HomeMy WebLinkAbout002-1087-60-000
a O 'O p
Q C N p N O
o 0
h
o 0
c
I
O N N
ell
C
O
3
N
L
J a
m 3 p
cry aai °
CD w
_ o
C
H
+s N O 2
h N
N C O)
CD a) L)
O C
Z O..L+ C z .O O
7 m O 7 i0 M
c0
LL CO U.
7
Q d U) S
0
N V
co
Z y yj
2 O O
rn
CL m a m
M I- Z
O
C U O U
O 2 a O ~
~ r 7
U O N N
p
fn F- r m N N z
~y7 f~ .O NL M
aJ C N
N a ca
En a)
2 rn ° O O
a- cu c
C C U
Z cn Z CO S Z Z o
O
N N Z
d d C
00 r_
N N
N N
E £
O
W
L ~ ~ L co
L
~ v
In ar
L L
cD
CL R >
c
0 0 a` w D D aL 41 oa Q) ° °o m C'4
-r 0
Q aiv~v~v> > o 0F~(A a~ y'o
z 3 3 m m 3 3 3= z° o
_ o 0 0 0 m 0 0 0
o m a a a a a
a 3:
~
B 4.; co
0 =3 0) a)
N p I- O N O
E c,
c 0
U O O N O p O c
m ~ T 0~
Ow w a) N
C
y~~ O T N C N C
'0 E
ql O C N n co O C m O) 0) C)
O~ N cn c6 N N N 0 C. N N
_Q CD O C 01 C co N O) C N O j N
G ° rn 3 c '0 W Z r- -0 w
a) o o c l0 a) o
*7' N N L co y co O U COD N O U
• T+ O co i, (n V O N S Z (n N O G: W Cl)
co
O CC !i ! I
.r £ £
da (DQ
Ok a i a L a
• 'as a c, a~ y c a y c
g L c c 3 c
u a M 0 cn U 0 in u
c
S TC - 10 4 (b
AS BUILT SANITARY SYSTEM REPORT
OWNER
~9 S7 GgO;X Y ~
~rADDRESS 'o ~a ~E
L) z
SUBDIVISION / CSMI LOT
SECTION : y T a_~N-R_Z/,W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING: WITHIIt -F ET F SY EM
36)0 GyI
6J. t 0.2 P. )0o. op J
"Ilk 4 b
y Qq0 YN
Z {~ovvle
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of senor- t-,;~ -I-, x,
a ,
BENCHMARK'
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
:SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
G~1 7 a 3 ELEVATIONS
Building Sewer ST Inlet: ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
~S O
LICENSE NUMBER: S'Q/ S
INSPECTOR:
J 00
3/93:jt
ti Wiscorisin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CR
Safety and Buildings Division OIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 268576
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
SCHILLINGER, GARY & MISSY BALDWIN
CST BM Elev.: Insp. BM Elev.: B Description: Parcel Tax No.:
Cl/
TANK INFORMATION ~l LEVATION DATA /
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i
Septic Benchmark 2S tc.
Dosing
Aeratio Bldg. Sewer ;,94 726
Holding1Ht inlet a7'
TANK SETBACK INFORMATION Sik~*tit Outlet
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aerati NA Dist. Pipe
Holding > as Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model r M
TDH Lift rI S stem Ft
Loss
or ai n Length Dia. Dist. To Well
[ I
F
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I N
LEACHING acturer.
SETBACK TEM TO P / L BLDG WE E /STREAM
INFORMATION TypeO CHAMBER Model Number.
System: OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold i ution Pipe(s) x Hole Size cing Vent To Air In e
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
xx Mulched
Depth Over Depth Over xx Depth Of xx Seeded/Sodded
Bed /Trench Center Bed /Trench Edges Topsoil ..❑~~iiYes El No El Yes 17 No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Baldwin.34.29.16W, NW, SW, County Road BB
k
1 ~t, ~~trt: ^.L~_:f r%2 ~ ` ~ ~G.C...Y ~L~ i , t.„~,..G%,~ ~ • . t x
P
Plan revision required? ❑ Yes No
Use other side for additional information. `t
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings Division
~~~I'i~.r■r,< SANITARY PERMIT APPLICATION Bureau of Building Water Systemi
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less Count
than 8 112 x 11 inches in size. SF CROIX
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency *~7
Y Y Y programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION S96-40782
Property Owner Name Property Location
GARY & MISSY SCHILLINGER NW 1/4 SW 1/4, S 34 T 29 N, R 16 YPO W
Property Owner's Mailing Address Lot Number Block Number
2417 CO RD BB N/A N/A
City, State Zip Code Phone Number Subdivision Name or CSM Number
WOODVILLE WI -1(715 ) 684-2564 N/A
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
Village BALD14IN CO RD BB
❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 002-1087-60
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. n Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
-
System -------System _ _ _ _ __Tank Only _ _ _ _ ___Existing System Existing ----yytem
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 K%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
o 600 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
N?A N/A N/A N/A N/A Feet N/A Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Plastic Ex
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank 3000 3000 1 HUFFCUTT CONC. C ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber El. I ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Sta ps) MP/MPRSW No.: Business Phone Number:
01
BENNIE HELGESON
PRS 3215 715/772-3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE, SPRING VALLEY WI 54767
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Si n amps)
p
Approved E] Owner Given Initial Surcharge Pee)
8 9_!
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SHD-6398 (R. 05194) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS `
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed-
11 . 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 appropi iate 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.
VL Absorption systern information. Provide all informatior requested for numbers 1 through -
VII_ Tank information. Fill in the capacity of every new/or existing tank, list the iotai gallons, nr mh; r of tanks and
manufac.urer's indicate prefab, or site constructed and tank material. Ccr plete f DI F, 11 ,tic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks receives experi 7!E )t:d ,roduct. approval from
DILHR.
VIII Responsibility statement. Installing plumber is to fill in name, licens^ number,^, ilh,appropra'~_ ,refix (e g. MP, etc.),
address and phore number. Plumber rnust sign application form
IX. County / DeparUment Use Only.
X. County/ Depart7ient Use Only.
] I[~X ...'ray -IPA' if r71U5t
f?"!_ _„lr'of (ji jt,_ P
_Cyf _i c ?ilt!!ii orslprrm
.cP •~11~ .,1 - .~=i - tl i`_' h., Id i~; _ #:.i'vec:
- . info i."`a!.ion.
GROUNDWATER SURCHARGE
19800l1sconsin Act 410 included the creation of surcharges ( ees) for a n;un b;;r c . ;,L is F"?" t which can
effect groundwater.
The monies coilected through these surcharges are used for rlonitoring groin d n!are cm.:arnin~ invest;claations
and estabii,'-.rTient of standards.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
July 25, 1996 2226 Rose Street
La Crosse WI 54603
HELGESON EXCAVATING
W1229 770 AVE
SPRING VALLEY WI 54767
RE: PLAN S96-40782 FEE RECEIVED: 60.00
SCHILLINGER, GARY & MISSY
NW,SW,34,29,16W
TOWN OF BALDWIN COUNTY OF ST CROIX
HOLDING TANK
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.
- Note: The holding tank must be anchored securely to counter any bouyant forces
that may be present as a result of the high groundwater that exists at
the site.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
C
6erard M. m
Plan Reviewer
Section of Private Sewage
(608) 785-9348
SBDA-798718. 10441
S96-40782
R
Jut
2
Private Sewage System P,f-m index/Chec F t 219*
-
-
Plan II? m: ~ IHW
S96-40782 _ _GARY & PIISSY SCHILLINGER
Legal Description %d`Ir`'s%
NW1 SW1 2417 CO RD BB _
City/Villa e/Town t ounly
WOODVILLE WI 54028 ST CROIX _
Contents Comments/Special Instructions
Page k Included Two copies needed for all
plans _
I X Plot Plan
2 Plan View/Lateral X Return by Mail
3 Cross Section
4 Tank & Pump/ 0 Fax Letter to (Count),) (Submitter)
X Siphon Information Circle One and Provide Fax -,q: ( )
5 System Sizing (Public)
6 Call for Pick Up:
. ( )
7
a Other
I, the undersigned, hereby certify that the Seal (if applicable)
plans and specifications submitted
herewith were prepared under my
direction and control.
Plumber/Designer License/Registration N
BENNIE HELGESON MPH 3215
Address City
W1229 770TH AVENUE
SPRING VALLEY WI 54767
signature
Attachments:
i 1
Application i se, t :y
L
Soil & site evaluation
fee ~S10o1Yi
` E
K~pNGi
Needed for Holding Tank Submittal:
One copy of notarized holding lank
agreement. (originals to Cotom,)
r
z ~.Y
NCCdCd for At-Grade Submittal: ° `,O~NrLE
Orivinal signed and notarized
Application for "Use of an At- G~
! iradc"
County on-site
One additional set of plans S IM-1020S (N 01/96)
pk~
A V-
i
I
i
r
+ U•~.~P, tOa,o.~
4-'ro~ON~. ca~ ~2 ~c~wsS
~ Y Q
~ l l
Pro asn.c~. 3000 Gal, V¢.► ,
T
z 5 ~ i
fir% g 0 C. CA o,:, ILA. .4
SeA..u r Mm
Ews4~~y
7~"~~,k ~x,s~,ns
Y 8ecl
+eiH e--
10
i
Tw- i c r L.o'f'
HOLDING TANK CROSS-SECTION AND SPECIFICATIONS
Approved Approved Locking
Vent Cap Weather Proof Manhole Cover
Junction Box with Warning Label
4" C.I. 12" Min
Vent Pipe Min
Final Grade
.1-7
,Approved Joint
18" Min
Water Tight
Seal
- - High -`Water - - - -
7N 7
Alarm Switch -
Approved
Joint w/
C.I. Pipe
Extending
3' Onto 57
Solid Soil
3 C,
SPECIFICATIONS
TANK Manufacturer: U--K( Lxi+
Tank Size: '?born Gallons
ALARM Manufacturer:
Model Number:
Switch Type:.
NUMBER OF BEDROOMS:
OWNER'S NAME : ct r SG t 'h -
Pr-ADDRESS: Woodai'lle t
LEGAL DESCRIPTION: , Sul , Sec. 3, T21 N, R /!o W
TOWNSHIP/ : L3^ /j yj
COUNTY : 5 ~ AO i s-
SIGNED :
LICENSE NUMBER:
DATE : -7I ,i - 9 G r
wiaronsinDepartmentofIndustry, SOIL,, AND SITE EVALUATION REPORT Page of ~W
Labor and Human Relations
Division of Safety & Buildings 'k In accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Cr O
Attach complete site plan on paper not less than 81/2 x11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), slope, scale or PARCEL I.D. N
dimensioned, north arrow, and location and distance to g
APPLICANT INFORMATION-PLEASE PRINT FORM 10 REVIEWED BY DATE
PROPERTY OWNER: - PR LOCATION
0 A h, 1/4 _4/ 1/4,S" j~flT 2 f N,R r X(or)&)
P OPERTY 01(V ER':S MAILING ADDRESS LOT LOCK SUED. NAME OR CSM #
CITY, STATE ZIP COD DE P / N''(EE~f'NU ILLAGE SHOWN NEAREST ROAD n
• (OQ `.Y^. 4'L 1 ! C r /j ~t
L... ~J l L- l.~l l oC U ( /A'
} New Construction Use Residential / Number o s [ J Addition to existing building w,
Replacement [ ] Public or commercial describe /g
Code derived daily flow 660 gpd Recommended design loading rate A'- A. bed, gpolft2 n 6. trench, gpd/ft2
Absorption area required.'/- _ bed, ft2 N 17. trench, ft2 Maximum design loading rate _A1.11- bed, gpd/ft2 6", /I trench, gpd/ft2
Recommended infiltration surface elevatiort~c-~, - ae ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material _ r, I E c„ t r 1 a rm _ Flood plain elevation, if applicable / lq. ft
S = Suitable `,:;r system CONVFMIONAL MOUND iN GROUND Pi?ESSURE AT GR i?.E SYSTEM IN FILL HOLDING TANK
U= Unsuitaole fors stem ❑ S III U ®U ❑ S O u 3 IIij U ❑ S ®U WS o u
SOIL DESCRIP.T➢CN RETORT
Depth Dominant Color Mottles Texture Structure Consi~noe Y Roots GPD/ft_
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends
Ground
elev.
ft.
Depth to
limiting
factor `
1.2 "14~ ~
Remarks: N P W026
Boring #
/0 YR
2,;..
Ground -
elev.
Al A ft. -
Depth to
limiting
factor ¢
Remarks:
CST Name: Please Print Phone: - wor
7 L5 Y-2-9 s~463
orr~~L lit, rr4t6tt (
Address. - Work ell o 6ltk,
Signature: (ate: CST Number:
, / A99 ~
4'
PROPERTY OWNERCI .2" / . SOIL DESCRIPTION REPORT`, P6tge ~f
PARCEL I.D. '
Boring # Horizon Depth Dominant Color Mottles Texture structure ConsiI~ Bow* Roots GPD/ft
in. Munsell Qu. Sz. Cont, Color Or. Sz. Sh. Bed
r
/0 Ye -17 /9,
l3 I/ 3v /
Ground
elev.
~l A tt. E
Depth to
limiting -
factor
Remarks:
Boring #
i
E3
11P ZL-~jl 'L eL
Ground
elev. ~t
Depth to r
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting i
factor
Remarks:
Boring #
Ground
elev. ft.
Depth to -
limiting
factor - -
Remarks:
5BD-8330(R.05/92)
r
Page 3 of 3
Bowman Plumbing, Inc.
Master Plumber No. 5875 ^ f
2819 Knapp Street
Menomonie, WI 54751
(715) 235-4634
FAX (715) 235-3650
SOIL AND SITE EVALDATION REPORT
Gary Schillinger
NW4SE14S34T29N/R16W
Baldwin township
St. Croix county ~w
y rZd " ay mckc c+ „
oretta la abee CSTM 3719 a+2 t ra
O V2A
7 7e
n
X
LEGEND
Bf3rings du withh I
rant X SC l 1)
back hoe
Site plan is in hC)
proportio with site area
i
k~ctu~.
HOLDING TANK FERVICING CONTRACT
Contract Date
-7 _ 4 - 14- This contract is made between the
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Holding Tank Owner(s) Name(s), and Pumper's Name
GARY & MISSY SCHILLINGER /41 L /GJj ASS
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:)
NW-41, SW-41, S 34, T 29 N R 16 W, TOWNSHIP OF BALDWIN
2417 CORD BB, WOODVILLE WI 54028
1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which
signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and
with the County of ST CROIX
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access an
enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather acc
road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to
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),
Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agr
to include the following in the semiannual report:
a. The name and address of the person responsible for servicing the holding tank;
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contr
the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipr
and the County named above within ten (10) business days from the date of change to this service contract.
• Owner(s) Name(s) (Print) Owner's Signature(s)
Subscribed and sworn to before me on this date:
60,0 fi' :!~41,/ Fey-
v '2
Pumper's Name (Print) Pumper's Signature S cep - Notary F
~ t L &.17 e ~e oe i My
S~,ev ~c comm/ isa sio expires:
%
Pumper's Registration Number
I OR 2 -2,3
SBD-7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department
of Industry, Labor and Human Relations, Bureau of Plumbing.
Wisconsin Department ofindustry, HOLDING TANK AGREEMENT Safety and Buildings Division
Labor and Human Relations Bureau of Buildings and Water Systems
Document No. /Plan Identification No. VOL 1190 PACE 180 This space reserved for recording data
546877 This agreement is made between the
governmental unit and holding tank -
owner(s) REGISTER'S OFFICE
greement Date ST. CROIX CTY., WI
County or Local overnmental Unit Holding Tank Owner(s) , RBCdforR=d
TOWNSHIP OF BALDWIN JUL IT, 1996
GARY & MISSY SCHILLINGER ;
called Municipality below { w1c 9 :45 A~
We acknowledge that application is being made for the installation of (a) holding i►~
tank(s) on the following property: (Provide legal land description) -A JAI,
NW4f SW4, S 34, T 29, N, R 16 W. TOWNSHIP OF BALDWIN Register of Deeds
2417 CO RD BB, WOODVILLE, WI 54028
A A#
Return To
AOOQcII 00 uJI 5
or that continued use of the existing premises requires that a holding tank be installed on the propperty 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 sev➢age system as permitted under Ch. ILHR 83, Wis. Adm.
Code, or Ch. 145, Stats.
As an inducement to the County of S f'Cre IT to issue a sanitary permit for the above described property, we agree to do the following:
1 Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks.. If the owner fails to have the
holding tank properly serviced in response to orders issued by the municipality to prevent or abate a human health hazard as described in s. 254.59,
Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing
the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats.
2. The owner agrees, pursuant to s. ILHR 83.18 (10), Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by
the County and State. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation
complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation,
r maintenance, and repair of the water meter, and agrees to allow the municipality to enter the above described property on a regular basis to read
and/or inspect the water meter.
3. Owner agrees to pay all charges and cost incurred by the municipality for inspection, pumping, hauling, or otherwise servicing and maintaining the
holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The municipality shall notify the owner
of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within
thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of
a human health hazard, and the tax shall be collected as provided by law.
4 The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have
the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality. The owner further agrees to file a copy
of any changes to the service contract, or a copy of a new service contract, with the municipality within ten (10) business days from the date of
change to the service contract.
5 The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the municipality on a semiannual basis a
report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3)
(d), Stats., the owner shall submit the report to the municipality. The municipality may enter upon the property to investigate the condition of the
holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained.
6. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the
property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this
agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the
existence of the certification to be determined by reference to the property.
7 This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the
register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be
determined by reference to the property where the holding tank is installed.
Owner(s) Name(s) - Print Notrized Owner(s) Signature(s)
O r 1 Subscribed and sworn to before me on this date:
M; s3v I;t /it' L!2 C. u/ /S /`mow
Notary Public
17
SOst .
uniupal Official Name - Print T~Icl-P`Srbf fical Signa re V- t0 ff
d 4J Gk My commission expires:
Get P Al a.yv
Munici al OfficialTitle - Print ✓o~ //r/~~
The infofmation you provide may be used by other government agency programs [Privacy Law, s. 15.04 (1)(m))
SBD•6123(R.04/94)
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property GARY & MISSY SCHILLINGER
Location of property NW 1/4 SW 1/4, Section 34 , T 29 N-R 16 W
Township BALDWIN Mailing address
2417 CO RD BB, WOODVILLE, WI 54028
Address of site SAME
Subdivision name Lot no.
Other homes on property? Yes_ No
Previous owner of property ~rC'\P
Total size of property. L~ r1cices
Total size of parcel AC I(
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes No
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded i the _office of the County Register of
Deeds as Document No. ~40 I i and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
r-33 5 5
d &&dm4. 7//s ZS6
Signa~ re of Applicant Co-Applic nt
Date of Signature Date of Sia natiira
C.LGUMENT NO. WARRANTY DEED TH!S +FA" RESENVED FOR RECORD.^ DATA
STATE BAR OF W iSCONSI I* FORM 2 - 1982
lsltt,s(.
~A'" CP,OlX CO.. ;yl
1148 73 Fm
'J%a~' e E. 4 o M.
_c'd for Pccord
Carole Hofstedt, p/k/a Carole M_ Caauwe
- - V 1 0 1
995
- - -
a t 10:00 A.
- - - 1A
convevi and warrants to Gary D-.._ Schillinger- and - -
Melssa J Schillinger, husband and wife Rrnct rd Do s
•
wct-4,
- - the folL.win iescribed real estate in - St. Crozx
- - -County,
-
State of Wisconsin:
Tax Parcel \o
Part of West Half of Southwest Quarter (W' of SW4) of Section Thirty-
Four (34), Township Twenty-nine North (T29N), Range Sixteen West
(R16W), described as follows: Commencing One Hundred Sixteen (116)
Rods North of Southeast corner of said 'Kest Half of Southwest Quarter
M of SW4); thence Pest Thirty-Two (32) rods; thence North Thirty-Two
(32) Rods to Southerly line of County Trunk Highway "BB"; thence
Southeasterly on said Southerly line Thirty-Two 32) rods Thirteen
(131) feet; thence South Twenty (20) rods to P1 ce of Beginning.
!i
TNQt51SFER
FEE
it
This is -riOt_.._.__ homestead
;j property. I
ji* (is not)
Exception to warranties: Easements and restrictions of record
Dated this day of -----CTO#7e.r-
.._(SE.',L) _ - - --...-.(SEAL)
Carole. M.`_.Cda.USdG_..._..._
■ -
(SEAL)
JUDITH & HMMU
IID~IIYI•plUC•i~f!lS01~ l~~(![`f!"~C- .
" IIrCe■■I■IOS EYIp6nJsa. ~1.tOM
dN ACKNOWLEDGMENT
it Signature(s) STATE OF WISCONSIN
I Ss
'j
-County.
authenticated this day oL........ - 19 ers na 1y c e before me this y
i ~~j day of
II _ ~1!_ dr 19-15Z the above named
---r;%ro_Le M Hofstedt.,._.p_/.k,/a-------------
` Carole_ M Caauwe
TITLE MEMBER STATE BAR OF WISCONSIN ~
(If not I
authorized by 4 708.08 Wis. Stats.)
to nee known to be the person who executed the
foregoing instrument nd ac nowledge the ame.
THIS INSTRUMENT WAS DRAFTED BY
I
Thomas A. McCormack
ST. CROIX COUNTY ZONING OFFICE ~LI
St. Croix County Courthouse Vi J4
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning Office offers the service of septic
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
Completion of this form is essential so that the property can be
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.
WATER TESTING----------------------------FEE: $ 25.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $127.00
(For VOC'S)
S -------------FWW IMEW
(Determines if syste is properly functioning at me of
4~ 1-11
inspection)
Property owner's name ~9-~!]~ ► ~P (~~~"~Si~j
Property owner's address te-JUAf- oZ l ~l"e
Legal Description of the x_1/4 of Section Z24 , TAN-R /(o L✓
Town of C ~_r71 Lot Number `-`,.,Subdivision Name
Lo'-y, -
FIRE NUMBER LOCK BOX NUMBER
Color of house ~r Realty sign by house? If so, list firm:
N 1.1 PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
' the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. if
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services:Fo(~J i L1D~
Telephone Number 2•, ~$,;7111 _ C71S 1 l - V
REPORT TO BE SENT TO: 9` LA f t\j?,L-i 1
c~ rt Sa~AA 1,1 LAJ
Closing date
Signature j`
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
`s ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
Mar. 11, 1991
Doreen Protz
First National Bank
307 2nd St.
Hudson, WI 54016
Dear Ms. Protz:
An inspection of the septic system on the property
of Carol Caawve, located at 2417 Co. Rd. BB, Hudson, WI was
conducted on Mar. 7, 1991.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and
did not involve any excavating or chemical analysis.
Accordingly, there is the possibility of hidden defects in the
system not discoverable by this inspection. This does not in any
way warrant or guarantee the continued proper functioning or
operation of this system. It is recommended that the system
should be pumped once every three years. Therefore, the
prolonged life of this system may be dependent upon proper
maintenance of the system.
It should be noted that although the system is currently
functioning there is standing water ponding within it. This
condition would tend to indicate that the system is failure pone
and may not have a great deal of useful absorption area
remaining. The length of time the system would continue to
function properly is very hard to predict and would depend a
great deal upon the personal habit of the household.
A hose was found which is believed to discharge gray water to the
ground surface approximately 10 feet east of the house. This
discharge is illegal and would have to be corrected by altering
the interior plumbing so as to direct this waste to the septic
system. This alteration will not be required at this time but
will be when the existing system is replaced. Byall indications,
this replacement system would most likely be a mound.
Should you have any questions, feel free to contact me at this
office.
Sincerely,
James K. Thompson a
Assistant Zoning Administrator
cj
CROIX COUNTY ZONING OFFIC
pp yj St. Croix County Courthou
911 4th Street
~C f7' Hudson, WI 54016
Q v s lltW-c
Telephone _ (715)386-4680
\\~e St. Croix County Zoning office offers the serve
/ a nd water inspections to Lending Institutions, Realty Firms, and
private individuals.
om Teti of this form iq essential g4 that
" ocated. jjg property cn Dg
lease provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received.,
WATER TESTING----------------------------FEE: $ 35.00
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.00
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00
(Determines if system is properly functioning at.time of
inspection)
PROPERTY OWNERS NAME : Carnl ('.aa»wP
PROP. ADDRESS: Route 1, Box 2417, Cty BB CITY Woodville
Legal Description W 1/2 X of the SW 1/4 of Section 34 T 29 N-R 16
Town of Baldwin Lot Number Subdivision:
FIRE NUMBER LOCK ~X NUMBER 0-2
Color of house white Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: Bye, Krueger & Goff Steven B. Goff
Telephone Number 425-8161 (for Tom Vehrs
REPORT TO BE SENT TO: Steven B. Goff, Bye, Krueger & Goff, S.C.,
710 North Main Street, P. 0. Box 167, River Falls, Wisconsin 54022
CLOSING DATE: Dec. 1 1-992
Signature ZbL~ f-2
BALDWIN T.29N-R.16W 33
• DD SEE -PAGE 47
na
l ~'reve° Edward • Roy 9 Wi//, p/7/ n 3r s .eve.. e • Ron .P r • a OD
rye • Ka~,sr7 l~et~smda Isle tfeir FOwa~d~Q ~7caianr • Grant
P/N£ y Qbar'c a ~s Ts s Hae Ke , d , , man
.o .Y• Esch&-bac rJ D
75
N Do Edw f • AD /Y r49 er„x ,m er./x
eis
74
Von7 t/nnse 699 endan E9~ c F /ss re ,sz
e~' o • ..v E s Sandia E • 9de aide ~ jtra/ 7 ~
p ,P 4eexndaa/ • Bo
° ` f7nfrSon NF e •
o y rHr/en /i0 be t hrNe
i Fs~m U _ lLan (So.nerer~ Y Fi f
9u o resat ,,ry e neth ~d ~'7 iTosr/~h Teen `n ~
~U 'C~~~ b Kurt s { Ma e:a ,iu.z / ,Bctt !^iMI~C J U U \
9 ~"C 0
o `Cti ~ mor "C N p re j Graf 7•Qd • rion,S ur/n .C.~ p
N"'1 ~ C o//e Ptd- .,rp Cori ,io 152.,6 \ tl h ~ •
q- n a r2J9 0 rs M.-a KC-ra l S IJc/o.e
nn ~9 ro 40 GiCbnv7 7p ~ w r•~a.//i
L - • V 6~ p fo aak- U p Q tl f Edo 4 • 40 • w • /zo CTr:
alra • ° 7 Harr s
i( ./c.eJ W~ ♦ f !W f on
ti - ub rorv /ha Cio~~ n ~ / ~ rr9..r roc.
6l + a nrd •Zbutqq/n3 M! tt~ cSiePhen Pobcrf •
T)~~ C C ~ k~./ BO rC)St/stiir L. man //3Bf rCOr'o/ f W t7a.x D.rKay ~tev~ e C e/rir7 H.
~$¢f 1, a \ LSaba
76 . Sandra Ka b ~a
~,1, ~ k , ca/enda// 4L. J1a Hare/- • Il~o n ThomP ~ ,3 NQ^-~.. 4/en
9/ etux Ma/cein
,r9 fo
/eo 80 VC -Dwayne .L1o_a/d obert
Faye
do// C'l ~•U u' • b o • efux e40 .Pobr t E,Een r rya 9 IF
► terroni a. wr/o d w.I tl+. eo ~+r'~an
Kue./cR. !/asks,,/, ~ 9. ♦ ` 6,p chord .Pabert J •
• es x .;.~i R $ l~ Q ° Fe n Tc~.i- 9. z'jO i7.>shorvy
E ' so of 0.O 3•tl Bo Power so Rartmann,
y • • • • • GO • • V ~N QO etLx
10,
0 ~ h` cjurX,K CC C 0 e • • • •
~l ~0 0 u tl tlC~ GeusF.n,( .tq ~ o, v 0 La✓ecrs k~ //en4C.onn' E
tlQly PhE \V \ rJi 7t p~ Robert el 'C~ C a </✓o/a 9 .Pad Sri
SHr~ .Vane oy \ R/VER Whitman Sr Da. ✓id N ~ v99 ~ yp ^ ~Tofnson r~R11cc tin roa rEin
0 ~ /l'u '/e,i~ O 8 ~ /i rVentin/C D C
0 q 6o Bo Q ~ NQ / d tl /ss • Crank . Na/a.
w`~ Nn f r Te r way-e e..~, /so • I S i,e 4 Q, IL.E.f 94
79
rrse /o'e oa.Err- ~/eenenda// / s
Aih* o
:s
W ~o se y/r.n • ar/1 yi csa/~• e" u
y`
/ _ ~ ~ ~ Pame/a. b rmei•S Davd <.Dori cCg Q'D h
114
i drri~e - ° Peterson C r s Homie ,Bun9eE. GZ b ~U C t
~ ° okker a'e,- q.o . w / ~ u \ Eiranar Rd/nexth r/a Q ein ~ ~ ~ \ l ~ pU
7/ eJ f ,sw-.,os .garb Q .7,.d U l • 9z Z n S `a
F m/ s/ . tv~( t c p
r • 39• 37 BD .o r,S fhn- 255E fiv V`'~
uJ /ec. 44 e% • ° Marrf 4. ` so • V •„q~ i J • Ul R
U
~f Ww C Paul LoC'.r~~ /d.ne Y v enm tY ss ~Qtl R
c• 7ss b verry b U o cog W
• Thomas `U C C tl •<Caro/9 ~ Uu
Webb ° ° 26.353 U .Poekwe!/< • Lester U °U Larent3 BO ao~ p ~n
hJ ~F Edna MOe • l/cc~v// qCF~ \ C ~~~p
'~°p • b Xi ~s 99 WbE /(.o pUC\ Qobrrt.P.
" t. 2".7 Lee E9eoe U\ usan /'7artl b p d/• Zwn/rL < Lloyd ` c C v
. ' y Ghr/ f 0° rnC Geor.a d
r,e a L,,,cFwa/dt C ` .C
j h .sail; l7ensen Ulk\ z„/- es0 F S'a~dra ~ q a
BO V VNI 3✓ M E ,C/C.tO: • ° 2JC ♦°,1J l
• G/can ' p • d w !r L 90 ` 14 AVE. • • • h.. ~T VQb
t E/aIle
S .Padu 3e/ •W\n LLr.F- < Qulh s 'oS~ fly/P /Y +'a 7YS VE s
7s m U d rve,Hf To//cfson ,,,er Tnhms, cStr re.r •
o. cam. Po%and
5 .B/6 7}eL ,ao i B7 eta/ U E ° • :fay zC /o~.ch e/ Larer,tson
-y~ ~ ~~.e a JLJ3 ~ C7ohn f ~1 ~ 4 n Them,wron .to to ,zo
SOH oy/cy-009 q/b-
• .6e ~setfj y • 5 ♦ Bo Ir7C ~ U
I /90 \l$ I/°r/i~' U a <GS% ~icyY 9~, 3 • Da/e R .David f 4/ v
/j • `C4,fti/iT~ ~C V • Peterson ~'b MJ° s E/a:ne /9S V4(. IV-
t"p iy • /ckwa/dt N/ LoGoc,E
BALD I' N 3"` 6rcee „S ldd4 U /xsrrxt e F C a U u C Fa6r so
J ley . titi -J I Jv~ a En D cy t Cameo „
Tff
as -t- h ~o C k y ~o. h°t C uC u., U r /2 ' ~c•
~n h U .lam y
xL~~ Inc. YU` U a v ~V p wQy ~p r°rrrn r
p~~ tl U ~U a ~'l,' ~•aCaa Ltod w!✓yt ux//~~.rrrmx
Ilk 72 • N V ~ ~ b`°i • q Q R. w 5 ~ y~ N ~ b~ 9chterh
4/era °thySa c •
CSC b C 0 M C -S
Ma/c e.n
s iz • son : ,TOe ,79chtrrtrof
L1e/ra eT v u`d~~ ~y ~pF o u y~`
i noeye0bos, N a5y < Gee ~~b ti , S ,so
Gkq eta E. ' •WU~y ] Ha.,eo./ • • V OH Nd os.
so ~ J\ Krrfi t~ j
S unyer
77
6.1 S v A ` .DGt/e Moulfzan Fi da M CTpy/ If! i ) x/ O VI `L E <Car
de y U~ ,zo Jr.~srn SAr//y E 98.0 /ao /cran ~ •L /G C jO/se,~•
L.~7 ery« 1. • //e./B ~SchmilJ' (r~ ~enne B.......:..: _ ~ /id 9s io
f'O'' P~/b/s Ina
9BB Roc.E d P r •.sro Caopri
SEE PAGE 2/
THE RESVLUS PEOPLE NELSON'S
SUPER VALU
South Highway 63 & Cedar Street
® see. SuW vdu stores. inc. Baldwin, Wisconsin 54002
REALTY WORLDe YOUR COMPLETE SUPERMARKET
Dowd-Reliance Full Line of Groceries, Meat, Produce,
New Richmond: Hammond: Woodville: Dairy, Frozen Food and In-Store Bakery.
246-6814 796-2391 684-3871
BYE, KRUEGER & GOFF, S.C.
TRIAL LAWYERS
Attorneys: 710 North Main Street, P. O. Box 167 Paralegals:
C. M. Bye River Falls, Wisconsin 54022 Sandra S. Lenzen
Stuart J. Krueger FAX# (715) 425-7413 Teresa L. Erickson
Steven B. Goff* Telephone: (715) 425-8161 Pamela A. Skorude
Dean R. Rohde *Board certified Trial Specialist by NBTA Connie M. Holck
**Also admitted in Minnesota
Office Manager. Investigator/R.N.:
Chris Stumpf Cornelia P. Larson
November 24, 1992
Mr. Thomas Nelson
Zoning Administrator
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
RE: Carol Caauwe Property
My client: Thomas Vehrs
Dear Tom:
Enclosed please find the completed form you
requested along with our check in the amount of $25.00 for
the septic system inspection. To get to the Caauwe
residence, you use the following directions:
Go west on BB from Woodville. Go approximately
one mile, and as you are going west on BB, you
will see a yellow farmhouse on your left. The
very next house, a white house, is the Caauwe
farm. If you are taking along your plat map, it
is located in part of the West 1/2 of the SW 1/4
in Section 34-29-16.
I have also enclosed the plat map for your
convenience.
Very truly yours,
BYE, KRUEGER & GOFF, S.C.
Steven B. Goff
SBG/pas
Enc.
cc: Mr. Thomas Vehrs
i
FU123092 i
ST. CROIX COUNTY
. rv
WISCONSIN
ZONING OFFICE
M;`
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
- - (715) 386-4680
December 4, 1992
Bye, Krueger & Goff, S.C.
Attn: Steven B. Goff
710 N. Main St., P.O. Box 167
River FAlls, WI. 54022
Dear Mr. Goff:
At you request, an inspection of the septic system serving the
residence at the Carol Cawwe property, located at 2417 Co. Rd. BB,
Woodville WI, was conducted on Dec. 3, 1992.
Even though the residence is currently vacant, there are several
indications that the septic system was not functioning properly
when the residence was last inhabited. Evidence of large amounts
sewage discharge to the ground surface was found at two locations
and there was water ponded within the drainfield, indicating that
the system had been functioning minimally, if at all. Because it
is not know how long the system has been in disuse, a throughly
accurate evaluation is imposssible to conduct. The longer the
property has been vacant, the more sever the failure would seem.
Based on the above observations, it is the opinion of this
inspector that there is no expected life left within this system.
A replacment system should be installed which is code compliant.
By all indications, this system would be a mound.
This inspection was based upon a surface inspection of said system
and did not involve any excavating or chemical analysis.
Accordingly, there may be additional defects within the system not
discoverable by this inspection.
A garden hose was found east of the residence which is believed to
discharge gray water to the ground surface. This discharge is
illegal and must be corrected by altering the interior plumbing so
as to direct this waste to the septic system.
Should have any questions or concerns that I can clarify for you,
please feel free to contact me at this office between the hours of
8:00 am.- 5:00 pm., Monday - Friday.
QSincely,
J es Thom~sson
ssistant Zoning Administrator
-0 C)
o 0 0
M 0. j
0
t~ I
o °o I
N N
Q L N
N 3 0
_N
Y Q Y
C'
N
+'T N
E
O
N
C
(D O U )
-6 cc U C 0 0)
C z aw C zo
-Fo N
3 O2 7
C
LL c C L L LL c
0)
_ G
p ,O W
Q w E Q CD
U
v 3 `Y' a v
z N
E E
co cn o o
0 0
L ~ L
H a m a m
Z
M
0
o z v c
U m O N N _
d z d' c c o
fn F- °1 N O Z
c E E '
2
III, _
L _ (D p 7
-~V j O C O
0 CL
N C
• Iy N O O L O
C~ cu 4) O ~ 0 0
o N Q 0 Q Q
Q z (n z 2 Z Z o
N
Z
O
N c d
N
00 E
d - C d - N
M« j C. R .L. C C fD
4D 2
v A d N W > y d N y 4 O
> G G IL a o 0 IL ° N N
Q ai fn v~ m ° O N V1 m N -6 CD
z 333 °-C° m333 m z * I
•~NV o a a a I a a a
►~i~ a. m w
m O O (O (O y
m U) N-1 V rn z o rn a) a)
U °
0
..T. N O ^ O O O
O O O N O O 'O ILI
U CO m d
III ^ V> O C73 N V ° m O
M N 0.'S N N
y
E '0 Z y
o Q C (D ° m ° y C ~ rn 0)
Q ° o o N C7 m E ch 0 a
co U L 'E E a a N
C co C O) C co e U + ~ C w O .mss C t N
O '3 C N C O pp
N L
N: - O 7 0 7 ~ t
• o a° co ca N o cti CO o N Z E
y„ O co M (n d' O _ S Z (n N O Z- Z 4 (n
Q ~
V ~ E N E N
0) m 6. IL IL
• a m G! a a s
cc3
"o1 A 0 a 2 0 v) C> 0 in 0
T
Wisconsin Department of Health cad Seeial Servioss
I VA Division of Health
SEPTIC TANK PERMIT APPLICATION
TYP% or USE BLACK INK
A. OWNER OF PROPERTY
Name ` Address (Street, City, Zip Code)
Be LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY l rJ
Check Onet - 1
CITY VILLAGE LEGAL DESCRIPTION J L J /
7-„ TOWNS HIP
/Liz- N 01 /4 e- Q A
C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? u YES NO rC' C? PERMIT NUMBER
D. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION T REPLACEMENT ADDITION
MATERIALSt Prefab Concrete V Poured in Place Steel Other
NUMBER OF TANKS TO BE IYSTALLED: E. TYPE OF OCCUPANCY
-Check One: One or Two Family Residence Commercial Industrial other
Specify)
Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES ~ NO Automatic Clothes Washer ~ YES NO
Dishwasher YEWS A` NO Automatio Potato Peeler YYS ,r NO
Other (Specify)
G. MASTYR PLUMBER MAKING INSTAiLTION
.j
Name: Address k
Lioenss Number:
Signature of App 'Xicant: ` i !!P R_ SW /
Addresst
H. (To be Pompleted by Issuing Agent)
Date of Application Fee Paid ,
Permit Issued %
(date) Permit Number
Agent (Name) r f" i ; For Tz4ji, Village, City, County, etc.
(Specify)
Note: The application cannot he considered for filing until all of "is above questions are answered and the
fee paid. Agents will forward application, the fee of $1.00 for each septio tanrc and the third copy
of the permit-(canary) to the Division of Health. Checks and money orders should be made payable to
the Division of Health..
Do not write in apace below - FOR DEPARTMENT USE ONLY
I. DATE RECEIVED 1.` r/" 7 ACCEPTED BY RETURNED
(initials) (Date) See Corres.)
FEE RECEIVED r! VALID. No, h, --7 PERMIT NO. -
es or No
REVIEWED BY APPROVED DATE
(Initials) (Yes or No
4 SEPTIC TANK PERMIT NO.
RSP0R? ON SOIL Pt RC0LA?ION ?EST
AND SOIL BORINGS
TO
DIVISION OF HEALTH - PLUMBING SECTIbN
P.O.Box $09, Madison, Wis. 53701
Pursuant to H 62.20, Wis. Administrative Code
P S R C 0 L A T 1 0 N T E S T
Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches utas
Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last rl
Fall
1st Wetted overnight in Minutes Last Period Last Period Period rI
nch
Example
P - 0 36" To Soil 10" Cla 26" 25 Yes or No 30 1 2 1/2 1/2 60
RECORD DATA FROM MINIMM OF 3 TEST HOLES
Compute size of absorption area in accord with H 62.20 Wis. Administrative Code.
S O I L B 0 R I N G S- Minimum 36" Below Pro posed Abe? Lion System
Boring Total Depth Depth to Ground Water De th to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with Thiokness in Inches
Example
B - 0 72" 72" n Black To Soil {{12" C// 18" Sand 18" Gravel 2411
J /l? G
7 Z,
RZC= DATA FROM MINIMUM OF 3 BORE HOLES
PT OF OCCUPANCYs
RESIDENCE: Number of Bedrooms OTHER= (Specify) Number of Persons
FOOD WASTE GRINDERS Yes No Dishwashers Yes No Automatic Clothes Washers Yes y. No
EFFLUENT DISPOSAL SYSTEM: NEW 1 EXTENSION ADDITION REPLACEMENT
Tile Size_ No.Lin.Faet Trench Width Depth f Number of Lines
Seepage Beds Length Width Depth Tile Size No. Lines
t7 Seepage Pits Inside Diameter Liquid Depth
Is too undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super-
vision in accord with the prooedtires and method specified in Chapter H 62.20 (13), Wisooasin Administrative Code, and
that the data recorded and location of test holes are correct to the best of my knowledge and belief.
NA.*SB r' T7-- ! ✓ TITLE
Type or Print
REGISTRATION NO., or MASTER PLUMBER LICENSE NO.
r7
ADDRESS .C!:
DATE SIGNANR1