Loading...
HomeMy WebLinkAbout004-1036-20-000 rY o ~ o I N 03 N n N c 0. 0 ~ I o I 0 N ti a v O ~ I c m I w ~ I ~ I ~ I I w rn i o c 'o Z I 'o c ii c o 0 3 -0 d Q ~ c I a I w a Z p v z 0 co W a c~0 Z I O z v N N r ~ I ~ I 'S m m ~ H c O 2 Z Z O w w m c a 0) c E -c •Oka'aaa a in J U o rn rn 0 ~ N z M M O CO Y c ~ M 1'yq C O O RS O m f0 c c N M O a a U N 0 E C co p O C E E C4) to 0* 4 N T CID V, a0+ ~ ~ co CD o U U N o z C5 '00 0 I ~ I at a a L: CL 0 CL ~1 A tia~ !,Oaici FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION T N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW BENCHKARK:Elevation 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 I~ j r PUMP CHAMBER V t r qui Capacity: Manuf actu L ' Pump odel: Pump/Siphon Manuf ct.: Pump Size Elev tion of inlet: Bottom tank elevation Pump n elev.: Pump off ele Gallons/cycle: Alarm: an.: itch Type: Location Distance om nearest pr line: Front-, Side_, Rear- Ft- Distance from: ell Building SOIL ABSORPTION S T Bed Tr ch: eepage Pit: Width: ength Num of Lines: Area Built Exist. Grad Elev. Proposed inal Grade Elev. Fill dept to top of pipe: No. feet rom nearest prop. line:Front , Si , Rear Ft. I No. feet f m well: No. feet from building HOLDING TANK L~ No. ~ . u 7-7 Capacity: ~O © d Manufacturer:- /.2 of rings used:-4-Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Frontt=-b , Side, Rear/5/Ft. No. feet from: Well, building 3~ nearest road /la Alarm Manufacturer: INSPECTOR. DATE: PLUMBER ON JOB: 4xapj LICENSE NUMBER:- ? (~OD •~9,~.• 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION NV,P ISi iy1,!§K. 16 , T 2 8- R15 State Plan I.D. Number: Town of Cady ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Hwy. 128 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: 7ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Town of Cady . 1, Wilson, WI 1 a - ~-9o I:oU Pn BENCH MARK (Permanent reference point) DE CRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber l MP/N1 SW No.: ,County: Sanitary Permit Number: Joe Menter 5658 St. Croix 128866 S£P+M:F*NK/HOLDING TANK: LIQUID CAPACITY: TANK INLET ELEV.: TANK QLLTLET ELEV.: WARNING LABEL LOCKING COVER MANUFACTURER, PROVIDED: POCKING DED: ES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH I'I ALARM: FEET FROM ~QQy1 / LINE: ~ ~ AIR INLET: ❑ YES ❑NO 4 ❑ YES ❑ NO NEAREST----* U~ DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: [__1 YES ❑ NO ❑ YES ❑ IN ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT LE FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) 1 ❑ YES ❑ NO NEAREST -00- ~ I - SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DIST ELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE, AIR INLET: B NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST 1 Retain in county file for audit. Sketch System on Reverse Side. SIG TUBE: TITLE SBD-6710 (R. 06/88) Qrt'JU414 a DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El 8% x 11 inches in size. Ch rev sion to prev ous application -See reverse side for instructions for completing this application. S ATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S5,6 -416 / PROPERTY OWNER / PROPERTY LOCATION -ro A) 0 el!9 -d 4, '6 % )/LL Y., S TX-, N, R / s E (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # / Wi`fsotiJ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER / S-7 II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLLAGE Aiw NEAREST AD Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL TAX NUMB 111. BUILDING USE: (If building type is public, check all that apply) t Q YZ 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 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify 76WA.1 5:~402° IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.E1 New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 IK Holding Tank 12 ❑ seepage Trench 22 11 In-Ground 42 F-1 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) 071747f ELEVATION 70 Feet Feet VII. TANK CAPACITY Site in a llons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank f3w? CU 7T EL. 1 7 -TT- L] L] Lift Pump Tank/Si hon Chamber I El El El I El Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): nature: (No Stamps) P PRSW No.: Business Phone Number: ,7o Q- " .e tuber's Sig ~ 7/5 73 y Plumber's Address (Street, City, State, Zip Cod j 1_~ it t~,o V, A- IX. COUNTY/DEPARTMENT USE ONLY K-1 L] Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Signature (No Stamps) Approved I Adverse ❑ Owner Given Initial Surcharge Fee) V10 A - Detrminationl I /_/T 7UI X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD4M (formerly Plb-67) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than Bid x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) DCPARTWNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOFZ MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: / N 1 /T,8 N/Rrl (or 0 Y: MAILING ApDRESS: , t COUNT S~ ~ C Po % T®(~ ~ OF e d _ •rWAJ A9`j r So ~U• ~ivi USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION:❑ PR_ FILE DESCRIPTIONS PER COLA TESTS: ❑Residence W A i t' 14t L New Replace 6- /..3 _ ~Q RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUNp: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S EU ❑ S U ❑ S 99 ❑ S 2U S 1410 /dl`~ S -t-Q If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 lop fo3 , 2}~ ''fe S,~ .T~. /o/t g bo` 1. ka~ ,GoJ"t/os B- 2 ~o © ~6 3' y e w 5 $ A rc d -L . ~-ed CL.klk.,v B- ?J tob ye.~ /2 R•r- B- .tea q S ~es 12- ` 8 L Jr/)~At arP~ ~ ~ B- B- PERCOLATION TESTS } TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P- P- P- d ' e v P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION E 4U_ - 3~ n or harp s- AV (b Y. _ y ~ EX,STI 1) ~ iC+ f 1~ f~5 -Its ,'d- TN . . I i - 3 7 7 [ l e ! 7s E t 4 ~ i ~ --^-f °f 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): A~ TES/TS WERE COMPLETED ON: C' O e, \2w ` e~- 13 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optio~n/aa : 3O / oZ c3~ 7 '7~ OTC/ 1j; 19roA-aW,%t_ 1&1r5 CS SIGNATUR : DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L ILHR-SBD-6395 (R. 10/83) - OVER - 4. INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than 'I - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. I ST. CROIX COUNTY : WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE t Pq F'. . ' 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 Nov. 14, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Cady Town Hall located at the NE 1/4 of the NE 1/4 of Section 16, T28N-R15W, Town of Cady, St. Croix County revealed that there are no suitable soils available for an onsite sewage disposal system throughout the entire parcel. Should you have any questions, please feel free to contact this office. Sincerely, i' V, James K. Thompson Assistant Zoning Administrator cj i SCE Nov rz a 1990 BLDGS. DIV z^ r; i 1 1-6 3 vo ~Ll J ~ fi z LU X 7>~' C-1 2 nl w L Ky • ~ , 4 ~ ,per,,){ 1 a~t" `Q O 2 w C t ` dry{4tit a' ~i vQ J a - % Z kr 4 ,Approved Weather Proof 'Vent Cap Junction Box /Approved Locking Manhole Cover 411 C. With Warning Label Attached Vent Pipe Mi ni muni "12 And Padlock I Final Grade } 4" Minimum 2~1 f Approved Joint 18" Minimum dater Tight-'' ~ Seal High Water ' Alarm Switch SPECIFICATIONS , TANK New Existing Approved Joint Manuf curer • f~~C UTT W/ C.I. Pipe Blind C. I . Tank Size: 2ooo Gallons Extending 31 Plug ALARM Manufacturer: ~'0 T . 4LZz6rR Onto Solid Soil Model Number: / o J Swi tch Type AA,--r c o r NUMBER OF BEDROOMS: - 1-00 ti +_LL GALLONS PER DAY: Sa 3" of Bedding Under Tank Owner's Name: /1vN of ej~d Address: o,V Legal Discription: IV wt - Township/, C0j j County: ~T,0 %u PLUMBER/DESIGNER Signature: License kum r: Date : f/- - ,w \ , C.• j to O ~V `fir D14 ocument No. This space reserved for record • dal HOLDING TANK AGREEMENT Agree `nte t _ '70 (/O This agreement is made between the r County or Local Governmental Unit Holding Tank(s) Owner(s) RCd~ ■ - F jV EU / wA) . o CfJdY w,U, 0,E C /Ajy 'L b 1990 Called Municipals below) ( NO We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) 5At t 1 Y V,5 -~(l F e- C_, /b TA 8 ti /4~ /9- VJ IA Iv o C R S 7°- a Return 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 Ali 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 - c e ,~X 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 s. 66.60. Slats. 2. Owner agrees to pay all charges and costs incurred by the municipality for inspection, pumping, hauling or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess- ment for the abatement of a nuisance, and the tax shall be 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. Owner(s) Name(3) (Print) i 0 erls) Sign to yls 7~w~~ a~ Cab JX~~s....; yf~ Subscribed ar~fd~9 X t>S before nt$Vate: ( / ~ AQ 3 i Municipal Official Name (Print) ( Municipal Official Signature e 5 N ry Putllie • My commissiA }y~~ t 7(hl E S f fL 1 L-'~So Af Municipal Official Title (Print) YJ c~~R . Subscribed and sworn to be.fq, In th~ RZkSE NUIE: This agremmt shall be mtll and void if both sigma- a A uses are not notarized individually or together at / ~i .''•N••ej ~,N the same time. V4 .1 e Nptary Public My Comm' 193101.1 expirlg u" y~`~• aas*.*. seo • HOLDING TANK SERVICING CONTRACT Convect Date This contract is made between the - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Holding Tank Owner(s) Name(s) and Pumper's Name We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) I I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 lie with the County of Gi` k . 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. ) r. ter` t.: 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract. the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) o A 1 ~~il~r~rt~ Subscribed and sworn to before me on this date: i ~11o~~ her /t 19 6 I Pumper's Name (Print) I Pumper's signature - Notary Public ~ Q? My commission 6-P es: S iq-9I CARA~sGr e Pumper's Registration Number i Subscribed and sworn to before me on this date: o t1 eay e / /9 90 Notary 'ublic My gmission expires: ME NIM: This agreement shall be null and void if both sig)atzes are not notarized togeti>Pw at the same time or individually. L • t cn H ST C- 105 r a: H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County z d ca OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE-V2-/L S'OAI 7, iP J `lO z PROPERTY LOCATION: _ `4, Section, T 98- N, R W, Town of St. Croix County, Subdivision Lot number improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into i the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. ) W,, 0 7 The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic.'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with ac I the standards set forth, herein, as set by the Wisconsin Depart- b ment of. Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. i S ICNED I DATE i i St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2235) or 715-425-8363 Sign, date and return to above address. i Parcel 004-1036-20-000 10/13/2006 12:22 PM PAGE 1 OF 1 Alt. Parcel 16.28.15.243B 004 - TOWN OF CADY Current * ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - TOWN CADY, TOWN HALL TOWN HALL TOWN CADY 398 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.200 Plat: N/A-NOT AVAILABLE SEC 16 T28N R15W 3A E 24 RDS OF N 16 RDS Block/Condo Bldg: EXC PART TO STATE (0.80A) AS IN 636/425 EXC W 6 RDS OF E 30 RDS OF N 16 RDS (6A) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) S 4 RDS OF N 20 RDS OF E 24 RDS 16-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 636/425 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/04/1997 Description Class Acres Land Improve Total State Reason OTHER X4 2.200 0 0 0 NO Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00