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Home My WebLink About010-1085-40-000Wisconsin department of Com nerce' `a y :safety and Bui,Ciing Division RIVATEFW~IGE~YSTEM INSPECTION REPORT GENERAL INFORMATION ~ Q' (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic `~~ ; .., Dosing / j / J`1b` ~ n, l a,w Aeration Holding TANK SETBACK INFORMATION TANK TO ~ P/L, WELL BLDG. Vent to Air Intake ROAD i ng Dos Aeration ..--'' Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well Coll ARC()RPTICIN SYSTEM FI FVATION DATA county: St. Croix Sanitary Permit No: 430655 0 State Plan ID No: Parcel Tax No: 010-1085-40-000 Section/Town/Range/Map No: 35.30.16.5146 STATION BS HI FS ELEV. Benchmark a. 5Z{ faa,5 ~a~ Alt. BM Bldg. Sewer 1.33 / rye' Z~ _1 St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade st Coverer. \ .~ .3,35 ~~ Z3 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR INFORMATION Type Of System: UNIT Model Number: DISTRIRl1TION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent to Air Intake ~~~ ~,~~ Length Dia Length Dia Spacing SOIL COVER v Prneenre Cvc4ame only YY Mnund Or At-Grade SVStemS Only J i ~~' Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2553 130th Avenue Emerald, WI 54013 NW 1/4 E 1/4 35 T30N R16W) NA Lot ~ l~'~~-~ Parcel No: 35.30.16.5146 1.) Alt BM Description = , ~~-~,v~,~O + ~ o~ / ~ ~%~~' -~~" ST/ ~ 2.) Bldg sewer length = ~ ~ ~~ _I_~t ~x ; ~~t /` `.~~?~91i~O~ ~ ~,~ ~ ~O - amount of cover = ~ '~ ~ ta` , ~~, V~~~~ ~~~ p ~ Plan revision Required? '', Yes ~.1 No I ~ i ~d~~j~~ ~~~ ~ 3 ~ - cc...~~ Use other side for additional information. '~____ _._ __ Date Insepctor' gnature Cert. No. SBD-6710 (R.3/97) ' I '~ P,.opo3edwcP3aaD-F~t ^So,lQ/a/(,c<t.t,'o~~~J.c. /30 A/e. , C,Y~SL'~ ~~y cue/% _ A ba., d~ as pe.- code.. 4~.b.n1.:Tao~' '-o~C-~e 5 opd. h o lcl,"~sj tin JC. ~ ~" fad/ a! t. c <, ; r t /a-l , r z w sss 5~/e: /_ sb , ~ 0 ~ zo q~. ~ 8~ / : T'o oF' b /out~f'oun o&.6'orl. ~ h~o~ ^ J , ~ ~ ~ / / ~ l ~ ~ ~" ~ .~ XN~L ~ / /~M /. C ~ A~ i Szwe.r ~ ~e~K p i o~~ 8 ~ ~ o q0~ EXis~E; n,9 ~ 2 bed~dO.-~ ~i.5fi ~ Scp~~c -~5-4~ r c sid en ae ~; ,(XNdo~-, ash code. 0 s aid d ~a~a9Q c b 06 ~ ~ • • o- • 4•~ ~ ~~ (~ ~~ .~jka a~' ~`s.. ~',~~oP~ C~p ? A'dd~Eion EXi-shinq Z ivt 11 J ~~ ~-~ ~ s/ doe 4 gy ^ I 3 h v v 0 a~. Safety and Buil V E h' L n r' ~ k ~ ~ ` 20l W. Washington ve., P. L • l.~i t ) ,~~O~~I ~ Madison, WI 707 - 7082 Sanitary ermit Number (to be filled in by Co.) . De artment of Commerce (608) 26 X546 04 ~ S~ Sanitary Permit Application U Stag PIs I.D. Number ~ CROIX CO ~ S , I ~ S~ ~ ~t l personal information y u prova In accord with Comm 83.21 Wis. Adm. Code . , , may be used for secondary purposes Privacy Law, s15.04(1)( ) ZONING OFFI dress (if different than mailing ad ress) I. Application Information -Please Print All Information ' Jt~Mt/ Property Owner's Name arcel `6et•Ih oio - ~o _ _t9o . SI~t3 .cr err - Property er's Mailing Address Property Locat i on ' O i~~ Z..~ `s.3 ~ ~' ~ ~ ~ ~ l ~'/. LLB'/., Section ~ City, State Zip Code Phone Number , ~ ~+ /~ ~~ e. _ ~/ W s.~ 3 ~ ,/ 3~~ `l- '/-(circle one) T ~Q N; R[~gffiW (chec 11 that a e of Buildin l ) T II 6 ~ pp g y yp ~ ~ ~ fd . ~ 2 Ttf} I or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number /~~ i l D ib U ~""`~ blidC ^ P ommerc a - escr e se u / ^ State Owned -Describe Use a Q~(-Ij /!-Y~ _ ^City_^Village I~Township of .r h'( 4 [II. Type of Permit: (Check only one box on line A. Complete line B if applicable) - A' ^ New System eplacement System ^ Treatment/Holdin Tank R lacement Onl g ep Y Other Modification to Existin S tem 8 ~ B. ^ Permit Renewal ^ Permit Revision ^ Chamge of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POW'TS S stem: Check all that a 1 ^ Non -Pressurized In-Ground ^ Mound >_ 24 in. of s itable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground olding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUl'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation c~ a 4 8 . so' VI. Tank Inf Capacity in Gallons Total Gallons Number of Units Manufacturer ~, /J ~~ ~ // ~ J ~ Prefab Concrete Site Constructed Stcel Fiber Glass Plastic New Existin a ` ,y ~ ~ d r~- ~Irt~ f~uX g Tanks Tanks V Holding Tank ~ ~O ~^f ---- (~r e ~ r ~l s/ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility tort installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature ~/MPRS Number Business Phone Number ~ / ~ 7,.ZSo3~ X0/2 gG$= J9,t7 Plumber's Address (Street, City, State, Zip Code) ....11 - [mot./ . S ~ VIII. Coun /De artment Use On ~pproved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued suing gen` Signature o Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~ ~S_. •I 6 IX. Conditions of ApprovaVReasons for Disap n ~--n ~~~-5 th ~y ~l~Y s^'~ SYSTEM OWNER - ~~ ~ C - : ~ CSf-~~~ L-' 1 ~ ~ ~ ' ust all ~ serviced g l~ gQ as er management plan provided by plumber, St,,~""_ . ~~~e~-- ~ ~"_ _ I ' ° _ _ _ _ 2. I set ac requlremen s mus a main Ine ( T as per applicable code/ordinances. ~ 1 A ~~~ Attaca complete puns (ta tpe Gouaty oaty) for rde system on paper wort K» ...... o••.. • • •••.••..• ••• •~.~ ,r ,gyp a h~d_b,(Cl.n~- ~~~~i„LI;~j Q~ SBD-6398 (R. 08/02) sa'-o" 12'-O" 2'-6" 2'-6" 11'-O" 6~-6" ~~~~~ 4'-6~~ 6'-6.. Z4 G Z4 b N ry~ (~ m l Q~ d ~I (1 m W D ~] Af v ~ ~ Z m O m r Z ni ~ ~ N ~ ~ iD O 1 ~ a Uu W ~ Zx z o ^ o N~ ~ b ~ D~ ~~ ~ ~ T m ~~ ~ w ~ ~ ~ ~ (1 ~ 2 N ~ \ I I A ~ ~~~III V_ ' I b a ~~----------------- ~_ 1n I~ I ~ D ~-{ ________ V T - Z ~ "~ ~ ~~ ~i ~ ~ z m '. _ m Z ~; ~ " ~~ zm ~ n ~ <_ ~ '3 IG~ API g; r ~ ~ ~ m --- -- `--e'lla-~ _I~-_ ------ 3'-514" x 3'-5~6" o EYj \, 4A" x 4-596" CN 35 ~ .y CW 45 d~`' 6~_3Y4" 15~-6" 6~-~~~ 21~-9/a° ~ > .~ i~consin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. comme rce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary January 06, 2004 CUST ID No.225036 MICHAEL P MC DONELL A.C.E. SOIL & SITE EVALUATIONS 1070 HUNTER RIDGE RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/06/2006 SITE: Jerry Carr 2553 130TH Ave Town of Emerald, 54013 St Croix County NW1/4, NE1/4, 535, T30N, R16W FOR: ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 957495 Site ID No. 669727 Please refer to both identification numbers, above, in all comes ondence with the a enc . Description: Two Bedroom Holdiing Tank System Object Type: POWTS Component Manual Regulated Object ID No.: 937290 Maintenance required; Replacement system; 300 GPD Flow rate; System(s): Holding Tank Component Manual, SBD- The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do by the department per s.145.06, stats. CUnd The following conditions shall be met during construction or installation and prior to occupancy or use: /'1~~~' General Approval Requirements: DEPARTNfEN' /LION OF SAF • This system is to be constructed and located in accordance with the enclosed approved plans and with the ~L~°~~'6~==-° "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). SEE CORRI • A meter, with remote reading device, shall be installed by a properly licensed plumber, on the water system, that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • A notarized Holding Tank Agreement between the local governmental unit/Municipality and the property owner is required prior to the issuance of a sanitary permit. A Holding Tank Servicing Contract may also be required if no other service provider for the holding tank has been identified. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.2U(2)(d), Wis. Stat • Comm 83 22(7) A cop, oY f the approvedplans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. MICHAEL P MC DONELL Page 2 1/6/04 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~~~~~i~~~" J Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state. wi. us cc: James K Thompson , A.C.E. Soil and Site Evaluations Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 WiSMART code: 7633 ,. CONCRETE HOLDING TANK DESIGN Sint~Ie Tank Opti~ara INDEX AND TITLE SHEET Project Jerry Carr 2 bedroom residentail holding tank Owner Jeny Carr Address 2553 130th Ave. Glenwood City, WI 54013 Legal Description NW1/4 NE1/4, Sec. 35, T.30N., R.16W. Township Emerald Subdivision Name Na Lot No. Na Parcel ID Number d01-1085-50-000 Plan Transaction ID Number Index and title sheet Page 1 RECEIVED Holding tank specifications Page 2 Site plan Page 3 JAN 0 ~ Z004 Maintenance and contingency plan Page 4 Hold Tank Agreement Page 5 SAFETY & BLDGS DIV. Designer Mike McDonell Signature ~ ~_ ~os~ License Number 225036 e >ti, ~~~ `~~~ co~~r~R~F U2Q GS SPpNpP CE Phone No. 715-386-8692 Date 12/31/03 Designed pursuant to: Holding Tank Component Manual For POWTS SBD-10571-P (R.6/99) Version 2.0 (03/01} Page 1 of 5 HOLDING TANK SPECIFICATIONS 2 Number of bedrooms 0.0 Non-residential estimated flow (gpd) 2!7®G.0 Minimum holding tank volume required (gal) 3000.0 Proposed holding tank capacity (gal) _ 3-~f '8~., ~G-cc-~y Wieser Concrete Tank Manufacturer WLP3000-FDL Tank model number LevelArm Alarm manufacturer HW101 Alarm model number County St. Croix Tank Dimensions and Data Tank Anchor Calculations ~1X fnr m~mri tank ~1iti~ into:..tii .,s ~~~ ~ e /3o A~/ . Abp., dog as Pe,- code.. 3 . b Pro po sad wG P3CD0-FVL ^ Sor l Q dQ/LIQ.~'oi~ ~: ~. ~ o /d. nq ~tn.~t:. ~ f~af'~l of ~• 5^: ! Q ,/cal', d 5~,,,,~lar~ ~e~oa~'adP,'b ~ EI¢/a~Er'o~. ~ 8~ ~ / /15Sccmed ~. lei : /G~• ~ r l ~ Zss3 ,19`'' p~ I Sca/e:/-5d for o ~ I ~1 q~. T po~'6/oc~~'ouna~.6or1, ~ ~ ~r~h ~ decK i o~ q~i ~li.5f;,~ .Scp{~c ~~~. ~d~-, as~fk.'Code. S h e,d d ~n~a9e b J 4 ,.-~iyti • • ~- o- y 4' ~ ~/,~~ QS •~~ . ; a~• ~~. ~• ~oP~ ~ EXi s#i h~ b eds .-, z Y'cside/lae ~ d EXi.sfin~ °~ c ~_ we // a ~-.~ ~ /0~2 ab V 0 61 ~ o_ 0 J ~ p iJ h v v ~, 61 ~ ~ J ~ s Q ~ ^ 3 By ^ ~~ doe 3°~~ ~ . ~, : Top o{' .,cre 5 pa n Y'~itiC+~~.rsdc~~ HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWYS) has been designed, and is to ~ installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P 6111/1999), and the St. Croix County Sanitary Orciinance. 1. This POWYS is designed to accommodate an estimated domestic wastewater flow of 600.0 gpd. 2. The owner of this POWYS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are re~rted to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWYS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWYS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWYS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWYS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ............................ Mike McDonell Phone: 715-386-8692 b. Service Provider ................. A.B.C. Complete Sewer Services Phone: 715-235-1666 c. Co. Zoning or Health Dept. St. Croix County Zoning Phone: 715-386-4680 11 Project: Jerry Carr 2 bedroom residentail holding tank Transaction Number: Page 4 of 5 Document Number I Document Title St. Croix County Holding Tank Agreement State Plan Transaction Number - Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1. He/~lx is the owner/p3rt~owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume ~~ Page 35 Document Number ~/1, St. Croix County Register of Deeds Office: Recordin Area A parcel of land located in the'/4 of the ~/4 of Section S~, Two N - R ! W, Town of ~'me~g,/a/ , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description):SQQ Q-~at.~,ya,~~, Agreement Date: / .3 Q,~ Name and Return ddress ~Q MSS ~ mrr9p S(iry 3~taPcuclse~ Co.Ke~t. %U~ /U63 -JU -CxJU Parcel Identification Number (PIN) We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property 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 onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Stats. As an inducement to the county to issue a sanitary permit for the above-described property, we agree to do the following: 1 . Owner agrees to conform to all applicable requirements of Ch. Comm 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 governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be 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. 66.0703, Stats. 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis. Adm. Code, to have a water meter installed in the structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, r-Maintenance, and repair of the water meter, and ayrees to allow the governmental unit or the Department of Commerce to enter the above-described property on a regular basis to read andlor inspect the water meter. 3. Owner agrees to pay all charges and costs incurred by the governmental unit or county for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit 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 the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to fle a copy of the contract with the governmental unit. 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 governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 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. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this 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) -Please Print Subscribed and sworn to before me on this date: 2rr ea.rr .z3 zGD.3 Notarized Owner's Signature(s) wutary Pu IiG overn ental Unit Official Name, Title -Please Print Commission Expires en E cra/a/ wn '~iai ~ ~~ ~~ ~ Govern ental Unit fficial Signature Drafted by: ~/---7-~' ~ /nC5 7\ • / ~v sd~ P al informati you provide may be used for secondary purposes [Privacy Law s. 15.04(1)(m)] "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT REMOVE" This information must be completed by submitter: document title, name & return address and PIN (if required). Other information such as the granting clauses, leagal description, etc. maybe placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recordino fee. Wisconsin Statutes, 59.517. Wisconsin Department of Commerce Division of Safely and Buildings SOIL EVALUATION REPORT in ~rrnrri~nro wi4h r:nmm RS \Nic Grim (:nrip 1765 Page I of 3 A.C.E. Soil & Site Evacuations County Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road . . . 010-108_5-50-000 P/ease print al! Information. Reviewed By Date Personal information you provide may be used iar secondary purposes (Privacy Law, s. 15.04 (t) (m)) Property Ovmer Property Location Jerry Carr Govt. Lot NW 1/4 NE 1/4 S 35 T 30 N R 16 W Property Owner's Mailing Address Lot # Block # ~ Sulxi. Name or CSM# 2553 130th Ave. Na Na _ Na _ City State Zip Code Phone Number City Village / Town Nearest Road Glenwood City ~ WI 54013 i 715-684-3145 Emerald 130Th Ave. New Construction Use: / Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD / Replacement Public or commercial -Describe: Parent material GlaClal 611 _ _____ _ _ Flood plain elevation, if applicable __ Na ___ General comments and recommendations : Site sunsuitable for POWTS due to limited soil conditions. Hoding tank required. Existing drywall elevation = 87.57'. ^ Boring # Boring <$ / Pit Ground Surface elev. 100.35 ft . Depth to li miting factor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ 'Eff#1 'Eff#2 1 ~~ 0-8 10yr32 none sil 2fcr mvfr as 2fm,1 c 0.5 ~i 0.8 2 8-18 10yr5/4 m1d 7.5yr5l8 sil 2fsbk mvfr cw 2fmc 0.5 ~~, 0.8 -- --- - - --r ------ 3 18-22 10yr5/4 m2d 7.5yr5l8 sil 1msbk ds cw 1fm 0.2 ', 0.3 4 ~ -- 22-30 10yr4/6 m2d 7.5yr5/8 gr sl 1 msbk - dh cw - 0.4 0.6 -I 5 '~ 30-46 7.5yr4/6 m2p 7.5yr5/8 -- gr sl Om dh - - 0.3 0.5 I ~ j----- - I! ------ _____ Soil condftions at this site do not meet requirements of A + 4" rule. ^ Boring # Boring <8~~ / Pit Ground Surface elev. 100.21 ft. in. Soil A lication Rate _ Depth to limiting factor - pp Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ _ in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr32 none sil 2fcr mvfr as 2fm,1 c 0.5 ~ 0.8 2 8-14 10yr5/4 m1d 7.5yr5/8 sil 2fsbk mvfr cw 2fmc i 0.5 ! 0.8 3 ~ 14-20 10yr5/4 m2d7.5yr5/8 sil 1msbk ds cw 1fm 0.2 0.3 4 !i 20-28 10yr4/6 m2d 7.5yr5l8 gr sl 1 msbk dh cw 0.4 ~ 0.6 T 5 28-45 7.5yr4/6 m2p 7.5yr5/8 gr sl Om dh - 0.3 0.5 --- ---- } ', -- t ~ _ _ Soil conditions at this site do not meet requirements of A + 4" rule. ` Effluent #1 = BOD 5> 30 <_ 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson 3602 Address A.C.E. Soil & Sfte Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 12/112003 715-248-7767 Property owner Jerry Carr Parcel ID # _010=1085-50-000 Page 2 of .3 Boring,# Boring -- -- / Pit Ground Surtace elev. 100.09 ft. Depth to limiting factor 12" in. Soil Application Rate H i th D r i t C l D Redox Descri tion Texture Structure Consistence Boundary Roots P ! _ or zon ep in. om nan o o Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr3/2 none sit 2fcr mvfr as 2fm,1 c 0.5 0.8 2 8-12 10yr5/4 none sit 2fsbk mvfr - cw 2fmc 0.5 j 0.8 -I-- 3 12-19 10yr5/4 m1d7.5yr5/8 sit 1msbk ds cw 1fm 0.2 0.3 - - - ---- -- ---- t ---f-- - 4 19-25 10yr4/6 m2d 7.5yr5/8 gr sl 1 msbk dh cw - 0.4 ', 0.6 5 ~ 25-49 7.5yr4/6 m2p 7.5yr5/8 gr sl Om dh - - 0.3 0.5 - ---1 -- ----- Insufficient area available to site POWTS at this location. Q I Boring # Boring - - /Pit Ground Surtace elev. 99.47 ft. Depth to limiting factor <12" in. Soil Application Rate H i De th Dominant Color Redox Descri tion Texture Structure Consistence Boundary Roots P / ' _ or zon p in Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-12 10yr3/2 none sit 2fcr mvfr as 2fm,1c 0.5 ~' 0.8 , --- - - - -- -- - --- - - t _ ----- - ;-- - 2 j 12-15 10yr5/4 m1d7.5yr5/8 sit 2fsbk mvfr cw 2fmc ~' 0.5 '; 0.8 3 15-19 10yr5/4 m2d 7.5yr5/8 sit 1 msbk ds cw 1fm 0.2 ~~ 0 3 -- - -~- 4 19-26 10yr4/6 ~ m2d 7.5yr5/8 gr sl 1 msbk dh cw = 0.4 j 0.6 _ _ 5 i 26-36 7.5yr4/6 m2p 7.5yr5/8 gr sl Om dh - - 0.3 ! 0.5 Soil conditions at this site do not meet requirements of A + 4" rule. Ij I Boring # Boring - / Pit Ground Surface elev. 97.55 ft. Depth to limiting factor <11" in. Soil Application Rate Horizon De th Dominant Color Redox Descri tion Texture Structure Consistence Boundary Roots P ~ p in. Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh `Eff#1 'Eff#2 1 0-11 10yr3/2 none sit 2fcr mvfr as 2fm,1c 0.5 0.8 2 11-16 10yr5/4 m 1 d 7.5yr5/8 sit 2fsbk - - mvfr cw 2fmc 0.5 0.8 --*- - - 3 ---- 16-28 - 10yr5/4 - m2d7.5yr5/8 --- sit -- lmsbk -- -- ds --- cw - 1fm --- 0.2 ~ 0.3 ----t 4 ~ 28-39 10yr4/6 m2d 7.5yr5/8 gr sl 1 msbk dh cw - 0.4 I 0.6 }---- - 5 ~ 39-45 7.5yr4/6 m2p 7.5yr5/8 gr sl Om dh - - 0.3 I 0.5 --; --- 1_~ - - Soil conditions at this site do not meet requirements of A + 4" rule. ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Property Owner Jerry Carr Parcel ID # 010-1085-50-000 __ Boring # Boring - / Pit Ground Surtace elev. 98•`8 ft. Depth to limiting factor <18" in. Page 3 _ of _3 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-18 10yr3/2 none sit 2fcr mvfr as 2fm,1 c 0.5 ~ ~ 0.8 2 3 18-24 24-40 10yr5l4 7.5yr4/6 m1d 7.5yr5/8 m2d 7.5 r5/8 Y sit scl 2fsbk Om mvfr dh cw - 2fmc - 0.5 0.0 j 0.8 0.0 i ~ i _ __ Soil conditions at this site do not meet requirements of A + 4" rule. ---~--~r -~.- ---~ . ~ /30 -Ave. ~ ~~~ s ~~e~~ C,Yi"Shin~9 ~ry cue//. _ A 6~., dam as ~oe,,~ code.. ~~.b, .Topo~' ;o.~cre-Ee. S pa o, 2. ~ ElaVat~'o~. Zss~ k9~ Sca/e: /rfh Zo, quo ~~ I~ ~ 8~ / : T Pof'd/oul~~'ouno~.6'orl. ~ A55u-.ned ~. lei : /Gig. A7,` c, ~, ~ i /~ /' ~ ~ ~ i ~ ~ ~/ O / ~/ ~~~ ~ a b / / '/ 61 ^ o qg°~ EX~sf; nr~jJ ° 2. bed~do.-, ~ res~dene.e ~ ~„~ as,ac.-cue. 4 ~ we // ~ v ~' ~ ~ 62 S h td d ~,~a9e t b ZJ J 4 ~ti . • ~- o~ 4,~ ^ ~~ ~ 3~~~ a`~' ~~~ y i-~ ~ /oFIQ By ^ ~ ~ doe 06 ^ J ^ 3 ~ 3 ~'~' RECEIVED Wiscor-sin Department of coin J AN ~ ~ 2004 SOI EVALUATION REPORT DIVISIOn Of Safety end gUlldl in arrncriancawwiFh m RS Wic Aram C:nrfe 1765 Page t of 3 A.C.E. Sal & Site Evaluations Sl . l;nvin "•••,, . FF ~ Cou ~ Attach complete site plan paper r~iQ~~2 ize. Plan must l t li i i d t d St. t.fODC nc u e, wt tro m te to: zontai reverence point ttsiN), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 010-1085-5Q-000 Please print all information. Y B Date Personal information you provide may ~ used fa secondary purposes {Privacy Law, s. t5.04 (1) {m)). ~N , I . ' 6 *tN Property Owner Property Location Jerry Carr Govt. Lot NW 1/4 NE 1!4 S 35 T 30 N R 16 W Property Owner's tlAailirut Address Lot # Block # Subd. Name or CSNI# 2553 130th Ave. Na Na Na City State Zip Code Phone Number City ~Ilage / Town Nearest Road Glenwood City ~ WI 54013 715-684-3145 Emerald 130Th Ave. New Construction lJse: / Residential !Number of bedrooms 3 / Replacement Public or commeroiat -Describe: Parent material Glacial till General comments and recommendations: Site sunsuitable for POWTS due to limited soil conditions = 87.57'. Code derived design flow rate 450 GPD Flood plain elevation, if applicable Na . Hoding tank required. Existing drywall elevation ~~ # Boring / Pit Ground Surface elev. 100.35 ft. Depth to limiting factor ~$" in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Coni. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr32 none sil 2fcr mutt as 2fm,1c 0.5 0.8 2 8-18 10yr5/4 m1d 7.5yr5/8 sil 2fsbk mutt cw 2fmc 0.5 0.8 3 18-22 10yr5/4 m2d7.5yr5l8 sil 1msbk ds cvv 1fm 0.2 0.3 4 22-30 10yr4/6 m2d 7.5yr518 gr sl 1 msbk dh Lwv - 0.4 0.6 5 30-46 7.5yr4~ m2p 7.5yr5/8 gr sl Om dh - - 0.3 0.5 Sal conditions at this sfte do not meet requirements of A + 4" rule. goring # Boring / Pit Ground Surface elev. 100.21 ft. Depth to limiting factor ~$" in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr32 none sil 2fcr mutt as 2fm,1c 0.5 0.8 2 8-14 10yr5/4 m1d 7.5yr5/8 sil 2fsbk mvFr cw 2fmc 0.5 0.8 3 14-20 10yr5/4 m2d7.5yr5l8 sil 1msbk ds cw 1fm 0.2 0.3 4 20-28 10yr4/6 m2d 7.5yr5/8 gr sl 1 msbk dh cw - 0.4 0.6 5 28-45 7.5yr4/6 m2p 7.5yr5/8 gr sl Om dh - - 0.3 0.5 conditions aft~is site do not meet requirements of A + 4" rule. ' Effluent #1 = BOD s> 30 < 220 mg/L a d TSS >30 < 150 L ' E ant #2 = BOD < 30 mg/L and TSS <_,90 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson "~-~- 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. 154020 12/112003 715-248-7767 gorier # Boring / Pit Ground Surface elev. 100.09 ft. Depth to limiting factor 12" in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr32 none sil 2fcr mutt as 2fm,1c 0.5 0.8 2 8-12 10yr5t4 none sil 2fsbk mutt cw 2fmc 0.5 0.8 3 12-19 10yr5/4 m1d7.5yr5/8 sil 1msbk ds cvir 1fm 0.2 0.3 4 19-25 10yr4~ m2d 7.5yr5/8 gr st 1 msbk dh cw - 0.4 0.6 5 25-49 7.5yr4~ m2p 7.5yr5/8 gr sl Om dh - - 0.3 0.5 Insufficient area available to sfte POWTS at this location. ~~ 1 a 16nrinn # ~~ Property Ovmer Jerry Cam Parcel ID # 010-1085-50-000 Page 3 of 3 Bonrg # Boring / Pit Ground Surface elev. 98•~ ft. Depth to limiting factor <18" in. Soil Application Rate ri th D i t C l D Redox Descr~tion Texture Structure Consistence Boundary Roots P zon Ho ep in. om nan o or Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 1 0-18 10yr32 none sil 2fcr mvfr as 2fm,1c 0.5 0.8 2 18-24 10yr5/4 m1d 7.5yr5/8 sil 2fsbk mvfr cw 2fmc 0.5 0.8 3 24-40 7.5yr4/6 m2d 7.5yr5/8 scl Om dh - - 0.0 0.0 Soil conditions at this site do not meet requirements of A + 4 rule. a Borin9# B~ng / Pit Ground Surface elev. 94.95 ft. Depth to limiting factor <7" in. Soil Application Rate Horizon Depth in. Dominant Cobr Munsell Redox Description Qu. Sz. Coni. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP •Eff#1 *Eff#2 1 0-7 10yr32 none sil 2fcr mvPr as 2fm,1c 0.5 0.8 2 7-15 10yr5/4 m1d 7.5yr5l8 sil 2fsbk mvfr cw 2fmc 0.5 0.8 3 15-25 10yr5/4 m2d 7.5yr5/8 sil 1 msbk ds cw 1fm 0.2 0.3 4 25-41 10yr4/6 m2d 7.5yr5/8 gr sl 1 msbk dh cw - 0.4 0.5 5 41-73 7.5yr4/6 m2p 7.5yr5/8 gr sl Om dh - - 0.3 0.5 Soil conditions at this site do not meet requirements of A + 4' rule. Boring # Boring ft. Depth to limiting factor in. Sal Pit Ground Surface elev. Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. 5h. Consistence Boundary Roots 'Eff#1 •Eff#2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mglL and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services of need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. -.~^^.-- Sr~+,"/ar~ ~e~oaracrJ~,~ ~ ~ Ela/a~E.'o~. C,Y~Svc"~/g ~~y U.~/l. Zss3 ,19`rl Sc,a/e: / ~tb ~ ~a, A ba., ola~ as ~e.r code... ' ~ ~ I ~~0 I n ~P o{' ~ /o~~'oun ab.d'orl. ~ 4 8~ ~ / /~SSumed .c leek : /Gt9. ct7., Q ~. ~. .:Top o{ ~ ~ /'~'~h~°~ /~i Co~cre 5 f~a, ~ ~ L, O Y''~~t1Ckv~.~sdcnr \ ~ ~ S~1° Elev: =9,~,~7~ ~~ ~~ ao 0 ~ / // ~ i ~, aecK qg°` EXis~ n~ ~t 2. beds m resida.~te ~ ~% go,r "~ EXi~%~q Scp~~c ~~~. A,fx~don ask,.' code. ~ ~ 5 h e.d d ~,•A9Q b Zl 4 ~"`- i I, ~ ~_ or . ~ 4,~ ^ i~~ ~ .~~Q ' ~~ a~° ~~~ '~ y Q6 o {~EXi.st~ln~ we // ~-.~ ~ /o~J2 ~ ~ a v ,n v J .9 3 B~ ^ ~ ~ ~; doe 61 3vff'q U 2'i90P St. Croix County Holding Tank Agreement tats Plan Transaction Number - ~~~~y Carr Name -' (Owner) Typed or printed being duly swom ,states, under oath, that: y s 7 75 1 4+06 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIR CO., MI RECEIVED FOR RECORD 01/12/2009 02:20PM HOLDING TANK AGRfifiNfiNT EXElPT t REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 1. He/,She is the ownedpprtowner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume ~~ Page 35~ Aocument Number ~~ St. Croix County Register of Deeds Office: A parcel of land located in the'/. of the ~'/. of Section ~, T_,,~0 ~N - R ~~ W, Town of Eifltla.i(d , St. Czoix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): SAC- A'~IAG-E~ Nama~andsReturn drospps 3SIc/+~~ C..Kcir~ Isarr:o4,~~ siroio-SN3 reament oats: 3 ~••~- ~r~°'' ~~ -•••~ Aq Parcel Identification Number (PIN) We acknoxAOdge that applieadon is being made for the irrstallafion of (a) hddinq tank(s) on the above descdbed property or that contlnued use of the existing promises requires that a holding tank be installed on the property for the purpose d proper contaironent of sewage. A{so, the propeAy danrwt rxrrr be served by a muntcipal sewer, or any ottrer type M private snails wastewater treatment system as pamutled under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Stets. As an IrWucement to the county to issue a sanitary permit for the atxrva-described property, we agree to do the fdlowing: 1 . Owner agrees to conform to all appliceWe requirements of Ch. Comm 63, Wis. Adm. Coda relating to iwking tanks. If the owner fails to hevo the hddirp tank properly serviced in response to orders Issued by the govemmental unit or the Department of Cammarrre to prevent or abate a human health hazard as described in s. 254.59, Stets., the govemmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by pladrp the charges on the tax bill as a speaal assessment for current services rendered. The charges will be assessed as prescribed by s. 68.0703, Stets. 2. The owner agrees, pursuant to a. Comm 83.54 (2), and Comm 82.40(3xe), Wis. Adm. Code, to have a water meter Installed in the stnrcturo. The water meter shall be installed by a plumber authorized by the Oepartmsnt of Commerce to make such installatlone, with said irudafiation complying with State regulatiorre and manufeaurere speafications. The owner agrees to be Bnandally responsible tar the purchase, Installation, maintenance, and repair of the water meter, and agrees to allow the govemmental unit or the Department of Commerce to enter the above-described property on a regular basis to road and/or inspea the water meter. 3. Owner agrees to pay all charges and cysts irxxrrred by the govammeMal unit or county for inspection, pumpng, tufulirp, or otherwise servicing and maintaining the txkding tank in such a manner as to prevent or abate any human heskh turzard caused by the Frolding tarot. The govemmental unit shall notify the owner of any costa which shell be paid by the owner within thirty (30) days from the date of notlca. In the event the owner does not pay the costs within thirty (30) days, the owner spedfically agrees that all the costs and charges may be placed on the tax roll as a speaal assessment for the abatement of a human health hazard, and the tax shall be collected u provided by law. 4. TM owner, agrees to contred with a person who is lcensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to foe a spy of the comrea with the govemmeMal unit. The owner further agrees to file a copy of any changes to the service contras, a a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to CoMrect with a person licensed under Ch. NR 713, Wis. Adm. Code, who shall submit to the county on a semdamual basis a report detai8rp the servicing of the holding tank. The govemmentd unit or county may enter upon the property to irnestlgate the condition of the holdup tank wfuut pumping reports end meter readings may IrMicate that the holding tarot is not beirp properly maintained. 6. TNs agreement will remain In effect aNy untll the county oMice responsibb for the regulation of private ensile wastewater treatment systems certifies that the property is served by either a munidpal sewer w a private onsite wastewater treatment system that complies with Ch. Carnet 83, Wis. Adm. Code. In additlon, this agreement may be cancefied by executing and recording said certification with reference to fins agreement M such mariner which will permk the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall sutxnk this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a mamer which will permit the e>stence of the agreement to be determined by reference to the property where the holding tank {s installed. Owner(s) Name(s) -Phase Print Subscribed and swom to before me on flue date: r~ r~ ..Z3 zca3 ..,~ -., %js'~~~ ~.. ~... Notarized ra Signature(s) Notary Pu ie J , ' ` tat Unit Offiaal Name, Title - Please Print salon Expires . : ti + ~ . ~y ~ ,~ c I untt sal signature ors by: -•yr....,.«.N !bs-YS 4~ p ~ // reprortai mrormautisryou provxte may oe used for secondary purposes [Pnvacy yaw s. t5.oa(ixmll !/ "THIS PAGE IS PART OP THIS LEGAL DOCUMENT - DO NOT REMOVE" This tnforrrration moat be completed by submmer. (ygg, name b return address. and ?IN_ (N required). Ofherlnfamation such as the granting douses. leagd deacrfption, etc. maybe placed on this fist page o/ the document or may be pieced on eddHional pages o/ the ~3 Il 2490P .468 t>oCUM[NT NO. STA".'>Z BAR Ot WISCONSIN tORII I-iNS ? TMts w.ee aestavee row aaeortwe e•re 1 ~~ WARRANQri DIED ;' It q 3~3~1.,~ -• '/Ol ~48V.~~f.3~t~ ~I IS ... v ..T. t X CA., ~V'16. !•) 'j't)ie DQad m.a. beere.a .... Wayne„~,e„ ~,!~tt~,a,.a;~d,,,,•., ~~ Rnc'c, a:, dtrr<.Yi 1:it 22nd '! .......:.xndy.:.E,•.,Muttlea..husband:.:and.:~~t'¢..a.{ ............... ' A.D I9gp it :~ Joint. cenaiit:} ............................. I d°r °f "-=- •i ............................. ......................................................... Grantor I Of B t 30 A ~. :ttd....,T.arrY..It....~4.r.><!..end..JudX..kl....Qarx.,...hua.~and..e.nQ II .........Nita..8a...Joinlt..tsnarls .................................................. 1 .................................'................................................................, cr.nt«, Witnesseth ')'hat the said Cranbr, for a valuable eotulderatioa...... • `•~ Or.C..d.O11~x..end...Rtha~'..vtlluabla...CAnaldGxat.loA....... i_-::._. _,.,-. _ _ .,_ ,- t aeTVaN r0 ' ~I conveys !o Grantee the tollotrtnS daeribed real utab in ..... St ....L'r.01X....... ,i 't County, Stab el Wiaeensin: ,~ '` That certain parcel of land or tract of real I estate located in the NW 1/4 of the NE 1/4 of Ta: Pared No :................................... Section 35-30-16, more fully described as follows: Beginning at the N 1/4 corner of said Section 35; thence S ; „ OOo06r E a distance of 1308,40 feet; thence S 87o21tE parallel with the North line of said Section 35 a distance of 332.93 feet; thence N : OOo06r W a distance of 1308.4C feet to the said North line of Section 35; thence Frith said Section line N 87o21tW a distance of 332.93 feet to the point or beginning, the above described parcel containing 10.00 acres, more or less. The North 33 feet of the above described parcel presently being used for public road, ..~~~s .,, This ...~.$ .................... homesbad Property. (is) (is not) Together with all and sin;ular tM heredibmenb and appurbnanea thereunb bebnQing: Ans....Grantor ........................................... ..... ............... . warrrnb that tM title u good, indefeasible in fee simple and tree and clear of encumbraures est.•ept and wilt warrant and defend the same. natnl this .. .............~.~ .................... Jay of .. ..... .... ... .................................... (SEAL) .........(SEAL) ... ~•~'Y ............. .... .lit 84 . Ir'r'iyne/ L. Tuttle .. Cyndye ~E....Tu?;tle ... AU?RSNTICATION ACSNOWLSDOh1ENT Sisttatunls) ............................................................ STATE OF WISCONSIN ................................................................................ St. Croix ........County. .............................. es. / authenticated this ........day ol ........................... 19...... Pers~+1~Y came before ma thji .....~.~.~.......day of ...:~ the above named 19. ................................................................................ . ........................................... .......W..ayXle..~r.e...~ut t te.. q!?.3...4'yn~y...Fe.r...... • .............................................................................. .......hut t 1 e............... _........................................... TITLE: ?IEaIBER STATE BAR OF WISCONSIN , ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,.,,,,,,_„ ................... ................... ttl not.. ........................................................ suthori:ad by 3 T06.1K, Wis. Stnb.) .._....................................................._....,.,............... b ma known to the person g.... ~„i? rltP. ~seFuted tM foregoing iestrumen n ncknowl _tk,..pme. ~ rNta 1NlT11UM[NT WAe On.R[D er ~ ~~ ~ ~ jl~ ~ JF lX~ J •• •: t .ti ~ ' ~ . ... ~. 1. r...: ~~~~~~~`~.. T.. p).. '' 1!eti.~:. ............................................................................. t Notarv Pohlie ........Jt... Cro ~c,:, .~ .C~ty,:41.~. ~ (Sixnndtrni may he authentfeatrtl or stttnowhvlgrd. Dotb - t~h•etatvjrs~ty n ?Ir Commissfnn is permanent.t • • are not naev<rarY•) !Q~ '6 t ,• ~,% ti •.•• date: .....j ~: ... .r •Y.,ew nt Mrtun..{fntae in tln/ e.OKft! •A.mld M it V•'t ••~ Vrinl•:1 t.l:~ ~ tMfr 1fen.t.:M. •" NenrN,ro...,® ~ariu"tul Nw t~tii+i stn Sfoek No. 13001 12/221x3 MON 12:20 FAX 713 386 1686 ST CRY CO ZONING HOLDING 'TANK SERVIC)CNG CONTRACT vote ,~~ ~-~3 This wntract is made between trte TonU uMerfelt~s.walel `' ~.-.A' D.rr.;r,~cGhrrira _ , ~.n61~)~ Q s .GNP # D/~ -/OS''S`- ~ ao1 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm $3.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Camponeat Manual. This agreement will also be filed with the St. Croix County Zoning Department 2. The owner agrees to have the holding tank(s) serviced by tht pumper and guarantees to permit the pttmper to have access and to enter upon the property for the purpose of servicing the holding tauk(a)_ ~'be owticr agrees to aoaintain the access rflad or drive so that the pumper can service the holding teak(s) with the pumping equipment. The owner further agrees to pay rho pumper for ail 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 local governmental unit that has signed dte ptttnpirtg agreement and to the County, a report for the servicing of the holding tank(s) an 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 teak; b. The name of the owner ofthe holding tank; t:. The location of the property as 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,rolunu inn gallons of thc;c'vdtetits Pumped frcm the holding tank-for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. ~. This agrcemp~it will`remai.n in effect until the owner or puinpez' terntinates this contract In the event of a change in this contract, the owner agrees xo iile a copy of any.changes to this service contract or a copy of a nt~w service Gorrtract with laeal governmental emit sad the County Warned above within ten (10) business days froth the date of change to this service contract. LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF EMERALD COMPUTER NUMBER 010-1085-40-000 Parcel Number 35.30.16.5146 OWNER NAME: First JERRY L & JUDY M Last CARR PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 2553 130TH AVE SECTION 35 TOWN 30N RANGE 16W '/.160 '/<40 Line Description Line Description TOTAL ACREAGE 10.000 PLAT LOT BLK 01 SEC 35 T30N R16W 10A IN NW 15 02 NE COM N1/4 COR SEC 35, TH 16 03 S 0 DEG E 1308.4' TH S 87 17 04 DEG E =N LN 332.93' TH N 18 05 1308.4' TH N 87 DEG W 332.93 19 06 FT TO POB EXC P 514C 20 07 ASSESSED W ITH P514C 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit __ ". _ ___ _,_ _ . DOCUMENT NO.. - STA^.'E BAR OF WISCONSIN FORM 1-3081 TNIa a-~e^ RRSRRVen roe RRCOROtNa owr~ ~1 a ;E r ~~ WARRANTY DEED IM t ~ I~ t ~ I ~an/~•`.1., ~+n( ~~ F^r,C,•5t1 ~~r4~ilitJ OfF1Ct ,i ___ .~. _. _ _ _ . .. __ .: ' {~ `~Zll D ed made between .....~"~8.yne..L.t..Tll~.tle,_&t)d....... , ........ ~Yn~~_• ~•..--~uttle,..-nusband.• and.-wi! a ,a ~ ................. i~ _.....,~ont...:tenarita .... .................... i .. ................. ........ ....-. ........................................................................................-., Grantor, f~ ana....Jerry..I,.....Ca.~''r'..and...Jud3c...M....~a.r.x.,...Yaus.band..~nd .......wife..ag..,jg~nt..t.etla.izt~ _ ............................................. ,i .............................................................................................., G-antes, ~{ Witnesseth, That the said Grantor, for a valuable conaiderstion...... One...dolls]"-.a.nd..Qth.etx..va3.ua~~.a...~Q.n~idexat.ion....... ~; conveys to Grantee the following described real estate in .....St ....CI'Oi.X....... County, State o[ Wiaconain: i R~:'~. 4, ,, rirx~r.tYf 1''rs__z2na i da of Maw A D. l 9,$.4 Y .--.- ;~ , ~ at s : 3o A ~~. • Melw« a+ O.da '~ R[TURN TO I That certain parcel of land or tract of real estate located in the NW 1/~+ of the NE 1/~ of T~ parcel No :................................... Section 35-30-16, more fully described as follows: Beginning at the N 1/4 corner of said Section 35; thence S 00006' E a distance of 1308.40 Peet; thence S 87o21'E parallel with the North line of said Section 3 a distance of 332.93 feet; thence PJ 00°06' W a distance of 1308.~C feet to the said North line of Section 35; thence -r.-ith said Section line N 87°21'W a distance of 332.93 feet to the point of beginnirtg, the above described parcel containing 10.00 acres, more or less. The North 33 feet of the above described parcel presently being used for public goad. (~S ., This -. i5_ ................_ homestead property. (is) (is not} ToKether with all and singular the hereditamenta and appurtenances thereunto belonging; And_-.Grantor- ...... ....-._ ...__ - - .................... warranty that the title is good, indefeasible in fee simple and tree and clear of encumbrances except and will wart-ant and defend the same. Dated this _ - - ~,~....___. ....._. day of i'I'•y _..- _ ...- 19 ~~ . // 1l, L ~~` ..(SEAL) L./`1-:^-._....__.~~ J-- .. _...._(SEAL) ~~~yne L. Tuttle ~ _, _... -. _.. - I Cyndy E~. _Tu±tle- _ ___ _..... AUTHENTICATION ACHNOWLEDGMENT Signature(s) ---- •-- -------- --•--------------------- -•--------•--.... authenticated this ........day of..-...-.._...__...._...., 19...... TITLE: ~IE~IEER STATE BAR OF WISCONSIN Ltf not, - ------- ---- ------ --- ----• -- - -•----...... authori;.ed by ~ ?06.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY RG~ ~~.. G.~•. WAL,TE~,-- ArTTvr{t~`.--rsl_ ,Z.t~'N {Signature; may he authenticated or acknnwled;;ed. Ilnth arc not nececsarp.) STATE OF WISCONSIN 39. St , CroiX --County. ~ Perswgqully came before me tln~......l. ~'~......day o[ ,~.a ......-----•------ J---- -• .......... .... 19... v~ the above named y~ayne-. L... Tuttle_-and -C~~ndy L. .......ut+-le--------------------------------•--------•-------------- .... to ma known tq be the person _°...-..~~~~whp~ ~ceruted the foregoinK i strume°Ltantl, ~ , 1 acknowi the same. r ,~ ~ C.r. ... F ....-_ - a-.. C} - a ~'.r~ ...- . Notarv Public .. . 3t... m i i i f ~} .0~.0~~ •• ~.. CnQat ti-i~t :a:;tencr ii•:t~tict+ t nent t P a s per ss on y Comm 5 date: _ ___ fi ; . . , , .r - •tism~ro of panunf siRninR in any cspaci!y .ehuu!d he ty~Ded ~~r printrd h.•h~w Chair eiR nata ren. STATE H1R f1F Vkl$COV5tN Stock No. 13001 N.GIA~u.rCanparry~ ~'UHtt \e. 1 - 19y3 .~ .~ ~•, ~, ~GQ~ ~'"" ~v'ri ~. yt ~~ / ,~N STS ~ ~ ~ ~~ ~'''~ p,,,,~ ~'~" ~~~" ~~~ y`~ . ~h' '~~% ~.~ I I I I I I I I I I I I I I i I I I I I I I I I ~ I ° I ~ I I m I n I 3 I ~ ~~ ~I `oQ I 1 ~~ ~I ~I N A O N ly o. ~ O ~ Z 0 ~_ v` o v ~ ~ m O m 1 N C 3 m N G~ f0 <~~ w 0' ~~ Cl d x 3 C w a .y. ~ N 7 ~ 7 %~~° ~•~`~~ ~ _~ vii ~N :l1 m > > n ~ ~ ~ ~ ~ ? ° S C Qom-. f~'f Z VJ Q~~~y~SW~~xQ7~~ N Om °'o Aviv ~ Ffm ~ ~^~~ ~ m ~~' y Quay x'01 -'3 ~.° ~ ~ m acg~ o ° m g o ~ ~ ~° ~i ~ < ao ~ ~ a3 .v~'- sy~m~~~mv°°ifD~m ~° a ~, -~~ o~ o3i ~' d 3 a~ o~ c ?ate v, as ~ ~ ° ~ c~~O ,°~-S~ v o a ~ C '~ ~ O ~ 7 x y~ n C N 01 ~ ur O 07 ~ ~ 7C ~ <p O ~ C m ~c~ fD ~ m Dam ad m °~° •z ~ 0 m 0 o:. c ~ ~ :~ o ~ ~ C71 cn m W ~ O ,~ a s a ~o o ~ J J ~ m c ~ w ~ ~ a O O O ~ ~~~o ~ o v_ " 'y ~ m ~ 7 C Z 2 ~ D O ~ a -i d C :'•" 3 u~ ~ N N N '~" C a 3 ~ n c 3 ~ ei ~ 'a ~_ ~ W m ~ o O a ~ a°o rn `5O ~ J 0 vl W S S '~ y o c 3 °~ .. m m ° '~ g a H -~ ~ f/1 A ? ~ ~+ .'0 L*. A Z O .. ~ ~ o ~ Z A ;U Z ~ m ~ J A d m A~ FBI Q O ~S ~1 ~• ~• ~a a fi „~O O p oro A ~ ti ti a PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION ~ O~I'INF~f~S On the document used to verify ownership, do the names match those on Part A of this application? If no, please attach additional documentation explaining. ~ Yes ^ No ff the applicant answered yes to question 4 on Part A of this application, did the applicant(s) own the property when the order or verification of failure was issued or the system installed Yes ^ No and incur the cost of replacement? ~ Document or Pa e V Document used to ve ' ownership: Olt' Number. 2. Will the system serve a structure that's being replaced? ~ Yes o No ff es, have all requirements outlined in Comm 87.20(4), Wis. Adm. Code, been met? t~Yes ^ No ^ NA 3. Is a public sewer available to this props ? ^ Yes ! No 4. Has a previous grant been awarded for this property under this program? ^ Y es ! No GG -- 5. Principal Residence evidence of income. Please indicate applicable annual family income: $ ~ 4~..~~~ Federal income tax form ,Line ,Year OR Affidavit of !~ bW ~1~~m1C ,Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross revenue: $ Profit & loss form used: ,Line ,Year 6. When was the existing failing system installed? ~ ~,( Prior to 12-1-1969 5Cj ~ ^ 12-1-1969 to 7-1-1978 Vertical distance from the bottom of the existing infiltrative surface to a limiting condition: ~ 0 to Less than 24" ^ 24 to Less than 36" Date of the Order or Determination of Failure: ~ ~ ^ Equal to or greater than 36" 7. Private sewage system failure caused by discharge f sewage to (check all that apply): water or roundwater ............................................................................................................. Category 1 A zone of saturation ......................................................................................................................... ~ A drain a or zone of bedrock ......:............................:.......................................................................... Category 2 ~ The surface of the ground .......:.......................................................................................................... Catego 3 Back-up of sewage into the structure served .................................................................................... ^ At-grade 8. This request is for what type of replacement system: ^ Conventional ^ Experimental if this request is fvr a aystcm no*, listed at the right, please explain: _ ____ __ * Holding Tank ^ In-ground Pressure ^ M d oun / ~^ 9. Unfform Sanitary Permit Number ~~~ t0 ~ J Date Issued_ ~a-ly, rho ~ ~C~O Plan Approval Number~`C 1 ~ T ~~S ~ ~s • ! ~ ~~ ~ Date Approved ~P'~ • ~ 6 ~ ~~~ Ex riment royal Number Date A proved i0. After reviewing this application, I have determined the applicant to be: Eligible ^ Ineligible If ineligible, reason ineli ible: 11. Governmental Unit Representative's Certfication. I certify that I have reviewed and verified all information provided on this forrn and attachments and that the are true and correct to the best of m knowledge and belief. Signatur f Authorized Governmental Unit Representative Title Date Signed lllf fi'G(141--JS l commerce.wl.gov rsconsin Gr De~rtment of Commeroe 1111 and Buildin Dlvislon Owner's Name: Worksheet ~(" 1 ~ r Governrnentai Unit: r ~ rn In Sections B-F, the number of `PST 1. ~ ~ t-~ ~ ~( estimateddail wastewaterflow~~ald~rninesthe ~~TFUNDING.TAgLES r da b grant award. To use the grant funding tables for A. Site evaluation and soil 150, round off to the next h' hest whole number, B• Installation of a re testln ' Grant amount $250. Placertlent anaa~ ~.~_ ._ Wisconsin Fund - Private Onsite Wastewater Repla ement ortRe ab litation Financial Assistance program ~ ~.,(-n ~-~y ~~ ~°°'~ni component. Number of Bedro oms 1 or 2 ...., . .............................................. 3 ................... ........... ........... .................. Grant Amount ..... 5 ................................................... .......................:............ .. .. .....................$500 ............ ............. ................. ............. . ............... 6 .. ............ 550 .. . .. ..... ................ ....... ........................ .. ...... 650 .. ............ ........... 8 or more .. .. 725 ...... ............................... ............................ C. Install ........... ~ .................. ation of a dosin ...... .......................... .. 750 ............ g co mponent, lift """•••• Pump or si h ............. Nu Pon. ............ mberofB ed .... ..........................875 ......... '"""'--•• 50 ""9 rooms 1 or 2 ..... . ....... ................................ or 4 ....................... ............................:............. r mo Grant Amount .. .......... ........................... $1 p _ re ................• ................... ~. Installati ono .................... .................................................1 nz .................... .200 and m-ground ure P ........................ Peroolation Rate Press OINTS trey "'~•••- yy}~n P Design Load. tmenf or disu~.r~r•;;_1,250 rn roPedY Filed Rate in Gallons with the Governmental P Unit Before 7-2_g4 er Square mutes Per Inch FO°t Per Day 0 to less than 10 10 to less than 30 0'7 °r more 30 to less than 45 0'60 to 0.69 45 to less than 60 0.50 to 0.59 E• Installation of an a ~'49 or less 'grade or o----=Design moun At Grade High Groundwater Mound High Bedrock M 1 $ 925 925 1,375 i 2 3 4 5 $1 200 $1,400 $1,450 $2 100 , 1,550 1.400 1.650 1,800 2 000 , 2,175 1,900 2,200 , 2 250 2,225 , 2,275 3atment or dispersal ~po nent. 2 3 4 $1,975 $2,350 $2,350 $2,925 2 5 $3,025 Each Additional Bedroom: $250 250 300 300 Each Additional ~droom: $275 ~~~ ound 600 3,150 3,525 4,250 3,300 3,850 3,975 4,500 4,775 *~~Y Permeable Mound 4,725 300 Mound with less than 24" of suitable 3,250 3,600 350 Soil or 3,600. 3,975 4,775 rester than 12% slo 3,050 375 *A ~Y permeable mound ma 3,450 4,000 defined In s. Cornrn 83.23 1 b Y be designed usin 4,550 4,550 $ soft loadin rate of 0.3 or less.) as hating a penopl lion ~ aof bst rnsults 375 F• Instapation of a PO p~e~ filed ~~ the county ~~ 7~~• A sk>wl w7'S Holdin greater fan ~ minutes g Component. per ~~ and ~ than or equal to 120 m nute~erpe ~ ~ having a 1~or3 4 Grant Amount: 5 6 7 Each Additional Personal information $2,500 3,150 8- ~roo You provide may be used for se 3'~5 3,625 SBD-9167 4,200 4,750 $400 $ -~~~ (R. 02/2005) condary purposes [Privacy Law, s. 15.04(1Xm)l. pAR~ 1. +6RANT'FU bDG o /,Cgp~riontinued G. installation of a Replacement Exterior Grease IntercePta' y 1 Gallons: Up to 1,249 1,250-1,499 1,500-1,749 1,750-1,999 2,000 or more $750 $800 $900 $ Grant Amount: $550 $650 Amount Requested For Installation: H. Installation of an Experimental System' ~ ~~ submit a copy of the Wisconsin Fund $ ff you are requesting funding for an experimental system, p nmental a royal letter pr+e-approval letter along wdh a~ copy of the plan approval letter and expe ' pP Amount Requested containing corresponding identification numbers. For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately at the $ . _ ____ ._a a.,. ,...l~.mi4tott With this request. 1. installations not Covered by the Grant Funding Tables. The Department on acase-by-case basis reviews installations not covethree 9 Ym~ Winding tables or listed `fables. ff you are requesting funding for an installation not coveredthbe paid invoice showing the cost of in Sections A H, please explain your request here, attach a cepY the item, and request 60% of the cost of the installation at the right. $ ~~~` TOTAL PART 1. PART 2. GRANT AMOUNT CAL,CUi.AT10NS ~ ~ ~ ~~ A. Enter the total from Part 1. B. Is the applicant a licensed plumber or contractor who installs private onsite wastewater treatment systems? If yes, enter 213 of the amount from section A or $4,667, whichever amount is less. ff the a licant is not a licensed installer, ca the amount fonn-ani from Sec1i°n A. C. ff this applicationt owns the slmall commeraal~establ'ishment is less thanl$362,500, tli s sf the the business tha total grant award. Carry the amount in Seaton B forward to section F. If this app~tcafion ~ for a principal residence and the annual family income of the owner(s) is less than $32,001, this is the total grant award. Carry the amount in Section B forward to section F. ff this application is for a prin 9 ~ ~~ ~u~~ ~ B here a d go on section DS) ~s between $32,001 and $44,99 . .. _ ___.....:., co..*ann R forward to section F. D. E tern 30°/ of the amount by which the applicants annual family income exceeds $32,000. Annual Famiry Income _ 3_~_ 2000 Subtract X .30 = Subtotal E. Subtract section D from section C. This is the maximum grant amount for this applicant. Carry this amount forward to section F. (The amount in sections E & F must be at least $100 to be eligible for any grant award. If the amount calculated is less than $100, Gl,ar. ,,.v..... ... . _ - - $ a~~ F. Total rant award re nested for this a licant u to the maximum of 57,000. NOTICE OF VIOLATION April 14, 2004 JERRY CARR 2553 130T" AVE GLENWOOD CITY, WI 54013 CodeAdminisuation RE: Failing POWTS at 2553 130th Ave. 715-386-4680 Town of Emerald - St. Croix County, WI Land Information & Computer # 010-1085-40-000 Parcel # 35.30.16.5148 Planning 715-386-4674 Dear Mr. Carr: Real Prorty As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in 715-386-4677 violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 12.1.F.4.d of the St. Croix County Zoning Ordinance. This POWTS (Private Onsite Wastewater Recycling Treatment System) has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category I). 715-386-4675 This violation was first noted on April 14, 2004. The violation noted is septic effluent discharging to zones of saturation. An on-site inspection on April 2004 did reveal the septic effluent discharging to the zones of saturation. If fines and or forfeitures 14 , become necessary to bring about the abatement of this violation, they will be assessed as of April 14, 2004 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING POVIITS ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION! REQUIRED ACTION: A sanitary permit must be issued through this office. You have already contracted with a certified soil tester, James Thompson, to have a soil evaluation conducted. The soil evaluation determines the type of septic system needed, the required sizing, and it's location. You have also contracted with a licensed plumber, Mike McDonell, who has designed the replacement POWTS. The sanitary permit has been issued. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sin rely, Kevin Grabau Zoning Specialist cc: file PZC~CO. SAINT-CRO(X. Wl. US ST. CRO/X COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W/ 54016 715386-4686 Fax W W W. CO. SAI NT-CROIX. W I. U S AFFIDAVIT FOR LOW INCOME RESIDENTS COMM 87.50(3), Wisconsin Administrative Code State of Wisconsin ) )ss County of ~ ~- • ~ 6Z~ 1 X ) (I was, We were) (a) full year resident(s) of Wisconsin during tax year Z O o 7 (year) (I was, We were) not required to file a federal income tax return for the tax year Zy o Y dear) because: (Explain reason here.) Signat of Owner Subscribed and sworn to before me this ..._.........: ~~ day of ~ s?~~ ,~~ -~~ ~ A~,. ~J ~` / a ~.. ~~ ~.~ ~ ,~~~_ ~I 1JOTA~q~~~~~, Notary Public, in My Commission Expires ~-[ ~ ~~ ? -~... ~f'1-JBLi~ Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)]. Comm 87.20, 87.21 (4) REPLACEMENT AND EXISTING STRUCTURES. (a) For a principal residence or small commercial establishment that meets all of the requirements of s. 145.245, Stats., the maximum allowable financial assistance amount shall be limited to the minimum .POWYS capacity that would have been necessary. to serve the original structure. Any increase in capacity required to serve a larger replacement structure shall not be eligible. Note: An example where par: (a) applies would be a POWYS- that. once served a 3-bedroom structure and the replacement structure is 4 or more bedrooms; the financial assistance would be based on the maximum allowable amount for a POWYS sized for 3-bedrooms. (b) For a principal residence or small commercial establishment that meets all of the requirements of s. 145.245, Stats., the maximum allowable financial assistance amount shall be limited to the minimum POWYS capacity that would have. been necessary to serve the existing structure. Any increase in capacity required to serve the existing structure may be eligible. Note: An example where par. (b) applies would be a POWYS that once served a 2-bedroom structure and such POWYS was later determined to be acceptable fora 3-bedroom structure. The existing structure served by sucF~ POWYS contains 3 bedrooms; the financial assistance would be based on the maximum allowable amount for a POWYS sized for 3-bedrooms. . History: Cr., Register, December, 1998, No. 516, eff. 2-1-99; correction in (2) made under s. 13.93 (2m) (b) 7., Register, April, 2000, No. 532; CR 04-068: am. (1) (intro.), (1) (b), (d) and (3) (intro.), r. and recr. (4) Register January 2005 No. 589, eff. 2-1-05. Comm 87.21 Ineligibility of owners. (1) As specified under s. 145.245 (5m) (b), Stats., the department shall notify a govemmental unit if it receives a certification under s. 49.855 (3), Stats., that an individual is delinquent in child support or maintenance payments or owes past support, medical expenses or birth expenses. (2) The department or a govemmental unit shall deny an application under sub. (1) if the department receives a certification under s. 49.855 (3), Stats., that the owner or an individual who would directly benefit by the financial assistance is delinquent in child support or maintenance payments or owes past support, medical expenses or birth expenses. (3) The department or a governmental unit shall deny an application if a financial assistance amount under this chapter has been previously awarded for rehabilitation or replacement work at the same site, except for financial assistance awarded on an annual basis for monitoring of approved experimental POWYS, as specified in s. Comm 87.31. History: Cr., Register, December, 1998, No. 516, eff. 2-1-99; CR 04-068: am. (2) and (3) Register January~2005 No. 589, eff. 2-1-05; correction in (1) and (2) made under s. 13.93 (2m) (b) 7., Stats., Register January 2005 No. 589. 12