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HomeMy WebLinkAbout004-1086-90-110 Q c, ° ° o 0 ~ 0. 0 r. v o o I E o ~ a I N aE~i o CL C C o~ 0 a) o Q Q) M o o 41 L) ~ IL°.• in I Cl) E N c N CD w ' a ° o ° 3 N Z C Z m N m 6 E 3 T N• LL O Y LL O O CL N - C N 0 7 a) O 'O O Q a y Q H 3 E C C 3 M U M Z VI N U) I•, O = O w 00 4) 0) 0 10 N w! d m a m M H Z 0 o z d w 0 E i!i H Z ~~ww co I (D L o • ~y '0 c O o Q Q w Q Z Z Z Z o z 0f a) 0) N n is o m a~ tT III y = 0 - ` Q. U') Q O. 010„ ° c W H y a) a) O o o c a s It c o a D E to E ,rkQ p to to N Fy- FN- E N CL 2 F- p N Z > O O O > O O O Z IL M IL CL (L (L a E i > I 3i°' N d M M O M CO f/1 J U OMi T Z C pOj Qj O a) _ CL Z a M O Ihiy M N _ NO NO O C) 0 E N N L O O O O y O C'4 U) co CD M N a) L '0 0 O a) 00 Q J- N 0 Q Z co ~l 7 w M 7 -0 U) O O O ~0 N C N C c cq co 0) (6 U~ LO F- O C M N O C ° 3 r (D L.. L G ° ao > E N a`) o Z ai a~ H a~ m o O 1Nn m m 00 y Eo o~ U w E o cLi O M U 2 co 0 ' ctl m O N 19 Z U7 Sk w' E d E d V w m a 0) a ° L: M T L: a t~• a 0) c c o m 3- 0 3 o t E L ° A 0 a 2 0 0 0 0 rn v Parcel 004-1086-90-110 12i28i2005 02:37 PM PAGE 1 OF 1 Alt. Parcel 35.28.15.558A10 004 - TOWN OF CADY ST. CROIX COUNTY, WISCONSIN Current , X, Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - MOGA, WAYNE T & LAURIE WAYNE T & LAURIE MOGA 48 320TH ST SPRING VALLEY WI 54767 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.120 Plat: N/A-NOT AVAILABLE SEC 35 T28N RI 5W NE SE LOT 1 CSM 8/2114 Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 (848/172 J6 /;1*7 D 2005 SUMMARY Bill Fair Market Value: Assessed with: 107000 221,600 Valuations: Last Changed: 09/07/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.120 38,500 195,300 233,800 NO Totals for 2005: General Property 10.120 38,500 195,300 233,800 Woodland 0.000 0 0 Totals for 2004: General Property 10.120 16,100 104,200 120,300 Woodland 0.000 .0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT ,Q~ ~`9 k, 411, CF/~/ ~~o OWNER r OWNSHIP _SEC. T~~ 3 -d Offal ADDRESS /AT. CROIX COUNTY, WISCONSIN. E Tom- 'z t SUBDIVISION LOT LOT SIZE PLAN VIEW Distances',and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - LL I #4 100 i 000, I Idi at N r h rr w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: /r~Q 5 Slope at site: , 4Z SEPTIC TANK: Manufacturer: r 1944CC pacity: Number of rings on cover Tan manhole cover elevations: Tank Inlet Elevation: Tank Outlet Elevation: '*1' PUMP CHAMBER Manufacturer: ~s Number of gallons l~ e5 0 Number of gal. -ump se for a cyc ~ gallons; Total capacity of distribution lines gallon: size of pump //)"2 head;. gallon per minute horsepower ;brand name of pump and model number ; Type of warning'de ce kw- 7 ~ ©u~~~/q y~ HOLDING TANK: Manuac't!urer Number of galons& Elevation of manhole cover ; Type of warning device SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length tile depth SEEPAGE TRENCH: width length " PERCOLATION RATE AREA REQUIRED AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL XIALTERNATIVE State Plan I.D. Number: gned Holding Tank ❑ In-Ground Pressure ❑ Mound If 8f3assi016 2 3 NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Genatd Hammond RR#2 Box 182 S ntin Va~2ey, W1 J-~3 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. P ELEV.: CST REF. PT. ELEV.: NE SE Section 35 T28N-R15W. Town of Cady Name of Plumber: MP/MPRSW No. Coumy: Sanitary Permit Number: Ho&ace Hut tbunt 5650 S Cnoix 385 12 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER i PROVIDED: 11ROVIDED: D 7 YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT EE HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ~f /ALARM FEET FROM LIN 60 ~ LAIR INLETYES ❑NO ❑YES ❑NO NEAREST .0 DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/S HON MANUFACTURER. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: 1-0 YES ❑NO ~J SP yo, YES ❑NO ❑YES ❑NO GALLONS F`ERC)CL : PUMP AN D CONTROLS OPERATIONAL NUMBER O PROPERTY WELL BUILDING IV ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NEAREST _~_j ~yl_ ~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nd , rH I E A AN K 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 TNO. RENCHES DISTR PIPE SPACING COVER INSIDE DIA #PITS LIQUID DIMENSIONS TRENCHES MATERIAL: PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PI PES. ABOVE COVER. ELEV. INLET. ELEV. END: PIPES. FEET FROM LINE: AIR INLET: 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- YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS YES ❑NO YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/ ED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER. EDGES: - I . : ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH: NO. OF ATERAL SPACING: JUHAVEL DEPTH BELOW PIPE - DEPTH ABOVE COVER: BED/TRENCH TRENCHES: LL4 DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.: DIA.. ELEV.: PIPES. DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOL.E7SPAC ING DRILLED CORRECTLY COVERYATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED C ® rW_I•'~_ PLANS. ---..J77 YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKER OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: ~y FEET FROM LINE: < V q, I ❑YES ❑NO ❑YES ❑NO INEAREST-77~ V L.L LA;t u Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) APPLICATION SAFETY &,BUILDINGS DEPARTMENT OF INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: ri? 49- t P, Pro rty Locatio(1 /4,2p tN A' n. City, Village r Township: County: 'a %S iT NiR r) W Lot umber: Blk No.: Subdivision Name: Near t Lake or Landmark: Sta PliI5 I.D. Number: - ( s' e TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* x Bedrooms: ❑ 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN 2STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY _ LIFT PUMP TANK/ MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experime al ❑ Seepage Bed ❑ Seepage Pit / ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (if other than present owner): K Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage syste shown on the attached plans. Namg of Plumber: MP1MP I6W#e.: Phone Number: L j2 AM Plumb Address: Name of Designer: 1 &Q, COUNTY/DEPARTMENT USE ONLY Signa ure of Issuing Agent: e: Dane: (APPROVED Sanitary Permit Number: e ~(p .9403 ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) ~DUS I N D RY, OF REPORT ON SOIL BORINGS AND 5 IN INDUS N LABOR AN HUMAN RELATIONS PERCOLATION TESTS (115) B AD I 3 (H63.090) & Chapter 145.045) LOCATION: SECTION: T OWNSHIP/Mfif*te+PRf_TY: LOT NO.: BLK. NO.: SUBDI N NA '/4sE'/4 35- /T_i N/Risk! (or) W C_ OD V ~li~ COUNTY: OWNER'S ebl*&~1E: M ILING ADDRESS: sT 1 0 A/6! ll LA USE DATES OBSERV TIDN4MA NO. BEDRMS.: COMM FIIAL DESCRIPTION: PROFILE DESCRIPTIONS: PE 1 S: Residence M9 3 ,XNew ❑Replace / _2~ _ RATING: S= Site suitable for system U= Site unsuitable for system (l (~J CONVENTI NAL: MOUND: IN-GROUND ESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) U S ❑U ❑S U ❑S ®U ❑S EZU M© /)Z) tion Tests are NOT required DESIGN RATE: 1 If any portion of the tested area is in the ^ 63.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: 'LJL PROFILE DESCRIPTIONS TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /31- S/L Ts S AN ?'o g S'/L 3- of ;0 2 s L'S GY g t S i i. -IS 31' /3 N' i/.6 /L 7-0 S/ G L 3 f S 7B- a N S w M o i Fe-u1 Cs' If &L a ` D EAtS 61-- oC-R R P-5 A- L.TAG9A14T/AICT W y N 5 !3L ~5- 14 T$ 31 6 Y/3 N 5'14 YA #_0 o i rK or- B- 3 p 3 s N ' W • 3' nl 3/C,4. u) R B- q AO- / o~' 02 y s Y S, L ANA s B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P- A! D 9. 5- S P- J, 0 6 30 3 -67R 4z 9 P- 0 3 0 _=S O P-_ P- d' : P-3 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 MOUND ' ~ . t b ( ~e I i - - 'IN i E i A. - 1 V- r E E ( I t j ct 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: 00 ra5 L W ,A Ls-:-- /0 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 112,0 Rr) E J x'4190 cs s7 UR E: M"e-_ DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - P a S IR,'"TRUCTIONS FOR COMPLETING FORM 115 - sBD - 6° To be a corns I accurate soil test, Your report n1L1st.include: 1. Complete legal Motion; 2. The use section ly ether this is a residence or commercial project; 3, MAXIMUM r r b f beclroor mercial use planned; 4. Is this a new o' 1, !nt SY• 5. Cornplet6 re eating SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SY - RULED OUT BASED ON SOIL CONDITIONS; 6. PL -SE ? here fc riting profile descriptions and comp' ing the plot plan; I. X L11 tely I r o ar test locations. Drawing 1,• pi ferred. A aesired; and vertical elzva,;,- >_nce point are clearly she Vn,, _nent; 9 boxers as to dates, nan =s, flood plain data, v ion t exemp- s flood plai,i, f } does not •I,, the appropriate box; i. ; our current ju,, r ' f y"Ur certif 1 1 ad distribute as ALL SOIL TESTS N.JST ICE FILED kNITH THE TY WITHIN 30 DAYS OF COMPLETION. _4 'N'EVI ft- "S FOR CERTIFIED SOIL. TESTERS d T Other Symbols - BR - 1C:"t SS C- LS - L ie s S HGW F, Je I mildwate:r P rc on Rate VV _ (Atka Y 1. • - R ra1t~ i ov rl i _ trnn~ H VL P> rt v R P ~r s r : As '7 8 C 10 0 -4 ~F~Fa ~ ~GCFCF~ ~ j~2~ 9FG ° joys ~ISFrj c 4, S Vq I? 4w of Property e p-a Intl A E' Z Z . cation of Property Section.. T Township Mailing Address ~Z_ 5~ r f X__/Subdivision Name f o t Number - L."P'revioua Owner of Property_ TOCal Size of Parcel__? r Date Parcel Was Created 0:_, Are all corners identifiable? yes No Include with this application one of the following; __•,_Qax. fled Survey Map Deed,. .Land Contract. or .Other legal Document which describes the property 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)arty described in this' information form, by virtue ' a w my de recor a Office of the County Register of Deeds as Docu nt No. ;an that I (we) presently own the proposed site for the os or I (we) have obtained an easement, to run with 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. QNArUFE Of OWNER r SIQNATURE OF CO-OWNER IIF APPLICABLE) J DATE SIG NE DATE SIGNED 8 Department of Industry, Labor & H, Division of S, State of I W18COri31ri Q Bureau of Plumbing Platting & Fire et, V P.O. E Madison WI. Tel. 608-266-1_ INALL CORRESPONDENCE e°~~r g f~ Vie'- REFER TO PLAN r IDENTIFICATION NO. NAME OF PROJECT •_-~~1\\~.~....~ . 7 ti fem. 4`„'''~ ~~,'`,y~ r ~ . `GG~f• L. TYPE OF APPROVAL,,..-3 STREET AND NO. h CITY OR TOWN UNTY STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. ?rY"'t1'ti?°"ever(t°Pnstgtlatfi7rr°af"tt'IE'pivrrttYitrg~improvements'vr`system•i~as•°comrne»ced--vvrthir~--lyrocty~aris-etiate; t#~is-anal shaltlm=mL-vatd-dnd-nEw-apphmtizn strait-be-mitWfiorapprovd, of-these tarlrbefore-wm*, rtaSrcrnrtrrmrrce. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. For Private Sincerely, Sewage Systems Only' This apjprcv~,! is V,-i;,:1 ' years e.- v;%ii ;r.,;! the i. exirr:; u eta cu,e or tree initial sanitary perii James Sargent-Bureau Director PLANS REVIEWED BY: DATE: - l cc: DPS-OWS Owner! DI LHR Local PI Plumber H & R (2) County Mfg. Rep. Bur. of Health Fac. & Services DI LHR SBD-6099 (N, 06/80) Rec. & Env. Services ST. CROI X COUNTY W I SC O N S I N e r, ~ = 1 ~ ~ -<G ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 August 18, 1983 Mr. Gerald Hammond R. R. 2, Box 182 Spring Valley, W1 54767 Dear Mr. Hammond, We have received in this office the form STC - 100 which is necessary for issuance of a sanitary permit. 1 am returning the form to you, as in order to complete our records on the system, the areas noted in red must be completed. A copy of the deed is requested. This can be obtained from the Register of Deeds Office in Hudson. The number on this deed is the number to be placed in the blank for Document Number. Your cooperation is appreciated on this matter. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Thomas C. Nelson .Assistant Zoning Administrator TCN:mj Enc. I NAME AND DESCRIPTION vi Y 'z 1, lUU T2-35 Gerald L & Marjurie Hammond ki o . ~ < aA gG'QFcF ~ ~ a Y w ~ ~F Sec 35 T28N R15W 'l r y~ m x 37 .6 A 9 g(g NE SE EXC N 3130' of S 72 ~A,4 ow Of E 325' W ~ Z ' r rcy S~CLiuit ~W mg rQ a! _ - < LL O n ~Ni1 i 5ubdiviuiun Nawa wl'oc Nutubar rdviuuu Owner of ?rop4rcy "1'ocul Size. of Nurcal Dula Puredl Wuu Cruucud Are. all curr►era lddncitiable? Y Yes; Nu include ulclt chid dA,pllcatlun Otte of L►Ie tui10wilt: _Car-.L tied Survey Map . Daud , .Lund CoaLraCL. or .Uchar !:dgal Duc:uutdnL which _deacrlbea the propurcy PROPERTY OWNER CERTIFICATION I (We) certify that all statumdnts on ttUa torso are true to the best of inn (our) knowlddyo; that I (we) am (d(e) drty described in this informution torrn, by virtue a w my deed rucor d Othed of the County HofJister Of Deade as Docu nt No. ; on that I (we) Presently own tho Proposed situ for the or I (we) have obtained an 0asement, to run with the abovo describod property, for the construction of said system, and the Mme has boon dUiy recorded in the Office of thu County Rayiitur Ot Duudi, ab Document No. / /0 , V(71 SIUNATUNE Of OWN6q SIUNATUNL uF COZWNEN )IF APPLICAULL) UATL 51t]Nk~r- UATL Zbi"NLO ST. CR01 X COUNTY a WI S C 0 N S I N .7ZONING OFFICE Yl.: 796-2239 (HAMM 425-8363 (R I V E R F A L LS) HAMMOND, W 154015 tune 24, 1983 Satiety and BLtitding Di,v,ib i.on "ptumb,i,ng Buneaux 1969 P• 0• Ba 53101 Madison, W1 Dean bin: n the Genatd Hammond B top 5wty "i-nvebt'i-gat-i.zhebS~% ob Section 35, b lizb An on bite NEB ob neVea~ed b Litabhegh 9nound .,ocated at the C at noix County Cady, St- be2aw wih,,ch beabanab.~e at a o depth th ob 2.8 beet, waten wab noted• mound b ybtem. abZe ban a contact This bite bhoutd be bui.t te Shau ase beet bnee to you have any gUiest,,on, p "2d y , th"i.b abb.cce, younb tnu~y, , Thomas C. NeZban Adminibtnaton Abb.istant Zoning TCN:mJ WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/4, SC 1/4, Sec. 35 T 28 N, R 15 E (or) W X Cady Street Address Town or UKi04i XM Lot No. , Block Subdivision Landowner's Name: Geta.Cd Hammond The application for this site is for: © new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: k1 to have one of the first five approvals guaranteed for this year. This is number 59 - 04 - 4 of those applications. (Use one of the first five quota num ers 'issued-to you.) I lone'of the applications needing a quota number. The quota number assigned to this application is - - L_1for one additional homesite on farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. [.for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. 1.1for an application on file prior to February 1, 1980. (__.1for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here.[_] ccertify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nets an Signature - (County Official Title Azzibtant Zoning Adm.in.iAtnatan Date June 24, 1983 DILHR-S80-6158 (R 12182) STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM ocation: Township/*""Imo 4E Z S T 28 N/R l$ R 0 Cad treet Address: Subdivision: County: St. Cnoix andowners Name: Mailing Address: ena2d Hammond I (Me), the undersigned, hereby make application for an alternative oystem 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 promises 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 Got in this application. Signature of Applicant Date DATE OF WISCONSIN Subscribed and sworn to before me SS. ;OUNT7*,OF This day of 19 Notary Public, State of Wisconsin DILHR-SBD-6413 (N. 05/81) My Commission Expires: ST. CROI X COUNTY ~xi`kre WI SC O N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 24, 1983 - Mn. Horace Hu&tbent Eau Gatte Ptumb.ing RR#1, Box 103 A Eau Gatte, Wl 54737 Dean Mr. Huttbent, Enctozed are the connected forms on the Genatd Hammond property. I would tike to apotog.ize jot any .inconvenience the mistake in names may have caused you. Pteaze destroy the b.inat set thghl ma.ited to you, as you w.itt notice the number assigned to have one o6 the 6.inst 6.ive approvatz guaranteed 6or this year was s.impt y trans 6enned 6rom your name to that o6 Genatd Hammond. Out neeondz have been connected to show this. Shoutd you have any questions on this ptease beet Snee to contact this o 5 6.ice. S.ineenety, Many J. enk.ins Secnetany to Mn. Netzon Encto.6 unez Iw ST. CROI X COUNTY WI SCO N S I N e 3 ZONING OFFICE r, 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 22,, 1983 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear sir: An on site investigation for the Horace Hurlbert property located at the NEk of the SEA of Section 35, T28N-R15W, Town of Cady, St. Croix County, revealed suitable soils at a depth of 2.8 feet,below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Yours truly, Thomas C. Nelson Assistant Zoning Administrator TCN:mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/4, SE 1/4, Sec. 35 T 28 N, R 15 %X W Town oK i1iKWXV Cady Street Address Lot No. Block Subdivision Landowner's-Name: Horace Hurlburt The application for this site is for: U new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: Hto have one of the first five approvals guaranteed for this year. This is number 59 - 04 - 4 of those applications. (Use one of the first five quota numFers-issueT to you.) I lone of the applications needing a quota number. The quota number assigned to ~ this application is - - [._]for one additional homesite on a farm to he occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. for an individual lot for which a sanitary Perin-it was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. ]for an application on file prior to February 1, 1980. L.Ifor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to Fehruary 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here.L 1 I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Signature County Official Title Assistant Zoning Administrator Date June 21, 1983 DILHR-SBII-6158 (R 12182) d STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: 1'ow:±ship9KK&1V" [ X NE 14 SE S 35 T 28 N/R 15 KW&JW Cady Street Address: Subdivision: County: St. Croix Landowners Name: Mailing Address: Horace Hurlbert RR# 1, Box 103A,Eau Galle, WI 54737 I (We), 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. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin My Commission Expires: DILHR-SBD-6413 (N. 05/81)