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HomeMy WebLinkAbout002-1090-60-000 a ~ ~ ~ I ° o O ~ I m I i R N O p C_ r ry ID Ma 8_0 M CD c > N ~.ay c o I U N C O-0, 'p Q N N C C p 1 -'z -0 co UO C C O O d > 4) I m f0y>~yc p E Co c Z `'c0cm0 I 7 t0 N C m LL C Vl V > T c O C M E Q N C 3 wo U) M 8 1 f0 M I Z o I z a m N ce) U) 1 o I o_zv w U d Z a c Z U) H d I E N M I N C H C v Y O t m z D 0 1 Z c E 04 y Q r g 1 m a~ s I G D a ~ d> co U) :3 S Z EL- U) 0 0 LO 0 0 0 z tv a a a ~a a fnJ V =>m~ (D ° ° E 1 r m y a I °'o d Q~ v~ m I Q o ° r°n v a co co 00 c C 1 V a a) CD to 0 o 0 0 c v o 1 c ao I 10. 1 ° 6 ~ y H c CO c F~ o " 32 CD O N E ►~l~, O M m Q N O Z 5 O ~ ~ I ~ I C/1 y IC I ~ d = at C ` d i 0 C. G> V 61 C E c r A t0 ~a~ vice STC - 104 AS BUILT SANITARY SYSTEM REPORT r~ OWNER ~-G Z 6 ADDRESS SUBDIVISION / CSM# LOT # i' SECTION ? G T~N-R W, Town of (~J 4 v,,, ,s k't ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~v e ; u !l~ IL li III`9`E"17~~2'I`1IZRI~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMAAK• ' ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (z;S r r7 Liquid Capacity: Q 0 G Setback from: Well 166 li- _ House r ~'~a Other Pump: Manufacturer Model#Size Float separation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House___ Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing G~ade Final grade DATE OF INSTALLATIO : PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: ` Labor and Human Relations ST. CROIX INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P o.: ACHTERHOF, JOE X CST BM Elev.: Insp. BM Elev.: -177 tion: Parcel Tax No.: TANK INFORMATION ELEVATION DATA /o TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ¢ Benchmark Dos r Aeration Bldg. Sewer ( Jv Ho St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet t" TANK TO P/ L WELL BLDG. Ventto Air Intake ROAD Dt Inlet 7 7- ( NA Dt Bottom Septic Dosin Header / Man. Aeration Dist. Pipe Holding Bot. System P SIPHON INFORMATION Final Grade Manufacturer and Model Number GPM TDH Lift F • Ion System TDH Ft oss Head Forcemai Length Dia. Dist. To Well SOi ABSORPTION SYSTEM BED /TRENCH Width Length No. No. Of Pits Insid ia. Liq id Depth DIMEN 1 N DI I N HI Manu actur SETBACK S. BLDG /STRE - I INFORMATION Type CH ER Moe Number: em: 01t UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressu ystems Only xx Mound Or At-Grade Ss n y Depth Over D Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Baldwin-36.29.16W, SE, NE, 270th Street ,i,Tp~1'',r'•, CGI~.lLIi2i•'c~.'' Lcrr~'~ Plan revision required? ❑ Yes U -No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signa ure Cert No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 1 "a Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 3 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less Coun than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs E] Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)1. Stat plaALQ_Nu bar ^ 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION t>11 S L~J bi`i J Property Owner Name Property Location Joe Achterhof SE1A NE 1/4, S 36 T 29 , N, R 16R(or) W Property Owner's Mailing Address Lot Number Block Number 666 270th. St. City, State Zip Code Phone Number Subdivision Name or CSM Number Woodville, WI. 54028 1(715 )698-2641 II. TYPE OF BUILDING: (check one) ❑ State Owned 'ty Nearest Road ❑ Public ® 1 or 2 Family Dwelling - No. of bedrooms 3 0 rowan OF Baldwin 270th. St. III. _ BUILDING USE: (If building type is public, check all that apply) Parce ax Numbe (s 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3' ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System SystemTank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ® Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fil I VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Lr ~~U Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank X 3000 1 Midwestern ❑X ❑ ❑ ❑ ❑ ❑ -4 I Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility f pr insta tion of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb s Sign r o Stamps) MP/MPRSW No.: Business Phone Number: Joe Stang MP 6646 715-698-2266 Plumber's Address (Street, City, State, Zip Code): 506 Willow Drive Woodville,`WI. 540 8 1X. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved San ry Permit Fe (Includes Groundwater Date Issue Issuing Agent Si n tamps) iy , arge Fee) - Approved ❑ Owner Given Initial C~ v ~/-9s Adverse Determination "`~~~PPP X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divr ion, 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. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete lima B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of nolding tank(s), septic tank(s) or other treatment tanks, building sewers; wells.; wager mains/water service; strearns anJ lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences, friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; soil test data on a 115 form; and F) all sizing information- - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. t T f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Ind bor and Human Relations July 19, 1995 2226 Rose Street 5. La Crosse WI 54603 IV WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S95-40839 FEE RECEIVED: 120.00 ACHTERHOF, JOE SE,NE,36929,16W 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. 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. J®rard erely, M. Sw'm Plan Reviewer Section of Private Sewage (608) 785-9348 1623R/ 1 SBDA-7987 (R. 10J84) HOLDING TANK Page I of 3 For A 3 Bedroom residence 895®40%839 LOCATED IN THE Sq 4 OF THENE 4 OF SECTION 3b T Z9 N, R !b T , TOWN OF ~34~~ pw ~tv sY. e_li IX COUNTY, TrdISCOIvSIN. INDEX PAGE 1 of 3 TITLE SHEET PAGE 2 of 3 PLOT PLAN PAGE 3 of 3 HOLDING TANK SECTION PREPARED FOR -zbxE- tbL-,38LIE T1" k rMlAtF T~+ sY. w~o~v1,LLE, ~vl sit ~ zd RECEIVED J U L 1 0 1995 SAFETY b BLDGS. DIV. PREPARED BY w ' r 9 W EC-,EVER E3 Oi = L- TEST I 1,,l CD AND ID ES I (13tq !E; lEF::Z V ICE a ARTHUR L. : Ea F.D. BOX 74 421 N. MAIN ST. ° i ,-s.JP GL L::/'JP:TH, RIVEF. FALLS. WI 54022 715-425-0155 es4 JOB NO. C) S - 87 2of Page - PLOT PLAN SCALE 1S95--40839 Q / ~ ( e Pt P~ w~,L \ x ~!S'vF ti{"pl.C (Y-I lni•l~Z'~ ` O co ~ toZ) I ~ WyvSl n - j BLDG. 8 Z ~ i i I i i k \-sm iL) S S95-40889 HOLDING TANK CROSS-SECTION Approved Weather Proof Vent Cap Junction Box 4" C.I. , Approved Locking Manhole Cover With Warning Label Attached Vent Pipe Minimum 12" I /Final Grade 4" Minimum { I (Approved Joint 18" Minimum ' Water Tight' Seal High Water ' Alarm Switch SPECIFICATIONS T f TANK New ✓ Existing Approved Joir1T / Manufacturer: ~tpw ~J P~ ,r4 ST, Blind C.I. Tank Size: 3 0 o p Gallons Plug ALARM Manufacturer: 5,::Y, -tT-.~'MA S`{S`i`Ly'I s Model Number: t01 IcA W Switch Type Y~► Q-,iZ_ec,jzY NUMBER OF BEDROOMS: GALLONS PER DAY: LIS O i I 3" of Bedding Under Tank VoA D. aF 1l1~uS oY, IAgE1tt ~ D 1~EL~~~~aS a pilis, HOLDING TANK SERVICING CONTRACT Contract Date - - - - - -This contract is made between the 1 - - - - - - - Holding Tank Owner(s) Name(s) and i Pumper's Name Joe Achterhof I -h ' A 13 C We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) The SE4 of the NE4 of Section 36, T29N, R16W, Town of Baldwin, St.Croix County, Wisconsin. 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and 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 and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agreeF 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 contract the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipaiilk and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Signature(s) Joe Achterhof I Subscribed nd sworn to before me on this date: I ~ I Pumper's Name (Print) I Pumper's Signa re Notary Publ: My commission expires: ji r T ' t 3-Z`6 -SS IDIANE _r_ P,mner's Registration Number a•jt-l y- SBD-7574 (R. 09/8!8) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations Wisconsin Department of industry, HOLDING TANK AGREEMEIVT_ -Safety and Buildings-Division _ L'abar:and uri,ar~-r e(ations bureau Of Buildings and water system.. •Documerr No /Plan Identification No. 9 ('I 1 . 36 S hisspoce reserved for recording date This a r emen is made between the governmental unit and holding tank eeme t Date owner(s) C unty or c I Gove mentaI Unit Holding Tank owner(s) fibcra fu F.: . . Town of Baldwin Joe Achterhof JUL. 2: 7 1995 calledMuni i fit b 1 w We acknowledge that application is being made for the installation of,(a} holding 4:15 P. tank(s) on the following property: (Provide legal land description) '112 The SE k of the NE '4 of Section 36, T29N, R16W, R4 :croft; 4s Town of Baldwin, St.Croix County, Nisconsin, VIO Return To t,u t Or that continued use of the existing premises requiresthat a holding tank be installed on the property for the pvrpose of propercont.inmeni of Sewage. Alsc, the-•prcp4 ,y cann,)t now t-e served bo ---m,unicipe+l ce>"~,. or-any p:lKar h,na of n:~;atti cgp~gucys-Pm as nprmitxed .ruder rh KHR 81, Wih -Alm Code, or Ch 145, Stats As an inducement to the County of S t • C r o i x + 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 81. 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 5.254.S9- Slats., the municipality may enter upon the property and service the tank or cause to have the tank io 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, maintenance, and repair of the water meter, and agrees to allyw the municipality to enter the above described property on a regular basis to read andfor inspect the water meter. Owner agrees to pay all charges and cost mCurred bythe 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 o a human health hazard, and the tax 5hail be collected as provided by law 4. The owner, except as provided by s. 145 20 (3) (d), 5tats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, tq 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. 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 8318 (4) (a) 2._ Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 145,20 (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 holdingla k when pure. ping reports and meter readings may indicate thatthe holding tank is not being properly maintained. b Tbis agreementwill remain in effect only urtil the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a munic!pal sewer or a soil absorption system that comphes 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(.) - Pnnt Norrized Owner(s) Signatu (s) Joe A c h t e rh o f Subscribed and sworn to before me on this date Notary Public Al" W46FIT L~ inicipal Official Name - Iri nICIPal 00 ffico1 Signal e h iupnl Official Title • Print j ~ou,rrt."~ ~~G ~Q r G~ , r/aT 14 L6-- The irlforrnatwn you provide may be used by other government agency p'rogra-iris IPfivacy Law, 15.04 (1)(m)l SBD•6123 (R. 04194) 'Jirmonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page [ of • Labor and Human Relations Division of Safety & Builklirgs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81! i j i . an must include, but T. 10-" 1X not limited to vertical and horizontal reference poi on c pe, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist nearest Wd 0 o Z- ) ) go lb o ; REVIEWED BY DATE APPLICANT INFORMATION-PLEASE P LQ7AL4_,rNI,FOt ON N_ r, PROPERTY OWNER: ° P TY LOCATION :::~t R ."-r-ERV}p sov6w SE 1!4 N e 1%4,S 3b T Z-°! N,R )C E (or@ FPROPERTY OWNER'.S MAILING ADDRESS .h BLOCK # SUBD. NAME OR CSM # 666 ~-~0 nn ST. CITY, STATE ZIP CODE B ITY []VILLAGE NrOWN NEAREST ROAD wouo vL~ , w [ sgro z?3 z-)D `rsf ST. [ 7 New Construction Use [~Q Residential / Number of bedrooms 3 [ J Additi.Qn to existing building Replacement (J Public or commercial describe Code derived daily flow LSD gpd Recommended design loading rate . bed, gpd/ft2 - trench, gpd/ft2 Absorption area required - bed, ft2 - trench, ft2 Maximum design loading rate bed, gpd/ft2 - trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations l~p~-ol ly 6 `S~P~aht tZZQi'b. Parent material 's1s_Seetl~levT ou t?rz- z l -ri t_t- Flood plain elevation, if applicable N. A- It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system ❑ S Q U ❑ S 19U ❑ S ®U ❑ S BTU ❑ S -7U QJ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou~iary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed lerxh o-S o. 6 \Z. Lo x..:.. Z lZ 3~ io `2R 5h- -7,3 '1 R S 1$ TS l -0 -,-n wl ~w Ground elev. ft. %t, NE,% Z.3 ~ ~sR~ SIMt~ '~0 31 wt h'IO ~vG lvo Depth to o" . -71N'l 1,31 P ~-C-e `C._C)" W S Xj s 1z c limiting factor ,t U S L Ova 'To _N1_3 N K3 G e Res Lt_ Pbl z7 F:~e~ ~o S Remarks: Boring # P F- o- Srs IL ?voi SU -P -n j Lls;r. 1 t- 1 U l L i xi cn, Ground elem. `ft. Depth to limiting factor Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-425-01.65 M egerer Soil. Testing & Design.Service-P.O. Box 74 River'Falls,WI 54022 ¢ - - - path: CAST, NnOn4t~ ~ ° q 58 6_- `Z.9=q5 106576 l PLOT PLAN Page - Z-- of Z '-.SCALE 1"= Zo Y cT' ov g~ I ~ z Q/ PP ` M V1 w~,L \ x O ~vs~ n . , _ OR.ivlTwMf O ~N f33 ~ W 8 ~r 6-Z9-015 9S-1$-7 (71 ) 425-m n5 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry. SOIL AND SITE EVALUATION REPORT Page L of Z . Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but lX not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. - O-O Z- 0 010-- 613 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION -77-& E GGVT-L Slv 1/4 1Ue W,S 3t T ZI N,R ) C E(or@ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK SUBD. NAME OR CSM # 666 10 nt ST. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN NEAREST ROAD wooovt~Lk, k, [ 54o19 (-11%98- z6~() 1 rpv_ w> fv z~D `nt ST New Construction Use [M Residential / Number of bedrooms 3 Addition to existing building ~j Replacement [ ] Public or commercial describe Code derived daily flow ISO gpd Recommended design loading rate bed, gpd/ft2 - trench, gpd1ft2 Absorption area required - bed, ft2 - trench, ft2 Maximum design loading rate bed, gpd$ - trench, gpd/ft2 Recommended infiltration surface elevation(s) - ft, (as referred to site plan benchmark) Additional design/ site considerations l~~ 01 6 rU 7ZZ-Ql"b, Parent material s 1%-'Cy S trt~,,T ou e'R l T t t-L. Flood plain elevation, if applicable N It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ❑ S 5~U ❑ S ®U ❑ S ®U O S I$U ❑ S -[9U IM S ❑ U I SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tw& v"`'` b-\Z. to~1 3 L2 - S t z 'FSb1z vn`Fl~ ~g - o-S 10,6 ..a s=Z P :k< Z, tZ-3`~ to`~R s!Z ~.S ylL SIB Ground elev. ft 30 VAJ /u6S Z, 3 1afR~ S t M l L 'To 31 w t M o bvG lUo Depth to O 7-M P R Z k~ 1L1 S 1Z G limiting factor,, v S _R'f~ij L. ©v~ 'TO "Z~) \ K3 It G G IS Q-No S ! = LL Fc)1 Remarks Boring # - o SOLI sn Sit L l lv 1 t_ 1J t U Ground elev. Depth to limiting factor Remarks: CST Name:-Please Print Phone: - Arthur L. We erer 715-425-01.65 . dress: egerer Soil Testing & Design Service-P.O. Box 74 River`Falls,WI 54022 ature - _ / _ - _ - of ) ~a' ' - fSTQtiTuter7-6 7 6:7,69 tpCs Maa5 Page 2 of Z PLOT PLAN SCALE 1"= ~-oD' ovYt, 1. 'n x ~ PIPS M cn A x ~ wrovSC h / ~ - OR.1vtTWMr ~ Q ~N 9\DG, 8 L 83 i f i. i j gY Llw~ 9S-L$`7 6 °~S amL (715 ) 425-n1 n5 1400576 CST Signature Date Signed Telephone No. CST # HOLDING TANK SERVICING CONTRACT Contract Date - - - I, 11 _ ~ - - - - This contract is made between the Holding Tank Owner(s) Name(s) and i Pumper's Name Joe Achterhof I A 13 C I We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) The SE4 of the NE4 of Section 36, T29N, R16W, Town of Baldwin, St.Croix County, Wisconsin. 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of S t. C r o i x 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding 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 contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Signature(s) Joe Achterhof Subscribed L sworn to before me on date: Pumper's Name (Print) I Pumper's Signa re NotaryPublic My commission expires:~ Pumper's Registration Number NIE 8- WILLEMi'P 7F d WICpL"c Condn SBD-7574 (R. 09/88) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations wiscon5tn oepartmentof Industry, HOLDING TANK AGREEMENT 5aferyandBuildings C)ivis;on l abarand Human-Relations - bureau of Buildings and Water systern . Documera No /Plan Idenlificat.on No. ~ ~ , , t U this space reserved nor recording data This a ri~ Ail Is made be ween the governmental unit and holding tank eeme t Oate Owner(s) l_ 1-7 J, C unty or c I Gove mental Unit Holding lank Owner(s) S+i~U IU; Town of Baldwin Joe 9chterhof JUL 17 1995 called Muni i lit b I w We acknowledge that application is being made for the installation of (a) holding 4' 15 P ° ; } tank(s) on the following property= (Provide legal land description) ' c„A The SE4 of the NE4 of Section 36, T29N, R16W, lr:l i~rra)i s Town of Baldwin, S t . Croix County, Wisconsin-, Return To or that continued use of the existing premises requires that a holding tank be installed on the' property for the purpose of proper containment of sewage A!--z,, thtpr,;p;rzy c4.n'it no•pr !~e sGrv2d b; ~municip2' w:•kr. ar-an•v car •,,pq rnf p:;;.;Tq ca cy am vraaa s . as permitted rtndnr Ch Il HR 83. W s_F~dr; Code, or Ch 1,65, slats i As an inducement to the County of S t • Croix + 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 thsr 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. 5tats_zhe municipality may enter upon the property and service the tank or cause to have the tank io be serviced and charge the owner by placinq the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66-60.5tats. 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, maintenance, and repair ofthe 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. I 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 toss with;; thirty (30) days, the owner specifically agrees that all the casts and charges may be elated or the taK- roll W a special assessment for the abatement rv; a human health hazard. and the tax shall be colle red as provided by law. 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 tc 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 hold ng tank. In the case of registration under s. 146,20 (3 (d), Slats., the owner shall submit the report to the municipality- The municipality may enter upon the property to investigate the condition of the holdingxank when pumping reports and meter reading- may indicate that the holding t::nk is not being properly maintained. E This agreement wfti 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. Wrs. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which w,il permit the existence of the certification to be determined by reference to the property 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 ,n 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 Gwner(s) Sign atu (s) - Joe A e h t e r h o f Subscribed and sworn to before me on this date: ludlv, Q Notary Public. i 0 A V-C 1llp~y rnFU* ictpal Official Nane - Pri unicipal Oftical Signal e t+r1 iupal Official Title • Print ,If - C Q - The inloi-mation you provide may be used by other government agency programs IPrivacy Law, 15.04 (1)(rn)) SBD•6123 (R. 04194) i 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 Joe Achterhof Location of property SE 1/4 NE 1/4, Section 36 IT 29 N-R 16 W Township Baldwin Mailing address 666 270th. St. Woodville, Address of site Same Subdivision name Lot no. Other homes on property? Yes x No Previous owner of property Total size of property 20 acers Total size of parcel 20 acers Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house)? Yes x No Volume 1130 and Page Number 590 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 in the office of the County Register of Deeds as Document No. 331344 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. 331344 S' ature of Applicant Co-Applicant )'re C / - Date f Signature Date of Signature p a.Il•~; , ~ t • ~ "s tTACe R[a[RV[D 1011 R[CORDINO DATA ;i - DOCUMENT NO. STATE ~aMARRANTYgDEEDAM 1-1982 'f i 5269-10 VOL jtGl 1 .i j This Deed, made between Larralm.AChterhaf SE CPICJ:' ) ' , i I JUN 8 1995 Grantor, 4 ,na.J seph.~.. A,canechuf It 10:30 A r 4 i - . RaCLmeofC'.'e., Grantee, witnesseth, Tbat th. said Grantor, Ter s valuable c„n,iderstien...... b R9TURN TO conveys to Grantee the following described real estate in ...SL....C['DIX...._....... , j County, State of Wisconsin: The East Half of the Southeast Quarter of the r T2ZPareel Northeast Quarter (E} of SEI of NE}) of Section Thirty-six (36), Township Twenty-nine(79) North, Range Sixteen (16) West. t This is-not homestead property. (is) (is not) Together with all and singular the hereditament and appurtenances thereunto belonging; And warrant that the title Is good, indefeasible in fee simple and free and clear of encumbrances except all easements,, restrictions and rights of way of record. and will warrant and defend the eamw 4-11,1-11111-11 day of .lanuary.............. 19-S.S_ Dated chin • ---•-------------------(SEAL) . (SEAL) • forrain.-Ac htutlaf.-• (SEAL) (SEAL) AUTSBNTIQATION AOENOW LBDGMBNT signature(s) -_Lorrdl.ne_.AdUer wf STATE OF WISCONSIN OL County. a a _,J-arW-y.._., 19__ 5 Personally came before me this day of 19 the above named - ob. t-.L.__RichardsQn-------------------------------- LE: HBEl3 STATE BAa OF WISCONSIN ( mot' ° - snthorised by ?iiBAd, Wis. Stets) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMMNT WAS DRAFTED BY Attoi e ait "wHARQSQN........................... y .-Spr1ng..Vae)l_,.-WL547f17 Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date: 19••----•••) ONanum nt persons signing In any capacity should be typed or printed below their signatures. WARnAPM DZZD STATIC BAR OF WISCONSIN Wisconsin Ieral Blank Co. Int FORD No. 1-1992 y ` Milwaukee Wis. ~y - '1+".V S1ktY_~s. s'- rl'\~C`:daLr~~iarC.j~t ,,'iC"i%~'~~I`''°~~s~~'-i*. (~?~a~'lis~S~id~rv.e~r,~:~ ~'~v`~('d'i~•St T'~f'~,5, r.