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HomeMy WebLinkAbout020-1179-10-000 r ~o O 4r O 3 0 a p U3, 1 O ~G d M C O -0 y C C C y N co a N ~o N 00 V C m N a w E CO a~ > c 0- CD o co -o c~eCO (D Is. O N uo co ` o N= - L c c N E C co U O N a) O 7 (p N ~ Uu N a C O E O C z j N co 7 co cx (n LL CO 00 .N N 00 > C !E 'O U N U I Z y Z . O Z m a m CO N N I- Z c 0 E C9 m O Z c U w Cvi 2 d' 2 c O F r E 2 m N N O (D O • 0.. U) L O N 0 Z co z 555- 0 N _ E z N N To C I N C N N 44 w a d d w Y C c0 S H d ~ N N ~ O I m G G a o N E :3 0) 1 d 0 -q -Lo 0 0 0 O Z •Fy I, a a a a 7 O N I. 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Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov ED LA CROSSE WI 54601-1831 TDD (608) 264-8777 [::0 www.commerce.wi.gov/sb/ isconsin 06 www.wisconsin.gov artment of CJim Doyle, Governor UNTY Mary P. Burke, Secretary ry ~ ry November 30, 2006 CUST ID No. 1039022 ATTN: POWTS Inspector ZONING OFFICE MICHAEL J ARNDT ST CROIX COUNTY SPIA 792 LARSEN LANE 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 APPROVAL OF PETITION FOR VARIANCE Identification Numbers Transaction ID No. 1347404 SITE: Site ID No. 720968 Michael Arndt Please refer to both identification numbers, Town of Hudson above, in all correspondence with the agency. St Croix County S28, T29N, R 19 W FOR: Petition for Variance Comm 83.43 (8) (i) Wis. Adm. Code The submittal described above has been reviewed for equivalency to applicable Wisconsin Administrative Codes and compliance with Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in section 101.01(10), Wisconsin Statutes, is responsible for compliance with all conditions of this petition approval and other applicable code requirements. Plan submittal and approval to the department or its agent may be necessary prior to construction undertaken per this petition. Your Petition for Variance of code section noted above has been reviewed. The code section petitioned requires POWTS treatment, holding and dispersal components shall be located so as to provide the minimum horizontal setback distances as outlined in Table 83.43-1. The variance requested is to allow the continued use of a new septic tank that will be as close as 3.0 feet from the deck support post. The intent of the code section petitioned is to provide the minimum horizontal setback distances as outlined in table 83.43-1 as extra safety factors for public health, waters of the state and structures during construction and in the event of component failure. The petitioner submitted the SB-9890 application form including 5 additional pages of supporting documents and/or plans. Reviewer's Comments: 1. Based on the precedent established by the previous petitions, this petition for variance is being processed as permitted by Wisconsin Statute s. 101.02(6)(g), and Comm 3. 2. The municipal zoning department recommends approval. 3. The deck support pad will be at an elevation of approximately 1 foot below the top of the septic tank and 3 foot horizontally. 4. All heavy construction equipment will be kept off the top of the septic tank. 5. The cantilevered section of the deck will be located horizontally over about 6 inches of the manhole cover and about 3 feet vertically from the top. 6. A pumping firm has a written statement indicating that servicing the tank will not pose a problem with the separation proposed. MICHAEL J ARNDT Page 2 11/30/2006 Departmental Action: CONDITIONAL APPROVAL Reviewer's Conditions of Approval: All of the petitioner's statements of fact or intent included on the variance application form, any other documents submitted to the Department, as well as any other conditions of approval listed below, shall be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. • The supporting pad for the deck support shall have a minimum of 18 inches diameter to disseminate the bearing weight. • The deck support post is to be located no closer than 3 feet from the septic tank. This decision will become final unless the department within 30 days from the date of this letter receives a written request for a hearing. A request for hearing should be sent to the address shown on this letterhead. A copy of this letter must be included with the request for a hearing. The request for hearing should state the reasons for objecting to the department's decision, because a request for hearing may be denied if it does not present a significant question in fact, law or policy. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 225.00 Fee Received $ 225.00 Balance Due $ 0.00 Charles L Bratz Y POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charlie.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 N RFCLI V L.® NOV 2 g 2009 commerce.wi.gov APPLICATION FOR REVIEW PETITION FOR V R ~l i s co n s i n SBD-989OX ~(Rupilll es- SBD-989OX (R. 08/06) (Check our website at httpJ/www.commaw-state wi.us/SB/SB- Department of Commerce DivForms htmt for the most current version of" form) Safety & Buildings Division This page may be utilized for fax appointments Bureau of Integrated Services Complete and indicate date plans will be in our office 1. Facility Information Complete for confirmed pointments*. . Facility (Building) Name: Transaction ID: I J V ` 0 Number and Street Zip: Previous Related Trans. ID: ~i Commerce Site Number (if known): Assigned Reviewer. Legal Description: _5C- C- :k-S Ta~ /V' ti c/ Assigned Office: County of St, C_2-0 . x Review Start Date: ( ) City Village W Town of /WS O 'Submittal must be received in the office of the appointment no later than 2 workino days before the confirmed appointment. NOTE: Personal information you Provide may be used for seconds u [Prhracy Law s. 15.04 1 m , Start. 2. Owner Information Customer # 3. Designer information Customer # Name _ / Designer Company Name Design Firm Number and Street Number and Street ,;L Get rs8vt L cts-, City, State, Zip Code City, State, Zip Code NCA_aSV•, WX: S-y 0/ 6 Contact Person Contact Person Telephon Number Fax Number Telephone Number Fax Number -os 8 S-S-,S' 7 7 r r- 38 / _ 3 s`o2 4. Plan Review Status Plan previously review by (please enclose a copy of review letter) _ Plan submitted with petition _ State _ Municipality _ Approved - Held - Denied _ Plan will be submitted after petition determination Code Being Petitioned _ Requesting revision - Other: -Commercial Building _ HVAC - Plumbing _ Private Sewage System Commerce Transaction Number _ Swimming Pool _ Electrical - Flammable Liquids _ Amusement Rides _ Uniform Dwelling Code - Boilers _ Elevators - Gas Systems Refrigeration Rental Weatherization Program _ Other. 5. State the code scion peing eti ionCefl.AND th s~iecific co ditio or issue u are requesting a covere under this petition for variance. Cc~/trrh ~l3.5/3 ~S ~l~ , for, S~t~Kc(< J I°rili$S;O.7 ~vr- Cor17-,`nc~&e_d Lx So- of SQ flti L 7L~n ~4 /t)Gcti d ,3r ~/c) o~2G/< Sc~~~vr y-, 6. Reason why compliance with the code cannot be attained without the variance. C-t!c j9o S7- /-0 C -v-e- d w 7- C."- e r 0 ~ c Le_(Y< ~ s7s ~G7° ~ ! o i ~7Y2~ r i 7e y G1/ ~ i Cs~. Y2~e_ go s -r 3 ' y ---t 9-all 7-~ Z . 7. State your proposed means and rationale of providing equivalent degree of health safety, or welfare as a ressed bx the code section petitioned. p~ t/ 7 -2{ fit-GIG. S dr T & 'o Xi a 4.ytP-/ 3 ~►"O<+t S o~.lZ f/ L L @ c.~ i tit:cr..-.. T 0 7-A.74 Cf,--r,°-s Co.~ ~yrK c+:`yy-t So ws Td ruc 7. Ccu~lJrc~~yr Ste. c am. / iti tee~,`~1, 8. List attachments to be considers as part of the petitioner's statements (i.e., model code sections, test reports, research articles, expert 7Zi" Ac . opinion, previously. approved variances, pictures, plans, sketches, etc.). ^ S ~ /t' Sc~n:7~o~rY sYS7rQ •*t r AC.~ e LP / O ~o`4-,'b' y ~o~ dLoh-t d~~w-e.r . ~:~L,VAnrN~~11 VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED WITH AFFIXED SEAL AND ACCOMPANIED BY RE 11, Note: Petitioner must be the owner of the building or system or credential applicant for a Comm 5 petition. Tenants, agents, desi~rters naft" attorneys, etc., shall not sign petition unless Power of Attorney is submitted with the Petition for Variance Application. CN A~ / s 4,-''t d T- being duly sworn, I state as petitioner that I have read the foregoing petition ar iev p C j Petitioner's Name (type or print) ft is true and that 1 have s' nificant ownership rights to the sub' buiidin or rv ugu Petitions s S• na Subscribed and sworn Notartr Pu 'c My dFinm n expir to before me this date on I"~~ f, Corn other side for variance re uests from Comm 20-25 and Comm 61-65 I t~ FA CHECKS PAYABLE TO DEPT. OF COMMERCE TOTAL AMOUNT DUE check here. 9 -t r ST CROIX COUNTY PLANNING & ZONING FAX DATE: Nov. 21 TO: " C-1 UJ- Code Administration 715-386-4680 1 FAX NUMBER: 33b C3'~ . 5'/ 3 2 Land Information 6 Planning FROM: ~i04+96-" 715-386-4674 FAX NUMBER 3S~ -~o Real Property 71" PHONE NUMBER: 3 R ES-386-4675 cling Number of pages including cover sheet: li ST CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715-386.4686 FAX PZC C S. ^ ,d RO+X VV(.US NiWW CC):SAINT-CRCIX.WI.US ST CROIX UNTY PLANNING & ZONING November 28, 2006 MIKE ARNDT 792 LARSEN LANE HUDSON, WI 54016 RE: HOUSE DECKING addition/remodel, Town of Hudson, St. Croix County Parcel 020-1179-10-000 Parcel ID: 28.29.19.1129 Code Administration 715-386-4680 Dear Mr. Arndt: Land Information & Planning You have requested the Zoning Office to review your deck remodeling/addition project 715-3864674 for compliance with the state sanitary code (COMM 83). When remodeling or adding onto a dwelling you are required to examine whether or not the construction involves 715Real-3386-86-467677 an increase of wastewater and whether all required setbacks will be maintained. ReLycling I have reviewed your construction/addition plans that were submitted to this office. 715-386-4675 The net result of this project will not increase wastewater load to the POWTS (Private Onsite Wastewater Treatment System). William Schumaker, MPRS, installed the POWTS on May 16, 1990. In reviewing this project, it has been brought to my attention that a corner post for the expanded deck will be closer than five feet to the septic tank. Comm Chapter 83 requires that a treatment tank or holding tank component must be at least five feet, as measured horizontally, from the closest portion of a building. The corner deck post would be considered to be a part of the building. The proposed corner deck post would be approximately two to three feet from the existing septic tank, and as such, does not meet the requirements of Table 83.43-1 of Comm Chapter 83. If setback requirements to Comm codes cannot be maintained, the property owner can apply for a Petition for Variance to the Department of Commerce. You have decided to apply for the variance. You have submitted all appropriate paperwork for the variance to the Department of Commerce, La Crosse, Wisconsin office. I spoke this morning with Charles Bratz, Plan Reviewer for the Department of Commerce in La Crosse, regarding your petition. After discussing this issue, your Petition for Variance has been approved to install the corner post footing to within two to three feet of the septic tank. The septic tank must remain accessible for pumping, and you have provided a letter to both the Department of Commerce and me from Ron Meyer, Ron's Sewer Service Inc., stating that he will be able to access the septic tank appropriately for pumping. Please contact the town of Hudson to obtain a building permit. ST. CRO/X COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715-386-4686 FAX PZPCO. SAINT-CROIX. Wl. US W W W . CO. SA I NT-C R OI X. W 1. U S i ` AV~ As a reminder, to 'prolong the life of the system, remember to haVe the septic'tank pumped once ever y three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. If this system should be found to be failing at any time in the future, the system will be ordered to be replaced according to current code requirements and all appropriate permits will be required. Should you have any questions, please contact this office. i Sincerel evin Grabau Zoning Specialist Cc: Brian Wert, Building Inspector File ST. CRo1X COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD, HUDSON, W1 54016 715-386-4686 FAX PZOCO_SAINT-CROIX.WI.LIS WWW.CO.SAINT-CROIX.WI.US M. I Arndt 792 Larsen Lane Hudson, WI 54016 Phone 715-381-3552 Fax 715-381-3552 11/27/2006 Mr. Charlie Bratz LaCrosse S&BD " 4003 N Kinney Coulee Rd LaCrosse WI 54610-1831 Mr. Bratz, Per our telephone conversation today, I have attached my Petition for Variance along with sketch of the site. Please call me if you have any questions. Thank you for your help with this. 3 Z Michael J. Arndt Cell - 612-868-1904 Home - 715-381-5557 conwrierce.mil.gov APPLICATION FOR REVIEW PETITION FOR VARIANCE ■ SBD-989OX -Complete all pages- ,S,'rn sin =D-ma oLoe~o~ccsz--.- ac tiioDepairtment tm~rr ,.r vri~dsass. DivFams.hrml for Me mast aac®t vasim efd& fam) Safety & Buildings Division This page may be utilized for fax appointments Bureau of Integrated Swvkes Complete and indkilits dabs plaits will be In our offbe 1. Facility Information Complete for confirmed appointments*: Facility (Bia'kting) Name Trmnwd n ID: Number and Street Previous Related Trans. ID: s Commerce Site Number ('f known); Assigned RrAGWOr. Legal Description: 5e c ,L % Tart N - A i19 t.,f Assigned Office: County of St. L1Z.0 • x Review Start Dates: ( ) City Village JW Town at A-A s o -1 'Submittal must be reosiwed be ft c M of the appointment no later than Z wroddw dove before the mimed appointment. NOTE: Personal Wonrmdori be used for Law a. 15A91)(04). Stabs. 2.Owner InIbrmation futomwf 3. Deelgrior bdxma*m CuslonisrS Name Designer Company Name ripmig Firm Number and Street ♦ Number and Sheet 7 ~ ttrSeh LCAIn City, S Zip Code City. State. Zip Code &..a So-, 0f 6 Contact Person Contact Person "CA C~&_/ i4rT Tell Number Fax Number Telephone Number Fax Number -71s-7S,I- S5-S7 7r3`-33 35S-a 4. Plan Review Status Plan previously review by (please enclose a copy of review letter) - Plan submitted with petition _ State _ Municipality , Approved _ Held _ Denied - Plan will be submitted after petition determination Code Being Petitioned _ Requesting revision _ Other. -Commercial Building _ HVAC _ Plumbing _ Private Sewage System Commerce Transaction Number _ Swimming Pool - Electrical _ Flammable Liquids - Amusement Rides - Uniform Dwelling Code _ Boilers - Elevators _ Gas Systems _ Refrigeration _ Rental Weatherization Program _ Other: 5. State the codes ice, Ing pet r~eti AND the s ecltic co diti° or issue you are requesti ng ye covered under this peuuon for variance. Loftin" ~l3• y3 LB Cif 7`~lij~ % -I l'7or, ~o,r / Sd; jr~..~ ln~ `or~1iSS:O-~ ~yr- Con7'.`nc.~ed (d5,0- C'S" siL TZ~n~[ /V~ctYed 3' ~y'c>•M d~L~< 5c~~~vr 6. Reason why compliance with the code cannot be attained without the variance. i/-ac-nC3T /0C-t-e_d T- C""P_t C~- CL'e_t~ Srr"C_V- / j'7ye- Pi KZ 4V j+"CA ri t - - - P/came Y4-,P- ev sir 3 ' .-A 9- ev-y Ing equivalent dogma of health Cs~afety or welfare as addressed bX the code section petitioned. 7. State Your pro posed means and rationale of provid' aZ 7 ~ ,war De-"C- S+~ ch-7- rid xir=4~/Y 3 lv' Q°+~ C QW Q*- kibyG « Kf~? r,/~~to ra 7- 0)* o 7'-krr d~,.fr, Co.• SI.-- c ty'dn So wj 7V N, T Ca /c~•*1 ; Ste. C~K c. l /h t~ I'i`i f 8. List attachments to be conside as part of the petitioners statements (i.e., model code sections, test reports, research articles, expert o ' ion, previously approved variances, pictures, plans, sketches, etc.). b~ /f- S c . fa S Y12f 14e2n- T S iLe Tc~. C9~ S.'7~? ~P A( 'Y 0 ~ S-ev"Qrdi VERIFICATION BY OWNER - PETITION 18 VALID ONLY IF NOTARIZED WITH AFFIXED SEAL AND ACCOMPANIED BY REVIEW FEE Note: Petitioner must be the owner of the building or system or credential applicant for a Comm 5 petition. Tenants, agents, designers, contractors, attorneys, etc., shall not sign petition unless Power of Attorney is submitted with the Petition for Variance Application. ; , being duly sworn, I state as petitioner that I have read the foregokg petition and I believe Petitioner's Name (type or print) It is true and that 1 have ownership nglft to the or Petitioner's Signature Subscribed and sworn Notary Public My commission expires to befiore an this date on Complele other side for variance uests Tram Comm 20-25 turd Comm 61-65 MAKE CHECKS PAYABLE TO DEPT. OF CODE TOTAL AMOUNT DUE $ - Attach check here. 'l 4 U V S rod ao . ~ ° -w -a? U d c{.. a L r~ 114 Q sol `k© o (2-1 c= 4}i 11/Z7/ZUU6 15:1* YA3 wool RON'S SEWER SERVICE INC. Invoice 1053 120TH STREET ROBERTS, W1 54023 Dale Invoice a 11/27/2006 1141 Bill TO MICIIAI.3. ARNI)1' 792 LARSEN LN HUDSON, Wl 54016 a P.O. No. Terms osc an rxclpt DescripUan AMWA %FRVICE CAI_uINSPFCTION 30.00 C ONSTRUC UON OF T I If, NEW I)1:C'K AS DESIGNED, WILL NOT HINDER THE ABILITY TO PROPERLY MAINTAIN AND PUMP THIS SEPTIC SYSTEM. RON MEYER. OWNERIOPERATOR 'Thank you for your hudncss. RON Total . s30.00 WE NOW ACCEPT VISA AND MASTE.Z CARD PAYMENT'S FOR YOUR Customer Total Balance CONVENIENCE', CALF. T'HE 01:11CE3 715-749-0153. S30,00 Phone 715-749-0153 Form- ST.C- 104 AS BUILT SANITARY SYSTEM REPORT OWNER-' ' i `ll /i~w-V e K TOWNSHIP d.°o ✓ SEC. *;~e T it N-R W ADDRESS _~T /,?.L h rf I ST. gROIX COUNTY, WISCONSIN ! SUBDIVISION r ,5(, 7 LOT •;2 LOT SIZE LLc o-• c s PLAN VIEW Distances and dimenaions to meet regvirementa of I3.HR`83' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM or IN di: to s.: ?G• _t - 4.1 _ - : INDICATE NO ARR& . CHMAMI . Describe the vertical reference point used -a 'T i15' Elevation of vertical reference points &D. Proposed slope at site: SEPTIC TANKS Manufacturer: &4<7` Liquid Capacitys Ada '-'-•'•Numbe= of rings used: 'Tank manhole cover elevation: Tank Inlet Blevation: Teak Outlet Slevations. Number of feet from nearest Road: O ~!ront Side Rear. r feet • Fran nearest- property line r Frontj(>"eUemr,O 17S feet Number of feet from: well . build1ng3-_..a f_ (Include this information of -the above plot plan)( 2'reference dinensioas to septic tank) HE REVERSE SIDE RPTION -SYSTEM : Bdd s ' x Trench: Width: 1e-& - Length:.S'a i Aumber 'of Lines: Q_ Area Built: Fill depth to tol of pipes . r/D Number of feet fnearest property lines Front, O Side, O Rear, It . Number of feet from well: Qd -:Lz ' N or of feet from buildings OF (Include di fences on plot plan). 3EEPACE PIT - Blue t- Number of pits: Diameters Liquid depth: Bottom of seepage pit elevation: Area Built: ' Ias either a drop box.0 or• distribution box0 been used on any of the above soil one). sbsorbtion sytmst ( T k HOLDING TANK Nanufacturer: Capacity: i Number of'-rings deed:. Elevation of bottom of tanks Elevation of Inlet: Number of feet from.nearest property lines Front, O Side, O Roar, 0Ft._____ Number of feet from well: Number of feet from buildings Number of feet from.nearest road: Alarm Manufacturers • Inspectors. Dated: Plumber on job: License Number: j5~.-3' P-2 ,1s 3/84:nij Parcel 020-1179-10-000 02/10/2005 09:58 AM PAGE 1 OF 1 Alt. Parcel 28.29.19.1129 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ARNDT, MICHAEL J MICHAEL J ARNDT 792 LARSEN LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 792 LARSEN LA SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.106 Plat: 0151-CEDAR HILLS ESTATES SEC 28 T29N RI 9W 2.110AC LOT 29 CEDAR Block/Condo Bldg: LOT 29 HILLS ESTATES EXC TO CTY HWY PROJ 1312/580 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 28-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09128/1998 587775 1360/116 WD 04/07/1998 576667 1312/580 WD 07/23/1997 1089/113 WD 07/23/1997 885/206 more 2004 SUMMARY Bill Fair Market Value: Assessed with: 49170 241,700 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.106 48,300 138,700 187,000 NO Totals for 2004: General Property 2.106 48,300 138,700 187,000 Woodland 0.000 0 0 Totals for 2003: General Property 2.106 48,300 138,700 187,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 209 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 M.,~►, r I I - w - V ' C:~~,~-~- ~ ~l S ~f~` ~ bra s `s iq°¢" r ~ - Z~~ Form - S T C - 104 i AS BUILT SANITARY SYSTEM REPORT "OWNER`' i ill A:~••• ';ue-Cl TOWNSHIP ~_d_ °c~,✓ SEC. a T ~y N-R W ADDRESS r T / t a ST. CROIX COUNTY9 WISCONSIN 1 SUBDIVISION r_ e lly r A/,• ! I s LOT a2 q LOT SIZE ttC~c- I~ c s PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM :r`?'S fir; :f J`'•.. . . !U i . 9i..i ; , INDICATE NOR ARROW BENCHMARK: Describe the vertical reference point used l5- Elevation of vertical reference points /,X~1, Proposed slope at site: ll= SEPTIC TANK: Manufacturer: •Aggl' Liquid Capacity: ,:~jeY C9 •-'-'•Numbet of rings used: - 'Tank manhole cover elevation: Tank Inlet Elevations Tank Outlet Elevations Number of feet from nearest Road: Front 10 Side Rear, Q feet -From nearest-property line : - Front,OSide0Rear,O 1?5 feet Number of feet from: well ~T /1 • , building: (Include this information of-Re above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAFER Manufacturer: Liquid Capacity: --.Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer-: Alarm Switch Type: -Number of feet from -:eareat property line:. Front, O Sids, O Rear, O Ft. Number of feet from well: Number of feet from building: (Include diatances.on plot plan). SOIL ABSORPTION,SYSTEH. Bdd:- Trench: Width: Length: S'? .--Number of Lines: 2 Area Built: Fill depth to top of pipe: yD Number of feet f 'm nearest property line: Front, O Side, O Rear, 0 1t. ~ sNumber of feet from well: N or of feet from building: _ S f (Include di Lances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: t Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Cieck one). HOLDING TANK Manufacturer: Capacity: Number of'-rings used:. Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: m Inspector:. ' Dated: Plumber ,on job: License Number: j5~5' e~2 3/84:nij 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 MADISON, WI 53707 State Plan I.D. Number: 11144 , NV,-, Sec. 28, T29-R19 CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Hudson, LOtL %olding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Trdm. Harwell 589 Cty Rd. UU, Hudson, WI 54016 1~0~7 ;06 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: _REF. PT. ELEy.:, CST REF. PT. ELEV.:/ s Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: IT'l. Schumaker 6382 St. Croix 135488 SEPTIC TANK - MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROV DED: PROVIDED: YES ❑ NO ❑ YES NO BUILDING: VENT ESH BEDDING: VEPiT DIA.: CENT MATL.: HIGH WATER J NUMBER OF ROAD: PROPERT WELL ALARM: FEET FROM LINE: AIR I T: ❑ YES NO ti ❑ YES NO NEAREST V oZ ? r s DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST 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: ~J<RIAL: PIT DEPTH: DIMENSIONS I \11 i / GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVED, ELEV. INLET ELEV. END, PIPES: FEET FROM LINE: r i AIR INLET: NEAREST 00- 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 r Sketch System on et in in county file for audit. Reverse Side. SIGNAT E: TITL~/j~l'S+"" 1 SBD-6710 (R. 06/88) i SANITARY PERMIT APPLICATION ~o~N A 7DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 8% x 11 inches in size. Ukirevel/sldphtiprevious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION r*s$! /UV '/a = '/4, S T „2Gi N, R % E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # C GL l1 ~~Jd ✓ u1 < Y4OG CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER I Z.-.Xx . II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned ILLAGE FLOWN f~ ❑ Public R 1 or 2 Fam. Dwelling-## of bedrooms"-27 PAR ELTAX NUMBER(b) III. BUILDING USE: (If building type is public, check all that apply) ,la q 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ,Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 4 ~r F`r ~r 0, GS-'' f Feet $:5 Feet VII. TANK CAPACITY Site p INFORMATION New sti a xisti Total # of Prefab. Fiber- Expn Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks structed Septic Tank or Holdin Tank Q d" Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system sho n the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: r-N ~ 4 ~f Plumber's Address (Street, City, State, Zip Code): 02 $-i mac' / G✓/1 IX. COUNTY/DEPARTMENT SE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved I ❑ Owner Given Initial / surcharge Fee) Adverse Determination / ~_t o = I X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber i 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 6 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 8% 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) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any Inadequacies will only result in delays of the permit Issuance. Should this development bra intended for resale by owner/coatractar.("spec house"), then a second form should be retained and completed when-the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property l.uc at tun of Property Section . T 2:L N - R Tuwnshlp Mai i l- irig Address `s GdG 1 r' r _ Subdivision Namu r ZeLT~ ~~•rl~r t.t)I Number - 12 Prt-viuus Owner of Property eo Total. Size of Parcel 7_ eR-e111_e yr Uatt! Parcel was Created Are all corners and lot lines identifiable? You No is this property being developed for resale (spec house) ? - Yes No Volume and Page Number 4s -:recorded with the Register of Deeds d ~ INCLUDE WITH THIS APPLICATION ONS OF THE FOLLOWING. 1.. Warranty Deed 2. Land Contract i. Other recordings filed with the Register of Deeds Office in addition, a certified survey. if available. would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Hap shall also be required. PROPERTY OILIER CMIFICATlO 1 (we) cetti.5y that W a tatewente on thie " "a twe to the beet 0j ay ( our ) knowledge; that I (we) am (w) .the om#A(e) o6 4k p4o tUy dt4gibed ill th4A .6160n►iwiati.on 60AM. by v.i.ntue 06 a WWuAKU deed~UGOA& ~n the 066jec. K6 the County RegiAteh o6 Deedb ae DoewwAt No. and that ( ) pneaently own the pupoeed -&Ug on the 60M90. dUPOA41 4y4tem Ian 1 (we) have ubtAi,ne.d an easement, to Aun with the above daecAibed PWPeA4# i" the eonA tAuct,i.on ob aaid qatefa, a,ad the ease has be" duty n.ec.04ed in the 066.i.ee o6 tAe County Re9i,6&i o6 Deeds, ae Document No. ? ! SIGNATURE OF OWNER SlONATURE OF CO-OWNER (IF APPLICABLE) DA'L'E SIGNET) DATE SIGNED WK. J Stj "a DATA .0 pse U, ~y ta, rNie ..ACS • ~c,;uMENT NO. tlP''1►I9t30N81ts iA i. _ LAND <C~Ii~~C ° cars s o~ ~ ~ Q F~1~"~. 1J.a?~` 4zos ro xsn it MR M ANS AND rH WO4. `wux a ST. CM CO.. W IS, TPANaa o %ecL for %=d ice. i1th by and between H1rr .Ar - Stewarta- as, Personal day of J„,~./4Q. 14 85' Contract .Representative of the-Estate of Aldro Larsen, 1.14A John of X11. ; 3lt:9jD,.Ur9.tR...A.*.. ("VendorJames O'Connell Al d q_, . 1 %1.4 .,j4h181. K whether one or-. more) and.. . wlt:lUitnl&P awn.11....................... .o........... ! a in. le man .............N • $ (Purchaser", .whether me or more). Vendor a& and agrees to env" to Purelaw, upon the prompt aced lull per' deputy formance of this contract by Purchaser, the following property, tois6a with the rents, profits, fixtures and other appurtaant interests (all cured the "Property"), " - - in St t.................................................. oiCounty, State of WisconsIn: aarusN TO See legal Description on Addendum Tax Parcel No X86 - Q.273 - . F~F WS This 11L.119L.......... homestead property. *4 (it o , Purchaser agrees purchase the Property and to pay to Vendor at . such._place as he Shall Aame.... the sum of =..192,x500.00.... in the following manner: (a) =...6Q.,QOQ..QQ at the execution of this Contract;' and (b) the balance of f. .r QQ..QQ.........•.•••... together with interest from date hereof on the balance outstanding from time to time at the rate of LeL1.. 10%)........... per tent per annum until paid In full, as follows: See Payment Terms on Addendum Provided, however, the entire outstanding balance shall be paid in full on or before the....... 11th........,, day of aI= ........................1si..9O. ( the maturity date). Following any default in payment, interest shall accrue at the rate of ...11~.... % per annum on the entire amount in default (which shall include, without limitation, delinquent Interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not boss interest unless otherwise required by law. Payments shall be applied Ant to interest on the unpaid balance at the rate specified and then to prindpel. Any amount uiay be prepaid without premium or fee upon principal at any time,00- In the event of any prepayment, this contract shall not be treated as in default with respect. to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to mouth shall be treated as unpaid principal) is leas than the amount that said indebtedness would have been had the jWjhkjjkpaYMGnts been made as first specified abow; provided that monthly payments shall be continued ice. the event of credit of any proceeds of insurance. or condemnation, the condemned premises being themefter excluded herstrom. Purchaser states that Purchaser Is satisfied with the title as shown by the title evidence submitted to Purchases for examination except: Purchaser agrees to pay the cat of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the f%U purchase (Pries is paid. Purchaser shall beentitNdto take possessba of the Properv on....... thA.. Am.h>aXS.9f t..,XSX...... x,14 •croea out ow a w nc wsarnussm wlaeuneln 9 *gat Mask Co. lne. Ott Ulip y 3 _ / pier P,urehaser promises to pay when due all tares and assessments levied on the Property or upon Vendor's in."arast ti . ir. it Ind to deliver to Vendor on demand receipts showing such payment. • Purchaser shall keep the improvements on the Property insured against loss or Damage occasioned by Are, ex- err.<led coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of $ .............n/A........................., but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance, premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to in:mrunce companies and Vendor. Union Purchaser and Vendor otherwise agree in writing, insurance proceeds shall lie applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be "Willically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Propert;• III mood tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the limes and in the manner above specified, Vendor will on demand, execute and deliver to the urchseer a Wass i J simple, of the Property, free and clear of all liens and encumbrances, except any k ens on encumurar ces crteai ~ y The act or default of Purchaser, and except: BaSeWBnXBf.:pX'OIrECLiYE.- ..=V"aats..Qf recard,_.if..any.,-.and..ztaning..O.rdi nance..requi>rements.._.. Purchaser agrees, that time is of*the essence and (a) in the event of a default in the payment of any principal or interest which continues. for a period of ...6tQ... days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of AD.... days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (I) Vendor may, at his option, terminate this Contract and Purchaser's rights. title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (inwhichevent all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract And as rental for the 1roperty if purchaser fails to redeem) ; or (ii) Vendor may sue for specific performance of this Contract to compel immedinte And full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of defnuit and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall Ile liable for any deficiency; or (iii) Vendor may sue at law fer the entire unpaid purchase price or any portion therr!if: or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action it' the equitable interest of Purchaser in insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have It receiver appointed to collect any rents, issues or profits during the pendency of any action under (i). (ii) or (iv) abcne.Notwithstnnding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable Attorneys fees of Vendor incurred to enforceany remedy hereunder (whether allpted or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement. or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, lneludin g. homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents. issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) •vthout the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first puid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do Ro and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and Inure to the benefits of the heirs, legal representatives. successors And Resigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subjut Property and agrees to join in the wMatm of the deed to be made in fulfillment hereof.) Dated this .......11th day of June .1p..86 . TF) (SEAL) *.N......-. n rr AL) • ..liarry..J....Stearart... (SEAL)~1......~~......... (......~•Q (QgAL l / 2-if William C. Harwell c AUT13ENTICATION ACKNOWLSDOMENT"~00'~~.~~,, ~.~1 o # Q Signature (s) STATE. OP- WISCONSIN a. S4A•..CrK4.4................... county. authenticated this ........day of.. 19...... Personally came. before me this .11.0k...... day of . ~!!LM 19..4.6.. the above named .Hitt. Jt.. a..Stewart-•and..Wi~, ...Uat?!!ell TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 7(1(3.06, Wis. Stats.) . to me known to be the person 5.......... who executed the • ~ forego` ip~ns eat an cknowledge the. same. THIS INSTRUMENT WAS DRAFTED BY 4 " J1W . . ~oi9.. A... MurtFBY.,.. HEYW4Ql)... ~Aq s.. HURRAY... S & SHERBURNE, P.O. BOX 229, rv~R - Huld'Bari.... "54$1$ Notary Public St.q..Cr........................... Copnty. Wis. (Signatures may be authenticated or acknowledged. Both My Commission is per anent. If no state expiration Are not necessary.) Q~ .e.1 .rr date:,: .r......•-•--.. 19......) 40 `tames of vereone wlaning In any e•pacity should be typed or printed be! - den•turee. - J r STC - 105 r' SENTiC TANK MAINTENANCL: AGI(EEME.NT St. Croix County 0 Y UWP;I•:It/IiUYLIt._..~%~°.:~/.~ ~_~!~...._1+~.-i4~a~:~-~.FF__....._._.__ rn ,o It 0U't' E'/ li U X N U M li l It leire NumbL,r I I'R4;PERTY Ll)CAT ION S Ct ion .._w2 1, _ N' !t ~ - -W' 's'own of A/Alee- y-!`---.-- 5t. Crui.x CuuilLy, i Subdivi'Isfun_ee cz- Lut number I Improper use and u,aintenattce of your SepLic System could result in iLS preu►ature'Iailtire to handle wastes. Proper mai.nternanCe cou- sists O pumping out the septic tank every three years or sountr, it needed, by a licensed 5t is tank i~umLer, What you put into Litt! syste►u Can affect the fu11l:L1011 of Lite SL-ptie tank as a treat - utunL Stage in Lite waste disposal System. t Croix County residents mwiy. be eligible Lo receive a 2;rant fur it maxiu)um of 6U7. of the cost- of replacemeLtt of a fulling system, wit ich^was iu operation prior to July 1, 19723. St. Croix County ,lecV:lited this program ill AugUSL of 1980, with the requirement thac owners of all now !~IstemS agree to keep their Systems pruperly. mi,iti►tained-. - - M The property owrnor agrees to Submit to St. Croix County 7.Oninb a curt iticatiun furor, signed by the owner and by a master plumber, _journeymau plumber, rest ricLed plumber ur a 1.icensed pumper veri- fying that (1) the ott-site waStawater disposal Sys tem'is in proper uperating 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 co 0 three year expiration. M I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ~ ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Uifi<ce within 30 days of tale three year expiration date. S I C N E U SL. C.-oix County Zoning 'Office 1'.0.. lox 9h. Iluuuna'ikd, WI 54015 715-7 16-2239 or 715-425-8363 Sign, date and return to above address. DUS TMENT`OF AND SAFETY & BUILDINGS I~ SNDUSTRY, REPORT ON SOIL BORINGS 1 C DIVISION '.LABOR AN P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: PNO.:BLK.NO.: SUBDIVISIONNAME: NO'/ N9- 7a /Tzg N/V E I ~WTOWgNSHI ~dso 2 CdAAk' j Ic COUNTY: I, MAILING ADDR ST C2o ► lecuk MILLS Dt4N LANofq/ Se9 C R t ct,~" k66 A./ h/ / USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: 'c~ S: 3 7 Residence UNK New ❑Replace MSC z7 / '10 1 3 ~a ~'►c_S 1A tLLo RATING: S- Site suitable for system Us Site unsuitable for system k+(Ake CMENTIONAL: MOUND: IN•GRO NDPRESSUR : S S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(o tional) oU mss []U s 11U s ❑u as A coNVcN,-foNlc~ 6p" 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: CLAS-S ( Floodplain, indicate Floodplain elevation: r Y T PROFILE DESCRIPTIONS BORING TOTAL PTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT}it19. ELEVATION OBSERVED H T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 6 S5 t46 4k~ > T,67 rZ'"$LC7_S ► ~~Sc. "$eN,ti,s csrG>~ B 2 ZS , oS d 9 Z ' i~''8 ~c-rs N AI&.3 SL CS iG'2 / ~Pa S B- 3 f 7 S I -1 , l I Iiija 1,4 > 7 S ► 3 ~&CCTS t 7 Bkn! S C ?6,94.1 ~1S / 7 ~~,e,,,csrffa 1R 5 °~a~l 1ti1.~ B- !D./7 4.25 a > !O-l7 l~ "rQcCTS 20~84NSC. z~,, N►24J8eUCSt~~ ~G gRti /'?S B- di Si$~ oN~ LrS I'Z"8e•jSL 76'~R"cz B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER 1 - S AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD P PER INCH P. 1 so g~ So > Z > > 1 ~ P. z 3-(,D ou6. 9s.6o > >Z <3' P. 4.Zq oN~ C.Yb >Z Z P- P L r[ 1~ i ICS tA1 C _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 efeKrenc points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. N 1J~~.N(Q - LT +4 . lu~ir /1 t^)~ IJ SYSTEM ELEVAT pN Z . oo P r l -Tall . a tom.:►00 / P - - bN - - 'tN WssT L~,--t- 1 Scd 8- 1, 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) TESTS WERE 72Z MPLE ED ON: (4A~VFY 5o j n~Sc~ ru P_Y1 N(, 3 4b ADDRESS: CERTIFICATION NUMBER: PHONE N MB R(optional): v7 ~EcSr v a N r S 4a to 3a6 - Cao CST SI ATURE: DISTRIBUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. DILHR-SBD-6395 (R• 10/83) - OVER - ~ I ~ ~ ~ ~ ~ ~ i ~ --.___._~G___-.___ t~ ~ 6 iG ~ s f ~ _ _ ~ 'n a _ G ~ ~ `'-s ~ ~J ~ 1 f~ I f I I. 1~ i ~~7r ~ G~