. H I- S Ft. B -- )S Ft. I IS Ft. Linear Loading Rate = GPD /LN FT J $ Ft. Design Loading Rate= 0.3 GPD /SQ FT K 10 Ft. L qS Ft. „lternat Position of Force Main W 2-9 Ft. L B K Win- w Distribution Trench Of 2 Pipe Aggregate I Permanent- Observation Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Page Of Perforated Pipe Detail 0 End View Perforated End Cap `` PVC Pipe Install permanent - marker at end of each lateral Holes Located On Bottom. Are Equally Spaced Q End Cap P *� * s PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cap Distribution Pipe Layout P 34 -S Ft. X 3 L Inches Y 3l, Inches Hole Diameter 1 l5' Inch Lateral L J IV Inch(es) Manifold Inches Force Main " Z Inches #of holes /pipe 1Z Invert Elevation of Laterals TIS Ft. *VZk\._t-)= ky 'by X Z = ZQ.t;B (;,Wl Place 1st hole from tee with succeeding holes at 3 " intervals. Last hole to be next to the end cap. Combination Septac. Tank and PLIMP CHAMBER CROSS SECTION ARID SPECIFICATIOMS ' PAGE S OF -VENT CAP WEATHER PROOF JUNCTIOIJ 80X 4' VENT PIPE APPROVED LOCKUJG MA,001_E COYER I-JIV —101 FROM DOOR. wARr.I L -I46EI '41KIDOW OR FRESH AtRIMTAKE I cor�pulY � I r _ i 5 h1�-x . 1 y "ItiJsot%n w p l Pt INLET PROVIDE I • -- AIRTIGHT SEAL I I 1 I I A APPROVED JOIIJT: APPROVED JOIIJT 3AFFL�S I I I II W /C.I. PIPEN*vC PIPEJ Tank construction I I I I ALARM shall comply with ILHR ()3.15 and 33.20 Js I I I I ON C I I $6.V,S I LLEK FT PUMPS - -� . � OFF D COIJCRETE 5LOCK ' 3.. APPRo+F'. RISER EXIT PERMIT(ED 01JLy IF TANK MANUFACTURER HAS SUCH APPROVAL BEDDINIR SEPTIC f SPCC_ IFICATIOUS oos � ti PZF S T NMb OF DOSES 3 '� 9 LI PER D" TANK MANUFACTURER: TAWK SIZE: ` 6so GALLONS DOSE VOLUME r ALARM MANUFACTURER: S.S• �L (_;w :3 � 3 INCLUDING 6ACKfLOW: 5 3 GALLONS MODEL NUMBER: �D " 'Aw CAPACITIES: A= �$ DJCHCS OR 3OtD GALLOWS SWITCH T:JPC: N� B= Z 1IJCHES0R 3�f G�LLOLJS PUMP M C q ANUFACTURER: � -�Z- CQ = I INCHES OR `S3 GALLONS MODEL NUMBER: D� °I INCHES OR ZS3 GALLONS SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO 5E MIM IMUM DISCHARGE RATE z'g' GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF ANO.DI5TRIBUTION PIPE.. \%113 FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , , , . , . , . . 2•5SJ FEET + FEET OF FORCE MAIN X 10 \ FYofLFRICT FACTOR_. �'� FEET TOTAL Dy1JAMIC HEAD = ` S.lb FEET Pump chamber DIAMETER IIJTERIJAL DIMEWSIOMJ OF TA1JK: LE*J&TH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231= GAL /INCH AS PER MANUFACTURER -- - GAL /INCH 0 : 3 7/8 6 1/4 �- W HEAD CAPACITY CURVE MODEL "98" 4 5/8 8 2 3 5/8 = 6 + + 15 tS•16 O 4 4 3/16 0 10 r- 2$ 2 5 1 112 -11 112 NPT 0 U.S. GALLONS 10 20 30 40 5 t6O 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENTANDDEWATERING CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LT s 1.52 72 273 3 10 305 61 231 15 4.57 45 170 4 3/16 20 610 25 95 Lock Valve 23' SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 Ibs. - ,2 H.P. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series Control Selection float switch. Refer to FM0477. Model Volts -Ph Mode Amps I Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075. M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) D98 230 1 Auto 4.7 1 or 1 & 7 — float system. 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in E98 230 1 Non 43 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002. 7. Two (2) hole J -Pak, for watertight connection or splice. CAUTION FornfwnationonadddionalZoeAerpnoducls refer tocatalogonCombination Starter, FM0514;Piggyback All installation of controls, protection devices and wiring should be done by a qualified Variable LevelSwitches, FM EleciicalAlternator, FMO486; MechanicalAltemator,FM0495;Sump/ licensed electrician. All electrical and safety codes should be followed including the most Sewage Basins, FMO487; and Single Phase Simplex Pump Control/Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 OEL E�' WTO. 3 l KY 40256. Manuraclwers of.. � SHIPTO: 3649 Cane Run n Road oad Louisville, KY 40211-1961 Z&Lffr /7 S�cE /9v'9 PUMP !O (502) 778.2731.1(800) 928 -PUMP FAX(502)774,W4 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT P ) of Labor and Human Relations �— DivWon of safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site an on - in . Plan must include, but pl plan paper not less than 8 1�1 inches not limited to vertical and horizontal reference t:(Jj ; iJirection arte sbpe, scale or PARCEL I.D. # 1 dimensioned, north arrow, and location and at> to nesest„aad. ' :�' C) - L F - 0 0 1 - 4 i; APPLICANT INFORMATION -PLEAS "R NT ALL 1 � 71p�TIO�. ,A R w � r ,� Y D ao 9e> PROPERTY OWNER: I _ _ PROPERTY LOCATION ZU - ' T ST � � f " S� 1/4 Ml 1 /4,S T Za ,N,R E (o W PROPERTY OWNER':S MAILING ADDRESS '": ON>ti �U) # BLOCK # SUBD. NAME OR CSM # 5 4 S�r-tri tT C \Zc °Nl% O pp, _ CITY, STATE ZIP CODE NUMBER CITY []VILLAGE [.MOWN NEAREST ROAD �fl-L till Sqpo2. a R vs� Ztuc v g1� b3 [ ] New Construction Use N Residential / Number of bedrooms 3 [ ] Addiit�in to existing building @q Replacement [ ] Public or commercial describe Code derived daily Bow q S o gpd Recommended design loading rate - bed, gpd/ft , 3 trench, gpd/tt Absorption area required 2 S bed, 11: __S trench ft Maximum design loading rate 5 bed, gpd/ft 0-b trench, gpdd/ftt Recommended infiltration surface elevation(s) a 1 ft (as referred to site plan benchmark) Additional design / site considerations */\b uKJ\:> w / S '>c 7 S' T1Z.t;'� 4 , 1'l tin, . ) ' 0 F S Q F L-L Parent material L ohs S Flood plain elevation, if applicable 1.� A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I] S O U IRS ❑ U [Is El U [I s Lou [IS ®U ❑ S @U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmrdary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trarch N I fl- 1. s `•t ii 3Jy Si I I, F1- c S v • S OS •S .� Ground 3 Z6 _3 elev. ot -9 ft. l Depth to � L11T tz rr\,L S v EL - limiting fact Remarks: Boring # o —� S -t fZ 31 y — sL Z Fsbk ��� es t �� s • 6 is zg to4Q �/� ti Z Ground elev. ft. Depth to limiting facto ZS Remarks: CS T Name Print Arthur L. We erer Phone. 715 - 425 - 0165 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022' Sgnature: Date: CST Number. M00576 PLOT PLAN Pa ' of 3 SCALE 1 "= y Q' Lc ,� L .wE Sao < -9 �v V3t' 1 B.3 Y s 3 0/o I 4s' LIJ c �6,p C / LW-0' OW h H u S C—_ S lfl�ti6. o , loo, y' 0) '3 WL � c18 ` -37 ( 715 ) 47.5 -n1 h5 I400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 7 Labor and Human Relations Division of safety & Buildings in accord with ILHR 83.05, Wi Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST C�I�IX, not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O Z's - 1 O 0 1 - ZZ APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ydl\ZU �J GOVT -LOT SC 1/4 Ml 1/4,S \ T ?- ,N,R 1 E (01 PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # S 40 SUFIm LT 01 11Z. - - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (MOWN NEAREST ROAD bft�Dw/nv w► StI6oZ. (>>s) 0V_ i8 so Rvs4 'ZtvkF�t va le b3 [ ] New Construction Use pc] Residential / Number of bedrooms 3 [ ] Addition to existing building P4 Replacement [ ] Public or commercial describe Code derned daily flow L( S o gpd Recommended design loading rate - bed, gpd/ft L • 3 trench, gpolft Absorption area required 3A- bed, ft S trench, ft2 , Maximum design loading rate S bed, gpd/ftt 0- b trench, gpo1ft Recommended infiltration surface elevation(s) °t, . O ft (as referred to site plan benchmark) Additional design / site considerations `I'\buk w ,/ S `y- S' T1Z-t'_)-JQ_ t� . 1_ titi . ) ` 0 F H L-L Parent material L_'3Qn S Flood plain elevation, if applicable 1.3 A It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem EIS ®U Pd S ❑ U ❑ S El U ❑ S 10 U ❑ S ®U [IS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD /ft B7 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. mnch ` == ( -8 - 1.S'[ ti Ily S 1 2`t �b F� cS � v� •5 A. I .. { 4 S S _ • S 3 ZL_3 1tj`12 '51 L - �L� `tiz s18 Ground - elev. a S•9 ft. V - lil C, Depth to - limiting factor Z6° Remarks: Boring # • S 6 M, >: S/p, s t 1 �►, w, �) - ti+>> . Z Ground elev. ` .0 ft. Depth to limiting factor ZS 4 Remarks: CS T Name :--PleasePrint Arthur L. We erer Phone. 715- 425 -0165 g rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Sgnature Date: - z�5 CST N 00576 PLOT PLAN Pa 3 of 3 SCALE 1 "= DLO' �u LwE _ r tam vi VA czE S7 0 -9 L so 8.3 � 4s' W i 9 . Z ' C i �. u cn i 0 U1 - rL - oO t�0� ��l \eft tT QV l Ul l hid 100.0 0)J Or V+ - 0USE-- - j IDItiG. 3Y`1 ,- - QIL loo, y' U,v 0) = H etD ( 715 ) 425 -0165 H QQ0 76 CST Signature Date Signed Telephone No. CST # Vi sconsi n SANITARY PERMIT APPLICATION 201 Safety and shn sion In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County nn than 8 112 x 11 inches in size_ Sz (.. • See reverse side for instructions for completing this application State Sanitary Permit Numb The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Propert wner Name Property Location I'(5 / 1r1/4 114, S T , N, R ,2'for) W PropertyOwner's Ma ing Address Lot Number Block Number City, State Zip Code Phone Numb F U Subdivision Name or CSM Number T YPE F BUILDING: (check one) ❑ State Owned it�r uS �i.e NearestRoa Public 1 or 2 Family Dwelling- No. of bedrooms C3 Town OF u� I L III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo L 0Z8 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. Ig Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - _____ System ________ System Tank Only ________ ____ _y______________ Existing System _________Exl S ystem -- -J - 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 i 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) Elevation Feet Feet Cap acity VII. TANK in Ca gallo 5 Total # Of Prefab. Site Fiber - Plastic Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con Steel glass App. New Exist in � strutted Tanks Tanks ) Sep#e-�fr ! rrk or Holding Tank 00 U ❑ El 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber ? El ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT i I, the undersigned, assume responsibility for install 'on of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum is Sig e Stamps) PRSW No.' Business Phone Number: Plumber's A( dress (Street, y, State, Zip Code)- / 6 (, (r/t` &4-- 01 &+� & Ziv J ( e 4/ s — �G Z.Y IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued lssuina nature (No Stamps) A roved / ® pp ❑ Owner Given Initial [ � Surcharge Fee) & Adverse Determination b �/� 0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Nj4 5j � y ld w wKse AA 9. c� (m 1 S F � t° �r v►til $BD -6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND A ARUe�f OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address J r 6/U S j` Property Address S 7 U 4 (Verification required from Planning Department for new construction) City /State IM I106u/--z- Parcel Identification Number OZ-8 — /OD - ZCD LE GAL DESCRIPTION Property Location &C '/4, 0 %4, Sec. L , T � N -R W, Town of 1 45/ Subdivision , Lot # Certified Survey Map # Volume , Page # Warranty Deed # 2 2 �� , Volume v , Page # b ,Z D Spec house ❑ yes �9 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, j ourneyman 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 expiration date. IGNA OF AP LICA 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. 11 - 1 a 1 2&ze- -3 IGNA 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 ST. CROIX COUNTY WISCONSIN �..`L ZONING OFFICE N N N N N - i move ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 EMERGENCY TANK REPLACEMENT APPLICATION STATE OF WISCONSIN ) ) ss. COUNTY OF ST. CROIX ) / CITY, TOWN, OR VILLAGE OF • I ?4 S f7 PROPERTY ADDRESS: S 2 0 1-4 w 1 52,7 - 3 w LOCATION: ;, '(L ',, Sec. _� , T N, R l W, Town of ffe ✓ e/ I, �`�q ye 1�'`� A the undersigned do hereby acknowledge that I am receiving a sanitary permit to leg14 c � -5e � e- < without a soil and site evaluation, or existing system evaluation, and private sewage system plan review due to inclement weather and health or safety emergency. Further, I acknowledge that a soil and site evaluation, or existing system evaluation, and private sewage system plan review will be conducted by the deadline stipulated by the permit issuing agent, or as soon as weather conditions or circumstances permit. If the private sewage system is found to be failing as defined in s. ILHR 83.02(18), Wis. Adm. Code, corrective measures will be taken such that the private sewage system complies with all application requirements of chapter ILHR 83, Wis. Adm. Code. Dated • l let pie y � 'c l 4 ", e PROPERTY OWNER �-f /0 "0 G '7, Subscribed and sworn to before me ��y this day of �-v1 a� -ck.� 19FL. •••eHee4� S 1 O . , n e00 Notary Public A St. Croix County, Wisconsin My commission expires / Q a ov1 cnv •. �' COMMENTS: .f E "�iSCOr PLEASE RETURN TO ZONING OFFICE, 1101 Carmichael Road, Hudson, Wisconsin VUL J j.LF iarfu�j DOCUMENT NO. STATE BAR, OF WISC IN FORM 11 -1982 T H15 1IP ACi IICSLIIVXZ NOR 111MCODING OATH LAND COWRACT I"vida" a" Corporal& (TO BE USED rOR ALL TRANSACTIONS WHERE OVER �5 $45.000 IS FINANCED AND IN OTHER NON- CONSUMM ACT TRANSACTIONS) MIS OFF i:' ._ _���,a�, , R:..x 4 ._ �? S CR or CO.. t' Contract, by an between ...... ...... �f .':. •, Reo'A for i�cu:;: F.�7.f;Rl1A.0 »� : »HQJI�IG.e...)kl,t tZ? �I.. sX�IS.». gx ... ............................... .......... ».. » .............. . . .......... (`VVendor ", "v4' MAR ' - 1 9 r whether one or more) and... 11c1ZXB3:. .it�AZ .. »............ ........... ^" `�" •�� at P . ........................... ............................... ("Furchaser ", whether one or more). W I Vendor sells and agrees to convey to Purchaser, upon the Prompt and till per- ! Regi3terDe; ; formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), in.... ........... . .. .......................I..... County, State ai Wisconsin: 11RVUeN To I I in it Pu ry promises to o demand receipts taxes and s paymelevied on the Property or upon venoora sioxvm Purchaser shall k eep the improvements on the Property insured against lost or damage occasioned by fire, aY perils and such other hazards as Vendor may require, without co- insurance, through i=urera approved b YIndor, in the sum of�.N11..�.xl ? -1P. V" 114%... but Vendor shall not require coverage in an amount more an the balance owed under this Contract. Purchaser shall pay the insurance premiums When du t9o. The po11Ci86 chilli contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writin , the original Of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give no CO of loss to Insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurauce proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deema the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed ou the Property, to keep the Property in good tenantable condition and repair to keep the Property free from liens superior to the lion of this Contract, and to comply with all laws, ordinances anW regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except . ........... ...... ..... ....... ,...,.,,,. -------- I ......................... . ........................—......................................--•--...... ............................... Tax Parcel No ........................ ......... Part of Southeast Quarter of Northeast Quarter (SEk of NEk) of Section One (1), Township Twenty -eight (28) North, Range Seventeen (17) West described as follows: Commencing at a point on the West line of State Trunk Highway "63" 19 rods and 15 feet South of the Quarter Section line on the North line of said 40; thence West parallel with the said Quarter Section line 17 x°ods;.thence South 9 rods and 6 feet; thence East -17 rods to the West lins`of'said State Trunk Highway 11 6 3 "; thence North to the Point of Beginning, including all rights and privileges contained in that agreement dated November 30, 1964 and recorded in the St. Croix County Register of Deeds office on January 4. 1965 in Vol. ",410" Page 8. 4 This ........ $ .... homestead property. is) (1a70o�oq Purchaser agrees to purchase the Property and to pay to Vendor thesum of $., 60.. DDD.. DO ....... ............................... in the following manger; (a) ............................. at the execution of this Contract; and (b) the balance of $ M QQQ. QQ ..................•. together with interest from data hereof on the balance outstanding from time to time at the rate ................. r cent anngnn until paid in full, as follows: monthly payments of $600.00 catmancing May 1, 1' 95 and on the first day each month thereafter 1 Pr vided howeve , the entire outstanding balance shall be paid in full on or belore�iiAF..f,.Yi'S$1F.�..7 �F!..?4'•.0......, ....... ( the maturity date). Following any default in payment, interest shall accrue at the rate of per annum on the entire amount in default (which shall ipolude, without limitation, delinquent interest and, upon acceleration or mawity, the entire principal balance) . Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici. ps.W &v=W !axes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assesements and insurance will be deposited into an escrow fund or trustee pccount, but shall not bear intavo unless otherwise required by law. Payment& shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any . amount may be prepaid without premium or fee upon principal at any ......... In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as Oe unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said 'indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title - *video" submitted to Purabasar for exont nation qxpeptr.., nQn6 . . Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract. it eha11 be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on ... date.. Alf— clooiM .... I ............... #? %........ •ores Cwf oae. LAND CONTRACT •.. Individual and 'STATE gAR OF wlacqq Spf Wboon.io ',.etmal Btask Co. iw. Corporate F08M rio. In .-1lQ7 Awwaunua. wu. ........................................................................................•.........------...............................--. ....._......................... Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of A5..... days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of ..5.._. days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become lmmediataly due and payable in full, at Vendor's option and without notice (which Purchaser hereby L a and Vendor shall also have the follawing rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity; (i) Vendor may, at his option, terminate this Contract and Purchaser's ri hts, title and inte s e Pro re in th Pp erty and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in. which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the data of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contractasacloud on title in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (l), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and alb costs and expenses including reasonable attorneys fees of Vendor incurred to enforce:any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in. curred, and shall be included in any judgment. Upon the commencement or during the pendenc of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action., and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is -first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by 'Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may -hake any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered ,payments >aiada on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of tke heirs, legal re successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the executions of the deed to be made in f bUment hereof.) Dated this .............. . � , ......... of .... dT, t!. Y-":..... :................ ...:........... ., Lk . .. ... ...... (SEAL) • I13X3FB� ................. • ,?� d _. t. .,' . - ... r �r,�., ..,,. ..... , ...,. .. ::.. ...... .................. .....:......................... 'SEAL)'.s�iry�L,Q.�,. iG4 s... . (SEAL) .. ... e+ ,. ................. .......... ...... ti:M.,sr.s.,..,....... r,' ................ AUTHENTICATION ACKNOWLEDGMENT Signature(s) .......................,....., . .... "...................,...., STATE OF WISCONSIN _ as. ......................... ...................... ................I.............. St . Croix .County. authenticated this ........day of .......................... 19...... . " Pere ally • came before me this • '• 1 ........................."..........•..........-•--------- ...,........----- ...... .... stir~ .. .., x8 95 t_. � , .. r......... H7_....3Cema ► DCiii M - Eleanor • A. Hou>� y. °- - q,,. a _* � Ele A $ T ITLE: MEMBER STATE BAR OF WISCONSIN . ,. . ".. .�... (If not, .. .............. . ..... ... n._. ....... ..... . ........... authorized by § 706.06, Wis. State.) • S -- to me known to be the person .._. ..,. „.r. foregoing i meat d ,ackno ed 'A• . +. .,.► TNIa INSTRUMENT WAS DRAFTED BY .. ... u:... ... Than A. 1�cCormack .... T� ...... ............ ................. ..........Baldwi.n� 54002 .... ............................... e.............1. ; ?�4:��:,.,, c�.........A.�:............. • -• .}• . . � Notary Public .. - County, Wis. 11, .;Signatures ink baauthenticated or acknowledged. Both My Commission is permanent. (If not, "to axpimUou are not necessary. date: ,.......... ... ............................... ......... asa.........� *Name of parsons signing In any aapaoity abouid be typ-d or xgtaii ♦ 7 R i . �q LAND CONTRACT — ladhideal sad Corporate —• stow Bar of lvipaenh.,_ :. eras Nr, LA —• 1183 ` HOLDING TANK SERVICING CONTRACT :ontracl Date This contract is made between the — folding Tank Owner(s) Name(s) and Pumper's Name — Ne acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1. The owner agrees to file a copy o(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 I with the County of 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 lank; 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) Owner's Signature(s) I Subscribed and sworn to before me on this date: I I I Pumper's Name (Print) I l?unvfw_(s Signa re Notary Public M mission expires: Pumper's Regist�n Numbgr SBD -7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. Doe u mentNumber/Plan I.D. N °. HOLDING TANK AGREEMENT This agreement is made between the government Name and Return Address unit and holding tank owner(s). Parcel identifier number (PIN) Agreement to W Governmental Unit Holding Tank Owner(s) We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property: (Provide legal land description. Use reverse side if additional space is needed) 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 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 governmental unit to prevent or abate a human health hazard as described in a. 254.59, Stats., the governmental unit 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 a. ILHR 83.18 (10), Wis. Adm. Code, to have a water meter installed in a new building or new structure. 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 finally responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit 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 governmental unit for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, 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 governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the governmental unit and the county on a semiannual basis a report in accordance with a. 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 governmental unit and the county. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the 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 canceled 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. "c 5s) Name(s) - Please Print Governmental Unit Official Name - Please Print Subscribed and sworn to before me on this date: .� /-�; Cif. !uy 11 'e- o o c Notarized Owner(s) Signature(s) Governm6ntal Unit Official Title - Please Print Notary Public G h q l Govern ental Unit Official Signature My commission expires Drafted by Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1Xm)1.