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HomeMy WebLinkAbout261-1211-10-000.. SANITARY PERMIT APPLICATION V- CaDILHR In accord with ILHR 83.05, Wis. Ad. Code COUNTY rumArrmAum �� " / V STATE APfiTARY ERM`iT # -Attac'fi complete plans (to the county copy only) for the system, on paper not less than 81/2x 11 inches in size. C6eck if re n�preeious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER if I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. /1 PROPERTY OYVNER PROPERTY LOCATION /V Y4 1/4 o N R r 4LZ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # c STATE ~ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0 CITY NEAREST OA II. TYPE OF BUILDING: (Check one) ElState Owned El VILLAGE 12 JOWN COW: JLJ NPublic El 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 10 6f III. BUILDING USE: If building type is public, check all that apply) 1 ❑ Apt/Condo 2 E] Assembly Hall 6 E:1 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 E❑I Campground 70 Merchandise: Sales/Repairs 11 ElRestaurant/Bar/Dining 4 El Church/School 8 F Mobile Home Park 12 El Service Station/C1rW I sh 50 Hotel/MotelElOffice/Factory) le 9 13 X1 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1, M New 2. ❑Replacement 3. ❑Replace ment of 4. ❑ Reconnection of 5. El Repair of an 10aj System System Tank Only Existing System Existing System 13) EIA Sanitary Permit was previously issued. Permit# Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 ®Seepage Bed 21 El Mound 30 El Specify Type 41 [:1 Holding Tank 12 M Seepage Trench 22 ❑ In -Ground 42 D Pit Privy 13❑Seepag e Pit Pressure 43 0 Vault Privy 14 El 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./' ch) ELEVATION t Feet Fee Vill. TANK CAPACITY Prefab. Site Fiber- Exper. in gallons Total # of Manufacturer's Name Concrete Con- Steel glass Plastic App. E I. ABSORPTIO N S P1 .GA N -el I INFORMATION New xisting Gallons Tanks structed Tanks Tanks Septic Tank or Holdina Tank ,leov F] 0 0 Lift Pump Tank/Siphon Chamber Vill. RESPONSIBILITY STATEMENT Ilatio9if the onsite sewage system shown on the attached plans. 1, the und?rsigned, assume responsibility for insta Plumber's ame (p9intlL - :-� Plumber' i tu re, N M MP/MPRSW No.: Business Phone Number: 1 ?01-7 77 ' Plumis Adardss (Street, City, State, Zip Co e): Ix., CQUNTY/DEPARTM ENT USE ONLY g A S' ru uh4ii, Ej Disapproved Sbajx*tary, Permit 5pe (includes Groundwater Date issued Issuing nt ig"ture (No amps),, , d e& Surcharge Fee) Aroved ❑ Owner Given initial pp Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Ygur sanitary permit may be renewed before the F," X P fk`ation a t Ih e t ry c; c date, a nd enew�ai any rlew Criteria ifn the Wiscorksm Administrative Code vi," e applicable. 3. All revilsi ons to. th is Perm it must be approved th, "A' tL 4 4 Changes in owners� 'l-imber requires a lip oir P�­III(Ij L) Submitted to the co�Untv to installation. F I k,.', J-. N -1 L ;14' 1%- t, sz te sewa;t�rnus'L .* ;, of, b e P o P P, r i Y d pumper wheriever necessary, usually every 2 to 3 years. G. If you have questions concerning your on-site-s-ewaJ SYsterD, cOrliaCt Your I a o d ad min i ti%aloe-or the State of Wisconsin, Safety & Buildings Division, 608-266-3815, To be complete and accurate this sanitary permit application: must include: 1. Property owner's name and mailing address, Provide the legal description alri,,j parcel tax nurnoerfs) of where the system is to be installed. 11. Type of building being served. Check only one Qairid-co rnplete # of bedrooms if 1 or 2? Family Dwellin.g. Ill. Building use. It building type is Public, check all appropriate boxes that apply. IV. Type of permit-. Check only one in 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., V1. Absorption system information. Provide all in fo r ma o V! 1. Tank inforrnatio-Fi. F--ili J,; the, cepa,.%-v-2 �::-.vzi- tanks and prf!"" c�­ y sc,ptic. purnpi'siphon and i-holid.4in16 g '1,1-%aiks for this Q,XPCr,F1W-n1',a-',, jn;roduct approval frcm DILH9 lilt!. Responsiblhty swerrient, r.� �� 5 �, .. iE plurn MP, etc.), address and phone number. Plumber rnu,;�J a� �. pp fi, C r'j IBC. County/Department Use Only. X, County/Departmen,t Use Only, TNall smal.hE v1 .13orr,,Ip`�Pste fans anf_J P; f o o iu wr & . �. 3,�.�.. r � r- . , � . Other cn� a " streacos �i n �J' a e s a ' a ua inhe, IocI.iC), c,;bi q S jj Z Ps and o n r 0,1 S J, 0 S t-,� f _--t C). Complete specifications fok- puln, performance curve; purr model drid pump manufacturer; D) cross sec-� p 1 1. 11 o n of the so i I absorptilon, systern �,g� � �+� �' � � �� }. �y it required by the county; E) soil test data on a 115 form; arid F) all sizing information. GROUNDWATER SURCHARGE is, for a nt!ql- cal Wisconsin Act 410 included the creation of surcharges (fee regulated practices which can effect groundwater J The nionies c`�,Hected through t h e r c h a r ,: g e,, >i j water, contamination knvestiqaik,,)ns SB D-6398 (R. 11/88) S�.��� .�� �er°- l�,9.,�,k /�,.��� N��� St ��; s,E� ; T.3�it�7f'i8�1 to 71010 01 �fiqlu635�51.e 3, y /-�' e ez PAC. E iii D F r of Fro rh Alt InliZ► And 4htorvalton Pips Apprarr�d Yard Cop 15�1lnlmuia 12' Above FInQI Grade 20- 42' Above Plpr 4" Cass Iron Ta final Grads Y+nl P=pa Mr sh Hay ar S nm4nc Covrr In win QliP�rllyQa�llori 2 ACi Qj49 ai& ow e(lps p fa • 1]~ A BePips ° P41101016d Pilo's Helor ° C194AIA9 i0+44lnalin4 Al r Balsam 01 Sy�lim pro P cl-C SOIL FILL. DISTRIBUT IQF.I P1PrL wo APPRC]�1E o S��JTIACTIC COVER 4R tAARSN HAy VIr z c t AG G R E G AT E r 5 D15TRlF5'JTIrDW PIPE TO DE AT L'EAS`T Iti.ICHCS BELOW ORIGIQALA R A,QU AT LCAs`r ?-o IMCNE . BUT 1•IC� MOR.0 THA1J 42. IMCI{ES BF,LOW FIM GRADE AL GLADE . rom ORItilINAL ���1v� WILL �E � - � IMcIaEs rMMUM OEF T-H of FACAVATIOW fAOM. �161PAL GRAVE WILD e LrcC1�.lSC r.JUM�EIZ. �, Y D A T F. :,.; Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations Division of Safety & Buildings in accord with I LH R 83.05, Wis. Adm. Code .F Y Attach'complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION ED BY DATE PROPERTY,OWNER: PROPERTY LOCATION GOVT. LOT 114 114,S T ,N,R for 'ofPROPERTY OWNER'S 1LING ADD SS LOT # BLOCK# SUBD. AME OR 9SM # e M12 -7 S/ CITY TATE ZIP CODE PHONE NUMBER ®CITY 2VILL7 [0TOVX NEARES ROAD xo dew Construction Use [ ] Residential 1 Number of bedrooms [ ] Addition to existing building Replacement [ Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpolft2 trench, gpolft2 Absorption area required bed, ft2 7< trench, ft2 Maximum design loading rate bed, gpd/0 trench, gpolft2 Recommended infiltration surface elevation(s) "� _ ft (as referred to site plan benchmark) Additional design 1 site considerations Parent material - Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑ U [@ S❑ U IM S❑ U ® S ❑ U ❑ S O U ❑ S O U SOIL DESCRIPTION REPORT Boring # ti. yS � s i'r �• titiv':: . Ground e^le�Wf � Depth to limiting factor >%q 7 � Boring # Ground elev. ft. Depth to limiting factor MaDominant Color Mun-sell Mottles Qu.Sz.,Cont. Color Structure Gr. Sz. Sh . M. 'MI 0 0M Nve Remarks: We 19 ),e, T e7 _5 d2) Z PROPERTY OWNER SOIL DESCRIPTION REPORT Page,, f .� PARCEL I.D. # Boring # r Munsell Qu. Sz. Pont Color Gr. Sz. Sh. yti�S�,{{Y:::..•.•1ti tiff Mw. 0 RA I'le, stir r awn M.- 0 AV M MM,0101 MR..FM =Mane Ground elev. ft. MM Depth to limiting factor Remarks: Boring # ............ ti 1 •.St ':•:titSS•:•.ti �: •.SS1. S . LLL Ground as_ lof elev. ZJ: ft. r A 09 Depth to � limiting factor Remarks: Boring #V-4 1 S•..•..' �r f tit :• Ground elev. �. WA ft. Depth to limiting factor y Remarks: Boring # S: Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05192) AA A S 7' �- -' A-7 I;z IL-119-4 • t SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations November 18, 1993 K o CONSTRUCTION KIM A OCONNELL RR 1 BOX 105 STAR PRAIRIE WI 54026 2226 Rose Street La Crosse WI 54603 RE: PLAN S93-41060 FEE RECEIVED: 210.00 FOSTER, STEVE NE,SE925,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROIX NON --PRESSURIZED IN -GROUND SYSTEM PETITION FOR VARIANCE TO CODE SECTION(S): ILHR 83.10(1). The Department has reviewed the above -referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made, All of the statements and supporting documentation included with the petition were considered. Since your request is similar to other petitions approved by the Department (e,g,S93-20340), the petition is approved. The variance requested was to allow the installation of a conventional soil absorption system to be approximately 7 feet from an existing slab constructed building. This petition approval is granted conditionally with the understanding that all of the petitioner's statements included on the variance application form and any other documents submitted to the Department will be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. All permits required by the city, village, township or county shall be obtained prior to installation. SM-6423 t R. 01181) r SAFETY & BUILDINGS DIVISION State of 'Wisconsin Department of Industry, Labor and Human Relations K 0 CONSTRUCTION Plan No. S93-41060 November 18, 1993 Page 2 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, � Oerard Swim � Plan Reviewe Section of Private Sewage (608) 785-9348 2080L/ 2 SH1)-%i.23 tR.0[191t Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 20� W 1st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, W1 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614 Fax (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what Information to submit- PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -If you have scheduled an appointment, fill in the information requested below to save time: Appointment Date 2. PROJECT INFORMATION I . /!v ­', Project Nme Prdject Locdtion GOVT. LOT 1/4 1/4 3. APPLICATION FOR System Type (check one): Plan Identification Number If this review is a revision or extension to your existing plan identification number, provide that number here: ''_, City Village Town Of: T, N,R Lr(orL\V1 1 -4. FEE COMPUTATIONS A At -Grade H Holding Tank M ❑ Mound N M Non -Pressurized in -Ground (Conventional) P E] Pressurized In -Ground 0 7 Other: Building Type (check one): D El Dwelling, 1 or 2 Family P [Z Public Building S 0 State -Owned Building Code Derived Daily Flow 4�4 gpd �Z Check If Replacing Existing System System Type I (include new and existing tanks) Up To 1,500 gallon septic tank .................. 1,501 - 2,500 gallon septic tank .................. 2,501 - 5,000 gallon septic tank ............ 5,001 - 9,000 gallon septic tank .................. 9,001 -15,000 gallon septic tank .................. Over 15,000 gallon septic tank .................. County FEE SUBMITTED $110.00 ........ $120-00 ........ $160.00 ....... $200.00 ........ $300-00 ........ $500.00 ........ Up To 1,000 gallon dose chamber ............... $ 70-00 ........ 1,001 - 2,000 gallon dose chamber ............... $ 80.00 ........ 4,000 -clpse chamber ............... $100.00 ........ gall(, 41� ;Goo gillo''f'r-A" chamber ............... $120.00 ........ 8 M ve V 2,fOOP gitUose chamber ............... $140.00 ....... O 1 2 6 9 ose chamber ............... $160-00 .... Up -To . 5,,QQQ�kllon holding tank ................ $ 60-00 ........ t' . 71 �* f 5,001 fl 0,,"6`0;`�U�)loAWbld Ing tank ........... $100.00 ........ Over 10,000 gallon holding tank ................ $150-00 ........ Experimental' ystem (additional onetime fee) $300-00 ........ Revisions To Approved Plan 2 ........ I .. I ........ $ 60-00 ........ Petition For Variance: Setback ................ $100,00 ........ Petition For Variance -tw Site Evaluation $225.00 ........ Plumbing ................. $225,00 ........ Revision .................. $ 75-00 ........ Groundwater Monitoring Groundwater Monitoring - Per Site .............. $ 60-00 ........ (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60-00 Subtotal: ......... iz2Z4�2 Priority Review-, Enter same amount as Subtotal: ........ Z9 MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ...... 5. SUBMITTING PARTY INFORMATION Telephone No. . (include area code & extension)' Compa y NameVConta Persio No. & treet Address Or P.O. Box City, Town or lage, State, Zi Cod I Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. OVER SBD-6748 (R. 03/93) PETITION FOR VAI2IAN('E APPL[ ATION S 9 3 `* 1 O v O Wisconsin Department of Indust , Labor and Human Relations OFFICE E ONLY--- Safety and Buil ings Division OFFICE USE ONLY Amount Paid 201 East Washington Avenue, P.O. Box 7969 Pet i t i on No. Madison, Wisconsin 53707 Receipt No. f� E—Number 60$ 66_ 3151 The rule being petitioned reads as follows: kite specific rule number and language) 7-,/, 2. The rule being petitioned cannot be entirely satisfied because: r Zr � C, r / A/ a Irk ,,i I f jL'. •• 3. The following alternative[s) and supporting information are proposed as a means of providing an equivalent degree of health, safety or welfare as addressed by the rule: . L ►ram )i-- tote: Please attach any pictures, plans, sketches or required position statements. VERIFICATION BY OWNER — PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE See Section Ind 69.15 for Complete fee information �)ote: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors, attorneys, etc, may not sign petition unless a Power of Attorney is submitted with the Petition for Variance Application. • Ir /I- ar —A ` r , being duly sworn, I state as petitioner that I have read the fore�o,r)n �(tAME OF PETITIONER, Please type/print} ��;�����a�►� petition, that I believe it to be true and I have signifi r�rpy ' r ghts in the subject building or project. •' io sw r-n to before me thi s date: ze� Zz- �-.� Signature of Petitioner -- _ k(p"iElion xpies : - _ - --- - - - tary Public ��" SB-8(R . 09/88� °���a�a��#,►%ty �X`` N of drain. and sy3 41os0 PAC, C o.� I L . toul) 0G' A �ro Sys�e�-� f(sih All JAIGI� Arid ObLo(wallon PIpis top ApPfQVi,d Veal Co# 1pk�'k Flno Grade jit10 C 0 20 4 2'* Above Pipp To final G11196 tMor th "0 Or Syno i1c'Cowellay MIA 20 Acjgo of Orel p 1po Teo CID Aggiogaj# 8611641h Pips, e.?ral pe 6819w CQ*IAIAV TOdnIrselling Al 13011om Of sli'lem 2/-q -- 4A 1 n �� tti Cl { ' 2' OF hG G RE G Al E EL E V. OF. FEET_� APPROVED S`WT14CTIC COVER -40"``.-tIATERIM- OR, q tj OF STRjkW ti tI D1S-rR1PJ,JTI0M PIPE To BE AT LEAST IQCHES BELOW ORIGIUAL CRA-DE A,I,JU AT LLA%STZO IUCHES BUT K10 MORE 'rHAQ 42. MCHES DELOW F%tiJAL CKAC)C- t M-MMUM pEPrH OF F--%CAVAT101J FKorl M16VAL 6�1\K WILL BE IQCHCS riNimm ()Efni OF ExCAVATION rAOM. C�164JAL (jRApf- N.-JILL, br- IMCHC S SIGMED: LICEWSC LJUMBFII: DATE: ZZ-,?, Ila Wisconsin Department of Industry, SOIL AND SITE EVALUATION REP A P of Labor and Human Relations 3 4 Division of Safety & Buildings in accord with ILHR 83,05, Wis. Adm. Cod COUNTY An nm Int % site Inn on nnnnr not less than 8 1/2 X 11 . inches in size. Plan must include, but ff6'0-104 t-1 r PARCEL I.D. # not limited to vertical and horizontal reference point (BIVI), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION --PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPS TY WNER: PROPERTY LOCATION 1-1-1ps -1 Alr' GOVT. LOT Al 1 N, RS (Or(�t) 'e P PARCEL REVIEWED W1 ELI E GOU T. PROPERTY OWNER'-.S VAILING ADD LOT # BLOCK # SUBD. NAME OR S # M CITY STATE ZIP CODE PHONE NUMBER ®CITY ILLAg [govylq NEAREY ROAD V, ��422 q7 [A New Construction Use Residential 1 Number of bedrooms Addition to existing building Replacement Public or commercial describe Code derived daily flow ZO _gpd Recommended design loading rate _bed, gpd/ft2-.,�trench,gpd/ft2 Absorption area required ?,�LZbed,ft2 trench, ft2 Maximum design loading rate gi _bed, gpd/ft2-,-,? -trench, gpd/ft2 Recommended infiltration surface elevation(s) 9'5�'2 ft (as referred to site plan benchmark) Additional design / site considerations Z Parent material oc,4��- 14ZtzZ';t Flood plain elevation, if applicable A11,4 ft Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK S = ❑U = Unsuitable fors stem Q S El U R S El U MS E1U O S El U El S 0 U El S ZU 010010� SOIL DESCRIPTION REPORT Ground elev. R24 Depth to limiting factor Ground elev. 99,_z ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structu re Consistence Boundwy Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend &-- 140 S sz Z Z -4� ZZ -Will Remarks: lZr';6e ZNS:�' v I Remarks: PROPERTYOWNER SOIL DESCRIPTION REPORT Page of ..� PARCEL I.D. # M�R� AIlI��J�'�1.��Ile'�JI�I�ls I wd M" M Nv- 'psi".0m I - WAW' Ono M,-0*M, Omar ', -4, M—, M-M a r AV Mom AN Remarks: - I SB-8330(R.05/92) ,c , s '4106 ' -AL; _sz V,woo</ I I � I i I I 1 � , , 4 I I I , I I I , , C 1 I y f a , � � �' i --t _-n�.--- _fir _ --• _ *— —" �". __.�. I , ' I r N , I I r j ? I t pe Jill I r I I I r j i I i 4 1 I. 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JJ ' { i � I t i I 1 S I j I i � � � � j" t � 3 � ; � E I f � � f 1 1 {� � � _ -� - - -- -- - _ _. — --_ -- _ . - _ . --._ - � -- -- - � _ . � i i � i � I I ff + I I -� t � f � I I � � � I i � { i � � i i � � � I i fi � I -- - .___-� - - ___- - . _ ._- _ { � � � � 1 i - f i -# i .. - - I il� ' I � , � � � I * f f I � I � { # � � � � 4 I 1 i i I I - �_ f- - - � � __�__ ._.- -- --- ----. __ ._._.___ -__- ---__ __ _-- _ - - - - - -. - � - _ � � � I I I a ' i j i I � � � � � I � �1 i i I I � � � I i { t � i { } + � t .� JI i t i � i � ' j � � I ' � _ _. _ _ .. .. _ -..___ ___ __ __.� _.._ ._.._- - - ---.. ___._ - --- - -. __ _... _. � � 1 - } - I � � � i I i ': i I f � i # # i i + I' I i I i t t r { I { I I I f - - _ _....- .-----------...� _ __.- ... _...... - - ---- .__ _..-- - - - �-- - --- y . _ ..._ � I -- ---- - - _... - - -.�w _... -.. _ 4 � t I � � � } { i � � _ _ � _ _ _ . _ _ .. _ _ _ _ _ __ ___ _ _ __ ._ . _. � � � I ,� ��� �+ I i I � r' � � { � i i 1 � � � i � � I ? � I r i I � _ _ _ I I ��NGER AREA LEASE and entered in�o on the da�e indicated below THIS AGREEMENT, made bI between the City o+ mew Richmond" State of Wisconsin, � municipal corporation, herein�fter c�lIed the Lessor~ and _8��!��_�o � ��________~ Richard Belisle hereinafter calIed the Lessee' - tillITNESSETHv WHEREAS, the Lessor owns and operates z-in airport known a� the New Richmond Municipal Airport �nd said Lessee is de�irous of leasin� from the Le��or a �ertain parcel of land on the ��id �irport, �ereinafter more fulIv described, for the purpose of aircr�ft �t�raqe; and �HE�EoS� th� Les�ee wi�} use the �elow de�cribed property for the purpose of storing ai�craft and shaIl conduct ooly �uch ��rcra+t maintenance on its own �ircra�t as performed by the Le���e or by reguIar �mployees of the-= see' uOw_ T��REFORE, +or and in ccmsideration of the rental charge�, covenan�s, and agreements herein contained, the Lessee �o�� �ere�v �ire, t�ke and ]eas� +rom the Lessor and the Lessor d�e� hereb9 gram�, �emise and le�se un�o the Lessee the foIlowing premise�� righ�s, and ea�ement� on �nd to the eirport upcm the following terms and condition5: 1^ 4-Diption= (Include lo± number d Use Map~ square footage cf Iand and map if �ppropr�ate') Lot 3, Dow 8, Airport Layout Plan Dated September l, 1989 being 5478 sq. f t. 2' �R[�Up r i0�- The L�ssee �halI have tne righ� to er�c+, m�intain and -lter-bu. 1 1 -��ding� or structures upon said pre� providing such buildings or structurorm to the applicable reqoirements of ��� Wi�consin Departmen� of Industry, L�bor & Human Relation� and pertinent provision� of �nv loc�l ordinance in effect- All pIans f�r such bui}dings or structure� shall be r�viewed end �pproved in writing �y th� Le�sor Prior to con�truction. 3~ imum per�o� Z�r�� The term of this lease shall b� + o r a max of ten <10> years commencing on July l"_l�9O and ending on June 30, 2000' 4' RPnt.. The Lessee agrees to pay to the Lessor +or the usc o+ the premises, rights, and easements herein described, a ye4M--r1y rental o+ five (5) centc_; per square foot for the land leased, for a total annual charge of 4_ 273.80payable on July 1 annuaIly' It is understood and agreed that the rental rate herein specified shall be subject to re-examination and readjuStment at the end of each three year period of this lease, provided that any readjustment of said present rates, or as same may be amended hereafter, shall be reasonable. 5^ -P-' C 1. LkSiV-_USE? The Lessee haII have the riht. ±o the non - ex. cIuSi: ive use" in common with others, of the airport parking �reas, appurtenanceand improvements thereon; the right 'Co install., operate, maintain and store" �ubje�t to the approvel of the Lessor in the interests of safety and convenience of all concerned, al1 equipment necessary for the safe hangaring of the Lessee's aircraft, the right of ingresss to and egresss from the demised premiseS., which right shalI extend to Less-ee's employees, que�ts, and the right, in common with other� authori�ed to do so, to use �ommon ai reas of the �rport, including runways" taxiwayS, �prons, road�ays, and other convenienc�s for the take -off, Ai: Iying and landing of aircraft' 6- Lavj=-_�;ind_R�g��������= The Lessee aqrees- to observe and obev during the term of this lease all ordinanCeG, ruIes and reguIationC_,_ promuIgated and enforced by the Lessor� and by other proper <Ruthority having jurisdiction over thconduct of ciperations at the airport' 7- Hgld_Harmle�s. The Les�ee �gree� �o hold the Leor free and harmless from Ioss from eac� and every claim �nd dem�nd C. w�ateuer nature made upon the behaIf of or by any person or persons for any wrongful act or omis�ion on the part of th� Le��ee, his aClents or employeeS;, and from aIl lo�s or damageczs� by reason of �uch acts or omi�sions' 8- �n��r�n e� The Lessee agrees ±haL hepo��t Lessor a poliry of comprc­ hense ziabiIity insuranc& upoT d�v� wr�t�en no-tice from the Lessor. 9~ M�i�t����c�_gf_��e m I e�� The Lessee shalI main�ain the structures occupied by him and the surrounding land premises in good order and make repairs as are necessary' NO outside storage shall be permitted except with the written approval of the Airport Commission' In the event of fire or any other Casualty to s±ructurer_,- owned by the Lessee, the Lessee shall eit�her repair or replace the leased area to its original condition: such action must be accomplished within 120 days of the date the damage occurred. Upon petition by the Lessee, the Lessor may grant an extension of time if it appears such extension is warranted. 10^ R J.ght_tq_�������� The Lessor reserves the right to enter - Upon the premises at any reasonable time for the purpOse of making any inspection it may deem expedient to the proper enforcement of any of the covenants or condition� of this agreement' ` Zav e s� The Lessee shall pay all taxes or assessments that may be levied against the pprsonal property of the Le�.=_.�see or the building� which he may erect on lands leased exclusively to him. 12- ������ The Lessee �grees that no signs or adverti�ing matter m8y be erected without the consent of the Le�sor. 13- D������� The Lessee �haIl be deemed in defauIt upon: aFaiIure to p4F"-y rent within 30 days after due date; b- The filing of a petition under the Federal Bankrupcy Act or any amendment thereto including a Petition for reorganization or an arrangement; C' The commencement of a proceeding for di��olution or for the appointment o+ i-:k receiver; d- The mak�nq of an �s��gnment for ±he benefit of creditors without the prior wri�ten consent of the Lessor; »iol�tion o+ �nv res�riction� in this lea�e, or failure �o k�ep anv o+ its covenants after written notice tosuch violation -and failurc? to correct _-.7uch violation wit hin t�irty day�' " -4- Default by the Le�see suall authorize the Lessor, at its option and without legal proceed ings, to declare this lease void, cancel the v_-.ame, and re-enter and take possession of the premises- 14~ TitDe� Title to the buildings, erected by the Lessor shall remain with the -Lessee and shall be transferable- Noon termination of this lease, the Lessee may, at the option of the Lessor, remove the buildings, all equipment �nd property therein and restore the leased property to its original condition' 15^ �now_RemovaL. The Lessor agrees to provide snow removal services to the Lessee's leased premises in the hangar area. Such snow removal shell be accomplished only after all runways apron and primary taxiways have been first cleared. 16^ Le-­=e_T����f�F. The LEssee may not, ,Ei7t any time durino the time of this assign, hypothecate or transfer this agreement or any interest therein, without the consent of the Lessor. The Lessor reserve= the righ± to fur�her develop or �mpro�e the landing area �f the airport as it sees fit~ regardless of the or view of the LesseE_-;-, and withou± interference or hinderance- If the development of the airport requlres the reIoca-IL ion of the Lessee, the Less-.or-agrees� to provide a compatible location and agrees to rel�cate alI building� or provid� similar f�cilities for the Lessee at no cost to the Le�see' 18' cS u b or d 1- n a t 4L ri n_C���S3 G-- This lease sh�ll be ­ubordinate to the provisions of any exi�ting or future agreement between the Lessor and t1 -4e United States or tme StaIC- E-m- of Wis�O_nsin relative to toe operation or mc--lintenance of the airport~ the executJLon of which has been or may be required a� a condition precedent to the expenditure of federal or �ta�e funds for the development of the airport. Furthermore, this Iease mDy �e amended to include proviEionS required by thos� agreem�n�s �ith the Uni�ed Stc-4tes or the State of Wi=consin. 19^ A b r i ti0 n Any controversy or claim ariIE�inq rela�ing to this lea�e or any aIleged breach th�reof, which cannot be �ettled between the parties° shall be settled by �rbitration in ac�ordance with the rules o+ the American Arbitration AssociatiCn, Ind judgement upom the dispute rendered by the arbitrator(s) shall be final and binding on the partieS~ S93 41 I N W I TNESc' WHEREOF Lhe p ---tl'-(RS hc--Rve hC-rC?Ul-)t0 Set their hands and Fcz_)4-A_ls t h i da- v of i n t h c-- C 3. t,,,, cj + W" New Richmond St Crol... _.ount i asconsi. n. IN THE PRESENCE OF: LESSOR: Bv: Airport Manmger Dv." 1� LESSEE: ,own T.1 TLE: GUIDSCrIbed and sviorn to before iTie thl S d a-v of N o t,-a r v M v C oq.-, rr, i s. s 1* o n p 1 r E_ . ..... .. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor and Hum - an - Relations REVIEW APPLICATION Bureau of Building Water Systems H,a , y*vZrd Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W I st Street 2226 Rose Street 201 E. Washington Ave, 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O, Box 7969 P.O. Box 434 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, Wl 53707 Shawano, Wl 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614 Fa I x (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -If you have scheduled an appointment, fill in the information requested below to save time: 4 Appointment Date Reviewer Name Plan Identification Number 2. PROJECT INFORMATION if this review is a revision or extension to your existing Ian identification number, provide that number here Project Name Q city El Village Town Of: County Project Location GOVT. LOT 114 1 T vnnmuww� _�� N, R or tW,/ 3. APPLICATION FOR 4. FEE COMPUTATIONS ===OWN FEE SUBMITTED System Type (check one). System Type 1 (include new and existing tanks) A At -Grade Up To 1,500 gallon septic tank ................ $110-00 ........ H El Holding Tank 1,501 - 2,500 gallon septic tank ............... $120.00 ........ M Mound 2,501 - 5,000 gallon septic tank ................. $160-00 ........ 5,001 - 9,000 gallon septic tank .................. $200.00 N Non -Pressurized In -Ground (conventional) 9,001 -15,000 gallon septic tank .................. ........ $300.00 ........ P Pressurized In -Ground Over 15,000 gallon septic tank .................. $500-00 ........ 0 Other: Up To 1,000 gallon dose chamber ...... ........ $ 70.00 ........ 1,001 - 2,000 gallon dose chamber ............... $ 80.00 Building Type (check one): 2,001 - 4,000 gallon dose chamber ....... ....... ........ $100-00 ........ D Dwelling, 1 or 2 Family 4,001 - 8,000 gallon dose chamber .............. $120.00 ........ P Public Building 8,001 -12,000 gallon dose chamber ............... $140.00 ........ Over 12,000 gallon dose chamber ............... $160.00 S El State -Owned Building ........ Up To 5,000 gallon holding tank ................ $ 60-00 ........ Code Derived Daily FlowZ 5,001 -10,000 gallon holding tank _ ............ $100.00 ........ gpd Z Over 10,000 gallon holding tank .............. $150.00 ........ Check If Replacing Existing System Experimental System (additional one time fee) .... $300M ........ Revisions To Approved Plan 2 __ ...... $ 60.00 ........ Petition For Variance: Setback ........... ...... $100.00 Petition For Variance Site Evaluation ion ............ $225.00 ........ Plumbing ................. $225.00 ........ Revision .................. $ 75-00 ...... E] Groundwater Monitoring Groundwater Monitoring - Per Site ............... $ 60-00 ........ (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater monitoring $ Woo ........ Subtotal: ......... Priority Review: Enter same amount as Subtotal: ........ MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ...... S. SUBMITTING PARTY INFORMATION Telephone No. (include area code& extension) Comp�Na a y Canto Pe 1-7 9 7Z L 2� 0, 7��,, ,�treet Address or P.O. Box City, Town or villacie, State, Z' (-od ZZ_ I Aerobic or prepackaged treatment system fees are calculated based on equivalent 'size septic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. SBD-6748 (R. 03/93) 0 V E R rAiN - 11 9 a & a & a 0 viol 9 1 im la a I Wisconsin Department of Industrv, Labor and Human Relations QFFJ�E*��E NLY OFFICE USE ONLY Amount Paid Safety and Bulf4ings, Division Petition No. 201 East Washington Avenue, P.O. Box 7969 Receipt No. Madison, Wisconsin 53707 E-Number 608/266-3151 flame 0wner etiion;ioner Build'ng or Project Agent Arch'-tect or gineering Firm T:7eLnn(, Name, if any Street & Number C o m P-a n y---1 Street & Number Location, Street & Number city Stat Zip Code C� City State Zip Code Cit County Telephone Number LJL 7 Telephone Number Plan Number, if known Name o Contact PIrson 1. The rule being petitioned reads as follows: (cite specific rule number and language) '4AzE41L Z22:aiEZJ!,a -Ale 2, The rule being petitioned cannot be entirely satisfied because: tLk�eE 122 400/ A& LJ X lez 3. The following al ternat i ve( s) and supporting information are proposed as a means of providing an equivalent degree of health, safety or welfare as addressed by the rule: Note: Please attach any pictures, plans, sketches or required position statements. VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE See Section Ind 69.15 for complete fee information Hote: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors. attorneys etc. may not sign petition unless a Power of Attorney is submitted with the Petition for Variance Application. being duly sworn, I state as petitioner that I have read the foregoina (R�?ME OF PETITIONER, Please type/print) petition, that I believe it to be true and I have signifi krEyff p rights in the subject building or project. t� 2yS w&rn to before me this date: tJ Signature of Petitioner a ft r1w 4. k�ihjion xpiles: ��r 46 t ary Pub 1 i c it, ('00 SB-8(R.09/88) gf;�' 4" SEPTIC TANK MAINTENANCE AGREEHENT St. Croix County 0 OWNER/BUYERa4 j r7— ADDRESS: LOCATION: AJ� 1/41 ly 144,ess 1/4, SEC. N-R.,/ZW TOWN OF:-f4b r ST9 *CROIX COUNTY SUBDIVISION., -AL . ) ---8LOT NO, ImPrOPer use and # maintenance Of yoursepticSystem could result 111 its premature failure to handle wastes Proper main tenance "'slsl--s ©f Pumping Out the septic tank every sooner, if needed by a licensed eptic tank three years or Put into the syst' s pumper, What you stem can affect the function of the septic tank as a treatment Stage in the waste disposal System; St* Croix County residents May be eligible to receive a 0 help with the cost or the replacement of was in operat 0 a failing system, which this Ion prior to JulY It 1978o St Croix County program in August of 19801 with the requirement accepted of all new sYstems agree to keep their sy that owners maintained, 11 stem Properly The property owner agrees to submit to Zoning a cert' the St, Croix County Plumber, Ification form, signed by the owner and by a master Dourney-man . Plumber, restricted Plumber or a Pumper verifying that ' licensed is in (1) the on -site wastewater disposal system Pumping Proper -operating 'condition and (2) after inspection and (if necessary)p the 'septic tank is less than 1/3 full of sludge and scum, Certification 30 days prior from will be sent approximately y to three year expiration, I/WEr the undersigned have read the above requirements and agree to maintain the Private sewage disposal systern.' the standards set forth, , here 'in in accordance with Certification form must be I cis set by the Wisconsin DNR, Croix County Zoning Offi completed and returned to the st, expiration date. cer Within 30 days of the three year SIGNED tf 1. DATE St. Croix county Zoning Office 911 4th St. Hudson, W1 54016 s . f• • s T C loo V1is a�plicatian form is to be completed in full +� property t and signed by Of thp p y bung devel,ope.d, Any inadequacies Will only reSUlt in delays of the permit issuance. should this development be intended for resale by owner/contractor s ec 110usc), then a second form should be retained and completedP the property is sold and submitted to this when office with the appropriate deed recording, ---.-.-------w-----.ter-wr-------mow-r----rrrw.rw.rwwrw�.•-...------------------- Owner of propertyt7/1( • �--- Location of ction' T 31' -R property 4 �� 1 4 Se Township o4a r f a) Y_ I Hailing address Address of site Subdivision name Lot no. 4 Other Homes on property?eyes No Previous owner of propertyA­( N_ f Total size of parcel Date parcel was created i Are all cornors and lot lines identifiable? 'Yes No Is this property being developed for (spec house)?Yes No Volume tnd Page Number as recorded. with the Register of Deeds e� - - --.-r .--. - -- - ------ 1'-IY.. r.+•Mr .••.w.w•-..,.-ww+.A-r. �.w-w� rrwrw�-rr--r--`y ---------r -- -, - - -- --F.•- T.14CLUDE WITH THIS APPLICATION T[;E FOLLOWING: h ��n[Z[WITY DUED which includes a I)OCUHLNT NUIMER, VOLUME AND PAGP. 1fU1iLifBEM �x 7'1[r SELL Or T11Z AEGIS' Z of DEEDS. In addition a eerti.fiecl survey, if available ;would be helpful. so as to avoid delay of the reviewing prvcass, If the deed description refezenca3 to o Carti.fied survey Maps the Certified Surveil dig small also be required. y P PROPERTY OWN RR CERTIFICATION I (Wc) certify that all statements on this form are true to t best .of ny ( our) knowleclge that I we am he the property described in this information(are) the owner(s) of warranty deed recorded in the office of theo C ' rm by virtue of a Decds- s Document no ounty Register of o,,.n the proposed site for the sewa er dis and that I (We) presently obtained an easement, to run the above' described system or I (we) t11e construction of said system, and the same .bed property, for recorded in the office of County Register of deeds has ag been duly No. Document f� o 0 �gnatu of ap�licant Co -applicant cant Date v 4Sig2nature Rate of Signature