Loading...
HomeMy WebLinkAbout261-7000-09-001 9-1 Q o az'i o0 ' w O 60 ti4 c e c rj' I N ~ O O Q S' Q ` O Its tl cC O `yU L ~U s c m y N 'C Z c c o LL , a > 4 ° 65 m 3 ° 00 w E U) + O z r £ N FM- Z o i o z N Z ° o (o F- (D z N M N O. 7 j O N N U) N O C • ~ U O L C C C O U N O ` z CL z F- N ° Z 0 d LO L: N d Y d o a .r c m Q' C L N i N C O 0 3 0 O 0 a E o N Z o> 0 H N H U N 0 0 0 a O z 0 •►v ~aaa N~~ a z co Cl) o N ~i e g N m rn rn y d M N .2 Zi, E N ° :3 O N iV c o E II, 3 N N L O N C ►y~ 0 U E cu C14 a) O 3 m fl. n c a°° O O N N O W Z C 6 O O N N Li r O O ~~M a) a) F- F- N r- n.l • A N 6' N E E U O yy N N LL fn r CQ E d ca CL cal a m . ! d a • 2 jr`IV c c A U d 'II O in o STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER s } ADDRESS- SUBDIVISION / CSM# LOT SECTION. 'j T_j N-R -ZL-W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM m A0 - b`. sr~~p INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r, BENCHMARK:g ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer:Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Modell Size Float seperation Gallons/.cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: s Length Number of trenches Distance & Direction to nearest prop. line: emu'/~- Setback from: well:- House Other ELEVATIONS Building Sewer ST Inlet; 107,3y~_ ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: i PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR - 3/93:jt L s~b`r~'s p~artrtr?~r In? RIE. 25. 3~RIVA1E 5 EWZE SYSTEM County: L-dborand Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 9951 Permit Holder's Name: ❑ City ❑ Village [k Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /OV,-/)~ /GD,': z/)~ S Z% 261-6019-00-000 TANK INFORMATION ELEVATION DATA A9300356 ,S- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S~/~ vv Benchmark Dosin Aeration Bldg. Sewer Holdin St/ Inlet TANK SETBACK INFORMATION St/ Outlet y7 4)3 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosi g NA Header Aeration Dist. Pipe 2, Holdin Bot. System PUMP/ SIPHON INFORMATION Final Grade 'tbF a 7- 3 lP 9 Manufacturer Demand 671 Model Number GPM TDH Lift Lrictio Ft ead Forcem ength 1 1 Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Of Trenches PIT No. Of Pits Inside Liquid epth DIMENSIONS DIMEN 1 SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHI ufacturer: SETBACK INFORMATION Type O rl 1., OR UNIT R Model Number: System: U-tr DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length ~J- Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade System Depth Over rr , Depth Over „ i xx Depth Of / Sodded xx Mulched rench Center 900lTrench Edges 3 c ;)'l ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRAIRIE.25.31.18,NE,SE,HWY 65 Plan revision required? ❑ Yes No Use other side for additional information. 5 F SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE T J Y # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. C4eckif r JRIT t~preLious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY O ER PROPERTY LOCATION Z Z 0114 Z.,ef- '/a , '/4, S T , N, R (Or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # d CI , STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER wo A I j -77 Lae- 0 / II. TYPE OF BUILDING: Check one CITY NEAREST OAD ( ) ❑ State Owned ❑ VILLAGE : R Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - Ill. BUILDING USE: (If building type is public, check all that apply) 9 e 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/C r W h 5 ❑ Hotel/Motel 90 Office/Factory 13 R3 Other: Specify xle IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. to New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ 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 ❑ 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 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./' ch) ELEVATION Feet Feet CAPACITY VII. TANK # . Site Fiber- Exper. in allons Total of Manufacturer's Name Prefab Con- Steel Plastic INFORMATION New istin Gallons Tanks oncrete structed glass App. Tanks Tanks Septic Tank or Hoidin Tank F1 L -LL+L] L] Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the and rsigned, assume responsibility for installatio f the onsite sewage system shown on the attached plans. Plumber' ame (Pent Plumber' i lure (N m MP/MPRSW No.: Business Phone Number: 1 -94 Plumb is Ad r ( treet, City, State, Zi Co e): oge IX. C UNTY/DEPARTMENT USE ONLY ❑ Disapproved Stary Permit a (Includes Groundwater Date ssue Issuing A nt Si ature (No mps Approved El owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS v 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permii may be renewed before the expiration date, and at the time of renewal any new criteria in the Wiscr. .;!n Administrative Code will be applicable. 3. All revisions tt- !this: i.•~rn i# must be approved by the permit issuing authority. 4. Changes in owne-shil3 f )r plumber requires a Sanitary Perm;t "transfer/Renewal I=orm (,S:;L) 6399) to be submitted to the r.osnty prior to installation. 5. Ons to sk'vt systems must be property maintained. The ~ ?sc tank(s) must be purr I~r.. y 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 -•,umberls) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If Ouilding 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 replacemeni, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. Vt. Absorption system information. Provide all information request-, in Vll. Tank r fnr:r ata7. Fill .n the cap,;:: ;'y of every new andior ex ,t~- ank, 1st the Mat number of tanks and manufacturer's nacre. indicate prefab or site consf and tanx rrrale nal. a-or `,r tar all s c_tw. purnp/siphon and holding tanks for this system. Check experimental approva: c s v arks received expe° rti;=r:ta! product approval from DIL_!-;R Vlh Resp(,nsiootty siatHment. installing plumber is to fill in name, IicensY nurnber with arrprot i~i:e prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specificaliona~ not smaller than P'/1 x 11 inches nit i-t be submitted to h- county. The P'Ens must inci;.de t`;c: following A) plot plan, drawn to scale or, •vith ,c r;piefe, d:were. ;c n, . rcaticn of hcild r g tank(s), septic tank(s) ,or other treatment tarks; builder, 8--! .prells; wa ei grater service; streams and lakes; pump or s4pha:-) tanks; distribution boxes s ` ,o i sys?erns; wt-ropnt system areas and the l:)cation c ~rtat bui,r'ng served, 8) horizontal elevation e .fora r, v points:; C) complete specifications for pumps and controls; dose volume, eievatan differerces; trio tion loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absc rption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - I I 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 gro.;.rr-dwater, jrcund- water contamination investigations acrd-establishment- oi starve rds. SBD-6398 (R.11/88) 77~f/h' II ` fj~eN A 77 as ®~~,~~Q GJs l~ y, 1-~ a l~ i 4 D~ f T l PAC-C 4;:2- OF z2 C r o I O I-1 p~ Iq ~ e l~ Sy 5 Frd►A Ali Iniel► And OD►ervallon pipe i Approriid Vent Cop ►/Inlinwn 12' Above final Grad. 20- 42' jAbowoPipp 4' Case Iron To FinVent Pipe union hot Of siiftlh min Y Ayyr.yols Or.r Pipe 016111b.IIon Plpa o o o -Too AOOo apota Beneath Pips ° Perforated Pipe Oslo, o C001012 Twmltkollng AS 84111om Of system Pau o)ep Pin.-I SOIL FILL DISTRIBLITIOLI PIPE APPROVED aS`mpir-TIC COVER 2"OFt%GGREGAlE MATERIAL- OR 9" OF STRAW - OR MARSH HAS y . f ! Li OF ~r2 -2l/2 AGGREGATE ELEV. OF FEET-.. DIS-rRIIjiJTI(.D1J PIPE TO BE AT LEAST INCHES BELOW ORIGIMAL GRADE AMU AT LEAST LO INCHES BUT 1.10 MORC THAN 42 ILICNES I5LLOW FINAL GRADE rmtmUM DEPrvi OF EXCAVATIOP FXoM OKIGYJAL 6~AOF WILL BE X12_ IIJCHES MKIMUM OEF T)i OF EXCAVATION FAOM 04 l16IWAL GRAp€ WILL BE .;2~2 INCHE S s►~►JEO: r LICE►JSE DUMBER: Z2f DATE: _.IX- /-~~Z Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _Z_ of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but '~7Z Llel Z 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY )OWNER: PROPERTY LOCATION _ GOVT. LOT 1/4S 1/4,S T N,R (or~ PROPERTY OWNER':S AILING ADDRESS LOT # BLOCK # SUBD. AME OR SM # CITY TATE ZIP CODE PHONE NUMBER ®CITY VILLA 5rO NEAR ES ROAD tVew Construction Use [ j Residential / Number of bedrooms [ ] Addition to existing building ])Q Replacement Public or commercial describer, Code derived daily flow gpd Recommended design loading rate _bed, gpd1ft2 , Y trench, gpd/ft2 Absorption area required bed, ft2 7-5- trench, ft2 Maximum design loading rate gibed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material c &&d- Jz F -;~L sg .9 s Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ® S ❑ U [al S❑ U OS ❑ U ® S ❑ U ❑ S O U ❑ S O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground - 7 /1 9 ellevv Depth to limiting factor --s 77 Remarks: Boring # ZLJ All Z i 'S Ground 2 elev. 2g~7 ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: c PROPERTYOWNER SOIL DESCRIPTION REPORT Page,2,of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bou day Bed Trench I el Ground elev. ° ft. Depth to limiting factor ~ Remarks: Boring # P Z 0-5 OM A~2~ Ground elev. Depth to ' limiting factor Remarks: Boring # Ground elev. _ ft. ^ Depth to limiting factor yQ~ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 44E41 s e s~ra?S, T~~,cljgr~J g 1,7 1 16 Hof ~~e~ I vI .c, I~ G 3 y%N i ~ as- ..Co f 3 14 r rep 8 ~°,~oP~p ,8,~g. lam fog ~uTU+PF_ - SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations i November 18, 1993 2226 Rose Street La Crosse WI 54603 K 0 CONSTRUCTION KIM A OCONNELL RR 1 BOX 105 STAR PRAIRIE WI 54026 RE: PLAN S93-41060 FEE RECEIVED: 210.00 FOSTER7 STEVE NE,SE,25,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROIX NON-PRESSURIZED IN-GROUND SYSTEM PETITION FOR VARIANCE TO CODE SECTION(S): ILHR 83.10(1). The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All of the statements and supporting documentation included with the petition were considered. Since your request is similar to other petitions approved by the Department (e.g.S93-20340), the petition is approved. The variance requested was to allow the installation of a conventional soil absorption system to be approximately 7 feet from an existing slab constructed building. This petition approval is granted conditionally with the understanding that all of the petitioner's statements included on the variance application form and any other documents submitted to the Department will be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. All permits required by the city, village, township or county shall be obtained prior to installation. SBD-6423 (R. 01/91) 3 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations K 0 CONSTRUCTION Plan No. 593-41060 November 18, 1993 Page 2 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, t\ #erard Swim Plan Reviewe Section of Private Sewage (608) 785-9348 2080L/ 2 Ili i I i S BD-64231 K. 01/91) . S93 41060 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division tabor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614 Fax (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -If you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Reviewe Name Plan Identification Number - L - 2. PROJECT INFORMATION If this review is a revision or extension to your existing , plan identification number, provide that number here: Proje N me r City Village Town Of: County Pr jest Location GOVT. LOT 114 1/4 T X R )1 9 ,E or 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type 1 (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 A At-Grade 1,501-2,500 gallon septic tank $120.00 H Holding Tank 2,501 - 5,000 gallon septic tank $160.00 M Mound 5,001 - 9,000 gallon septic tank $200.00 N Non-Pressurized In-Ground (conventional) 9,001 -15,000 gallon septic tank $300.00 Over 15,000 gallon septic tank $ 500.00 P El Pressurized In-Ground O Other: Up To 1,000 gallon dose chamber $ 70.00 A&W--A,000gall 001 - 2,000 gallon dose chamber $ 80.00 Building Type (check one): g> chamber $100.00 4, 1 - 080~II chamber . $120.00 D Q Dwelling, 1 or2 Family 8M„1241OQ9~ osechamber $140.00 P UsJ Public Building Ove V12, 0~ I ose chamber $160.00 S E] State-Owned Building up o 5 Ilon holding tank $ 60.00 . 5,0 1 - 0, loNlding tank $100.00 . Code Derived Daily Flow 9pd Over 10,000 gallon holding tank $150.00 Check If Replacing Existing System Experimental System (additional one time fee) $ 300.00 Revisions To Approved Plan 2 $ 60.00 Petition For Variance: Setback $100.00 //t) n ® -w Site Evaluation $225.00 Petition For Variance Plumbing $225.00 Revision $ 75.00 Groundwater Monitoring - Per Site $ 60.00 Groundwater Monitoring (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 Subtotal: 4;242 Priority Review: Enter same amount as Subtotal: Z-2/4 " MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 5. SUBMITTING PARTY INFORMATION % Telephone No. (include area code & extension) Compa y Name Conta Persqr~, ( ) _ No. & treet Address Or P.O. Box City, Town or ' lage, State, Zi Co e i Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. SBD-6748 (R. 03/93) OVER PETITION FOR VARIANCE APPLICATION S93 41060 Wisconsin Department of Industry, Labor and Human Relations OFFICE USE ONLY OFFICE USE ONLY Amount Paid Safety and Buildings Division Petition No. 201 East Washington Avenue, P.O. Box 7969 Receipt No. Madison, Wisconsin 53707 E-Number 608/266-3151 Name f Owner/ eti Toner Bui ding or Project Agen Architect or gineering Firm Compan Tenn Name, if any 5tree & Number Street & Number s Location, Street & Number City Stat Zip Code City State Zip Code Cit County Telephone Number x7t Telephone Number Plan Number, if known Navo~-- Contact Pgrson 3 S - 1. The rule being petitioned reads as follows: (cite specific rule number and language) - /194 - 2. The rule being petitioned cannot be entirely satisfied because: _J -2-4)641ejgc 4.)n .z.~ft n~~li7fn FnP Yirs'r - 3. The following alternative(s) and supporting information are proposed as a means of providing an equivalent degree of health, safety or welfare as addressed by the rule: '4.113 )d.i c 4 b 04-21 T/..~^J,Gi~ Il l~'n Aw"F .7i'.~i...'i/..•n - r4-ote: Please attach any pictures, plans, sketches or required position statements. VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE See Section Ind 69.15 for complete fee information Note: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors, attorneys, etc. may not sign petition unless a Power of Attorney is submitted with the Petition for Variance Application. o-A 71rJir]a , being duly sworn, I state as petitioner that I have read the foregoina (~&ME OF PETITIONER, Please type/print) ~11y~lfWat petition, that I believe it to be true and I have signif;g~( r6y J~ijights in the subject building or project. fts sw~n to before me this date: ~af 93 Signature of Petitioner lq~alDY L li ---~i~n xp es: - ~Q tary Public ILL-YAW Q69°~~ f rw 076 i fi- Is4 ttt I -7 I : : PIP, 4 i C~Fg~ __1 I i Y. I 1 I I _ I : 4 : . I r I i ~ I 1 j I I I ~ Y I ' q ~ I i I I I I ~ I , 1 N I TI-A's r{~t'nc ud~ rvi of - - iclh idiii9 f th S P ~tnca~si cs f 8$ t - and I - - et efhr Pla submittal ran ia plunnb n _ a v re~uir dur gnat i I t r-- 1 I I~ ' I I ' i i , r- I: , I ~ -t -+I -t - : I I 1 I i , i ' S9 41060 PAGE4;:L0F Cr~SS J~C~1V Q~ A VC SYS Fifth Ali Well, And 0p►dirollon pip, IB,~(w1 ~ L..2-- Apprdl~CJ Pie-.. Cad 6. 'to vo flnol Gr•d• y ti . s +5 v z~a~ z0-,z• AOor• Pipr To fln•1 o••d• Nv • N . 0 r Ma •n her Or SinMlk Co••iMO woo of •ru~ 2' A r• 01 VA 9 • $ Owes Pipe Qw OUrrl•dlo~~ Plp• f 0 T•• AICjO 0 • 8•n••d Y• 6.1•r o C001011 T•roln•Ilny Al 9ollonm Of Si•1•m i SOIL FILL DISTKIBUTI0F.1 PIPE • APPROVED Sj1JTNETIC COVCR 2'A of 11GGR>;GA1E "--MATERIAL- OR 4" OF STRAW OR MARSH HAy iy e"~'r ! l.~0F P-1/2 AGGRCGATE ~p ELEV. OF~FEET_,. i DIS•1'Rlf5UTI0Q PIPE TV BE AT LEAST - INCHES BELOW ORIGIWAL GRADE A UU AT LEAS7LO INCHES BUT 1.1 O MORC THAN 42 IAlCNES BELOW FINAL GRADE MU-um DaprH OF EXCAVAT100 FXoM OR16WAL 6XhDF_ WILL BE INCHES 1Nt11rr UM 9£P T-H of EXCAVATION ~fj• o /''1 04~►41tJAE GRApf_ WILL BC INCHES 51GUCO: r LICEAISC I.JUMBEIi: DATE: 110 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPvv of Labor and Human Relations 3 410 10 bivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Cod COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY. DATE PROPE TY WNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4 S T N,R (or~ PROPERTY OWNERS ILING ADD SS LOT # BLOCK # SUBD. AM~ R M # CITY TATE ZIP CODE PHONE NUMBER ®CITY VILLA [?f0 INEARES ROAD , P*w Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building D4 Replacement [4 Public or commercial describe Code derived daily flow /.',0 gpd Recommended design loading rate ~ 7 ed, gpd/ft2_trench, gpd/ft2 Absorption area required bed, ft2 7-< trench, ft2 Maximum design loading rate , . bed, gpd/ft21Xtrench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U WS ❑U ®S ❑U OS ❑U EIS OL ❑S OU SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 5 1' Ground - 7 elev. Depth to limiting factor >S 7 Remarks: Boring # €tititi t< Ground" /2al 4e I,/ elev. 26~Z ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: J - Address: Signature: Date: - C CSTNumber: S- 1 f ?3Y PROPERTYOWNER SOIL DESCRIPTION REPORT Pa e of PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Pont Color Gr. Sz. Sh. Bed Trench 49 Z X% Ground elev. ft. Depth to limiting factor ~ 7 Remarks: Boring # ,r y J^1140- ell ebZd "*j f~, as I/ LJ Ground elev. Depth to limiting factor Remarks: Boring # t ¢ /1 -7 Ground -1 lag gle - " elev. ft. Depth to limiting factor Remarks: Boring # „w::•.~.w~tcv cF< N. . Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) n Ab Y44/ AJ) S'vc• _f--, i 1, '1~1 - J' l - - I I I 1 I i I i I i - I I r I I I ! ~ i I I II I Joe - - - - I I I I [ I I I I i_ I I I I I I i I ~ ! I I , I I I I 1 ! , t I I r , I I I I, i ! 1 1 I y +2 i , I I I I I I ! I I s I I I _ I I I i - - - - I I I I _ I r- - / - j I I I I I i r--t-t----~- i - t - I 1 I I i I I -77 I I I i i ~ , ~ - i i i ~ j - ~ _ . I , _ ~ - _ - _ _ f - t I - I I. i ' - - - ' _ _ _ - ~ l ~ ~ i ~ 1 I ~ I i _ , ~ , ~ I _ - -f _ _ _ - - , - ~ I _ _ - - - - - _ i _ ~ _ _ - - l- i i i ~ ~ - _ _ _ _ i ! ~ ; ; I - - , i ~ ~ - ~ ' ' ~ 1, I I. _ I I_ ~ ~ i ~ ~ I i ' ~ I' ~ i i , 1 j ` i ~ i F ~ - - - - _ _ - E - - j _ - I ~ E - - - _ ~ - - ~ ~ I I i , - _ i - - 1 ~ ~ ~ ' ~ f ~ ~ ~ 1 -i I 1 - ~ j ~ f i f I i ~ I I I' ~ f~; - ~ _ ,i I ~ ~ j 1 I I _ i i ' ~ i 1 _ . - - - - _ _ _ _ i , 1 I I I i I - - - - I 1 _ _ ~ i ~ I ~ i ~ I I _ ~~f i { _ - _ - - _ - _ _ _ ~ i i ~ ~ ~ _ - - i I ; I i ~ I i ~ j ~ , ~ i f ~ j I i t i l`, ~ I ~ { I ~ I ~ i ~ - _ _ i t I_ ' ' ~ I} _ - - - - - ~ I _ ; i ~ t i ~ i I ; - _ - _ ~ ~ ~ - ~ I I I tI I I ~ f i j ~ I ~ - _ - _ ~ f ~ } I I ~ i I i ' ~ _I _ - _ _ _ _ _ _ ~ _ j ~ I ~ ~ ~ i ~ 1 ' _ . _ - - - - _ _ - _ _ _ _ - r ' _ E a } l I _ _ _ . _ _ . _ _ _ _ _ - - - - - - - ~ - ~ ' ~ E _ j - l I ! _ I- i , i ~ I , ~ f ~ i - ~ i I ' 1 I S93 41060 -{ANGER AREA LEASE THIS AGREEMENT, made and entered into on the date indicated below by and between the City of New Richmond, State of Wisconsin, a municipal corporation, hereinafter- called the Lessor, and Steven_Foster & _ hereinafter cal I ed the Lessee. Richard Belisle e W I TNFSSETH: WHEREAS, the Lessor owns and operates an airport known as the New Richmond Municipal Airport and said Lessee is desirous of leasing from the Lessor a certain parcel of land on the said airport, hereinafter more fully described, for the purpose of aircraft storage, and i WHEREAS, the Lessee will use the below described property for the purpose of storing aircraft and shall conduct only such aircraft maintenance on its own aircraft as performed by the Lessee or by regular employees of the Lessee. NOW, THEREFORE, for and in consideration of the rental charges, covenants, and agreements herein contained, the Lessee does hereby hire, take and lease from the Lessor and the Lessor does hereby grant, demise and lease unto the Lessee the following premised, rights, and easements on and to the airport upon the following terms and conditions: 1. I'roperty_DescriL,t.ion. (Include lot number - from Land Use Nap, square footage of land and map if appropriate.) Lot 3, Row 8, Airport Layout Plan Dated September 1, 1989 being 5476 sq. ft. Hanoer QV,truct.ior. The Lessee shall have the right to Fred . maintain and alter --building or structures upon said premises providing such buildings or structures conform to the applicable regoi rements of the Wisconsin Department of Industry, Labor Q Human Relations and pertinent provisions of any local ordinance in effect. Ali plans for such buildings or structures shall be reviewed and approved in ►•;ri ti ng by the Lessor prior to construction. r, . Term_ The term of this lease shall be for a maximum period of ten (10) years commencing on ___July and ending on _ June 30, 2000. 4. F(ent._ The Lessee agrees to pay to the Lessor for the use of the premises, rights, and easements herein described, a yearly rental of five (5) cents per square foot for the land leased, for a total annual charge of s 273-80___, payable on July 1 annually. It is understood and agreed that the rental rate herein specified shall be subject to re-examination and readjustment at the end of each three year period of this lease, provided that any readjustment of said present rates, or as same may be amended hereafter, shall be reasonable. 5. Ncn- xclusiy lJs , The Lessee shall have the right to the non-exclusive use, in common with others, of the airport parking areas, appurtenances and improvements thereon; the right to install, operate, maintain and store, subject to the approval of the Lessor in the interests of safety and convenience of all concerned, all equipment necessary for the safe hangaring of the Lessee's aircraft, the right of ingress to and egress from the demised premises, which right shall extend to Lessee's employees, guests, and patrons; the right, in common with others authorized to do so, to use common areas of the airport, including runways, taxiways, aprons, roadways, and other conveniences for the take-off, flying and landing of aircraft. 6. 1_aws and _F(eg:ll ti ons. The Lessee agrees to observe and obey during the term of this lease all laws, ordinances, rules and regulations promulgated and enforced by the Lessor, and by other proper authority having jurisdiction over the conduct of operations at the airport. 7. Hol d_._Harml FSS_ The Lessee agrees to hold the Lessor free and harmless from loss from each and every claim and demand of whatever nature made upon the behalf of or by any person or persons for any wrongful act or omission on the part of the Lessee, his agents or employees, and from all loss or damages by reason of such acts or omissions. 4. lnsyrarccg. The Lessee agrees that he will deposit with the Lessor a policy o'fr comprehensive liability insurance upon 90 Cat's written notice from the Lessor. X060 9. Maintenance of Premises. The Lessee shall maintain the structures occupied by him and the surrounding land premises in good order and make repairs as are necessary. No outside storage shall be permitted except with the written approval of the Airport Commission. In the event of fire or any other casualty to structures owned by the Lessee, the Lessee shall either repair or replace the leased area to its original condition; such action must be accomplished within 120 days of the date the damage occurred. Upon petition by the Lessee, the Lessor may grant an extension of time if it appears such extension is warranted. 10. f: i.ght_to_Inspect_ The Lessor reserves the right to enter upon the premises at any reasonable time for the purpose of making any inspection it may deem expedient to the proper enforcement of any of the covenants or conditions of this agreement. 11. Taxes_ The Lessee shall pay all taxes or assessments that may be levied against the personal property of the Lessee or the buildings which he may erect on lands leased exclusively to him. 12'. Si ons. The Lessee agrees that no signs or advertising matter may be erected without the consent of the Lessor. 13. Default. The Lessee shall be deemed in default upon: a. Failure to pay rent within 30 days after due date; b. The filing of a petition under the Federal Bankrupcy Act or any amendment thereto including a petition for reorganization or an arrangement; C. The commencement of a proceeding for dissolution or for the appointment of a receiver; d. The mak-i no of an assi onment for the benefit of creditors without the prior written consent of the Lessor; e. Violation of any restrictions in this lease, or failure to i,.-eeeo ;_:tny of its covenants after written notice to cease such violation and failure to correct such violation within 10)irty days. -4- Default by the Lessee shall authorize the Lessor, at its option and without legal proceedings, to declare this lease void, cancel the same, and re--enter and take possession of the premises. 14. Title. Title to the buildings erected by the Lessor shall remain with the Lessee and shall be transferable. Upon termination of this lease, the Lessee may, at the option of the Lessor, remove the buildings, all equipment and property therein and restore the leased property to its original condition. 15. Snow Removal. The Lessor agrees to provide snow removal services to the Lessee's leased premises in the hangar area. Such snow removal shall be accomplished only after all runways, apron, and primary taxiways have been first cleared. 16. Lease Transfer. The Lessee may not, at any time during the time of this lease, assign, hypothecate or transfer this agreement or any interest therein, without the consent of the Lessor. 17. Airport_PevelopmEnt_ The Lessor reserves the right to further develop or improve the landing area of the airport as it sees fit, regardless of the desires or view of the Lessee, and without interference or hinderanc_ce. If the development of the airport requires the relocation of the Lessee, the Lessor agrees to provide a compatible location and agrees to relocate all buildings or provide similar facilities for the Lessee at no cost to the Lessee. I.S. Subordination Clause. This lease shall be subordinate to the provisions of any existing Or future agreement between the Lessor and the United States or the State of Wisconsin relative to the operation or maintenance of the airport, the execution of which has been or may be required as a condition precedent to the expenditure of federal or state funds for the development of the airport. Furthermore, this lease may be amended to include provisions required by those agreements with the United States or the State of Wisconsin. 19. Abri_tration. Anv controversy or claim arising out of or alleged breach thereof, which cannot be relating to this lease or any settled between the parties, shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and Judgement upon the dispute rendered by the arbitrator(s) shall be final and binding on the parties. S 41 IN WITNESS' WHEREOF, the p ti s have hereunto set their hands and seals this .----V ---day of 19_.?Q_, in the City of. New Richmond St. Croix Co&nWisconsin. IN THE PRESENCE OF: LESSOR: i By J Airport Manager By:____ LESSEE: -(I TLE ©CV4e"e-.Y Subscribed and sworn to before me this day of 19 Q 9 0 - I~ Notary .~C My Commission Empires: 3~.•;' ~ ~7 ~ ~ J` ~ ~ ~dJ ;a Wiscorisin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone(715)634-4804 Fax(608)785-9330 Phone(608)267-5119 Phone(715)524-3626 Fax(414)548-8614 Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. 1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time: Appi5intment Date Reviewe Name Plan Identification Number 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Project Name City Village Town of: County Project Location GOVT. LOT 114 1/4 T X R ,E- or 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type t (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 - A At-Grade 1,501 - 2,500 gallon septic tank $120.00 H Holding Tank 2,501 - 5,000gallon septictank $160.00 M Mound 5,001 - 9,000 gallon septic tank $ 200.00 N Non-Pressurized In-Ground (conventional) 9,001 -15,000 gallon septic tank $ 300.00 Over 15,000 gallon septic tank $ 500.00 1.411 P Q Pressurized In-Ground O Other: Up To 1,000 gallon dose chamber $ 70.00 1,001 - 2,000 gallon dose chamber $ 80.00 Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00 4,001 - 8,000 gallon dose chamber $120.00 D Dwelling, l or 2 Family 8,001 -12,000 gallon dose chamber $140.00 P Public Building Over 12,000 gallon dose chamber $160.00 S State-Owned Building Up To 5,000 gallon holding tank $ 60.00 5,001 -10,000 gallon holding tank $100.00 . Code Derived Daily Flow gpd Over 10,000 gallon holding tank $150.00 . Check If Replacing Existing System Experimental System (additional one time fee) $300.00 Revisions To Approved Plan 2 $ 60.00 Petition For Variance: Setback $100.00 ,[I`J!) ® Petition For Variance o Site Evaluation $225.00 Plumbing $225.00 Revision $ 75.00 Groundwater Monitoring - Per Site . . $ 60.00 Groundwater Monitoring (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 Subtotal: _ Priority Review: Enter same amount as Subtotal: ' f D MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: - 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) Compa y Name Conta Perso ( > No. treet Address Or P.O. Box City, Town or lage, State, Zi Co e t Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. SBD-6748 (R. 03/93) OVER PETITION FOR VARIANCE A-PPICATT N Wisconsin Department of Industry, Labor and Human Relations OFFICE USE ONLY Safety and Buildings Division Petition on E USE ONLY OFFIC Amount Paid 201 East Wshington Avene, P.O. Box 7969 No. Receipt No. Madison, Wisconsin 63707 608/266-3151 E-Number r tlame/~ f Owner/ eti Toner Bui d'ng or Project Agent Archecor gineering firm . l7 Compan Ten Name.,if any Stree & Number ;W1 &ZZ, Street & Number S Location, Stt/reet & Number City Stat Zip Code City State Zip Code Cit County Telephone Number iJr V&7 Telephone Number Plan Number, if known Name o Contact Person -3 7 La' 1 90 S - 1. The rule being petitioned reads as follows: (cite specific rule number and language) r- - 2. The rule being petitioned cannot be entirely satisfied because: - 2426 /AU f .4. Jt1 t F~ n~iJi)in } n f 4 f ~iit~r' 3. The following alternative(s) and supporting information are proposed as a means of providing an equivalent degree of health, safety or welfare as addressed by the rule: /.J 4TY, <14Z Mote: Please attach any pictures, plans, sketches or required position statements. VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED AND ACCOMPANIED BY REVIEW FEE See Section Ind 69.15 for complete fee information Mote: Petitioner must be the owner of the building or project. Tenants, agents, designers, contractors, attorneys, etc. may not sign petition unless a Poower of Attorney is submitted with the Petition for Variance Application. ,"r 12aui ? on 'J',an a , being duly sworn I state as petitioner that I have read the toregoino (LAME OF PETITIONER, Please type/print) "jibelwaekV petition, that I believe it to be true and I have signif;~jy/~~ ghts in the subject building or project. fto, .4 A n to before me this date: Ao?- 93 Signature of Petitioner ~q t/V0~. sN tary Public SB-8 (R . 09/88) ocsaew'' 'y~`+ • B 9f Wlgsio' t, 3 :too" Hi1L'+3~ SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYS r^ 4- ADDRESS: -J,5 ~el C - A pt1 1(" i1 1~y~' FI L~ NO • f ~ s a ~d~sS LOCATION:_ 1/4, 1/4, SEC._____~')~< Z+~N-R_,ZZW V-) , TOWN OF: r _ST. • CROIX COUNTY SUBDIVISION: LOT NO. Improper use and maintenance of your septic system could result in its premature failure to, handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman. plumber, restricted plumber or a licensed pumper verifying that'(1) the on-site wastewater disposal system is in proper operating 'cond'ition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix county Zoning officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in full and signed by the ottiner(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 S r--' Location of propert-YN ~l/4 ~~1/4, Section', T 31 N-R_aW .Township r ra l r l Hailing address ~ w ~C h Ah,4 /it LIT Ne S 19 Address of site Subdivision name MR, -Lot no. Other homes on property? yes- No 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 (spec house)? Yes _„(No Volume and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WAttttA ITY DLED which includes a DOCUMENT NURBER, VOLUHE AND PAGE 1tumui n It THE SEAL OI' THE REGISTIhR 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 refeZencas to a certified Survey Map, the certified Survey Nap shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of ny (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. 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 County Register of deeds as Document No. Z e-,-- ignatu of'appi cant Co-applicant Il ~ ~ I Date o gnature Date of signature