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HomeMy WebLinkAbout004-1087-40-000 St. Croix County Planning and Zoning Y Monday, March 23, 2009 at 8:54:19 AM Detail Sanitary Information Page 1 of l Computer #: 004 - 1087 -40 -000 Sub /Plat: metes & bounds Section: 35 Parcel #: 35.28.15.561 B Lot: TN /RNG: T28N R15W Municipality: Cady, Town of CSM: 1/4 114: SE 1/4 SE 1/4 Owner: Chilson, Dennis 3198 Pierce-St. Croix Road Spring Valley, WI 54767 State Permit: 384224 Issued: 06/12/2001 POWTS Dispersal: Holding Tank Permit: Replacement County Permit: 0 Installed: 07/19/2001 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau >4/1/00 - Not Required Helgeson, Bennie 2 acre parcel - abandoned existing holding tank $0.00 Kevin Grabau Signed Off: Yes and existing house to build a new house and install new 3000 gal. tank. Not even A +0" conditions. Recorded a service contract and holding tank agreement #643591 Maintenance Notification Scheduled Pump Date Pumped Notification 7/19/2004 3/12/2005 04/01/2005 3/12/2008 3/7/2008 3/7/2011 6/24/2008 6/24/2011 4/7/2008 417/2011 9/30/2008 9/30/2011 12/26/2008 11/17/2011 12/26/2011 11/17/2008 Wisconsin Department of Commerce RIV T SYST M County: Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 384224 Permit Holder' Name: ❑ City ❑ Village ff Town of: State Plan ID No.: 11 hilson, Dennis Cady Township 6f 11 15 - = T^�• / A*) — CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: r 00.6 �� %Ak C.&*- 004 - 1087 -40 -000 CID - TANK INFORMATION ELEVATION DATA 35" L8• TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ark Basing p8ldg M 2" D oO• Sewer F - S , fi'S 96•(oS r Holding -C�-tr G� 3 St t Inlet S •`i C rb • q`f r TANK SETBACK S t Outlet TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet Air Intake NA Dt Bottom NA p Header / Man. Dist. Pipe Holding • f S fo z3 d 3S r+ Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufa r Demand t cover Model Number GPM rorc For Lift Friction S stem TDH Ft Loss ad emai n Length Dia. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. tenches PIT No. Of Pits Inside Dia. Liquid Depth D IM E N S IONS 1 SETBACK SYSTEM TO P BLDG WELL LAKE/ STRtA LEA CHING Manu acturer: INFORMATION Type OT �IfiA1SQBER Mo a Num er System: r OR UNIT``'" DISTRIBUTIONS M Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over ]�xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges opsoil ❑ Yes [] No ❑ Yes ❑ No / COMMENTS (Include code discrepancies, persons present, et 4spection #1: */11 /©� Inspection #2: —4 --- Location: 3198 Pierce -St. Croix Road, Spring Valley, WI 54767 (SE 1/4 SE 114 35 T28N R15W) - 352815561B �� 1.) Alt BM Description = 5��� `Z �C'""'`-_S S e 2.) Bldg sewer length = a<-" z - amount of cover 3.) contour= I i.6 evisio � Q Yes �Q No e S" Use other side for additional information. L SBD -6710 (R.3/97) Date Inspector's Signature Cert No C) 3 4 7 S r anitaiy Permit Application Safety & Buildings Division i In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Nvisc®nsin Personal information you provide may be used for. secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) i� Attach complete plans (to the county copy only) for the s e e n t s than 8 -1/2 x 11 inches in size. } C;aunty State ani Permit umber ❑ Ch ton to revio li ticm State Plan I. D. Numbe ST CROIX � 22 :i . TRANS ID # 641115 1. Application Information - Please Print all Inform Location: Property Owner Name Property Location 15W DENNIS CHILSON JU N 3 6 SE 1/4 SE 1/4, s 35 T28 ,N, R E (or) W Property Owner's Mailing Address ST CRON _ Lot Number Block Number 31 PIERC -ST. CROIX ROAD z oFlc % NSA N/A tty, Mate Zip Code din ber Subdivision Name or CSM Number SPRING VALLEY WI 54767 ( C T !+5 „5 N/A I l 11. Type of Building: (check one) �/ �� ❑ City X 1 or 2 Family Dwelling -No. of Bedrooms : 3 at P �" ❑ Village D Town of CADY ❑ Public /Commercial (describe use):_ ❑ State -Owned Nearest Road Parcel Tax Number(s) 111. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 3S , ,Z ) 5 1 .0 A) 1. ❑ New 2. ES Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System - g) Permit Number Date Issued O A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 0 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground 12 Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. DispersaVfreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final, de Required Proposed Rate (GalsJday /sq. ft.) (Min. /inch) Elevatin 450 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 3000 3000 1 HUFFCUTT CONCRET VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature no stamp RS No. Business Phone Number BENNIE HELGESON 220292 715/772 -3278 Plumber's Address (Street, City, State, Zip o e W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued . Issu'ng Agent §i (No stamps "Opproved ❑ Owner Given Initial Adverse Surch ge Fee) ao - Determination P10 - �Z 2 �� n X. Conditions of Ap roval /Reasons f r Disapproval ' � t�nr .t �-�otY ��w ►�n� w-�s�s A - ern S , -t a�nk. . p{aQ�y c„�t1o�►'�t � 6 e a,laet tn4"C a4 pa” C-O&L - Ew SBD -6398 (R. 07/00) ` C6 ` t� � •td 4 n � z O o 4 Q 0 l Q6 Ilk P 3 c6 Q- �x wY 0 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �sconsin www.commerc .wis c www onsin.gov .wisonsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary May 14, 2001 CUST ID No.220292 ATTN.• POWTS Inspector ZONING OFFICE BENNIE W HELGESON ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/14/2003 Identification Numbers Transaction ID No. 641115 Site ID No. 629446 SITE• Please :. refer to both identification numbers, SITE ID: 629446, DENNIS CHILSON above, dn all comes ondence with the agency. ST CROIX COUNTY, TOWN OF CADY; 3198 PIERCE -ST. CROIX RD SETA, SETA, S35, T28N, R15W FOR: DESCRIPTION: THREE BEDROOM HOLDING TANK SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 791598 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. -The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD- 10571 -P (8.6/99). • In the event this holding tank system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VI of the holding tank component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A meter, with remote reading device, shall be installed by a properly licensed plumber, on the water system, that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. BENNIE W HELGESON Page 2 5/14/01 • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/01/2001 FEE REQUIRED $ 60.00 �«2 FEE RECEIVED $ 60.00 Charles L Bratz BALANCE DUE $ 0.00 POWTS Plan reviewer II- Integrated Services (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz @commerce.state.wi.us INDEX SHEET PROPERTY OWNER: DENNIS CHILSON 3198 PIERCE -ST. CROIX ROAD tp, SPRING VALLEY, WI 54767 PROJECT NAME: DENNIS CHILSON O PROJECT LOCATION: SE 1/4, SE 1/4, S 35, T28 N, R, 15 W MUNICIPALITY: TOWNSHIP OF CADY • COUNTY: ST CROIX DESIGN: HOLDING TANK COMPONENT MANUAL SBD- 105714 CONTENTS: Page 1: Plot Plan Page 2: Huffcutt Concrete Tank: 940259 Specifications Page 3: Huffcutt Concrete Tank 940259 Specifications Page 4: Holding Tank Cross Section & Specifications Page 5: Anchoring Calculations Page 6. Holding Tank Management Plan Name: Bennie Helgeson Signed Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: April 30, 2001 f t r O � «►�.e aNC,� � /nom 1 LA S P e w o ��o � W s • d n s c3 f 3' 1 �b � O� - -V `? ► S OA 0 Lk) In �P a o2 r m ti 57 10' Ln 4.75' 1' 4' DIA. N 1 2 N is s Ln O w r v < N N N N w 2 2' a cl m �n 0' E Om D b b b b O x O D D r O n m �c O m A UI -3� N nE O < x m D ;U Cl n o c m 00� D r r - zz °� w O D rn o D r m C z m m m 3 n r rn f~'1 m y n A U r b z m O D= E C N N A n = A O a �s m n b n conditi011a �am °. 'r n m .b z D i D R u'V < Ob M m N A J O A ° I V1A1ER DEP f;E 6.5' r a < r. T AP.TME,IT OF C N z z I p DIVISION Of SAFETY AND ail► SINGS O D n O < -� A rn C RESPONDEN SEE A q• � I z w I i i I i 55' 12' a 52' 4' DIA. 2' D I N • i W 5' DIA. in in 1 2 0 0 0 0 p � 5� r m = TA NK: 940259 H U E C U T T C N C R E T E 737 HERBERT STREET MEMBERS OF: CHIPPEWA FALLS, V1 54729 NATIONAL PRECAST CONCRETE ASSOCIATION Z ( ro 3000 GAL. LOW PROFILE (715) 723 -7446 • FAX (715) 723 -7111 v(SCONStN PaECASr CONCRETE ASSOCIATION , <800) 924 - 1516 A V "I SEPTIC. HOLDING, AND PUMP TANK THIS DRAVING SHALL NOT BE COPIED OR SUBMITTED TO OTHERS VITHOUT CONSENT Of THIS COMPANY 4 174' 169' 164' w o+ r - 0 0 :o v r _ > _ z ' N O A O D rT z A to 7' N t1 w Conditionally ,APPROVED f DEPARTMENT OF COMMERCE pIVISION OF SAFETY AND BURS SEE C RESPONDE qE ----------- --------------- - i I ` D r 1 = x O Cl C D I = N r m I m r > c - I ;o r m l7 m I N O I r � I ox n < I O m -n D > I b n C SIG o o 00 + I C o° ° D I � n o z I z o Z I C n C L m 1 N V) Z r0 m I ow n RECEIVED I i I I MAY 2 4 2000 --------------------------- SAFETY & BLDGS, DIV. TANK: 940259 H U E F C U T T CONCRETE 737 HERBERT STREET MEMBERS OF, A = CNIPPEVA FALLS, VI 54729 NATIONAL PRECAST CONCRETE ASSOCIATION Z m 3000 GAL. LOW PROFILE (715) 723-7446 A FAX (715) 723 -7111 (800) 924-1516 WISCONSIN PRECAST CONCRETE ASSOCIATION hl R) -� SEPTIC, HOLDING, AND PUMP TANK THIS DRAVING SHALL NOT SE COPIED OR SUBMITTED TO OTHERS VITMOUT CONSENT OF THIS COMPANY - HOLDING TANK CROSS - SECTION AND SPECIFICATIONS Approved Approved Locking Vent Cap Weather Proof Manhole Cover Junction Box with Warning Label 4" C. 1 12" Min Vent Pipe 4" Min Final Grade 18" Min ^' � 1 Approved Joint U 14 .2.G Water Tight Seal - - - High +later Alarm Switch - - Approved Joint w/ C.I. Pipe Extending 3' Onto Solid Soi 3 ECC.C[ , n n sca w SPECIFICATIONS TANK Manufacturer: Tank Size: 3ppo Gallons ALARM Manufacturer: C) 0 .Slc ft, s Model Number: Switch Type: 1 of i A- NUMBER OF BEDROOMS OWNER'S NAME: b enk M 1� C o ADDRESS: '?/2g ) 0 j , : ie e -- PJ LEGAL DESCRIPTION: S. Sec. T,;gN , R f7W OWNSHI /MUNICIPALITY: g ` SIGNED: LICENSE NUMBER: o a DATE: ANCHORING CALCULATIONS DENNIS CHILSON OWNER P AGE , S TANK VOI. = 486 CU. FT. 486 CU. FT X 62.4 #'S (CU. FT.) = 30326.4 #'S 30326.4 X 1.5 = 45,489.6 POUNDS MIN. WEIGHT NEEDED 45,489.6 #'S ------------------------------------------------------------------------------------------------------------------ TANK AND COVER = 2 1, 000 #'S FOUR RISERS = 600 #'S 3 FEET OF SOIL COVER OVER TANK = 273 CU. FT. 273 CU. FT X 1 10 #/FF = 30,066.66 #'S FOUR RISERS = 600 #'S TOTAL WEIGHT = 51,666.666 #'S ------------------------------------------------------------------------------------------------------------------ TANK SIZING: 3 BEDROOI\1 = 450 GPD 450 GPD X 5 = 2250 MIN. TANK SIZE 2250 GAL. DENNIS CHILSON OWNER HOLDING TANK MANAGEMENT PLAN When tank alarm goes off, contact the pumper you have a servicing contract with. If holding tank leaks or overlows, contact licensed pumper, tank installer and St. Croix County Zoning Department. Licensed Pumper: Ron's Sewer Service Inc. 715/749 -0153 Tank Installer: Helgeson Excavation Inc. 715/772 -3278 St. Croix County Zoning Department 715/386 -4680 SEE CORRESPONDENCE VOL 1624 PAGE3 10 � Document Numbqr/Plan I.D. No. HOLDING TANK AGREEMENT t6.r4�59 AL KATHLEEN H. WALSH RE63rfi.TER OF DEEDS This agreement Is made between the government ST. CROIX CO., WI Name and Return Address unit and holding tank owner(s). RECEIVED FOR RECORD I 11 04 -24 -2001 10:30 AM 5 f 6 ' ` a 1 X A HOLDING TANK AGREEMENT S n R 'e. Lkh W �j 6 EXEMPT D U CERI.COPY FEE: COPY FEE: 3.00 Parcel identifier num (P Agreement Date FEE: RECORDING FEE: 12.00 Governniontal Unit Hold�T=7M S � We acknowledge that application is being njade for the installation of (a) holding (s) on the following property: (Provide legal land description. Use reverse side if additional space is needed) � �zhn /) �' �, eQ..� C.+�trntr.e_ � il\t. cbl['k �i• C orn we � lao�tls�'�:tL�.s.slsa`c..W�3'�E.s�i1 a a Mtinued us of the existing premises g4. requires t a holding tank Im installed ou 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 1 ocjJn a f' (1a &.4 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 s. 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, State. 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 motor. I 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 a. 146.20 (3) (d), State., 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 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), State., 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. UM 83, Wis.- Adm. Code. In addition, this agreement may be canceled by executing and recording said certification with reference to this agreement is 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) Names) - Plcase Print Governmental Unit Official Name - Please Print Subscribed and sworn to before the on this date: a o izcd Owner(s) Signature(s) Governmental Unit Official Title - Mime Print %tilt tilt Notary Public Governmental Unit OATIcial Sl O I to G J Drafted by rr1 R- N:Z- �!, Personal inform%-- p %Privacy Law, tts.a (txm)l. HOLDING TANK SERVICING CONTRACT 1624 PAGE - Contract 0a1e VOL 3 73 This contract is made between the _ —' Holding Tank Owners) Names) and i Pumper's Name OA We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) 8s, T S -1�_r 5 4z _.�T _ a �- t_ t„�rr1�. C, ea 3t cs C�rac -t Sa�M'nA alCrCAro,CA nc -tQL41� -n+t US:t `� LL XW1:� he.0 W . If v...c_,�aa✓4 � 3 b� ax - '� �hL � e. e. �._o�}�._ v` 1 � �� . o� sa; r� F�trbt�. e,v _ mc -------------I------ 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 X54 Crc 14 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), t 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 nitmber issued for the holding tank; e. The dates on which the holding tank was serviced; I. 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 municipt and the County named abovo within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) i Own r - s Signature(s) I 011;1 n Subscribed and sworn to before me on this date: MIA '01 A -,n J- -- - - -- -- - - -- a4 i Pumper's Name (Print) i Pumper's Signature otary i `, >> 111/11 My commission expires: %N N �. 111p�� Pumper's Registr tionNumber • ` w • SBO -7574 (N. 1 1/85) This instrument was drafted by the State of Wisconsin Department y �v81.� 0:1. of Industry, Labor and Human Relations. Bureau of Plumbing. '�, �`� • • •��.` .` � u f�t)•ti Q , sconsin rintofCorfirrri3res SOIL EVALUATION REPORT Page of 3 bivision of S� Buildings , in accordance with Comm 85, Ws. Adm. Code Attach complete site non paper less than 81/2 x 11 Inches in size. Plan must include, t It tot Iird hand horizontal reference point (BM), direction and Parcel I.D. peroent ibpe, "CZr nits, forth arrow, and location and distance to nearest road. o 0 �� R awed by Date Please print all Iniformat/on. �- estional inform n you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). t Prope er Property Locauon GovL Lot :Sr_ 1/4 1/4 S T g N R S E( W 1J 2tnK(S kiI SOlti L Property Owner's Mailing Address ot # Block # Subd Name or CSM# 1 R PI ere p - 5+ Ciro ► v IzoQ / City State zip Code Phone Number ❑ City ❑ Village BTown Nearest Road 1✓� 76 (7 ❑ New Construction Use: Residential / Number of bedrooms - Code d design flow rate �SU GPD 21 eplacement ❑ Public or commercial • Describe: Parent material ', Flood Plain elevation If applicable General comments and recommendations: [) Boring © Boring # 95�" �� In. Ground surface elev. ft. Depth to limiting factor Soil licauon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G D In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a _ D Ye S 56 (L a m SbK 1' r (u S' �v M3P - 7.57R .ScL I rn'" r 3 1-3 12 D - Boring # ❑ Boring Pit Ground surface elev. �° �� ft. Depth to limiting factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 0 OD p C y. SYI2 SbkC Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 <_ 150 mgA. ' Effluent #2 = BOD _< 30 mgA. and TSS 130 mg/L CST Na (Please Print) Signature CST Number / ac z) sZ) e vt Vie r � e( e sew. Address n Number Date Evaluation Conducted Telephone Numb wl - 9 zv 5 7� 7 - Parcel ID # Page_ Property Owner' . of 3 _...._ _. n ; f r � - - ❑ Bon' 3 . Bonng # 9� 5 ft. Depth to limiting factor 1C� ; Ground. surface in' Soil Application Rate i Redox pesrxiption Texture Consistence Boundary Roots Structure : GPD/fP t.. scri _ . _ •Eff#1 . ; . 'Etf#2- '. Horizon. Depth .Dominant or Gr: Sz: SK in. Munsell Qu. Sz. Cont. Color E] Boring T Boring # g, Depth to limiting factor _ in. (�[J ❑Pit Ground surface elev. � �_ Soil — Application Rate Horizon Depth Dominant Color Redox Description -7 T8 — exture Structure Consistence Boundary Roots •E ff#1 t'•Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. a" S a S .... �. -SQL ✓�s�O ,', ,. - ..' D � 3 •' Boring # ❑ Boring Ground surface elev. / �. Y S ft. Depth to limiting factor in. Soil Application Rate ❑ Pit Horizon Depth Dominant color Redox Description Texture Stnrcture Consistence Boundary Roots GPD/fP *Eff#Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. lo` vn ' 4 8, a -ems Effluent #1 = BOD > 30 <_ 710 mglt. and TSS >30 150 mg/L ' Effluent #2 = BOD _< 30 mglL and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (86/00) V� n y QN NO Q tp ! G L , , x cr �r P O M1 a- 0 (n S� C n W fi� �_ � C� �� � I� J _, 3 b � � N � LT c� �T' N �, --�. V� � � .J ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer `Dr­nvi t s U J Mailing Address 31 S -�► e we vd- eriw R ' *-Drina, YeA ll 0- ; cc i 642 4---7 Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location _ 1 /4, _aL ' /a, Sec. ?, , T -R 1;L W, Town of Subdivision 1A , Lot # �. Certified Survey Map # �JIA , Volume , Page # Warranty Deed # `� 616 , Volume Page # 3 Spec house 0 yes VA no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. I/we, 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 slag 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 expiratio date. f 4 ' 7 ;7-1 - ' I — / / 0 / SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of he pr perry described above, by - virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT 15ATE * * * * * * 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 u8iU4f00 11:48 0608 723 4175 SKYLINE 444 NORTHWEST HOMES ID003 /003 F 1 M 7j:1 l ; 0 f i l m ! 0�$ --- - - - - -- r � ItC� •�� / \ r , F W3 to ONCE . i I f ! I , i 1 1w 1 1n K O0 LUUA i VOL 1624PAGE 70 0.0 3� =Documeti4Nut>lber/PIanLD.No' HOLDING TANK AGREEMENT KATHLEEN H. WWA H REGISTER OF DEEDS This agreement is made between the government ST, CF'OTX CO., WI unit and holding tank owner(s). RECEIVED FOR RECORD Name and Return Address SO i1 04 -24 -2001 10:30 AM HOLDING TANK AGREEMENT a I eI W L j G EXEMPT # J N v CER:i.XZY FEE: COPY FEE: 3,00 Parcel identifier num r (P I Agreement Date IR ER FEE: 0 ' oo p _a y , R ECORD I N G WAGSS '4- FEE: 12.04 2 Goverantental Unit Holding Tank Owne s) St L- We acknowledge that application is being njade for the installation of (a) holding (s) on the following property: (Provide legal land description. Use reverse side if additional space is needed) 7SE yq 5 T - w '�6 ia►-,� n �' �� �....� r�.r..r -0.c ►-�,c t s..;���.SEAtIU °� "Z�C1Ya�il Ftinued us of the existing premises requires t Hat 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 Gwrn e (' 0& 14 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 coat 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 coats within thirty (30) days, the owner specifically agrees that all the costa 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 a. 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 liolding tank. In the case of registration under a. 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. A.dm. 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. Owner(s) Name(s) - Please Print Governmental Unit Official Name - Please Print Subscribed and swom to before me on this date: ti o d Owner(s) Signatures) Governmental Unit Official Title - Pliase Print tttt tttr Notary Public Governmental Unii0 rcial Signature �� on s ,j *• *_ Drafted b Personal infonn 00 y ed f se6ndary pwpows (Privacy Law, x.15.04 (1Xm)]. rn �., p „ OF renCGO��° _ r Ii DOCUMENT NO. i T DATA i STATE BAR OF WISCONSIN FORM 11 -1982 i !, HIS SPAL6 RESERVED FOR RECORDING • ' ; LAND CONTRACT I Individual and Corporate 1 i(TO BE USED FOR ALL TRANSACTIONS WHERE OVER I �' 1 126,000 IS FINANCED AND IN OTHER NON ACT �� ! o TRANSACTION3) _ I t o / i i Q f a 1 GO r�tract , by and between - ---- na B. Pol esk --- ___ -____ 1 ...- '! s� ng --- _ woman------------------------------------------------------------------------- - - - - -- i ---------------------•---------------------------------------------- --- ----- ----- --- ----- -- - -- -- ( "Vendor ", whether one or more) and... Dennis M . Ch i l Son and Janet M. ----------------------------- - - - - -- ------- - - - - -- �hil_ th__________ ri ht of survivorshi _ i ------ .- ___g_____________ _____-------------- p ___..__ ( "Purchaser ", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the rents, proft$, fixureq and other appurtenant interests (all called the "Property t ! ln ----------- ---------- ro County, State of Wisconsin: ! TO That art of Southeast Quarter of Southeast Quarter I I p Q Q � (SE4 of SEI) of Section 35, Town 28, Range 15, 1 - - -- -- 1 described as follows. 4 Commencing at the southeast corner of said fort acre tract thence North Y Tax Parcel No .............. along the center of Town Road 264 feet, thence due West 330 feet, thence South 264 feet to the south line of said forty, thence East 330 feet to place of commencementt. 1 J. l i i i ' i 4 This ........15 ................ homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to Vendor at whi _chever__pl,ace__she__may__di rest the sum of $ 30,000 : 00 ---- -- --- --- - -- - --- - O ...____. _ _______________ in the following manner: a .__ - 1288.:7 -8 ----------------------- . li at the execution of this Contract; and (b) the balance of .................. together c to with interest from date i hereof on the balance outstanding from time to time at the rate of --------- l0l4 .... ........ per cent per annum until paid in full, as follows: $322- per month commencing March 1, 1988, interest to be first deducted and balance to apply on principal. This contract to become fully due and payable i 1� Years,Ac;rrAnt o fre[n,.date hereof. i i � P rov'ded, however, the entire outstanding balance shall be paid in full on or before the .......... I.St.......... day of ______MdrC�_____,_ 19A the maturity date). Following any default In payment, interest shall accrue at the rate of --- 1 0....% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire i principal balance). l i Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, f Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of i taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest ` unless otherwise required by law, !I Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any ` i� amount may be prepaid without premium or fee upon principal at tiny time after ...__ JdllUar� lg 90 um >Et x s�c�cxa we �xafx c�xatxa sa�ctx "MX"XY0XXMA6Xxxxx In the event of an prepayment, this contract shall not be treated as in default with respect to payment so long i P P � Y ii ..a �l.n ..... -:.i hnln »ten of »r. »mnnl n »A i»�arnc� (n »rl i» ct. n1+ risen arr rn j»r. intnrrc# fro— mnnth to month shall be treat _1_ Vol- 1624PAG1 272 �Qo KATHLEEN H. WALSH Document Number Document Title REGISTER OF DEEDS tdf _ ST. CROIX CO., WI RECUMED FOR RECORD 04 -24 -2001 10:30 AM K=LLANEWS EXEMPT # "Y FEE: CORY FEE: 3.00. DER FEE: RECORDING FEE: 12.00 - 2 Recording Area Name and Return Address lSon 5 +Q rP CLIl�u��► Dot / 7_ yo - onQ) Parcel Identification Nmnber (PM "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This inforusation must be eompletod by submimr.. d=mu nt fide. name &return addren. and FIN (f required). O&er.Woamadon such ar &%e granfint clauses, kcal d-cn d—. etc. map be placed on d di irst page of the dotuneant oror map be placed on addi+iond pasts of the doeranent ofe: We of this eavrr page adds one past w pour doerorernt mrd X2.00 to the reeordurt tcc_ Wirtauin Stn.., SP.S17. WRDA 2196 HOLDING TANK SERVICING CONTRACT VO .1624 373 Contract Dale ' This contract is made between the — Holding Tank Owner(s) Name(s) and I Pumper's Name �4 I We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) S I � Z 5 . T $_� _t_5 ? - -- °-�.�- �+��,rn� -mac; ut h e Sov��h (A-4 Ct +nec �C s4',cy�'c� ciu gC Cc \r sus. 3 \.,v\ h Ac4 e,: � e, hG� . & \.,(- , \rz4s_t,t l b�e,,.A c e, Sin , 11. EL&..d-t9_A�h_c- , Sz sd 4.�hC�C�. gs3csscz� \�c�R1 ��C�mm�nCSLr�n - - - - - - - - - - - - - - - . - - - -- 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 83.713 (4) (b), L'u'is. Adm. Code and with the County of .�� C• %� ,t 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), I 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 municipi and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) (Own is Signatures) - D— 1s 6 r\ ( _?!duo _ _ Subscribed and sworn to before me on this date: U - 0 I Pumper's Name (Print) Pumper's Signature otary F I My commission expires: ••'• Pumper's Registr tion Number ? • �� • gy�pp,, SBD -7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department��' �e/eL�G • �'�: of Industry, Labor and Human Relations, Bureau of Plumbing. �'�,�� • •���`� �Wl _ `��0�