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Home My WebLink About018-1021-80-000 STC - 104 AS BUILT SANITARY SYSTEM RE OWNER,y,®.6 .ToIA,✓ S'o tai `sr E~,. (s C'.~.., rS.;.. ADDRESS SUBDIVISION / CSM9a~1'1'J LOT SECTION~T Of' N-R__ 12 W, Town of-AA A ST. CROIX_,,COUNTY, WISCONSIN PLAN VIEW OW EVERYTHING WITHIN 100 FEET OF SYSTEM w rp l i T .e 4 Q i 0 INDICATE NORTH ARRO~' Provide setback and elevation information on reverse of till-, form. Provide 2 dimensions to center of septic tank manhole cover Jr ' + BENCHMARK: ,,5n~ a f j` ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity:Z 61,00 Setback from: Well `",y House 2,0 a Other Pump: Manufacturer 2 a~~~Cey~ Model# Size ~v Float seperation Gallons/cycle: ZS Y Alarm Location~((~ -c. SOIL ABSORPTION SYSTEM Width: Length -7{- Number of trenches / Distance & Direction to nearest prop. line: SetbacY, from: well: L House phi vc Other 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: ysr //ff PLUMBER ON JOB: dL LICENSE NUMBER: INSPECTOR: 3/93:jt g 9 f~. ~'`s ST. CROIX COUNTY ZONING CE CERTIFICATION STATE 4M FOR UTILIZATION OF AN EXISTING 4 f This is to certify that I have inspected the nk presently serving the d6 U &A!5;oJ -residence located at: ,o114) 1/4, 1/4, Sec. , T of N, R C7 W., Town of wrn.,A►~.r/~[ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete KSteel Other Manufacurer (if known) : ~Je~flg Age of Tank (if known) : (Signature) (Name) Please Print „W.! '07 p elf (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name 1l gnature MP/MPRS 5/88 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Lafe~jc urx nIs Division INSPECTION REPORT- ST. CROIX Safety il~R~..4ng ;1'~ GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City El Village Town of: State Plan o.: JOHNSON, ROBERT T. 1i CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: i /CEO D D dA, I A9400297 TANK INFORMATION EL ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic fir. Benchmark /a~ oo Dosing r ~ Aeration Bldg. Sewer g- 35' q~ c~ 7 / Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANKTO P/L WELL BLDG A irIto ntake ROAD Dt Inlet Ar Septic 7~S 750, ao '~?S NA Dt Bottom , Dosing o- . S NA Header/Man. /,9S' 7' Aeration NA Dist. Pipe I Holding Bot. System a: 70 o a PUMP/ SIPHON INFORMATION Final Grade gam' U,o z Manufacturer a 9d o ~ Demand e,r, Model Number /t71'GPM TDH Lift/o, Loss 2 O Syste J TDH ~3~ Ft Forcemain Length,,?,yL)r Dia. of „ Dist. To Well>S-o SOIL ABSORPTION SYSTEM BED/TRENCH Width Length _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S S / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING manufacturer: SETBACK INFORMATION TypeO CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 3.5 / Dia. Spacing Iy _6 >$0 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth Of xx Seeded / Svd~i~ xx~M/u~ched Bed /Trench Center ` u Bed/ Trench Edges l~ Topsoil f° (]Yes ❑ No p'Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hammond.11.29.17W, NW, NE, 110th Avenue e 3>r ?.t } c c < ~ ~ : ~s Plan revision required? ❑ Yes [Ef/hlo Use other side for additional information. S / 7 SBD-6710(R 05/91) Date nsped6r-s signature Cert No. ADDITIONAL COMMENTS AND SKETCH ? s ; _s SANITARY PE141415 NU;WBER: 77LHR SANITARY PERMIT APPLICATION I In accord with ILHR 83.05, Wis. Adm. Code C J STATE SANITA Y ERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than /C a o10 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER 7e1tW5a,--1 PROPERTY LOCATION -r" ,l/a) %,ele Y4, S /l T.Z9, N, R 17 E (or)d PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 107X r~ ` 4/4aC-, as't CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD 101 ( ) State Owned VILLAGE : m a ❑ Public or 2 Fam. Dwelling- # of bedrooms 3 PAR GEL X . U ( ) Ill. BUILDING USE: (If building type is public, check Z11 that apply) 1 ❑ Apt/Condo C~ 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 80 Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. 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 lvs_z~ j 3 2 S Qol• °L Feet 4q Feet -3 7 CAPACITY VII. TANK Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Concrete glass App. Tanks Tanks strutted Septic Tank or Holdin Tank G 2 Lift Pump Tank/Si hon Chamber " tae ,q 'f 0 1 [1 F-1 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 Stamps) "Pr PRSW No.: Business Phone Number: ~A( 0"2 ell Plumber's Address (Street, City, State, Zip Code): , / 7 e, 107'- IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent S' na re (No Stamps) Approved ❑ Owner Given Initial $ Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber r INSTRUCMONS K 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will tie 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 (SBP 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 & 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. ll. 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 in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/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 muse sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than I:i% 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 holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains"water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elev-ation 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; E) 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 1 ~ • f- ~ ~ .yam l 1 • SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations March 2, 1994 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING PO 74 RIVER FALLS WI 54022 RE: PLAN S94-40081 FEE RECEIVED: 180.00 JOHNSON, ROBERT NW,NE,11,29,17W TOWN OF HAMMOND COUNTY OF ST CROIX MOUND SYSTEM 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 existing septic tank must. be inspected for structure, soundness, and baffles. Replace if necessary for conformance with ch. ILHR 83, Wis. Adm. code. 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. Sinc rely, ' h Gerard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 su0-6423 (9QiR/ 1 Page of 6 MOUND SYSTEM S94"40091 FOR A 3 BEDROOM RESIDENCE LOCATED IN THE NUJ 1/4 OF THE NE 1/4 OF SECTION 1 , T Z9 N, R 1'7 W, TOWN OF V\ K a~i pN~ , ST, C\-431X COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~ a ~ 3 o T-rE ~vE . QA(.Z~Lv11v, wl S4 C) PREPARED BY ~,~ecunhy~ WECGEFZEF;Z SO I L TEST = NG s~p` ~0•NS~/~i I~ AND o J 1 DES = ~N S1Ei~ V I CG i APTHUR L. i • SVEGF REER SWO SWORTH, ~ F.O. 801 74 421 N. RAIN ST. = wrs RIVED FALLS. MI 54022 i o 115-42`,t-O1b5 ,1®® ~~'$•I G j; Z-lS-9~ RUCEIVED E E 9 2 8 1994 ETY & BLDGS. DIV JOB NO . 93- 'T -7 S94 ` 400 8 1 PLOT PLAN Page 2-of 6 Scale 1"= YO' o,ss w,i Ta zoo `rh sr. 1~LD6. ovTT-I~L1 L6N Lv 7 Lj 17 I T~@L"S c3 C7 ' cp N t'3T ~~Rli\~ 1'w Uric- OF 440 HCkt(-Z \ Mze. IS 3aDtH of \1 p nl 1)UQ- • ! ftFS1D6NCe 14 S ~ve C'}C\ST. 1000 Gkl- GCY~1 Q.~'?!°a S L A--B , SLIP 11 C ''('f~f Vye Ll~wtJ FiLSLD 0 '°►0 s Z•65' 0 F X FlPPS2C1X1Mft`tT~ ° v 7-4 PVC F.H. WkEo- L'4 c+t'1tON DLQPLr A R. an~►.~ertc121 pplVATE SEWAGE SYSTEM Conditionally ~ ro jkEftpFj0VjE MA~~I~FIS H137AAN F OF INDUSTRY, ~B7Y I3UtE.i 30 DEFT. DIVI QF e• Z ILL loo 1 E€ 1'ON J =':.'1, SWet. D [ 1 SEE C 1 1 1 ' tLIo%°- 1 83 1 c c F I I Z /o OD lJOT `ah RN cu►w~Rc-T oR a- ~ 7li~ ~X 15TiM~ TAOr. MOST gjk~ iNS ECT(-.l7 FG2 a' 1 i ` '1 ~[tS.sA ~RUc.TURG~ 5;0LWDµESS A►aD SAVR-e5 . R-Pu4cC- ll= A16CE.-%,s-R`( FM C oOTbam4i) & k u" Co. I"fr- ZS b31 WIS. $JM, GOpe, o .1- lops F~u~-E -NOT \~1?4p1~'R`ry LW~ NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( 2 required) 4. Septic tank to be vooo gallon capacity manufactured by ti Q)--)%~ w t:-YeIr S CEx1VD# C") vMp ~b Be X50 6RL_ ?"11z►•e-srg1z.N pR.e'G~5T -rtovle. 5. Bench Mark S929 ftgp Ve 6, Divert surface water around mound to prevent ponding at the uphill side. S 9 4~ 4 0 0 8 1 Page 3 Of 6 Approved Synthetic Covering Distribution Pipe Medium Sand _ H _ ~G Topsoil Elev. 1 OZ. Z E I 3 D b I %Z/o Slope -mer'JeA &--d Of 22 %2 Force Main Plowed Aggregate From Pump Layer Undisturbed D \ • 6 Ft. Soil E 1. 68 Ft. Cross Section Of A Mound System Using F 0-B Ft. Trench For The Absorption Area G N•D Ft. A 5 Ft. H I. S Ft. B -15 Ft. I 1 S Ft. Linear Loading Rate= b • 0 GPD/LN FT J t') Ft. Design Loading Rate= 0.3 GPD/SQ FT K \Z Ft. L 99 Ft. W 3 o Ft. L Force _ ---_B K_ Mai- . A ~ I, W " Distribution Trench Of 2 - Z'2« Pipe Aggregate I Permanent f Pipes Observation Markers .fStOA (Anchor securely) S~n~AO'~ S diti Coll VIA Mound Using I Trench For Ab ITS eo ap o~ ~ ~~t~GS Dom' ~vl a¢~ ~ FrE GO ~'tl: Page y Of 6 94 ,40081 Perforated Pipe Detoll 0 End View Perforated End Cap.) PVC Pipe Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop * PVC Force Main i Distribution Pipe Last Hole Should 8e Next To End Cap Vii= Distribution Pipe Layout - p S y4 c~ ~dv~Y ,r,y Ft. X S1- ~ ra P•~~, Inches M M„ Y -SL Inches } Hole Diameter )A/ Inch Vi s101 FL Ego Lateral Inch(es) of of s~~~Y ~ prrV1 Manifold- - Inches Force Main Z Inches SSE of holes/pipe 8 Invert Elevation of Laterals 107-7 Ft_ Place lst hole Z8 " from tee with succeeding holes at 3(:1 1 lintervals. Last hole to be next to the end cap. S94'40081 Pf\GE 6 0 F 6 HEAD/CAPACITY CURVE 4A 6' MODEL 97 4% - 30' m 8 p 45/ 25'- 11k - 11 > NPT Q 20' W 6 43/16 = 0 U Q 15'- z I y ~6 p 4 F ~ O 10' ~ 18.12 2 5' 0 US 10 20 30 40 50 60 70 GALLONS LITERS 0 80 160 240 t0"/,6 FLOW PER MINUTE TOTAL OTNAMIc HEAD/FLOW PER MINUTE EFFLUENT AND DE WATERING CAPACITY HEAD UNITSIMIN - 31/16 FEET METERS GAL LTRS n 5 1.52 56 212 10 3.05 46 174 - 15 4.57 35 133 / 20 6.10 15 57 Lock Valve 23.75' CONSULT FACTORY FOR SPECIAL APPLICATIONS e Electrical alternators, for duplex systems, are available . Mercury float switches are available for controlling and supplied with an alarm. single and three phase systems. III Mechanical alternators, for duplex systems, are avail- Double piggyback mercury float switches are available able with or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard All Models - Weight 33 tbs. - % HP 2. Single piggyback wide angle mercury float switch or double piggyback mercury float switch. Refer to FM0477. 97 series Control Selection Model Volts-Ph Mode Amps ~~x 3. Mechanical alternator 10-0072 or 10-0075. Duplex 4. See FM0712 for correct model of Electrical Alternator, "E-Pak". M97 115 1 Auto 12.0 1 or 1 & 7 - N97 115 1 Non 12.0 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3) 2 or 2 & 6 3 or 4 & 5 or (4) float system. D97 230 1 Auto 6.0 for1&7 - 6. Four(4) hole "J-Pak", junction box. for watertight connection orwired-in simplex or E97 230 1 Non 6.0 2 r2&6 3 or 4 & 5 2 pump operation, 10-0002. 7. Two (2) hole "J-Pak', for watertight connection or splice, 10-0003. For information on additional Zoeller products refer to catalog on Combination All installation of controls, protection devices0 and wiring should be done by a Starter, FMO514: Piggyback Mercury Float Switches, FM0477; Electrical Alternator, qualified licensed electrician. All electrical and safety codes should be followed FM-0486: Mechanical Alternator, FMO495: Alarm Package, FM0513; and Sump/- including the most recent National Electric Code (NEC) and the Occupational Sewage Basins, FM0487. Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ZZ71Z O_ 3280 Old Millers Lane Manufacturers of . © O /P0 . Box 16341 • Louisville, Kentucky 40216 (502) 778-2731 • FAX (502) 774-3624 Qu ZITY PUMPS S.vCr ~S3y Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor aad Hij"anORelations DivisioniofSafety & 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 ST- Gnu l X 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. C )I 8 - r p'?- - g O APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION `►~v~ T, SQL ON 06Vf.-r T"- NW 1/4 NE 1/4,S T Z9 N,R \1 E(or@ PROP16 ERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # \ 3 \ tv ` li wE. - - - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE R FOWN NEAREST ROAD 3ALDW►U I S4OOZ ()lS)6gy_3ZO8 ~~DND ~[0 RUE. New Construction Use Residential / Number of bedrooms 3 ( ] Additiqn to existing building j~(] Replacement [ ] Public or commercial describe Code derived daily flow LISO gpd Recommended design loading rate bed, gpd/ft2 a - 3 trench, gpd/ft2 Absorption area required YN S bed, ft2 3-1 S trench, ft2 Maximum design loading rate o . S bed, gpd/ft2 0 • b trench, gpd/ft2 Recommended infiltration surface elevation(s) \ Q i"4 • _L ft (as referred to site plan benchmark) Additional design / site considerations `N ouvp w / 5 x 1 S 11~ u C\{ - w~ t f`, • \000F- S h-xjlz~ Ey t-L Parent material - L,OLS S w `I~M Tt LL Flood plain elevation, if applicable N • A. ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system ❑ S IR U RS ❑ U ❑ S O U ❑ S Q U ❑ S EXU ❑ S wil SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistience Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench `F-sous r) ElLoMIJ, Z •5 0.6 Z$- t o `12 ~-1 l6 - s l 1 2, ~ s b m~ c s - o. s o. >o h ~ e.\ syQU/6 Ground 3 \l 4S 7.S Ll 2 Vl6 ~o dl, sJ s\ a w\ iM`~1- - elev. 1Ob .7-ft. Depth to limiting Remarks: Boring # Z Z 9- l$ 10 `12 IF/6 - ~k r+n'F1~ CS - o.S 0.6 3 c\ SLIQ Yip - - - f$-37 ~.S`1R V/6 ~ Io yR s~ c'3' . s,.~ wl~h Ground elev. (~y h 9n iS• \ob- Z ft =1"+ Depth to ' ' y Y limiting factor , t Remarks: j ' CST Name:-Please Print Arthur L. W e e r e r Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: Z _ 15 - 9 CST Number: L a"a-, d. 93-Zip M00576 PROPERTY OWNER ::~b \ K3 SON SOIL DESCRIPTION REPORT ` hgeY Zcot,•- 3 PARCEL I.D. # 018- 1 o Zj - $ D Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourldary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trencfi 11Z z/z - sil Z 5~ h R.s o,s 0,6 Z 9-~(0 to `l t2 v/6 - S1 1 Z `~sb>T vv, c3 o.s 0, b Ground 3 ~6-Z3 7, S y t2 y~>o - L Z 9 b12 vh u u/G elev. C I cx' 51R Oft. 14 Z3-t4 -7 ~•s y2 qA vo'te sIZ S o Y►~ ~h Depth to limiting factor Z Remarks: Boring # `4A•.Yv tiff: ii\.:i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev, ft. Depth to - limiting factor Remarks: SBD-8330(8.05/92) - • `1 PLOT PLAN Page 3 of 3 y0' !;L ► l q 'TN 1 V E. 0, 3 5 wl j 18 -zoo TH S 1', R ovTr-r\X.L ~I C LtN ~ L'y I TR.~ S 11 Ivor - of ~o 1~~2L C~rcaze~Z ! S ~ 33D4►~ ' F \ 1 p T►1 1~ uL . Res bENCC S- ~}C\5T. 1000 GkL - ~L. 100,0 o►v \AeF,)czy wtffi-tzs CCYJ CI~Ly^Ra S L h} $ 5csP Tl C 'r(~i~e CA l L A ~J N ~ I 'cTL 17 O -DI x APP~20X11-~t4'TN ~ ~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of ~ 3 aborand PumAn Retations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 5`T-• Gov X 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. 018 - 1 O 2.1 - g O APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ~~TC_Y T• SQ)'L7 ) 0 tV 0eVf7t'0T- Nw 1/4 N E 1/4,S \ T Z 9 N,R 1-1 E (ore PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # \963 \\u T1} FwE, - - - CITY, STATE ZIP CODE PHONE NUMBER []CITY E]VILLAGE MOWN NEAREST ROAD gALOW I`\) t,-J I Sg0v2. (Its) 6gy_ 3zog D 110 `M RVE. [ ] New Construction Use [XJ Residential / Number of bedrooms [ J AddibQn to existing building p(] Replacement [ ] Public or commercial describe Code derived daily flow U SO gpd Recommended design loading rate bed, gpd/1`12 a . 3 trench, gpd/ft2 Absorption area required 3-1 S bed, ft2 3-1 S trench, ft2 Maximum design loading rate o • S bed, gpd/ft2 0' b trench, gpd/ft2 Recommended infiltration surface elevation(s) \ O Z . _L It (as referred to site plan benchmark) Additional design / site considerations 11 ok-'tvp w / 5 ' x 1 S ' 'T R %Aj C f { - wti t ►v • \ of " o F S tt-,_~ L L Parent material 1_OLS S OU `~M Tl LL Flood plain elevation, if applicable N . A. It $ = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE7 AT-GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable for stem 0S EMU g~S O U 11 S O U 0 S 14U O S [XU O S X11 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD/ft Consistence 130unday in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch 1 0-8 loutZZ/ - sit 2- `1~5 bk a,s - t) 'S 0.10 Z %-1-1 tp `12 Ulb - S; j Z ~sb>z m-C-V cS - o•s o.b ~ \ S `1tz 4r /6 Ground 3 \l-4S -7.S y2 V jl \o ~►2 s1 s l o `n\ ~rt`F1- elev. \w .-z- ft Depth to fimifing factor Remarks: Boring # 1 0-9 lo`1\Z ZI Z - s~ 1 ZSbk a s - o.S 0.6 Z Z 9-18 1O`1 a. VA - S11 2vhs~k ~n~l cs - o•S u.b 3 I$-3_7 ~.S yR Y/6 \Ill y s/Z S 1 ~`y\ Ground elev. 1bb-Z It Depth to limiting factor t Remarks: TT Name:-Please Print Arthur L. We erer Phone: 715-425-0165 erer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 ge Signature: ~pp Date CST Number: d. 93-ZIP Z_ 15-q~ M00576 PROPERTYOwNER ~~1}N SON SOIL DESCRIPTION REPORT R Page'xZ.of' 3 PARCEL I.D. # 018- l O ZI - Flo Depth Dominant Color Mottles Texture Structure Consistence Bwd3y Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T" 3' \ d- 9 ~o y lZ 2;/ z - s i 1 Z `FSb wt h a-s a f t Z 9-~(~ Io 2 ~~6 - s~ I Z `~5d~ c3 0.s o. Ground 3 tb-Z3 • S `1 lZ y~6 L Z •F3 b1T Yh U `Fh C S - 0.5 elev. C 1 S`7R y/~ _ _ La ft. °-S yR ~1/G q >o Li e Depth to limiting ' factor i Remarks: Boring # i =•44 I i Ground elev. ft. Depth to limiting ; factor Remarks: Boring # ~ . Ssy i ;lack\i't+,:,,. I I Ground elev. j ft. Depth to limiting i factor ; Remarks: Boring # Ground elev. ft. Depth to - limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 o,as hi 1~, zoo 771 sr. J 1~ ~ p G. r ' o v Tr--i1 L 3~ r L LN t2 1 Y I TR~+ g 1 of 40 I'~~~ZL ~~fit, e~Z ! t 3 BDQ1~ 2'_ o F \ 1 O Tt~ uL . RITS►~E+JCF S- C}C~ST. 1000 Gk~ ~•Cw e..~.L~ s ~ ~B . s~~a r c m,v,~ ` 0 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/BUYER ~ U b Qr ( Vein « Tel' ii Sr/l MAILING ADDRESS PROPERTY ADDRESS Su'rn (location of septic system) Please obtain from the Planning Dept. CITY/STATE Sa l d yll i n W i 5 PROPERTY LOCATION kl u) 1/4, A)F;~ 1/4, Section It T aA N-R r 7 W TOWN OF _ Hq m y?U`t a ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: I DATE: - -l St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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. fio t Te' WP2.L~ 50h1730"? Location of property gU) 1/4 114, Section Tj_N-RZ_W Township HGrornV 1 of Mailing address _ Jg9'3 we &hlall r7 Li i-5 Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property gar-,w e loiw?5-ja J r Total size of property_ YO QC re.3 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? -~Yes No Is this property being developed for (spec house) ? Yes- No Volume IQ and Page Number l6- 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. ~/~13 t( 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. Signature o Applicant Co-Appli ant O~ 'S -9y ?-as -IN Date of Signature Date of Signature DOCUMENT NO. ii STATE Ilk ?01, C (7Fi5I~V Hof t1 - 1982 I THIi SPADE FE ER 'EO FOR REGORDINO DATA li LAND CONTRACT ~j Individual and Corporate ~j 481384 I $25,000 ISSFIhA.~ACTI'1RANSA TIONRINONFCOhSU SER jI REGISTER'$ OFFICE I ST. C Reed fVReCord Harold E. Johnson? Jr. Ilti'aCNr by and between APR 2i ~ySG lnd Ruth . Johnson, husband and wif e, and - - each_._in }1-1s or her lndl,--vldua'( ri fit__("Vendor", whether one or more) and R o b e r t__ T..__ Johnson and Nan C y A. l; 8:30 A. M K-2 Johnson~ hus.band-_ and--wjfe~ o.~ng as suryi_vorsfiip„ ..marital._ propert, - - ("Purchaser", whether one or more). I V Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- Of Deeds formanee of this contract by Purchaser, the following property, together with the ji rents, profits, fixtures and other appurtenant interests (all called the "Property"), jl in r.Q.I-X-_..._.....-................... County, State of Wisconsin: RETURN TO Tax Parcel No. See Exhib;t A attached hereto and made a part hereof. This . 5............... . homestead property. (is) kilt x4k Purchaser agrees to purchase the Property and to pay to Vendor at -a__p_l_,a.C.e---dP_s.Ignr7t,?_d..by-..veRdor. the aum of $A.61.0.00_010 in the following manner: (a) $-_283-.-52.... _ at the execution of this Contract; and (b) the balance of $ ---1.16.0-. 1.6_e 48 ------------together with interest from date hereof on the b..lance outstanding from time to time at the rate of...? 1_tlh t per cent per annum i; until paid in full, as follows: monthly payments of $1,396.85 commencing February 1, 1992, and on the first date of each month thereafter. Provided, however, the entire outstanding balance shall be paid in full on or before "__-2 Q-_-y e-d r 5----- A4XA .f C9-m-__da-t_e_._hE.re-of_, x% ( the maturity date). j Following any default in payment, interest shall accrue at the rate of % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance 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, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be aprlied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after.-Jdn,Ud•ry-- 1_----- 1993 Pal xthsrx "x ftmqc rs-x*xiA *9 )P)axgmak )vkk0Xfx xeca Nstoaxot A%xdoxlt In the event of any prepayment, this contract shall not be treated as in default with respe t to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned prem.~es being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except; a mortgage to Farm Credit Bank of St. Paul in the approximate amount of $70,000.00, which vendor agrees to pay when due, and in default of which purchaser may pay to Farm Credit Bank, and credit all payments made toward the amounts due under this contract. Purchaser has waived examination of an updated abstract of title. Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it s-All be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on...... ~ d n U a ry 1 19 92 rosy Out One. LAND CONTRACT-Individual an4 STATE BAR OF WISCONSIN Wiacoein L,+z.f Blink Co. Inc. Cor Drste V - - f ne ' IIIR 943PA1~ Purchaser promises to pay when duP all taxes and assessments levied on the Pruperty or.upori Vendor's interest in it and to deliver to Vendor on remand receipts showing such payment. Purchas<-r shall keep the iruuovements on the Property insured against loss or damage nc,asioned by fire, ex- tended coverage perils and such oter irasards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of 4f.U_1-1.... lfl_Wrf3_(?le...V.a1U2but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest arid, unless Vendor otherwise agrees in writin4, the original of all policies covering the Property shall b,: deposited with Vendor. Purchaser shall promptly give nctrce of loss ,o insurance companies and Vendor. Unles; Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of ti,e Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from lieu. superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act of default of Purchaser, and exec t: n-e i.t h e r_.p U r G h a S e r n 0 r ...vendor may ass-i..9 this contract without the wr tten consent of the other party-'-•••----- Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of ..-.6.Q.. days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of ..6.4... days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall becwne immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redenrptior to be conditione-1 upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forereited as liquidate.! damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall he liable for any deficiency; or (iii) Vendor may sue at law fur t;.e entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above.Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses incluting reasonable attorneys fees of Vendor incurred to enforceany remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the arpointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a predge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediatelydue and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due und- this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this ...J.s.t.......... day of January =9..92 . t."....(SEAL) l,T(SEAL) Ndr. 1.d...E ......JQh on J-r.._._....._-. Robert T. Johnson _tE Y171), ~ ~G~CIC/ l/i.._.•Ct"/.._.(SEAL)Qir a I"LYVJ7t (SEAL) Ruth M. Joh on Nancy A. Johnson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. County. authenticated this ........day of 19 Personally came before me liiB:M1f -day of " 1llvttC~ 19. Harold E. Johnson, !f i• i .---J o h n s on , R_o b e r_t-- Zr - TITLE: MEMBER STATE BAR OF WISCONSIN N d n C y k. J o h n s o n_+. ' r (If not- ' authorized b y § 706.06, Wis. Stats.) to me known the person S ....ho x+ foregoing in ent and acknowledge tbe4s THIS INSTRUMENT WAS DRAFTED SY /J _ v Thomas-- k, McCormack - . B_..1 d w........_. WJ-_--4 0 0 2--- - Notary Public .._C1tLL'_~~.---------- Cauaiy, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not; 'state expiration are not necessary.) date: 19._......) -Names of per. .ns signing in any capacity should be typed or peimea below their signatures. I,. ER 913FAS` EXHIBIT A 1. Southwest Quarter of Southeast Quarter (SW4 of SE4) of Section Two (2), and the Northwest Quarter of Northeast Quarter (NW4 of NE4) of Section Eleven (11), all in Town Twenty-Nine North (T29N), Range Seventeen West (R17W). Subject to any and all easements of record. 2. Northeast Quarter of Southeast Quarter (NE4 of SE4) of Section Ten (10), Township Twenty-Nine North (T29N), of Range Seventeen West (R17W), St. Croix County, Wisconsin, except North 841.5 feet of East 363.0 feet thereof. 3. The Southeast Quarter of the Southeast Quarter (SE4 of SE4) of Section Two (2), Township Twenty-Nine North (T29N), Range Seventeen West (R17W), EXCEPT a parcel described as follows: Commencing at the Southeast corner of said Section Two (2); thence West along the South line of said Southeast Quarter (SEk); 807.60 feet to the point of beginning of this description; thence continuing West along said line, 180.00 feet; thence North 275.00 feet; thence East 180.00 feet; thence South 275.00 feet to the point of beginning. I o o° Go (D a 4 c c I N i v I N C 0~1 O U C O t d O U C O h T N ~ f0 Z C T O N. C O O O z04 3 (D O E ¢ U) r M 3 W E ~ Z = o I Z ~ I a m r N ~ I r F- Z o O Z ~ i o fn FZ- ~ E Z v ~ I c o c 0 2 Z Z O Z N _ E ~ N N = 4 O Y If) a o c O H d E g oo o o N m a NNCL EL E. (n Z o o o •N IL P-z (D CD C, N N O N t0 y O M ~ ~ Q ~ fJ~ 16 b 7 C O I v to C i v- is E Go Go O N H O CA O V a 0 0 C 01 O Q N CO C N C 7 r N FC ° i E N y~' Z c °CD v c co cc O N O U c6 z ~E N O Z fn E € CL • CC CL 0f ,V d d C rr`N~ o a! 3 9 ) i ~1 A c~ CL 0 o co o v, 0 O N 0 o; f 0 m 4 y o a m O d cv~ V (D 3 3 3 3 OD C- 5T z n N N ',,5 p N 0 n ~ O N (y/~ O 0 W 0 C- z O N vi t1 0 0 (w O p2j et CD 7 CD s M f,") 3 O ry N A 7 3 O co 7 N r.+ A Vt CM "I Iz, C M- N C (D CD O O C Z :z y Cn U) z d U) N O 3 p A O\ O x 7= co C N y W 0 pj t=f) ? to p) N 7 CD Co ET 0 N O. C Q. O O = O L r~~. \ 11 O co C N y p 0. C N CD O N n 0) O N O O p p (D 6 3 O y y 3 O y O' • 7 y fl' 7 O C y (A (A c m o O m m rn! y O y (D m v n< D a w v t c D a i. < D a .h1, CD (D y y d j m y n :3 Q rn 05 N y C rn rn W o f W w co w N O C c O O C O 0 C) N N 3 N co D 3 j co 000 = OD Oo O C, u C) C V O O L CD 4 N L N ? N S o C', :3 D D CD CD co v' UO) A a)~? O a)~ N O C Co c rn rn c +S a CD CD lV a C> o ' o O O O£ O O O 0 0 0 a _ = o -q-1* aQ =r aiaiv~i~l °v 0 ac aat~i~' y v~it~nai' °oN o 3 c D o o 0~ O 0 c O O n O O N fl) fD Ul CD !l~~1 N PD N O d A LI)' '0 (n 0) 0 N ID p y !~i C • • d y O fD Cy) N CL .~i O. y~i N z 3 " z _ N O D D o o z m o z z 2 O D o O O D D a ~ a0i O .n CL Er a) 3 CD fD CD (a "ft s ~ :0 ~ m N Ft11i11 CD _ C CD C N C C co @ I w @ a a 3 a 3 7 3 z CD z CD O O = p O Z N A '_h _ti y C U) pnj p_ A z o Z -1 W m w~ W~ m 0 3 a a z e o' 3 0 p 3 3 0 z -4 C m y y y z CD CD 'O O A G W N W N W a 3 F, v s D 3 3 c) D OD n' .yam.. ?-0 n a *Cc CD C. c ~CD me m 7c -I CD? m _ O> d d m y 00 O d O N O. d m ? Oz O. O y S O (D 'T CD CD y O Q y (D d S y O = y CD CD O f0 7 7 'O ~ CD Z 7C CD y N (D Q O 3 m 00 4 ' n y. Q I ~ I a m c ~ 3 3 a y m K 2)) O f o y 3 m y Er ),4 a rA o 0 0 0 b CD =3 CD CD ti 0 <A o O „ a o o CD CD CL 0 a C) CL Parcel 018-1021-80-000 11/22/2005 09:28 AM PAGE 1 OF 1 Alt. Parcel 11.29.17.162 018 - TOWN OF HAMMOND Current rx is ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner ROBERT T & NANCY A JOHNSON O - JOHNSON, ROBERT T & NANCY A 1963 110TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Addresses : " =Prim ry Type Dist # Description " 1963 110TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 11 T29N R1 7W NW NE 40A Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 04/16/2003 717590 2208/383 WD 942/164 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/24/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 36.000 4,300 0 4,300 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 3.000 16,000 130,900 146,900 NO Totals for 2005: General Property 40.000 20,400 130,900 151,300 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 20,400 113,100 133,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER D2 TOWNSHIP SEC. T N-R~W ADDRESS /'~f. ST. CROIX COUNTY, WISCONSIN Jl~lwlzl SUBDIVISION LOT LOT SIZE AIX PLAN VIEW Distances and dimensions to meet requirements of I•I.HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 751, r 82 - 7 / I Ems, r~~ I ~ Ii go. moo' I A/ -10y-a; lef ch e z5 z®Doc~. I I ~f- ✓ent I r II • 1 I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used n~ Cl~iyle/l~ Sze D nr' l~otlsF /~Orf~' S;a/1.° of Elevation of vertical reference point: /l.X~>0 Proposed slope at site: -317e SEPTIC TANK: Manufacturer: Liq d Capacity: Number of rings used: Tan a of c ver elevation: Tank Inlet Elevation: T k tl vation: Number of feet from nearest Road: Fro t, Side o Rear, O feet .From nearest-property line Front ,O Side,O Rear, O feet Number of feet from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank), SEE REVERSE SIDE PUMP CHAMBER Manufacturer: L quid pacity: I Pump Model: Pump/Si on Manufa t rer: Pump Size Elevation of inlet: Bottom f tank elevation: Pump off switch elevation: salons per cycle: Alarm Manufacturer: Ala Switch Type: Number of feet from nearest property l ne: Front, O Side, O Rear, © Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Lenith: We: Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest ro t, O Side, O Rear,0 FtNumber o fee Number of f et fr(Include distances n plot plan). SEEPAGE PIT Size: Number of pi Diameter: Liquid depth: Bott f eepage pi elevation: Area Built: Has either a drop box O or distr buts box been sed on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: ~QC/D /-s- Number of rings used: 3 Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front , O Side, Rear, 0Ft.1011~1. Number of feet from well: 235" Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Xl' a,-/~ Pl_a7 Inspector: Dated: ~ - Z'2 Plumber on job: :Z)Ql' License Number 3/84:mj Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT C ✓oTOWNSHIP /~7✓~//fJl~/~`~ SEC. N-R~W OWNER D// l> ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 LJ~j- SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i~75/ " /0 i z Nr~• ,70~ j e-d 41 4 5 ~11 `j I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used i / 5?.`p i Elevation of vertical reference point: Proposed s o e Oaf t s te:o u> e__3`/) SEPTIC TANK: Manufacturer: Liquid Capacity: Xeoo qQ/ Number of rings used: O,oe Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,® Rear, 0 zCI)Q-` feet From nearest property line Front, G)Skde,Q Rear, 0 200'1- feet Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) CFF. REVERSE, STDF PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Ma tiI fact er: Pump Size Elevation of inlet: Bo tom ank elevation: Pump off switch elevation: ons per cycle: Alarm Manufacturer: Al Switch Type: Number of feet from nearest property ne: Front, O Side, O Rear, 0 Ft.~ Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Len$th•/Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest pro a ty n Front, O Side, O Rear,O Ft Number o fe t fro we 1: Number of -'eet from b,'ildi g: (Include distances on plot plan). SEEPAGE PIT Size: Number of p s: Diameter: Liquid depth: Bot m o see a e pit elevation: Area Built: Has either a drop box O or di/trib ion ox been used on any of the above soil i absorbtion sytems? (Check one . HOLDING TANK Manufacturer: Capacity: Number of rings used: Etat17 `of/ ttom of tank: Elevation of inlet: Number of feet from nearest pro er y ne Front, O Side, O Rear, OFt._ Number of f t f, m we Number of feet from build g: Number of feet from nearest road: F Alarm Manufacturer: Inspector: Dated: F-22 -dc?41 Plumber on job: License Number: A?y 3/84:mj / f EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS A8QR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O. BOX 7969 BUREAU OF PLUMBING ADISON, WI 53707 El CONVENTIONAL DALTERNATIVE slalePIS. I.D.Nurnl- (11 xfrpnMl D Holding Tank ❑ In-Ground Pressure O Mound TANK REPLACEMENT ONLY NAME Of PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE D / Harold Johnson, Jr. Rt. 2, Baldwin, WY 54002 --,L2-~-O1j BENCH MARK fp"Manenl reference porntl DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF PT ELE V NW NE, Section 11, T29N-R17W, Town of Hammond Narn« nl PlunHr«r. MP/MPRSW No.. County- Sall I.,V P"rort Numlur: Dale Hudson 6629 St. Croix 83845 EPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANKINLETELEV. TANK OUTLET ELEV WARNING LABEL LOCKINt; COVER PROVIDED PROVIDED OYES ONO OYES ONO BEDDING VENT DIA. VENT MAT L. I/IGH WA IT NUMBER OF ROAD: PROPERTY WELL JBUILDING VENT TO fNFSH ALARM FEET FROM LINE AIR INLET DYES ONO OYES ONO NEAREST DOSING CHAMBER: MANUF ACTUREH ISFUDING ILIOUID CAPACITY PUMV M/IUEL PUMP. SIPHON MANUF AC TIMER WARNING LABEL LOCKING COVER PROVIDED PROVIDED OYES ONO OYES ONO OYES EINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF P'4( lilt it IV 11111 Lt 1111111 DIN6 VENT TOT 111 Sri (DIFFERENCE BETWEEN FEET FROM LINE AIR INIFT PUMP ON AND OFF) OYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I F N(sTtl Ili 111A 11'11,11 AND MAIIKINI, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO O UISiR PIPE SVACINIi COV H =Sllll 11.1 IU THE NCHFS MATEit UFP111 DIMENSIONS (,HAY LO.PFR rILL DEPT '1 11%11( PIP! UIS tH PIPF ISTR. PI MATERIAL NO DISIH NUMBER OF ,PHUPERIY WELL RUILOING Vf NT to 11OSrl 1111 LOW PIPES ABOVE COVEH ! 1 F V 'NI I 1 ELEV ENU PIPES FEET FROM LINE AIR INLE T NEAREST-► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it . ON REVERSE SIDE. SHOW ELEVA- OYES ONO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TfxTURF PFNMANI NI MARK 111.5 11IM 11VAnnN Will.,, _ NO OYES LINO UFPTHOVER THENLOVFR HlNC.11 AEU OYES ti1111UFU E_J U111 MuI UrIU CENTER EU(:E5 OYES ONO DYES ONO OYES r--]NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH Lt NGT11 TRENCHES LATERAL 5PAEIN6 6HPVEL UIPT'1 Hf LOWPIPI ' 11 L UFPTH AHIIVf (:()V1 H TRENC DIMENSIONS MANIFOLD PUM MA N II DLL) DISTR PIPE IMANII OLD MA E141Al ]NO U1511/ 1:15111 PIP! I)Iti1PIHUIIUN Vn'I KiP,1l Hlnl 1L KINIK IN4 ELEVATION AND ELEV ELEV DIA ELEV. PIPES WA DISTRIBUTION INFORMATION HOLESIZF HOTESPACIN(1 UHIL Lf)(o'OI(Elly CUV(H MA1k IIAL VF HlWAI 111 T COHHI SPIINUS TO AVPItOVIit PL nn~5 DYES ONO OYES ONO COMMENTS: PtRMAN NT ARKER OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE OYES ONO OYES ONO NEAREST-~ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILUkr.va ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O. BOX 7969 BUREAU OF PLUMBING ADISON, WI 53707 teO.NumbeC. Plan OCONVENTIONAL LnYALTERNATIVE 111Snasag nedlgnMl (THolding Tank O In-Ground Pressure Cl Mound At -Z 3 95 [AME Of PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE Harold Johnson, Jr. Rt. 2, Baldwin, WI 54002 a -02 q? 449 BENCH MARK (Permanent reference potnl) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV. CST (EEF PT ELEV NW NE, Section 11, T29N-R17W, Townof Hammond nrrr.M PlurMler. MP/MPRSW No.. County Sanrlarv Perron Numller: Dale Hudson 6629 St. Croix 83842 EPTIC TANK/HO DIN TAN : MANUFACTURER ILIQUIO CAPACITY TANK INLET ELEV. TANK OUTLE T E LE V W N (i LAL LOCK (i COVER DED P UED ES ONO _ YES -1 NO TO FR SH REDOING JVENT DI VENT M L. HIGH WAT NUMBER OF ROAD: PROPER TV WELL BUILOIN : IVENONLIT ALARM FEET FROM Alll DYES NO DYES ONO NEAREST OSING H BER: MANUFACTURER BFDOING JLIOUIDCAPACIIY PU67V MUUEL PUMP. SIPHON MANUI ACTIBIEH WARNING; LABEL LOCVKING COVER PROVIDED PROIDED DYES ONO OYES ONO DYES LINO GALLONS PER CYCLE: vuaP AND CONTROL OPERATIONAL NUMBER OF PHnP(It IV Wt Lt HUH DIN(, VENT TO FTUStI (DIFFERENCE BETWEEN FEET FROM LINk AIR INLET PUMP ON AND OFF) DYES ONO NEAREST---*-; OIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I NGIII n1AMI n R j1AffI#IA1 ANO MARKINt. r excavation. (If soil can be rolled into a wire, construction shall cease until FORCE e soil is dry enough to continue.) MAIN IhONVENTIONAL SYSTEM: WIOTH LENGTH NO OF UISIR PIPE SVA(:IN(i COV II JINS11)f H•1 aPITS LIOUIU - BED/TRENCH 711ENCHES MATERIAL' PIT IIFPI 4 DIMENSIONS f,11AV1L UFP H FILL OF PTII I 111DISTIL PIPE DISTR. PIP. MATERIAL NU UIS1H NUMBER OF PROPEL(IY WELL HUILOING VENT TO Ffit SO ItF LOW PIPES ABOVE COVER 11 f V ONO I T ELEV ENU PIPfS FEET FROM LINE AIR INU T NEAREST-► OUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it . ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. OIL COVER TFXI)Ht PC R61ANINIMA14KIH$ 1"I'MIIVAIt(INWIIIS Uf PTII OVER IHE N(:11 HfO UEV111 OVlH IRENCI/BED IIAPTH OF TOPSOIL DYES ONO C]YES D NO tit 11)OI I) ~F[O(O MI)I t:HIO CFNTER EDGES DYES ONO OYES DNO DYES C_INO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LIN(011 NO.OF LATERAL SPA(:ING GHAVEL OE P714 HI LOW PIPI f It L OF PI If AHOV( COVI 11 BED/TRENCH TRENCHES DIMENSIONS MANIFOIA) PUM MAN If GTU UISiN PIPE MANIFOLOMA EIIIAL INOtOIS114 1:15111 {'IV! UItiIIi1HII1 H)N VII'1 KtAIIHIAI an1AFfKINt, ELEV ELEV DIA ELE. 1' UTA ELEVATION AND V IT, S DISTRIBUTION INFORMATION HOLE SIIF 114LESVAcING UIIILtLUCO1tRl CILy COVERMATERIAL V1F111t1A1 III fC0I/HFSI'f INUSIf)APP1/11VIU PLANS DYES ONO OYES DNO COMMENTS: IPERMANENT MARK R : OBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING FEET FROM LINE OYES ONO DYES ONO NEAREST o 'Sketch System on Retain in county file for audit. Reverse Side. ' I LL DILHR SBD 6710 (R. 01/82) [7ATURE 77 5ILHR SANITARY PERMIT APPLICATION ~~NTY --s- In accord with ILHR 83.05, Wis. Adm. Code STA©TE SANITARY PERMIT # - .133 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE 8% x 11 inches in size. TE PLAN I.D. NUMBER -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION n/i Tr S / T ,N,R 7 12 (or W PROPERTY OWNER'S MAILING ADDRESS LOT N7ZR BLOCK JV~BER SUBDIVISIO/NAME CITY, STATTE, ~ p ZIP CODE PHONE NUMBER C/IVTY/ NEAREST RO.A.,D✓ LAKE OR LANDMARK V TOWN OP ILLAGE : I-10 ~r1/y'oo`'r~ II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family -3 OR ❑ Public (Specify): X1X III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. ❑ New b. E1 Replacement c. -K Replacement of d. ❑ Reconnection of e. E1 Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑ Conventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e- E] Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Feet ❑ Private r~1 ~ Joint ❑ Public VI. TANK CAPACITY Site in INFORMATION alions Total # of Prefab. Fiber- Exper. New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank /4~ /GY7C~ G'f Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ VF-I II. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: e?/e Z", /-&4~snj ~ . ~-~-~%x~-,-V- ~ / G~'`•r-:3.37 Plumber's Address (Street, City, State, Zip Code): Name of Designer: Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # CST's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Sum arge Fee Adverse Determination p~S Q X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR: COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanita,y Permit Transfer/Renewal Form (SBD 699) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintainEd. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions; concerning your private sewage syste (;ontact your kcal cocse ac:m; istrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: . Property owners narne and r,iailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: IT public is checked, indicate lype of use J.e. 10 unit apartmen~, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in #1. Complete #2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; Vll. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z 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 holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is 'Trore commonly known as the groundwater protection law. This change in statutes wa . the result of over 2 years of steady negotiation and public debate. The groundwater ~)i;l (;;oUrCuvater - inciuded the creation of surcharges (tees) for a number of regulated practices which Wisconsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water tha' buries: )feasure A is used ir,, your building is returned tc the groundwater through your soil absorption ; system or the disposal site used by your holding tank pumper. \ U he r ion es :,ollectec` through these urcharges are credited I.:) the gr-)undwa' 7 fund adminis t rec; by he Department of Natural F?SOUrces. These funds are used for mop loOrg ground- g zte; , grour!Jwater contamination in-c estigations and establishment :;f stamda- d arou ldwate, i:_'s worth protecting. `-ZD-6398 (8.03/86) Viol4tion Number Form - S T C -101 f PRE SANITARY PERMIT ISSUANCE PROCEDURE Location Section Township Municipality Lot No. Blk. No. Subdivision NW ~4 NE '4 11 IT 29 N R 17 W Hammond Procedure prior to sanitary permit issuance where a septic tank must be replaced. during winter weather or other health emergency and soil evaluation or other sys- tem evaluation cannot be conducted. 1. Obtain assurance that the property owner is aware of further requirements for a system evaluation. 2. Obtain assurance that owner is aware that if system is found to be failing, it will be their responsibility to replace it with a code complying system. AFFIDAVIT TO BE SIGNED BY PERSON REQUESTING THE SANITARY PERMIT: I, Harold Johnson Tr , the undersigned do hereby acknowledge that I am receiving a sanitary permit to replace conventional system without asoil and system evaluation due to inclement weather of health emergency. Furthermore, I acknowledge that a soil and sy~~-m evaluation will be conducted as weather permits and that if the system is then found to be failing as defined in Section I L H R 83.02 (18), Wisconsin-Administrative Code, it will be replaced with one that complies with Chapter I L H R 83 of the Wisconsin Administrative Code. If temporary pumping is to be utilized for maintaining a newly installed septic tank, due to failure of the system, the tank shall be maintained by a licensed pumper in accordance with N R 113, Wisconsin Administrative Code. Al- SIGNED DATE August 21, 1986 A copy of an affidavit in lieu of EH 115 along with the PLB 67 must be submitted to the Plumbing Bureau for purposes of fee reimbursement. 8-21-86 Signature of AoKplicant Date Subscribed and sworn to"before me STATE OF WISCONSIN This 21 day of August 19 86 SS. COUNTY OF Nota Publ c, tate of Wisconsin My Commission Expires: January 7. 1990 SANITARY PERMIT APPLICATION COUNTY 'ZDILHR In accord with ILHR 83.05, Wis. Adm. Code J , Cro r~Y STATE SANITARY PERMIT # I'3rll -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. - d 339. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER / PROPERTY LOCATION C T, 1W114 /VS' S T N, R /-7 l ®(or W PROPERTY OWNER'S MAILING ADDRESS LOT NU BER BLOCK NUMBER SUBDIVISIO ~ME k3~f 2 W /V CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK wi f y O VILLAGE : ~C!/J'J/ls~Oj/:/(/ l~P✓ TOWN OR 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): 11114 III, PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. X New b. ❑ Replacement c. E1 Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑ Conventional b. ® Alternative C. ❑ Experimental 2. a. ❑ System- b. P? Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. E1 IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. ❑ seepage Trench c. S a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA X4115 S R O AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): P SE q re Feet): O joint ❑ Private I~.I Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank y-r Lift Pump Tank/Si hon Chamber ❑ ❑ F-1 ❑ Li 1 ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ale f_ . f~tr~s0~ ai Z e,,?9 G8~ :3378 Plumber's Address (Street, City, State,~Zip Code): Name of Designe VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # Dale ~ ~u sow 3~/.3 CST's ADDRESS (Street, City, State, Zip Code) _ Phone Number: IX. COUNTY/DEPARTMENT USE ONLY X❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (N Approved ❑ Owner Given Initial ~y T Surcharge Fee o Adverse Determination V as O 401 X. COMMENTS/REASONS FOR DISAPPROVAL: 0 Vj ~C SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION h TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be humped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage syster,,, contact your local code ac+niioistrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description; where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a ole or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/z 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 holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more 7 commonly known as the groundwater protection law. This change in statutes was the ~ result of over 2 years of steady negotiation and public debate. The groundwater bill Grog:-)d ater = - i n c 11H 'he creation of surcharges (`ees) for a number of regulated practices which WW€s'ron's Pl~rar' groundwater. The surcharce took effect on July 1, 1984. All of the wate that Dur€e- treasure s i:, liour building is returned tc the,groundwater through your soil absorption f ~stem ow the disposal site used by your holding tank pumper. N ollected through these surcharges are credited to the groundwater ±und aciminis # Apartment of Natural R,-'sources. These funds are used for rnor ?or irg ground- rw"i rater contamination €r estigatinns and establishment c' st~r?da d4 arc~r,c watt :,te. ting. ~.;lU.-o~0~ ~o /1 h SOrI U r ~rGt u.~~7 ~y: 19,2P~~ 29 APIIPROVV.D PtiImB'rN0 E.M. - leo, o KPARTMENT (If INDUSTRY. iANW AND 4:SMAN REEATtQ1VS DIVISION OF-SAFETY AK,,BVILDtNGS Q 31-91,52 3 Z - q,2 G'9 ; re MR~.~Pt~►~I~~rac~ Q~~' ~ e~e- J ~ W Nf~ 97,19 ~'z9N RiWd r7 5 L /3e n C A /~ar e `s 7ro~ B Z, F- 8 a of ce rn e fi/ f<<-- 7 q S cP a n ~o~fh s~c% a~' house o u -0 -zr 4 r3,/~,-.~er~ofs Bench /~a~~ aoMt `~5 I B # a - keno fes (3 owe ~✓o ~~,5 4 70 /'6tg1~ rc ,25 Se~~~'ce Rood Sba yS~vc ~c v°Lv .2000 Go~, f„I,e.~f 55 35 ►y A , 3 I ~ 814 ?3 cb 2, RIO -1 IL A? 17 /0 7 90' ~o RECEIVED ►~1~07 v L I PLUMBING BUREAU C1. PAGE 0F-L_, L ♦ I Cl3 oC F- Li -4 L~J :2 2 -xi-11 > W f~_ `C o W > p W = 0 W 0 0 h~ tc cL O c1 ~ 0 W W > ~ ~ T 2 Q O ce Li 000 `n wo '7 a>ic F-Q p p~ W ,n i.. H c1 2 r 2 O tia Q O Wp W~ ~Llp miry cJ 0 2 £W O 'n w F" 4 a W W Q F- F- < CC %J ce Li J n W W 0 ~r N > O n.J m= p 0 W¢ a o w Y Y U. a D> of I 20F- C ~w o-'o to Q Q W ~~~0 ~o J d :3 :C 2 Li Li 4QZ Z .19 W Q 0 O cc \ } W K U W Q ;.1 0 Ln :2 j 'n ~ iV N 2 J W go O Qa y C J co U. 2 H Li 0 CC CC 2 -3 2 , J WE J O a 2 I a- 3- O W ~l lwr ~:N W O p _jJ W v J ©~nk z o~ V x. n c I 2 Ti Of o F- fv 0 J H Q e 2 e 3 : \ a W N Q W > ¢ ~J :2 ja f~ o Q W T)i O J m v zW 2 f YQ o ~ M c~ v J F Li O W Q s,! w J d Q ? W OC 0 J 2 W W x c9 J_ Q tJ to J p DEPAR711,LrNTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INuUSTRY, ' DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 HU:rVIAK RELATIONS N WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: pp/ TOWNSSHIP/MUNICIPALI Y: LO`T/NO.:BLKK..~NAO.: SUBDIVISION NAME: COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES BSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: PER ATION TESTS: I0 Residence ❑New ❑Replace 1.7 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(opti al) DS ®U DS ~U 11 DS Zu ❑S MU DS ❑u v If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXT D DEPTH NUMBER DEPTH m, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) O B- -317 -53~ y~ "I~ f ~V " Ups/~~ I/. 413 B-6 3, 0" A7 15' //S " ° 1s7"' 3' sG PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D2 PERIOD PER INCH P- P- P- P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9. t i ~ 1 I t i i I I I Document No. This space reserved for recording data HOLDING TANK AGREEMENT k Agreement Date June 30, 1986 This agreement is made between the ~t 1~_ ° f~ County or Local Governmental Unit I Holding Tank(s) Owner(s) Township of Hammond Harold Johnson, Jr. (Called Municipality below) I We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) NE4 of the NE4 of Section 11, T29N-R17W, Town of Hammond Return To Dale Hudson Boldt's Plumbing & Heating Baldwin WI 54002 or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. As an inducement to the County of St. Croix to issue a sanitary permit for the above described property, we agree to the following: 5- 16-o 3 fir 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 nuisance as described in ss. 146.13 and 146.14, Slats. the municipality may enter upon the property and service the tank or cause to have the tank 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. Owner agrees to pay all charges and costs 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 nuisance or 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 of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. fek '3 . The owner, except as provided by s. 146.20 (30) (d), Slats., agrees to contract with a person who is licensed u, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municip=i nd with t ounty. the owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with tp~litthe county within ten (10) business days from the date of change to the service contract. r1~V 4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall sub~'fzJtf~rAu?'tc~n -0R"he county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under s. 146.20 (3) (d), Slats., the owner shall submit the report to the municipality and the county. 5. 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. p 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit tgrepasaht 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. 11 11 O 7 1986 Owner(s) Name(s) (Print) I Owner(s) Signature(s) PLUMBING BUREAU Sub cribed and sworn to before Fne on this date: Harold Johnson, Jr I , I Mary J. Jenkins Muni 1 1 Official Name (Pri I Municip I Official Signature ~J Notary Public My commission expires: t~ f;.Ge nt) S I January 7, 1990 M OR ic" Ti GALE SBD-6123 (R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. M ST. CROI X COUNTY c:; ,91r~. x: , WI SC0 N$I N 4yl~' 796-2239 ING OFFI Po,6t 0666 'ce Box 227 r /F f. `11 I Hammond, WI 54015 O W N E R P U M P E R A G R E E M E N T PLEASE BE ADVISED, Tkat unt.it you are again no.ti.6•ied, I wilt eontAact with kA s s l' .C gs aav~ o 6 WjAconain, (Pumper), box the punpoae o6 nemov.ing att waa-te 6nom the ♦an.i..tany aya•tem to be toeated on the pa.open.ty and 6u.tune home a.i.te Located in St. Cxo.ix County, Wi4cona.in, Townah.ip o6 being in •the~~ o6 the ~4 o6 Sec. T. W. (Ox mo ne Gutty dea e/Lib ed as 6 ottowa . ) 0 3 3 9 5 Dated thiA day o6 19 . (OWNER) State 'b6 W.iaconain) as County 06 St. Cto.ix ) PenaonnatCyappea g. be6o4e ne .th.ie day o6 -Gt~xcJ 19~~. the above named to nown to be the pexbon who execute .t a egoing xn nument and acknowtedged the Game. o an y u .t nox.x oun y, My Comm. (.%e penman.t) (Expi&ea) - -9D /s es hen.ein:be6o4e ne6e4ned to as Pumper, jokn 4.n the above agneemen.t to the extent that I have a eon.tnact with Ownex as above etated. (V~( vL~ IX, ~~MPER RECEIVED JUN 2 4 •196b PLUMBING BUREAU • H z cn H a STC - 105 r' r a SEPTIC TANK MAINTENANCE AGREEMENT r St. Croix County z 7 ty OWNER/BUYER V /`~'QYO D-I'1-~"Dl? ~/r > y ~ a cv ROUTE/BOX NUMBER_ IF 7-. Fire Number .CITY/STATEZIP PROPERTY LOCATION:N&) Section 1/ T~V N, R /7 W, Town of ~~-ll/✓~iB/?L , St. Croix County, Subdivision A/X Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC - 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 Location of Property 4~ ~)Ig 14, Section T N - R ~Z W Township /Yoi~7/~?OII~ Mailing Address Z4/i . J`L~~d U ' / A v Subdivision Name Lot Number /0 , Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume 'VI-10 and Page Number 97v f as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (We) eeAtl.6 y that at t b tatement6 on thiA 6otm ate true to the but o S my (oun ) hnowt edge; that 1 (we) am ( cute) the owneA (d) o6 the ptopW y de,& cA i.bed in th,ie in6o4mation 6o4m, by vi tue o6 a wawtanty deed teeotded in the 066.tce o6 the County Reg.iAteh. o6 Deeds ab Document No. -291OO ; and that I (we) p4e6entty own the pnopoeed & to Got the 6ewage dizpo,6at aydtem (ot I (we) have obtained an eabement, to tun with the above dedehi.bed ptopexty, Got the eon6ttucti.on o6 baid d yetem, and the dame h" been duty tecoAded in the 066.tee o6 the County Reg.cdteA o6 Deed6, a6 Document No. ) . . ,s./ SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED No. &L W&rrantY Dodd-.Common Form (STATE OF WISCONSIN) Boa. Zss-18. Wis. Statutes. Form No. 1 PubAsbed by Eau Clain Hoot # Station= Co. 201300 This Indenture, Made this da of February , A. D., 19 68. between aka Harold E. Johnson Harold E. Johnson, Sr./and Mae Johnson, husband and wife and each in their awn right, part iesof the first part, and Harold E. Johnson, Jr. and Ruth M. Johnson, husband and wife and as . joint tenants., • part ie $f the second part Mitntoottb: That the said part ies of the first part, for and in consideration of the sum of One dollar and other valuable consideration to them in hand paid by the said part ies of the second part, the receipt whereof is hereby confessed and acknowledged, have given, granted, bargained, sold, remised, released; aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ies of the second part, their heirs and assigns forever, the following described real estate, situated in the county of St. Croix II and State of Wisconsin, to-wit: Southwest Quarter of Southeast Quarter (SW~, of SE') of Section 2, and the Northwest Quarter of Northeast Quarter (NWT. of NE~) of Section 11, all in i Town 29 North, Range 17 West. Subject to any and all easements of record. i I . r. IIi 1a it Sogttbet with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said parties of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises and their hereditaments and appurtenances. 'Co I?abt anb to 1?oIb, the said premises as above described with the hereditaments and appurtenances, unto the said part ies of the second part, and to their heirs and assigns FOREVER. qnb tTjt %aib. . Harold E. Johnson, -.Sr. and Mae Johnson for their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said part iesof the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents they are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said part ies of the qq. L ~QIG P~? • (b U1 ~ y I 0 10 LND r" b :t1 t;* (b L 0 00 y h O b R { OIQ a ;4 (b -0 C', til b p. Cb ! ;a a. co i (•.uglou Pug asoaaa;}es 'Saaquu.a amaugas 91p jo eagagu oqt aoaaaq; uaUVA8d4 so Pa;a{ad Sjujgld essq llvgo POP40004 M 03 g1uam048II) Ulm lgga vDP}Aoid '1414S VIA 84 "q0'-"II"K) Qq pa;;eza utsuooSTR `~aZZe~ Sut,zds `RL-I uosp.zsuotU pule 07-AVO • ~4uausui.zad sarrdsa uorssimmoo AN •~}uno j aoaazd `oFlgnd ~fmoN pa A R y. ,T L'rJ •11 gaego-g •e aq ; pa pal ouzo ue ;u rj7&10 ; aq; pa;noasa orlAi s uoszad aq; aq o; uMouq auz o; uosuuor alaN pine --IS `uosuuor •9 PTO-ILH pauzgu aeoge aq; 6.8 Liunagaa ;o Agp m srq; `aur azo;aq arueo Allauoszad J-Swnoo `u;ouc3olm ao MOM t IeaS)_.. - OTAVO •H q,zagoH uosuuor e I.Tuosuuor 'H pZo H v 79L ;o aouasard ur pale S pug pau2r .89 61` a -V ` Sjun.zga j ;o lop srq; s [gas pus s pugq JTI;Dq . ;as o;unazaq a1Bq ;zed ;srg app sat ;zed pres aF1 a4m MUM UT *aMff d.7Q Pue .L111 VUUVAJ ranaro; UFM Rauq `;oaraq; ;zed Aue ro alogAi aq; 2urrure[a ZIln;Aae[ 'suosrad ro uoszad A.Fana Pug Ile ;sure2e `su2rsse pue srraq,ztau-} `z.red puooas G vvck DILHgR Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, Wl 53707 Private Sewage Plans Telephone: (608)266-3815 r Plan ientitication No. Gallons Per Day j - w ! PRIORITY PLAN REVIEW ONLY Plan Review Fee Received Petition f nr Variance Fee Rec. Project Name Project Location - Street No. or Legal Description 1 County ❑ City ❑ Village lY Town of: The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: 1 , 1 l ~ ~P i -A / Qm~:~ ~L \ l rte; c' James Sargent Bureau Director T? 1 If Questions Plans Approved By: Date Approved: ; Contact y cc: ❑ Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health k-f County ❑ Local PI ❑ Facilities Need Analysis Section ❑ L)W-SSWMP ❑ Plumber ❑ Department of Agriculture DII.HR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other fState of Wisconsin ` Department of Industry, Labor and Human Relations August 7, 1986 SAFETY & BUILDINGS DIVISION Bureau of Plumbing 201 E. Washington Avenue P.O. Box 7969 Madison, WI 53707 Mr. Harold Barber Ily Zoning Administrator St. Croix County ' ~1 1030 Davis St, Box 98 Hammond, WI 54015 Dear Mr. Barber: Subject: Harold Johnson's Holding Tank Plan Submission Late last week you and I had a conversation regarding state permits and after resolving that issue, you indicated to me that the Harold Johnson, Jr.'s of the Town of Hammond, St. Croix County had submitted plans and specifications for a holding tank. You also indicated that two months had passed and seemingly nothing had happened in terms of an approval for that installation. I checked on the status of that file and will give you a chronological order of events as they occured on that plan submission. We received the plans on June 24, 1986 without the required plan review fee, holding tank agreement signed by the owner and the local governmental unit responsible and the need for a plot plan signed by a certified soil tester. The request for this additional information was sent out the next day to Boldt's Plumbing, 820 Main Street, Baldwin, who was the submitting party. On July 7, 1986 the information requested except for the plan review fee was submitted to us, and we returned an acknowledgement statement indicating that the $30 fee was still required prior to review of the plans. On July 16, 1986 a $30 fee was submitted, and the plans were accepted for review. On July 28, 1986 a plan examiner reviewed the plan and found that the holding tank was serving a replacement mobile home next to an existing structure. The soil report for the proposed holding tank indicated very specifically the soils in the area would not support a private sewage system and the plan examiner wrote to Boldt's Plumbing on July 28 requesting information on the type of system serving the permanent residence. On August 1, 1986 Boldt's Plumbing responded to our inquiry for information and indicated that the existing home did have a private sewage system. That private sewage system was a conventional system but was in noncompliance to chapter 83 in that it only had a 300 gallon steel septic tank and an overflow pipe discharging into a roadside ditch. Mr. Boldt indicated they were proceeding with plans to replace the existing system with a mound. The chronological order of events establishes that the request for and submission of additional information and fees took a substantial amount of time. Once the plan submittal was complete, we reviewed the plans within DILHR-SBD-6423 (N. 04/81) State of Wisconsin \ Department of Industry, Labor and Human Relations Mr. Harold Barber SAFETY & BUILDINGS DIVISION Page 2 August 7, 1986 the 15 working days allowed. This plan has now been accepted, reviewed and the holding tank approved. The bulk of the time spent on this plan was just trying to obtain all of the applicable information. The information was crucial because not only did we approve the proposal but we found a private sewage system operating adjacent to this mobile home that discharges raw sewage into the roadside ditch. Harold, I believe the system worked the way it was suppose to, and it also points out that an incomplete plan submission makes it difficult for everyone. If you have any further questions or if I can be of any further assistance, please do not hesitate in contacting me. Sincerely, J es Sargent, ureau Director r JAS:mge:0247b cc: Senator Harsdorf DI LH R-SBD-6423 (N. 04/81) i ST. CROIX COUNTY WISCONSIN " ZONING OFFICE 796-2239 (HAMMOND) ` 425-8363 (RIVER FALLS) HAMMOND, WI 54015 August 4, 1986 UMr. James Sargent, Director Bureau of Plumbing 201 E. Washington Avenue P. 0. Box 7969 Madison, WI 53707 Dear Mr. Sargent: An on site investigation of the soils was conducted on the Harold Johnson, Jr. property, located at the NWT of the NE14 of Section 11, T29N-R17W, Town of Hammond, St. Croix County, and no suitable soils were found less than 18 inches for the holding tank. This will be for a new mobile home. The Plan ID# is 86-03395. Please rush plan approval to facilitate issuance of county permit. Thank you for your cooperation. Sincerely, Harold C. Barber Zoning Administrator HCB/mj STATE 01.WISCONSIN INSTRUCTIONS TO SENDER: REPLY MESSAGE REMOVE YELLOW COPY FOR YOUR FILE. FORM AD-16 SEND REMAINDER OF FORM INTACT WITH CARBONS TO PERSON ADDRESSED. TO: FROM: Sao S`Ic)c3Z fn4r~:aciv., w ~S Sblo7 SUBJECT-MESSAGE (ny p _ IJo,rol~ \lot~. u.z o... Z r . M u , N P-- Lk 129 , cl w - PIAu ~D 6~- C~ t~ 1~ ~ ~O.MM O►~~ ~ S~. CCO~X ~ ~J~S, ~1~ l a 5 ut. \A,. ~ r _ C2) Q, cl`5 Cx'.~~;MS > o"a- \ka ~c~ 4 SQ:JC.,~~ S7S~Cw. ? (3~ (w~ 7 b ~ S ~ r1 ~1 ~,w~, ~ v..~ Cc`..-~ ~ iwb~ S o . ~-S ~ ~ V : l ,~c,ve Q~ ~~e,~0.cac~\So. - (k So.~ 'JOri+ I~~y0.Ce ~U tl~. 'h'\tiv. REPLY SIGNED DATE cc. P.g.c, _t c-c . . T Vr- tFJ, ~ ra r. ~ . SIGNED DATE ,x t -Ct ;y ~rO~o1 VO /7 /')Sa17 U r • ~r0 u~I7 ~y: r•, 'fit' 2 • h~«ol~ 29 3 l - 9/+ 52 v~JP abo ~PJ 97,19 T29N R176v 75 I ' L ~e nC h //or i S Tai B Of ~ err~Ei'1f Sf~~ an /~o~-fh s~c% c~ house . , -21 Q ~3,/n,-~~nofs Bench /~a~7~ aQM~ # n - D5• I f3 eno fps j3o~e /,~o%s 70' ,25 se~~,ce Rood I Shell .2000 Gn~, o "IV 55'~ 82 ate- 7Y• > o X 3 o5I v 83 4? Al ICI ls /07 90' RECEIVED I I. I l J L 0 7 198b r,~ i in,APONG BUREAU DEPAR-n^,M~ENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTITY, c DIVISION P.O. BOX 76 LACOR AND PERCOLATION TESTS (115) MADIS ON WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHHIP/MUNICIPALITY: LOrT/N/~O.:BLK/./NCO!.: SUBDIVISION NAME: N&1 '/44'/ /TZA/Rr71 (or) W1 12 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES BSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS. [Residence ❑New ❑Replace I / ,17,.~~ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: JMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(opti al) os ~u os ~u as ~u as ®u ~s au n' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ~O under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: J PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, T XT AND H NUMBER DEPTH M. ELEVATION OBSERVED ES . IGHE T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7-6 _50 wo '95 3 1 J7 (,3 B- 5 17 IV PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 P R PER INCH P- P P. f jSBD 6678 (R. 08/85) (Plb 100a) (Wis Stats. S. 145.02) ' t ( s STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 ' Any Return Correspondence P.O. BOX 7969 Private Sewage System Only- Does Not General Plumbing or MADISON, W153707 reviews that must be submitted to t ings & Structures. 608-266-3815 DATE: f PROJECT: N tr,;'~c, /may _f~ tst. l r~ i r!, n ! 41V'Lj.~ PLAN ID. ~i v- J3:f Sl J DETACH HERE - - - - _ - - - - - - - - _ - - _ _ - _ _ - - PROJECT NAME +)Cli Csy1711, Jt'., ii +"C )C; - kL-siE r Fitac PLAN ID. This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ 30•0) Fee Received is $ 'lJ-O U Plan accepted for review. ❑ underpayment-Please submit additional fee. Plans will be held in abeyance. ❑ Additional information required-SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. ❑ Overpayment-Refund forthcoming. ❑ Plans being returned. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Variance signed by county, owner and. ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Common ownership Plumbing System Easement. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Cross section of system. ❑ Pipe lateral layout. V. Dosing Information ❑ Plan view of system. ❑ Calculations for total dynamic head and gallons Verification of Exception Status Form by county. (1 copy) pumped per cycle. ❑ Size, length and depth of force main. III. Private Sewage Systems ❑ Detail and model of pump or automatic siphon, including ❑ Ground slope with 2' contours in entire area of soil absorption size, pump curves, drawdown, and average flow rate (GPM). system extending 25' minimum on all sides. ❑ Cross section of dosing tank showing pump(s) or siphon(s). ❑ Location of area suitable for replacement system - provide soil data. VI. Systems in Fill (Fill must be placed prior to plan submission.) ❑ Construction details of septic, holding or dose tank if site ❑ Total area filled (fill to extend 20' beyond<edge constructed, or tank manufacturer if state approved. of trench before side slopes begin.) ❑ Construction details and cross section of soil absorption ❑ Depth and type of fill. system. ❑ Copy of signed onsite report by county or district staff. SBD 6678 (R. 08/85) (Plb 100a). (Wis Stats. S. 145.02) "R STATE OF WISCONSIN DILHR Detach And. Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 MADISON, W1 53707 Private Sewage System Only -Does Not Includ eral Plumbing or reviews that must be submitted to the Bu u a & Structures. 608-2663-3815 DATE: PROJECT: X36?iiliSJil' g l~~/,~► X986 r.. ►~t.,i;c, i 1 Li i 7 . 601uL's P luiToi-ty y` . .rctx i CCU a9c1 ii: JCt^~~%. alGwia, VI b4U02 PLAN ID. # DETACH HERE PROJECT NAME dt~ttttSOEi, at"., ttdti"r0 it - itESls~~tlGi PLAN ID. Ur"-Lt3' ja' This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ 'U."JO, Fee Received is $ 0 Plan accepted for review. ❑ Underpayment-Please submit additional fee. Plans will be held in abeyance. ❑ Additional information required-SEE BELOW. XNo fee has been remitted. Plans will be held in abeyance. ❑ Overpayment-Refund forthcoming. Plans being returned. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Variance signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Common Ownership Plumbing System Easement. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank: Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Cross section of system. ❑ Pipe lateral layout. V. Dosing Information ❑ Plan view of system. ❑ Calculations for total dynamic head and gallons ❑ Verification of Exception Status Form by county. (1 copy) pumped per cycle. ❑ Size, length and depth of force main. III. Private Sewage Systems ❑ Detail and model of pump or automatic siphon, including - ❑ Ground slope with 2' contours in entire area of soil absorption size, pump curves, drawdown, and average flow rate (GPM). system extending 25' minimum on all sides. ❑ Cross section of dosing tank showing pump(s) or siphon(s). ❑ Location of area suitable for replacement system - provide soil data. VI. Systems in Fill (Fill must be placed prior to plan submission.) ❑ Construction details of septic, holding or dose tank ifsAe ❑ Total area filled (fill to extend 20' beyond edge constructed, or tank manufacturer if state approved. of trench before side slopes begin.) Construction details and cross section of soil, absorption ❑ Depth and type of fill. system. ❑ Copy of signed onsite report by county or district staff. 190 SBD 6678 (R. 08/85) (Plb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILHR Detach And Return Upper - ; DIVISION OF SAFETY & BUILDINGS Portion Of This Form With ~ BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 Private Sewage System Only-Does Not I eral Plumbing .or MADISON, W153707 reviews that must be submitted to the & Structures. 600-266-3815 DATE: 06/24/86 PROJECT: » JU jolitison, Jr., Harold - Residence j 19 6T6. boldt's Pluabiny SL. + ruix W1 Z" 820 Piairi Street r~ 'I Baldwin, WI 54002 # PLAN ID. DETACH HERE dutinson, Jr., Harula - Reside ice U-03335 - PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Plan accepted for review- ❑ Underpayment-Please submit additional fee. Plans will beheld in abeyance. Additional information required-SEE BELOW. KNo fee has been remitted. Plans will be held in abeyance. ❑ Ovyyerpayment-Refund forthcoming. ❑ Plans being returned. 1. Plan Submission 1 ❑ Soil boring and percolation test data on 115:completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Variance signed by county, owner and Plans not clear, legible or permanent. notarized. (1 copy) All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Common ownership Plumbing System Easement. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. Holding tank agreemRt ii by owner and local II. Pressure: Distribution Systems (Mound or Inground Pressure) unit of government ferenclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) Cross section of system. ❑ Pipe lateral layout. V. Dosing Information ❑ Plan view of system. Calculations for total dynamic head and gallons Verification of Exception Status Form by county. (1 copy) pumped per cycle: - - ❑ Size, length and depth of force main. IIL Private Sewage Systems' ❑ Detail and model of pump or automatic siphon, including ❑ Ground slope with 2' contours in entire area of soil absorption size; pump curves, drawdown, and average flow rate (GPM). system extending 25' minimum on all sides. ❑ Cross section of dosing tank showing pump(s) or siphon(s). ❑ Location of area suitable for replacement system - provide soil data, VI. Systems in Fill (Fill must be placed prior to plan submission.) Construction details of septic, holding or dose tank if site ❑ Total-area filled (fill to extend 20' beyond edge constructed or tank rrianufaaurer if state approved: of trench before side slopes begin.) ❑ Construction details and cross section of soil absorption ❑ Depth and type of fill. system. ❑ Copy of signed onsite report by county or district staff. Docuoient No., This space reserved for recording data HOLDING TANK AGREEMENT Agreement Date June 30, 1986 This agreement is made between the - - County or Local Governmental Unit I Holding Tank(s) Owner(s) Harold Johnson, Jr. Township of Hammond (Called Municipality below) I We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) NEB of the NEB of Section 11, T29N-R17W, Town of Hammond Return To Dale Hudson v Boldt's Plumbing & Heating Baldwin WI 54002 or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. As an inducement to the County of St. Croix to issue a sanitary permit for the above described property, we agree to 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 nuisance as described in ss. 146.13 and 146.14, Slats. the municipality may enter upon the property and service the tank or cause to have the tank 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. Owner agrees to pay all charges and costs 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 nuisance or 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 of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20 (30) (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 and with the county. 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 and the county within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under s. 146.20 (3) (d), Stats., the owner shall submit the report to the municipality and the county. 5. 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. 6. 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) I Owner(s) Signature(s) I Sub cribed and sworn to before line on this date: I Harold Johnson, Jr I Mary J. Jenkins Muni i I Official Name (Pri Municip I Official Signature Notary Public My commission expires: tt~~ M 0 ic' Ti GI rNS ( January 7, 1990 55 SBD-6123 (R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. 4 1 ' - NOTE: As specified in 1-163.18 (4 A) Wisconsin Administrative Code this document is to be recorded in the 'tract Index, lo- cated at the County Register of Deeds. At the time of Sani- -tary Perinit Application, a copy of this a-reement, with the recording dates and number should be subutitted to this office. HOLDING TANK AGREEMENT . U This Agreement is made and entered into this 18 day of June 19 866 by and between the Township of Hammond , hereinafter called an Harold Johnson Jr. here nafter ca e t e "Owner.11 We hereby acknowledge that application has been made for a building periniton the following described property, to wit: or that continued use of the existiog premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. We also acknowledge that said property cannot now be served by a municipal sewer or septic tank-- soil absorption system. Therefore, as an inducement to the County of St. Croix to issue a sanitary permit for the above described prem ses, we hereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbing Code relating to holding tanks. Any time the Town or Municipality of Hammo d , through its Plumbing Inspector or Health Offi- cer, deems it necessary to pump out the subject holding tank, the Owner shall have same pumped out in twenty-four (24) hours, or Hammond Township will have said work done and charge same back to Owner an place same on the tax bill as a special charge. The Owner further agrees that the Town or Municipality of Hammond may enter upon the property des- cribed above at any reasonable time, o nspect, or pump and haul wastes from the subject holding tank. 2. -Owner agrees to pay all charges and costs incurred by the Town or Municipality of Hammond for inspection, pumping, hauling or otherwise servlc ng an maintaining a subject holding tank in such a man- ner as to prevent or abate any nuisance or health hazard caused by such holding tank. Townshi Clerk shall notify the Owner of any such cost which shat be pa by the Owner w thin thirty (30) days from the date of notice and in the event that the Owner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Wisconsin Statute. DILHR-SBD-6123 (R.3/81) is t L Page 2 _ 3. Owner agrees to have a quarterly pumping report submitted to the local government and the county which will state the Owner's name, location of the property on which the holding tank 1s located, the pumper's name, the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted to the Department of Industry, Labor and Human Relations by the governmental unit responsible, per section 145.01 (15), Wisconsin Statutes. 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code. 5. This agreement will remain in affect only until the sanitary permit issuing agent in St. Croix County certifies that the subject pro- perty is served by e t r a pu c sewer or a septic tank - soil absorption system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agree- ment may be cancelled by executing and recording said certification with re- ference to this Agreement, in the Tract Index indicated above. 6. This agreement shall be binding upon the indicated governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this 18 day of ' June , 1986. TOWN OR MUNICIPALITY OF C~ •ta La Faye, ammond Town l~S by by STATE OF WISCONSIN Personally came before me this 18 day of June , 19 86,-the above named Harold Johnson Jr. , to me known to be the persons who execute the foregoing instrument an acknowledged the same. THIS INSTRUMENT DRAFTED BY: My commission expires: January 7. 1990 `It ST. CROI X COUNTY W i S C N 4 0 N$I , 4r," r.~ Z O N I N G O 796-2234 i,•A~~. 1.r sit, fit Poet 06664.ce Box 227 11 f `11 I Hammond, WI 54015 O W N E R P U M P E R A G R E E M E N T PLEASE BE ADVISED, That unt.it you arse again not.i6•ied, 1 Witt conttAdet with _L i /fin : ss- 2 ss rev - o vi4cona.in, (Pumpex), bon the punpoae o6 %emoving att waste 6xom the san.i,.tany ayatem to be .Located on the ptope4ty and 6utun.e home e.ite located in St. Cxo.ix County, Wia cona.in, Townah.ip o6 being in the)VL--h 06 the ~f h o6 Sec. /A_, T•_g_N.-R.JI_.W. (Ox wou 6utly de,&c&ibed as 6o•Ctowa: ) Dated th.ia day 06 91 19. (OWNER) State b j WiA eo na.in ) ea County 06 St. Cxo.ix ) r 10 . PeKaonnaLLyappeane be6oxe ++e thJ day ° 19 to 4 nown to -6e the the above named umen.t and acknowledged the came. peAson who execute t e egoing •c.n 04u oun y, o t no.cx My Comm. (i46 pexmant) (Expi&ea) T /S L es hene.iAbe6o4e %e6 enned to as Pumpers, Join in the above agreement to the extent that I have a contract with Ownen• a4 above atated. v2,~~~t `~~UMPER 1 STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 r MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township/Municipality: NIL'S NJ' JS T ~ N/R D(or W Street Address: Subdivision: County: Landowners Name: Mailing Address: 26~ 1T011?ir4n U)", I (Me), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. 4 f -1~ a Signature of Applicant Date" STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19,?/, Notary ub c, t e of Wisconsin DILHR-SBD-6413 (Ni 05/81) My Commission Expires: / - ~ y