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Home My WebLink About014-1010-70-000 ~I ~ o a O ~ 4 ~ I h ~ I n O I' I N i O I ~ I b ~ I I aNi 1 7 N LL 0 C ~ LS ~ Q m v ~ m I ~n o Z ~ m a 1 ai a CO o I o z :t m Z o fA F- C Z ~ m I c N f- c •py c ~ g N :0 0 is 2 Z Z = I Z N ~ m £ N O i 4) = N c y _ d co « c Co y Yl y d U G a m .2 00 O ~I1 2:1 cn y V a -o 0 1 04 o •rv oo a a 0 0a d m a (D N I fp J V rn OOi .0 N - } m 0 1 00 0 _ N N m LL '6 n Q D) 0 a 4 Z O O N C Ca o O N O C E d' O 0 E 1 n c c a- N 1 } _o ° LL N E c 10 N jn co 1 r/ o ~n F-: c C) C o d 4. C) m c` ~2 CC) "t $ ea N E m 'm U o LL = o Z _ cn O ~ I ~ y v~ W M a o a L: a T `I~►i E m d y c ca O o U L~ v a 2 OU) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN&U'STnY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISO N WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNS HIP/j0kft-MNUt90XY: LOT NO.:BLK. NO.: SUBDIVISION NAME: SW 1/4 SE 1/4 5 /T31 N/R15)&(or) W Forest n/a n/a n/a COUNTY: OWNER'S XN)==AME: MAILING ADDRESS: St. Croix Fred Hansen 2770 Co. Rd. # Box 26, Clear Lake, Wi. 54005 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: 1:1 PROFILE DESCRIPTIONS: PERCOLATION TESTS: I Residence 3 n/a New ~ieplace 4-16-91 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIAL: MOUND: IN-GROUND-P RE: SY ❑ ~ I L H ®ING TANK: RECOMMEDED SYSTEM: (optional) ❑SS UU EIS S Do I S U holding tank 771 If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 7 MaB-FnB BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHA, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B_1 3.42 n/a .67 .67 .67bl.l. .75bn.mot. sil. 2.00bn.mot. s.l. 2 3.83 n/a .75 .75 7 3 4.50 n/a 1.00 1.00 1.00bl.l. .50bn.mot.sil. 3.00bn.mot. s.l. 13- L nn 1 CZ r) B 5 2.00 n/a 1.00 .50 .50bl.1. .50bn.mot. sil. 1.00bn.mot. s.l. B 7-1 3.00 n/a none .67-1.00 .67-1.00bl.1. .75-1.25bn.mot. sil. B- 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 PER D PER INCH P- P- P- n /a P- P- P- yy~~ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. }r~dire'scale or distances. Describe what are the hori- zontal and vertical elevatio 7w oints and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 6 8 f~ SYSTEM TIN n/a 160 , , , I o .4l, F 3 r~ , d , E s , 71, o , lee / l ~ lC0 i I, 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): TESjS j f~ j COMPLETED ON: Gary L. Steel 7 y ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, Wi./ 54017 229$ 71 246-6200 CST SIGNAT I , 4. 1&-Z - DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER « TOWNSHIP ,~oy cs~ SECTION ~ T~N-R_`',W~ j ADDRESS 77~Co c(~ ST. CROIX COUNTY, WISCONSIN SUBDIVISION t--- LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM a m ay~ 30 y,Gr 00 INDICATE NORTH ARROW BENCHMARK:Eleva ion and description: Alternate benchmark SEPTIC TANK:Manufacturer: Liquid Cap. Rings used: Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:Front , Side , Rear Ft. No. of feet from: Well Building: (include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE rPUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front Side , Rear Ft. No. feet from well: No. feet from building HOLDING TANK f Manufacturer: Capacity: No. of rings used: Elevation of botm tank: D- 7 5 Elevation of inle£: -5-,25-- No. feet from nearest prop. line:Front_)~,,, Side Rear Ft. r No. feet from: Well4e~2 , building,,0 , nearest road 3t9-D J Alarm Manufacturer: 0 INSPECTOR: DATE : PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj I Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT St. Croix iaf'ety and Buildings Division sw,sE,5,31,15w (ATTACH TO PERMIT) Sanitary Perm itNo.: GENERAL INFORMATION Q Co. 149138 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: Fred Hansen Forest S91-20615 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 014-1010-70 79 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ' , b5 10 ' (ao ' Dosing Aeration Bldg. Sewer Holding St Lt Inlet 9~- 15 a-/00 L TANK SETBACK INFORMATION St/Ht Outlet 01 ~0.7 TANKTO P/L WELL BLDG. Air Ito ntake ROAD .B~-+I~Ietl~u 4-1-vk IQ`gS go.as, Air Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding 3 0 0 h Q 30 3C 0 Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H 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 Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 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 ❑ No ❑ Yes ❑ No `).~OMMENTS: (Include code discrepancies, persons present, etc.) Q< y -711 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date I ' ector's signature Cert. No. SANITARY PERMIT APPLICATION a0j" HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY Gro r n STATEN 21oz -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBED 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. - / PROPERTY OWNER PROPERTY LOCATION 410 '/a 'S T F/, N, R (Or J PROP R OWNER'S MAILING DRf ✓ 110T # BLOCK # 7 ? CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR M NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAR ROAD ❑ State Owned ? VILLAGE re $ / GD TOWN OF: ❑ Public [91 or 2 Fam. Dwelling-#~ of bedroom PA T Nu B ( 111. BUILDING USE: (If building type is public, check all that apply) f ` / O 7 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 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 OHolding 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 Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App structed Tanks Tanks Se tic Tank or Holdin Tank F1 1:1 F1 U Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's me (Print): Plumber's n ture: (No Sta MP/MPRSW No.: Business Phone Number: Plu er' Address (Stree , City, state,- Zip Code): h lti ~S~i b IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved itary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt Stgnatur No Sham Surcharge Fee) Approved F-1 Owner Given initial 1.7 Adverse Determination rf~ O I :~2~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6396 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber )EPAI~TMENT QF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION NDUSTRY, P.O. BOX 7969 I _ABOR AND PERCOLATION TESTS (115) MADISON, W153707 1UMAN RELATIONS (ILHR 83.09(1) & Chapter 145) I LOCATION: SECTION: TOWNSHIPn~Y: OT NO .:ELK. NO.: SUBDIVISION NAME: 4 SE 'V 5 /T31 N/R15c(or) W Forest n/a n/a n/a S[d 14 COUNTY: OWNER'SIAME: MAILING ADDR SS: St. Croix Fred Hansen 2770 Co. Rd. fir` Box 26 Clear Lake Wi. 54005 DATES OBSERVATIONS MADE 1SE-___._ R IL 1 S: ON TESTS: NO. BEDRMS.: COMMERCIAL DES RIPTION: Residence 3 ri/a ❑Newteplace 4-16-91 n/a RATING: S= Site suitable for system U= Site unsuitable for system ING TANK: RECOMMENDED SYSTEM: (optional) CON_VENTIONAL.: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL OLD U S ~U ❑ S ~U ❑ S ❑ S ®U ®S ❑U holding tank ESIGN RATE: If any portion of the tested area is in the - D I I P :olation Tests are NOT required n under s. ILHR 83.09(5)Ib), indicate: Tl/g Floodplain, indicate Floodplain elevation: n/a. decimal' PROFILE DESCRIPTIONS page 7 MaB-Fn8 BOR I NG TOTAL PTH TO GROUNDWATER-I CHES CHARACTER OF SOIL WITH THICKNESS, OR, TEXTURE, AND DEPTH '('R =R DEPTFI~{2[, ELEVATION OBSERVED ST. GHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B.1 3.42 n/a .67 .67 .67b1.J.. .75bn.mot. sil. 2.00bn.mot. s.l. r' 9"rMbaimet. a.!. -~-.mot. 9-J-14 l. ` B 3 4.50 n/a 1.00 1.00 •1.00bl.1. .50bn.mot.sil. 3.00bn.mot. s. _7 r% Obp mot __Q -4. 00 .75 .75bl. 1 - all. B 5 2.00 ::nn/a 1.00 .50 .50bl.1. .50bn.mot. sil. 1.00bn.mot. s.l. 7-1 3.00 n/a none .67-1.00 .67-1.00bl.1. .75-1.25bn.mot. sil. B- - B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME Dff_0?_1_1q_WAT5R LEVEL-INCHES RATER IINCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P- P- P n a P- P P- _ _ ~ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. ght e tale or distances. Describe what are the hori- zomal 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. 0 ` ( A 6's n/ a \ p SYSTEM ELEVATION s ( I 1~ ire ' 160 acres Opel k 4 TN f_ I 12 I4 11 1 ~ J r 66-V I I, 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 (p(int): TESTSjfgi COMPLETED ON: Iii-Try 1'. Steel. 7 CERTIFICATION NUMBER: PONENUMBERIoptiunal): AoulESS: 1554 200th. Ave., New Richmond, Wi./ 54017 2298 CST SIGNAT DISTRIBUTION: Oi i9utal and one copy to local Authority, Property Owner and Soil Tester. S91-20615 - L i n, c.L' I astt5 (R 10183) - OVER - r U11 ii-LAN .Pft0JECT' G Gt`/ ADDRESS.,--7~e .1d 1/4~~1/4/S /T N/R W TOWN i COUNTY r MP RS Byron Bird Jr. ~ . 3318 DATE BEDROOM CLASS PERC CONVENTIONAL- IN-GR N OU D ESSURE CONVENTIONAL LIFT MOUND- HOLDING TANK--..X- SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA PERC RATE BED SIZE k Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H. R. P.., 0 Borehole Q Well Scale Feet 0 Perc Hole System Elevation f7 i ONSITE SEWAGE SYSTEM Ir-` M-0 I RELATIONS 111v { ..:sd L i Jr,i i i r~ia:J L "U1, l~l~~Gy 2,1 / i 9rC'~1 SEE CCRP,~SP0N[)! NCE 1l w~~ _"Vo A-) fY`C•,'s S L~ l ICI 591-20615 61 N V I FLAN PROJECT c ah a ADDRESS 77r1 ~o_ ,xx•Z,~ X1/4 Jr~ 1/4/S /T~ N/R/ W TOWN vet COUNTY PRS Byron Bird Jr. 3318 DATE BEDROOM CLASS PERC CONVENTIONAL- IN-GROUND ESSURE CONVENTIONAL LIFT MOUND- HOLDING TANK__" SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a-o-U ABSORPTION AREA PERC RATE BED SIZE ► Benchmark V.R.P. Assume Elevation 100' Location of Benchmark ~o•~ ,S, ~~:~s * H.R.P.=.~ Cl Borehole Q Well Scale Feet 0 Perc Hole System Elevation no -71 J#_2,7, .-v A_ 1-k e- F A /Vii,; Cpl, s - ~ j " /O LI n ~ a Vii; rsOf"~Cr"~1i1:.~Jr'l.i~LE~L r tr::~ ~2~r 30 35~ At le /1,1111 Se- L j 1`rJ GJ S91-'20615 Q Y Y •t t1 u •V O Y ~ O r. Y n.• u/~ M r r E ~ u • Y 4"a L t V v tt 1 `a N t 7 `~a a ~t j a~, t • ° ~ " J~ L ~i i ~.1 111 r ~ Y ~ Cfj F:z . ~ 3 r~ ~ v rt v • 9.. J 1 i < c s tv r _'i L11 W Y nIJ V N F- f s W r Q Y M O V o r s•• •4 r• ••Ow d yr • > A.•M u M s r <"fYN~1N 1 w ~ J 1 V1 • S • + t ..1 I r • E d M ~ a y • g' V . • • .7 N • r C c , 1 •Y • ~ ~ n w tt 1 a Z o 1 ■ • a O N 9{ S w M • M Y • V■ ` • ■ O • r M N Y M 1 < • • f 0 ' w ; xt u Y •~i l ba M Mr y w K ~ N < IR1 /r 119 M x ~ = y r • t/~ tR h1' M ' w Sae IS Al N 59 -20615 •ft Document No. , This space reserved for recording data HOLDING TANK AGREEMENT Apreemenl Dele - This agreement is made between the Cou y or L al Governmental Unit I Holding Tank(s) Ownc,~~ Township of Forest (Celled Municipality below) We acknowledge that application is being made for the installation of (a) holdng tank(s) on the following property, (Provide legal land'descriptiom) Return To or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose o1 proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. As an inducement to the County of S 7- d P- en-;CX to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and 146.14, Slats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by a. 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 collected 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. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. S 91 O b 15 Owners Name) (Prins) I Own s) ignalu e(s) Subscribed and sworn to before me on this date: July 26, 1991 Municipal Official Name (Print) I Municipal Official Signature Notary Public Leon 0. Helgeson my commission expires: - • I ~ ~ i~ U~~ Municipal Official Title (Print) I October 9, 1994 Town Chairman SBD-6123 (R.10/65) This instrument was dratted by the Slate of Wisconsin Department of Industry. Labor and Human Relations, Bureau of Plumbing. Document No. This space reserved for recording data 472455 HOLDING TANK AGREEMENT Agreement Dale ~i - VOL .911 PAGE 618 This agreement is made.between the Cou y or L I Governmental Unit Holdinfl Tank(s) Ownol - = REGISTERS OFFICE I Township of Forest ST. CROIX CO., WI ( Reed for Record (Called Municipalio,"low) I R F / (s SEW AU G 121991 We acknowledge that application is being made for the installation of (a) hold ng fat 2.50 P. M tank(s) on the following property, (Provide legal land'Llescriptiom) R;gisw Of Deeds R -turn To - - - - - - - - - - - - - - - - - - - - - - - - - - or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. As an inducement to the County of -S Z_d E t 3C to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. It 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 a. 66.60, Slats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauting or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be collected as provided by law. 3. The owner, except as provided by s. 146.20 (30) (d). Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch. NR 113. Wis. Adm. Code who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2.. Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under a. 146.20 (3) (d), Stats., the owner shall submit the report to the municipality and the county. 5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement In such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. OwnerjV N&MOPQ (Print) I Ow") ignalu e(s) Subscribed and sworn to before me on this date: f _ -1______ July 26, 1991, - cow i Municipal Official Name (Print) I Municipal Official Signature •Nota POW / Leon 0. Helgeson MY commission expires: r ~'yj_ Ci Municipal Official Title (Print) ) October 9 1994 Town Chairman SOD-6123 (R. 10185) This instrument was drafted by the Slate of Wisconsin Department of Industry. Labor and Human Relations, Bureau of Plumbing. - HOLDING TANK SERVICING CONTRACT Contract Dale This contract is made between the c---------- Hotnq T 9k OwnerM Name and I Pumper's Name I I I &6a T Ss &-t We acknowledge the installation of (a) holding tank(s) on the following property. (Provide legal description:) 77 3/ Al 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of .S r G ,4~ D ZK 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank: b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in elect Untii the owiier or`pumper terailnates this contract. In the event of a chance 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. Ownerj4NamaW (Print) I Owner's Signature(s) A. A09 Subscribed and sworn to before me.on this date: I Jul 26, 1991 I U~ E2/ . Pumper's Name (Print) I Pumper's Signature otary u ip My commission expires: I ~pb er..~ Q,SS e,11114 5 I October 9, 1994 Pumper's Registration Number 7 SS7 _ cen_7c7A Isl nomn% Thic instrrimont was d' by the State of Wisconsin Department APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~~F Q 1 yS~ WA AJ,_1Z ,Al Location of Property L~4 Ew14, Section _ L , T aL N-R_L;j_ W Township 42 R, a L Mailing Address Address of Site .,5-lf0 k Subdivision Name A21 Lot Number J~ Previous Owner of Property f dT 44 ad S F Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No 011 Volume and 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, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 ( ) centi.by that a t statements on this Bohm cute tlule to the best ob my (Pov) am (gee) the owner ) o6 the pnopenty de s ch(bed in thii s Fznow edge; that 1 ( in6mmation bonm, by vi tue ob a waA&ant~eed %ecoiLded in the Obbice ob the County Reg.c step o j Deeds as Document No. ; and that I ( ) pnesen tty s (on T (we) hive obtained an own the proposed site bon the sewage di pos system easement, to nun with the above descni.bed ptopenty, ban the constcucti.on ob said system, and the .same has been duty necanded in the Obbice ab the County RegisteA ob Deeds, as Document No. ~ ~v SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) G /99/ DATE SIGNED ~7 DATE SIGNED oor~'MENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA I STATE BAR OF WISCONSIN FORM 2-1982 450'75:. ! REGISTER'S OFFICE ST. CROIX CO., w Ka thin A. Hans g- en a sin le pers on ReC'd for Record i - - AUG 211989 11:30 AM a redexick.. L,--Hansen conveys and warrants to Register of Deeds RETURN TO I!. the following described real estate in .t- CrO ..................County, II ` State of Wisconsin: e Tax Parcel No- {'I! it W2 of SE and E2 of NEB;, Section 5-31-15, St. Croix County, I W, sconsin ; This deed is in satisfaction of a land contract dated August 1, f 1979 and recorded in Volume 600 of, Records at Page 49 as Document No. 359370, i g' 0, I I i This is homestead property. (is) (is not) Exception to warranties: Subject to municipal and zoning ordinances and record- i ed easements, restrictions and reservations, and any liens or encum- brances created or suffered to be created by the acts or defaults Dated this he grantees. 18th day of Augus-t 19..89... (SEAL) (SEAL) ii Kathryn A. Hansen I i ; (SEAL) (SEAL) i~ iI * I AUTHENTICATION ACKNOWLEDGMENT ~j Signature(s) STATE OF WISCONSIN SS. Polk County. - - --------..day of authenticated this day of 19...... Personally came before me t 1 1-8 th August' 19........ the above named ----Ka.thry_n -A....Hams en---------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN L_-... . -If not ~.......-......J~_ authorized by § 706.06, Wis. Stats.) to me known to be the person hd gitelltQd~A4,,, foregoi ru d same. p~~J►'" _!V / THIS INSTRUMENT WAS DRAFTED BY ---'Y1 Bert..D:___Petersen C.tQr_ne.V_.at_-Law c Berk---~-•---P_et~.xs_en--------- Clear LakeTaI .4_QOS Notary Public Folk-•-•----------- --4.4._C~un y,,' Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state •e6iration are not necessary.) date: 19.........) i .I I ii •Namea of persons signing in any capacity should be typed or printed below their signatures. ii STATE BAR OF WISCONSIN StOCIC NO. $OOZ KC. illerCorrp" FORM No. 2 - 1982