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HomeMy WebLinkAbout032-1079-70-000 c (D 00 o 50 I 0 0. 0 M I a °c o r., r c = v o .p O 0 p ° 1 y E C -0 m c~ m N 0 o z C a : ~Q U. c _ n _ a) o C C C E Q U v U f6 N v ~ I E Z o o z a m N F- cn I I O z d ~ I Y ~ co 0 o m s I C (Cf N o a a N =zz ~zo n 4) C _0 LO Vl C l'V .0 ~ _ d O C a o o a` Z E E N H H FN- c tw a cn • E a a a L ~ CL c I QMl = 0 y m N N N J t) J OOi p Q) > c~ oo '3 o I .2 N N O C O 0 C) O 000 Q 7 Q • N d v - Q Z o vii a I C o c c_ w e o 3 0 N _ Ln 0) l V o c c aMi c E c " 2 eo 0 O O - a) c N M E 3 Z. n • 7. O N U) 0 a) in CL r O Q, Z co 0 ~ - I w' am a a w a E d c `~1 U a 0 in 0 AS BUILT SANITARY SYSTEM REPORT OWNER DFzw t( )eEZaSo0+/ TOWNSHIP 6a0 ' -fiF7 SECTION_jZ6 T3//Vf N-R--LLW ADDRESS-/303 So y?ff STr ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM roe/? iJ ~ X'~s r CAM ~ECTD/1 f~4~"~P J G tL. ~I $S, yG 9a Eis r (j)C- A P 6A N, ,0 ~rCS'o, INDICATE NORTH ARROW BENCHMARK: Elevation and description : /V4U G ly/1NE/1 ©G 51,O&WAL)Ot- jpA/P/-/ Alternate benchmark PTIC TANK:Manufacturer: Liquid Cap. Rings use Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Fro Side Rear Ft. From nearest prop. line:Front , Side , Re Ft. No. of feet from: Well , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of t elevation Pump on elev.: Pump off a Gallons/cycle: Alarm: Man.: Switch Type: Location Distance fro earest prop. line: Front_, Side_, Rear_Ft. Dist a from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length -Number of es: Area Built Exist. Grade Elev. l Grade El ev. Fill depth to top ipe: No. feet m nearest prop. line:Front Side , Rear Ft. No: 'feet from well: No. feet from building HOLDING TANK Manufacturer: WE/SE/ -Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: 01 691 Y& No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well,/OD's building 6 nearest road Alarm Manufacturer: L &y&z- ALA ifn INSPECTOR: q DATE : PLUMBER ON JOB LICENSE NUMBER: ~dV 6/90:cj LOCATION: SOMERSET 28.31.19.390D,SW, NW Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: 'Labor and uman Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 171434 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan D No.: PETERSON DELWIN P & MARILYN ASOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: , 032107970000 TANK INFORMATION ELEVATION DATA A9200199 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding d / Ht Inlet °f SL TANK SETBACK INFORMATION/ Ht TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding L r >lba 125 O Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes C] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) f5r~ &t4-~: c b(} tJ cam, (J '3o Plan revision required? ❑ Yes ❑ No Use other side for additional information. a g 9 y I y (p SBD-6710 (R 05191) Date f spector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH a SANITARY PERMIT NUMBER: ILHR SANITARY PERMIT APPLICATION EZ I In accord with ILHR 83.05, Wis. Adm. Code !uNTY . q&40_~ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANI Y PERM # El ~ 8% X 11 inches in size. h rev ion to revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION D-4 a Cl/ ~oN SW Y4 aP14,S T ,N,R E(or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1303 Tti s ,4 A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER /L e2 /,J~ if' 11. TYPE OF BUILDING: (Check one) 11 State Owned VILLLLAGE : NEAREST ROAD ,4QUN OF: ❑ Public 91 or 2 Fam. Dwelling- # of bedrooms P ARCEL TAX NUMBER(S) _ 111. BUILDING USE: (If building type is public, check all that apply) L r) 3 IL A0 7 7- 70 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.E1 New 2. " Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 51:1 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./inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New isting Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holdin Tank 2X0 F] F1 F] 1-1 =FR: Lift Pump Tank/Si hon Chamber I-Xi- 0 El F] 1 0 El Ej VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown =!M hed plans. Plumber's Name (Print): Plu er s Signature: (No p IM MPRS Business Phone Number: T 3 S/ Plumber's Address (Street, City, State, Zip Codfl: S ` - cSS~® IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater EDate Ise ' g Agent Signa (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial y~ Adverse Determination OTC) X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS • . 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 renev al any new criteria in the Wisconsin Administrative Code will be applicable. 1 All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ovvnership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SGD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) m;jst 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 8t 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 DILI-iR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate ;prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans; and specifications riot smaller than 8'/z x 11 inches must be submitted to the county. The plans must Incl;_ e the fol;owing: A) plot plan, dravm to scale or with complete dimensions, location of holding ta,,A(s), 3iuptic tank(s) or ether treatment tanks; building sewers; .~ieks; water rnair~1water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption system- rap?r cement system areas; an the location of the building served; B) horizontal and vertical elevation referee.,) points; C) complete specifications for pumps and controls; dose volume; elevation difference,;'ric ion loss; pump performance curve; pump model and pump manufactures; D) cross section of the soil abso ption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATIER SURCHARGE 1983 %V:scc,¢ s~ a I included the cre;ati. n of surcharges (fees) Rrss a nun,t, r ref regulated practices which can effect groundwater. Tht monies cctl;eclu_l d ihrough th se, surcharges ate used for monitoring goon=tdv at.,r, ground- water contamination investigations-and establishment of standards. SBD-6398 (R.11/88) l I ~ I i I ~ I 8911 I ,I I ~ I 1 - - i I I , .ILR .SeZ 3~oC/v~ I l I - I FAR Se~' A&C e46C7OR : PvwR EAISTsd4codT/,av . RlNir A - - _ _ . Jl' i I i I l b o-'A-A • Bf•TbJ_ EF,M ICE, bk.ot AMD 'TANK SFRVIG£ MAHHOLE, T +NK---044N4K4LE To e.-Et LYATION - ~ ~I3 T O vv sate oK T Ft ,fix - I - - - i _ - - - - - r - - - I l I , rop ~L, 6 1 - - I U~ P VIE - - 9 r-- i _ - ' to SS`__ ' 1 I I i I r E NO , I _ t i I I , , _ ; WAS '3,V- PAGE 3 wi, onsin Department of Industry, ONSITE SEWAGE SYSTEMS Office of Division Codes and Application Labor and Human Relations Onsite Sewage Section Safety and Buildings Division 201 E. Washington Ave., Rm. 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 (608) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this fr • • with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. 1. PROJECT INFORMATION (Type or print clearly) Plan Number Previously Assigned 91 40 6 1 e Name o Submitting Party (plans returned to same) Project Name DeAlA01 Al t / Street Address, P.O. Box # or Rural Route Project Address or Legal Description 5,84 V,41-Ley ICJ c City or Village State Zip Code City ❑ County r (1 ~j Village ❑ of Telephone No. (include area code) - S j Town s'j,~~ ,I- I Designer Name of Owner Telephone No. (include area code) Telephone No. (include area code) 612- ~Z3 -00 .2- Street Address, P.O. Box # or Rural Route Street Address, P.O. Box # or Rural Route /3c3 sp, V,24 57, City or Village State Zip Code City or Village State Zip Code 1Lt / 6-522d,-7, 2. APPLICATION FOR: ❑ Experimental ❑ Mound System XHolding Tank Z ti3 /2 ❑ New Construction ❑ Large System ❑ Conventional Gravity System ❑ Groundwater Monitoring Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ Pressurized System ❑ System in Flood Plain (attach SBD-6698) ❑ Other Alternatives 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. a. 750- 1,500 gallon septic tank $ 50.00 b. 1,501. r 2,500 gallon septic tank $ 60.00 C. 2,501- 5,000 gallon septic tank $ 80.00 d. 5,001- 9,000 gallon septic tank $100.00 e. 9,001- 15,000 gallon septic tank $150.00 f. Over 15,000 gallon septic tank $250.00 9• 500- 1,000 gallon dose chamber $ 30.00,~"t h. 1,001- 2,000 gallon dose chamber $ 50.00 71 i. 2,001- 4,000 gallon dose chamber S 70.00 j. 4,001- 8,000 gallon dose chamber $ 90.00 k. 8,001- 12,000 gallon dose chamber $110.00 I. Over 12,000 gallon dose chamber $150.00 M. 500- 5,000, gallon holding tank L, $ 30.00 n. 5,001- 10,000 gallon holding tank $ 5.00 ?5~',QC . o. Over 10,000 gallon holding tank $100.00 p. Revisions $ 20.00 q. Groundwater Monitoring - Per Site $ 32.00 (other than a proposed subdivision) r. Petition For Variance: Setback $ 25.00 Site Evaluation $ 50.00 Subtotal: S. Priority Plan Review: Enter same amount as Subtotal Total Fee: i SOD-6748 (R. 0488) NOTE: Fees are pursuant to Wis. Adm. Code, Chapter Ind. 69, and OVER , are subject to change annually. 1 C7 S91-40618 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET a HUDSON, WI 54016 - (715) 386-4680 July 25, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Delwin Peterson property, located in the S 1/2, the SW 1/4 of the NW 1/4 of Section 28, T31N-R19W, Town of Somerset, St. Croix County, show no suitable soil for an onsite septic disposal system. Should you have any questions, please feel free to contact this office. Sin rely, y : James Thompson Assi ant Zoning Administrator cj y f ° s 40~ w 00 C IN rs o i ~ 1. I cz- J 3A s91 40 18 r l + ~i' ! k . 1 1/ o Ufa ~7 /.uvaNnos AINnoD / ~ lI3Atl XIOa~ ]S,' w,m T 5 " O Z 2 m m w m ~ N ~mz ~O u ;jm D N 5 v O R iZ „ o w m a ° s m m O my a J m A 3 » N ~ ~ ♦s ep4 ;3z m J m t~ m D rn pO O m -i 2 w• m i 1. ~n n N r- O C St. Rt. 3S N 2 0 o m m m 0° O uD ~ I ,f N O CA co APPRO%IMATE SCALE = DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 8 ~OltO _008 8088 FEET Federal Imuranee Administration 2 ST. CROIX CO., • • I MAF REWBED p (UNINC AREAS) FLOOD HAZARD BOUNDARY MAP H 07 MARCN M. ,976 FLOOD INSURANCE RATE MAP 1 07 i J' s v ~ HOLDING TANK CROSS-SECTION AND SPECIFICATIO•NS9 1. - 4 V 6 18 Approved Approved Locking T Weather Proof Manhole Cover w/ Padlock & Vent Cap Junction Box Warning; Label 4" C.I. 12" Min Vent Pipe 25' From Final Grade\ I 4" Min ~I Any Door or L 11 Window '77 . Approved Joint ~ 18 Min i Water Tight Seal High Water i F i - - --1,_ Note: C.I Alarm Switch C.I. Blind Plug Used SPECIFICATIONS Approved To Seal Unused Joint Openings TANK Manufacturer: Tank Size: 2303 Gallons ALARM Manufacturer: LN/LT' AZ-,4k1'°I Model Number: /U Switch Type !"IC-- j!t urav NUMBER OF BEDROOMS:_ d 31, Approved Bedding OWNER'S NAME: naL /'EsTE11.50Al ADDRESS : 1303 c, ~e;r* ST4 cS~~GLLIJAT~".6~ /1711 cSc~O~.2 LEGAL DESCRIPTION : ffW k, ,6~&;4,Sec . AS T 31 N ,R-L-2_W TOW NS H I P 4-MI-1 NI-C-1-RAT TTX: ~SOM~/2s1• COUNTY: ~"r G/IO/k : TEM S I G N E D LICENSE NUMBER:- DATE:- " r~WA~'~ gYS 0 N$1~~ io~af A T1~ p310 R Y , LK l F INDUSV DEPART S 0 . E~'1CE SEE GO 4/86 ~f ' fS91-*4061 S )cumenl No. This space reserved for recording data HOLDING TANK AGREEMENT treement Oats This agreement is made between the - - - - - - - - - - - - - - - - - 3unty or Local Governmental Unit I Holding Tank(s► Owner(s) I Delwin P. Peterson and Marilyn A. Peterson :alled Mankei all below I Is acknowledge that application is being made for the installation of (a) holding ink(s) on the following property, (Provide legal land description:) ginning at a point on the South bank of the Apple River and to West line of Section 28, Township 31 North,Range 19 West; pence South on said Section line 170 feet, more or less, to le center of a private road; thence East along said private ,ad 100 feet; thence North to the Apple River; thence Return To ~sterly along the South bank of the Apple River 100 feet to to PLACE OF BEGINNING; being in the South Half of the South- ~st Quarter of the Northwest Quarter of Sect(on 28 ,r that continued use of the existing premises requires that a ho d ling 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 :h. ILHR 83. Wis. Adm. Code, or Ch. 145, Slats. 13 an inducement to the County of St. Croix to issue a sanitary permit for the above described property, No 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. Slats. 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 collat., as provided by law. 3. The owner, except as provided by s. 146.20 (30) (d), Slats., 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), 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. 8. 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 Own' a) gnature(s) Delwin P. Peterson Subscribed and sworn to before me on t ? delete: Marilyn A. Peterson z ein- 3:4,e 6 o) I ithic ' r V- I Municipal Off ial Name (Print) I Munici at Official Signature Maw F. ~I ry Pub I ~j~ My mmis irp~SppypXZ4R MTA L11 IO . I MY C MW. EXPIRES FEB. 12, 192 M pal Official Title (Print) I 5804123 (R. 10185) This instrument was dratted by the State of Wisconsin Department of Industry, Labor and Human Relations. Bureau of Plumbing. ,ae.nd ~ HOLDING TANK SERVICING CONTRACT; contract Date July 24 , 1991 This contract is made between the - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Holding Tank Owner(s) Name(s) and Pumper's Name 1 Delwin P. Peterson and Marilyn A. Peterson 'S ~y~ ~,/~Ur,~. We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) Beginning at a point on the South bank of the Apple River and the West line of Section 28, Township 31 North, Range 19 West; thence South on said Section line 170 feet, more or less, to the center of a private road; thence East along said private road 100 feet; thence North to the Apple River; thence Westerly along the South bank of the Apple River 100 feet to the PLACE OF BEGINNING; being in the South Half of the Southwest Quarter of the Northwest Quarter of Section 28. 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of St. Croix 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s).. The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; PLEASE NOTE b. The name of the owner of the holding tank; Pumping this holding tank' c. The location of the property on which the holding tank is installed; may not be o s s i b 1 e in possible d. The sanitary permit number issued for the holding tank; Y e. The dates on which the holding tank was serviced; the winter or inclement f. The volumes in gallons of the contents pumped from the holding tank for each servicing; weather. g. The disposal sites to which the contents from the holding tank were delivered. 17P 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract. the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) 31wner*s Signature( Delwin P . Peterson Subscribed and sworn to before me on this date: Marilyn A. Peterson I Pumper's Name (Print) Pumpers Si ture Notary Public ~Npy s 2Uf~ I MY;commission exp res: a~ q5 Pumper's Registration Number T_ so :SHARON L COEN Ar. MW Public msnnosora Dakota Counts t SOO-7574 (N.11185) This instrument was drafted by the State of Wiscon in rtiMeRP"m 6-0 g 2 t °C _ of Industry, Labor and Human Relations, Bureau o P1 MAI, 1 a lip RINK as OMMU, am Pftg&Adp t a "&at 00 tba Soutb bank of the Apple River. „ate t -49 ltort%# "*'It hest; tbeaes so*"- is A"* or toms to the meter of a private road; tlisrMi`, y. t M kilt; tbes~e `Rortb to the Apple Rim; tbs A¢ath b•* of 0* Apple 'River 100 feet to the pLM OF S If of-tho Southwest Quarter of the Northwest Quattar Mlfii 611 ball#ioss or structures, permanent or otbo"44e ~0006~ iiMCtilsd'*ad estate. (continued on back) - of /llp'~ ~0~ 1t IININd, MM11M! MMMd ,a ~ V . trN►b sW applIjtl0I11MIbM 104106 inS 6494ft, nAbjeft do ft 7 { IIIIIIIIIIIjjII - iz,6-A it 'Oh y .tA -1 .a J&A 717 Mau AL ►AttX PIJQL!C lNtIVNFSOTA w w~~iwiMfi . liol4lTioalplAgtA11e(tDOOiisk Mow ii-h fittelJ7oe ' ;liee~ota ~ t , s i t s _ w tom' r d#14 carrying, PIPis9 of privilsas of drawing, am. "raoaal use from a spring stream aC arssk, loss, south of above bargained Premises asd sh" Mldhiwt farther or other consideration for said right aoL -40 asst mot to esassd 30 feet in width over the drIL46 my 0 or~l~` the Smth Ralf of the Southwest Quarter of the porthwst ;suss as described above. ,J at n T f ri' 0 p ~b gi-401618 BARRET-I' M. STACK REGISTERED LAND SURVEYOR 9090 FAIRY FALLS ROAD NORTH STILLWAT11R. MINNESO'T'A 85062 HOME TELEPHONE e 26, OFFICE TELEPHONE +r•;n W21 434.487.1 Jun ' - 1612) 439-5630 Mr. Del Peterson 1303 South Fourth Street Stillwater, Minnesota 55082 Dear Del, Pursuant to your request and at your direction, please be advised of the following: I have conducted a closed level run from Benchmark TT21C-1946, a Brass disc in concrete located 500 feet, more or less, westerly of the southeast corner of Section 29, T31N, R19W, St. Croix Co., Wisc., to your property located o- the southeasterly bank of the Apple River in part of the Northwest Quarter of Section 28, T31N, R19W, St. Croix Co., Wisc. Said Benchmark TT21C-1946 has a published elevation of 880.97 feet, N. G. V. Datum, 1929 adjustment. Elevation reference points were set on your parcel as follows: 1. Paint mark on NW Cor, BBQ in back yard: Elev. 685.73 2. Paint mark on w'ly edge conc. sidewalk: Elev. 685.46 I hope this data fulfills your needs in this matter.and if I can be of any further assistance to you in this or any other matter, please contact me. Sincerely, B(Ir! et tack, RLS I hereby certify that this survey, plan or report was prepared by me or under '0% 'z my direct supervision and that I am a ~~~~~~~N duly Registered Land Surveyor under the ~```a~ Laws of the State of Wisconsin. or BARRETT M STACK S-1740 Date June 26, 1990 Reg. No. S-1740 y< STILLWAT • ST. CROIX EXCAVATING ROUTE 2 SOMERSET, WIS. 54025 PHONE 549-6651 Holding Tank for Delwin Peterson S%2 W, W! 28T31R196 Somerset Township St. Croix County Pages #1---------------- Plan Approval application #2------------------ St. Croix County verification ofsoils #3------------------ Plot plan view ##4------------------Tank cross section #5------------------- Holdi,ig Tank agreement #6------------------ Holding tank service agreemtnt #7------ Surveyors statement Donavin L. Schmitt 586 Valley View Trail Somerset, Wi. 54025 MPRSW 3205 7-30-91 ST. CROIX COUNTY ~ plop WISCONSIN h ZONING OFFICE ST. CROIX COUNTY COURTHOUSE IN pq 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386-4680 July 25, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Delwin Peterson property, located in the S 1/2, the SW 1/4 of the NW 1/4 of Section 28, T31N-R19W, Town of Somerset, St. Croix County, show no suitable soil for an onsite septic disposal system. Should you have any questions, please feel free to contact this office. Sin rely, r' i' 1 • / ter-, James Thompson Assi ant Zoning Administrator cj i SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _CC J&fA1 R&7e- S d& ADDRESS: 13193 S 417,q '5 71 S FIRE NO : LOCATION : ~15W 1/4, _ AfIV 1/4, SEC. _T 3 _N-R_ Lf W TOWN OF: &/,?ZIET ST. CROIX COUNTY SUBDIVISION: /`A 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 condition 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: 9C, LC X_4___ DATE : S- 19-9.- St. Croix County Zoning Office 911 4th St. Hudson WI 54016 1 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. --------------7-------------------------------------------------- Owner of property _ f)E1ZV/Af c/1.SDAf Location of property&&L1/4 1/4, Section T_.U_N-R_j2 W Township r_Crggw VeT Mailing address 1303 ~So y T1IS7, - MzwAT /1 17N' c O Address of site Imo' ILi Cr i/ Lq<__ Subdivision name A/A Lot no. Other homes on property? yes No Previous owner of property ~s P-C, i,A e. Total size of parcel ' /70' X 100' Date parcel was created "mk_k0"-,^ Are all corners and lot lines identifiable? /V Yes No Is this property being developed for (spec house)? Yes XNo VolumeCand Page Number 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 & 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. 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 .t 163 Signature of applicant Co-applicant S 7-0 Iq2, Date of Signature Date of Signature y-~z AS BUILT SANITARY SYSTEM REPORT OWNER ELGV1A 9ZLeASiON TOWNSHIP csa/`'/Ei~'s,ET SECTIONZ-9 T-3/N N-R--L?-W ADDRESS /?O.3 So V7l' ST. ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~F ~ xis T SECTOR ~4M~ . tFl, ~I ~gS, yG ~Of 1 Eis T ~o®O Gang ' ~RruC A /SEA N~ D rhNtt l~rCSOS INDICATE NORTH ARROW BENCHMARK: Elevation and description: MW C_ 012Ale-12 .6F S/D Ae~ PA/ri"~ /',rAPF Alternate benchmark PTIC TANK:Manufacturer: Liquid Cap. Rings use Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Fro Side , Rear Ft. From nearest prop. line:Front Side , Re Ft. No. of feet from: Well Building: a . (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE