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HomeMy WebLinkAbout030-1052-30-000 '°v ~ O vy y N 0. O C -00 000 0 c o ~m n o H O :2 Orno v N 0'0Lf)M f6 i mvoL tl 49 :t:f Y O Z" .C+ C > I', yLL y co M 0 0 0 0 0 N 0 y 'C C O ? O 0 .2 Z ii .C-. 00 y co O ~i LL C 0 0 co m CL O O E CO m LO m O 0 CL C4 C C =p N w u1 0 m 0 •0 ' 0INLO m ! E Q N m cc I- O 0 N I, a I~I O _O U) !I C ~ 0 N H U) C t7 O Z ? 0 r N (D Z C CO F- r N O O O • L m m N C V U ° O 2 Z Z O 0 o N N ~zo 06 CL LO H d m ~ w a~ ~ to to b> j •a I u"~J a 'm 0 0 0 •N ~aaa CL 1~ a a' O N o ~n v~ U 3 rn rn 4) } rn (A N Q1 0 N N 0) m 0 0 D N N N N O n N 0) 0 N a 9 Q } o ~i 0 ~l O p° Y A C O $ Y O O C C to O N V L m~ N N N N W O 0 C (O O O C 0\ N N C O O a CO y (D H F- C N M (D N L 0.4 0 00 7i • o c) U) M N O Z w "i 2 Cn Cd d m d 0 2- L: a rr~~i r~+ £ •C C 7 ~1 A 0 a jI0 ca 00 y ~ FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER y.~ G!?l TOWNSHIP D e SECTION ADDRESS fTzj'3 ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE - PLAN VIEW ~y SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r~ w G~erlG INDICATE NORTH ARROW BENCHMARK:Elevation and description: r~, c 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 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear-Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front Side Rear Ft. No, feet from well: No. feet from building HOLDING TANK Manufacturer: e Capacity-./2 No. of rings used: Elevation of bottom tank: y3 a Elevation of inlet No. feet from nearest prop./line:Front , .Side, Rear Ft..z No. feet from: Well Cd building, nearest road Alarm Manufacturer: CTu ru' INSPECTOR: DATE: `3 PLUMBER ON JOB: yrG~ h/, C/~ (r LICENSE NUMBER: 3 3l~ 6/90:cj i)EPARTOENT 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, WWI 53707/~ SW , SE; 2 3 , 3 0 , 19W State ass igned D. Number t . Joseph ❑ CONVENTIONAL ❑ ALTERATIVE St, Holding Tank ❑ In-Ground Pressure ❑ Mound 14 N ME OF PERMI HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Mark Montbriand Rt. 4, Box 753,140th Ave.New Ric and 'z BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: j L+ 1) 1 REF. PT. EELEV. T REF. PT. ELEV.: / Name of Plumber: MP/MPRSW No.: County: - Sanitary Permit Number: Byron Bird, Jr. 3318 St. Croix 128786 LDING TANK: - 0' =99. y' MANUFACTURER: LIQUID CAPACI TANK INLE TANK OUTLET 7EEI~ES WARNING BEL LOCKING COVER 8 / 7 PROM ❑ NO PROVIES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATE NUMBER OF ROAD: PROPERTY WELI~r~y~ BUILDING: VENT TO FRESH i ALARM: FEET FROM LINE:// ly i AIR INLET: ❑ YES O ~y C ❑ YES NEAREST -11110- w C~ 50• a / a 11 DOSING C MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF S ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth o wing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease til MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: C ER INSIDE DIA.: # PITS: LIQUID TRENCHES: MA IAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. UMBER OF PROPERTY WELL: BUILDING: VENT FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: ET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill mater ia or PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that i ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARK RS: OBSERVATION WELLS; ❑ YES ❑ 0 ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SE ED: 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. IDSTA.PIPE IDIS IBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL IFT CORRESPONDS TO INFORMATION APPROVED LAMS ❑ YES ❑ NO YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST, / 47 (iL/KKK('/~i~C~~!.~""I/I"'~'GC~.,t ~~v`iii/-(~//~//Q7/~/~(~'Ss~;re+•-~% ~-f7~. V / Sketch System on etain county file for audit. Reverse Side. SIGNAT E: TITt Oning Administrator SBD-6710 (R. 06/88) ' DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY G Ea C: 25 STATE SANITARY P WT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ 1,2f r-evision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION /a :'/4, S 3WT N, R, E (or PROPERTY OWNER'S MAILING ADDRE LOT # BLOCK # CI STATE / ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check one CITY NEAREST RO D ( ) State Owned VILLAGE-/,oQSe ❑ Public Z 1 or 2 Fam. Dwelling-# of bedrooms PAR EL AX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 7 v` 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 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) 11.0 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 El Mound 30 El Specify Type 4140 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 90-00 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank C Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' ame (Print): r Plumbe ' i nature: (No S MP/MPRSW No.: Business Phone Number: PI Ad e s (Street, C' fate, Zip Code): O V IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing ent Signature (No Stam XApproved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ; 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of 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 cowity 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. II. 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) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION , LABOR HU AN REDLATIONS PERCOLATION TESTS (11J) MADISOP.O. BOX 7969 N WI 53707 rn er ll 83.0911) & Chapter 145) LOCATION: SECTION: errOWNSHI UNICIPALITY: T :BLK. NO.: SUBDIVISION NAME: 4,67 FY4 IT 3o N/Ri E l o , v e COUNTY: MAIILING A RESS: n , ,77. Li1•DI~ n4li o O t~~Ul_ -~.tY!!X/rLa! USE DATES OBSERVATIONS MADE eo - a af 4r NO. BEDRMS.: ICOMMERCIAL DES RIPTION: OFI LE DESCRIPTIM: PERCOLATION TESTS: O Residence ~ ❑New Replace ~ RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:( t' 1) as ®u asZu os 1A I osEu ros ou 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: AX0 PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. E TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- o ©-/6~~ ~/6-~$ sg=3~ 07 - o a ~ ~ B- a 9 o z 64 ~-If -90 ?,e e7p t/ B- 7` Si ~l/ o 't PERCOLATI TESTS TEST DEPTH , WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINU ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RI t PERIOD PER INCH P- P- o- l°`~ • 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. Cef-Pry •t~ d~ 6r~^ 7 71 i FT_ wiff I& 1_1 ._4_ 41 010v 14 Ilk'. e 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 COMPLETED ON: t i i^0 Y- _ _ - ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIG U • -RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. OAOJE,CT~9~ ADDRESS AleAM16-c- Xr e'_14d~~e.`J~1 /4,f~ 1/4/Sg 3/T~p N/R/O;l W TOWN 65~ COUNT Y G~vix ,~rv~~ MPRS Byron Bird Jr. 3318 DATE BEDROOM- , CLASS PERC CONVENTIONAL- IN-GR D PRESSURE ~ f...~ CONVENTIONAL LIFT MOUND- HOLDING TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE - e-c-c - z2 ABSORPTION AREA PERC RATE BED SIZE 11116 Benchmark V.R.P. Assume Elevation 100' Location of Benchmark * H.R.P.r1.1 M Borehole Q Well Scale = Feet 0 Perc Hole System Elevation I i i U 3 la < , 00 f a Ce4,hr., 4; VV O1 ' " ' ~ S1~JNS . s , , AN R~IA ~o R S ~o~ O~p~NGE FtRESP S S90-20'72'7 ~ • W .t 1e r d • ~•'.•ow 16 r, o ~ u •v 00 to ~ al s i 3 Z.) c CC" Y • • + ~ Y III H • w e M " u rl ~ 0~t w I•. H N M : w \ W ► t " • .y i• ••a M • ON O ~i. O s u . •o•• , to W. 0. "dad 60 pf d wo 00 w V ~1 M ~ • fie 0 .p .1 r n M 1 W ~;B O a .i • W s s •Y O • L • • • tr. • all. 0 0 60 so* 60 40 C 0.0 ZtArO i 16 C, pow L. 19 9100 41 see. ~s Y ~ , pR~' woe ac R 19 r C i1GAVa VVM c~' i% • N ae A w q •i O N} o s .a , . i• t pyy State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Northwest Regional Office 209 West First Street P.O. Box 754 Hayward, Wisconsin 54843 BYRON BIRD, JR. Owner: MARK MONTBRIAND ROUTE 4 BOX 6 ROUTE 4 BOX 753 AMERY, WI 54001 NEW RICHMOND, WI 54017 RE: Plan Number: S90-20727 Date Approved: September 17, 1990 Gallons Per Day: 300 Date Received: September 10, 1990 Project Name: MONTBRIAND, MARK - RESIDENCE Location: SW,SE,23,30,19W Town of ST. JOSEPH County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT HOLDING TANK Inquiries concerning this approval may be made by calling (715) 634-4804. Sincerely, CARL J. LIPPERT ,ction of Private Sewage 'ision of Safety and Buildings 4RK MONTBRIAND X Private Sewage Consultant Cered ~uI, eY "ai, Q~ v~ e01a • 'vyeo io9 34 ~.8 i 93 ,L ti 68 s9ho ~ ~ i/ ,M SGQIe: / 406, . f' l i 63 z Gov. Lo Sec. Z3, T.30N, Rl9W S.E. corner o of SE~4 Sic. 2 3 si 'SIN Z~ i ,5 l%ne Sec. Z3 _y~/es-~ /024.o A parcel of land located in Gov. Lot 1, Section 23, T 30 N, R 19 W, St- Croix County, Wis., ftLrther described as follows: from the southeast corner of the southwest quarter of the southeast quarter (Gov. Lot 1) of Section 23, T 30 N, R 19 W, go west along the south line of said Section 23 a distance of 1024.0 feet, thence North a distance of 142.0 feet to point of beginning; for parcel to be conveyed hereina thence South 68°25' East a distance of 63.0 feet, thence North 18 3F' East a distance of 66.1 feet, thence North 680230 '~est a distance of 310.8 feet, thence South 2°O1' est on a meander line a distance of 70.0 feet, thence South in- ~ a distance of 228.0 feet to point of beginning, 68 2. T East cluding all land between meander line and Bass Lake and also in- cluding an easement for an access road from the above described parcel over a strip of land 1-'0 feet in width adjacent to and eatt of the above described parcel and extending south to the present town road. I certify that the above is a true and correct map of the parcel so surveyed, mapped and described and that I have fully complied with the provisions of See. 236.34 of the Statutes. Surveyed Oct. r 18, 19F8 at request of Janes Simon. Above instrument prepared by Carroll A. Grubb, Reg. 71s. surveym_ 0\\ i Kc' 17 ~rtJ'. `fop n.. ~y^ - ~ ~ .A .-S `1 .s. J x ~ Wis. 2 ri - o L^ V pr„Y;}~+.~, :R +acr a..ryr,a. < r y,..t'`.`Su'r wt AL J ..--~•n y.~'v a,. w rs ~V-.ewc. ......P+ .ay .+kii.•- 6rO, - - J - ~Surva yJcc/ SsP9S5 d Siirve ed -Jvrie Z8 / 5.3 C ~yGrubb,-??E. Surv a cre d 152104. v Secfon 11'r7e se cee ~vti// SE/g S~c.23 h b o~i^_1- 5 i q t(f hl 2 G { I a?sh o<¢'te car. i zc, C7 c . . I Document No. v r _ ME r This space reserved for recording data X2533 HOLDING TANK AGREEMENT Agreement 0 /s-~c~o - - This agreement is made.between the - County or Local Governmental Unit I Hoidino Tank(s) Ownor(s) j~ REGISTER S OFFICE J`h ST. CROIX CO. WI S I GQD)K Co - I Recd for Record (-Called Municipality below) I We acknowledge that application I being made for the installation of (a) holding _P 2 01990 tanks on the following o er , Provide lei land desert Lion. 1:30 P . M PrP ty ( 9 P ) at .r (J• 07 f Ga+-.t s rS ~d Register of Deeds 3 0,4CL J19 19 7-/< Return To am', 2.3.~•~`~-- - or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. As an inducement to the County of S C 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 falls to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in as. 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., tho owner shall submit the report to the municipality and the county. S. 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. Coder 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) Na e(s) (Print) I Ownel~t^s,) Siypa re s) l Subscribed and sworn to before me on this date: Municipal Official Name (Print) ( Municipal Official Signature a Notary Public M commissio ^^r ~ u N y Al (,V ~ /N / L le L I r y MYRfJA L. titkll ~R I N07A Jy@ -MI'VNESOTA Municipal Official Title (Print) J I ~ ) I J ros July 6, Im S8D-6!1723 (R. 10/85) This Instrument was drafted by the ate of Wisconsin Depar ent of Industry, Labor and Human Relations, Bureau of Plumbing. HOLDING TANK SERVICING CONTRACT Contract Date A-A?b This contract is made between the / Holding Tank Owner(s) Name(s) and I Pumper's Name I We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) ko c 1 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in 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) (Prin!) Owner's Signature(s) nn I Subscribed and sworn to before me on this date: I Pumper's Name (Print) a~J6 ,~i _I Pumper's Signature otary Public T 3iV-y S I My commission SAAAA A yy~ pr ' MYR.dA L. A DENMER' Qm i/~ D~ ~ N87AAY ?llBUC-Mf~tNESO'TA Z:~ PAN Pumper's Registration Number i MY Comm. Expires July S. IM • SBD-7574 (R. 09188) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations ~n~ky f~~ ~ J I `'U 1 i I li 1 I " i t r l Document No. This space reserved for recording data HOLDING TANK AGREEMENT ' Agreement Date/ 5_ /~O - This agreement is r ade.between the County or Local Governmental Unit I Holding Tank(s) Ownor.(s) 5r..• 3c)ks PH 7FA0110r6J61P I/-Afl P-K R-1AA0)VrA'q14101 51-6 Qo)x Ci) • a 1w MualoJ Il below We acknowledge that application Is being made for.the installation of (a) holding tank(s) on the following property, (P(ovide legal landdesixiption:) . o e-r• ~ _ Gam,. ~ ~ ~ try / 7. Return To Ac-L -9 or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose o} proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Slats. As an inducement to the County of~ C K D 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), Seats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county. The owner further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code who shall submit to the municipality and to the county a report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under a. 146.20 (3) (d), Seats., the owner shall submit the report to the municipality and the county. 5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code: In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the agreement to the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. S`90- 2072 7- Owners) Na e(s) (Perin" I Ownec~jjs) S1 re s) . r ~!1ilei11wo-._ Subscribed and sworn to before me on this date: Municipal Official Name (Print) ( Municipal Official Signature Notary Public + ( My commissio ~j Gt r 7 ~ Al (J, /N 2- / C= J~ L i ~ I MYRItIA Ca N>V;£A G PU6UG-MiAWESOTq Munici i Official Title (Print) I L~, RA~bISFY R-rrv .SOD-6123 (R.10/85) This Instrument was drafted by the ate of Wisconsin Deparl4nent of Industry, Labor and Human Relations, Bureau of Plumbing. H z H 9 ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER/BUYER IA !'C - O ~JRI.~I✓l7 ROUTE/BOX NUMBER 'I Fire Number y S~ .CITY/STATE &~U R l C_HW.0-V ~IS ZIP PROPERTY LOCATION: k, 14, Section, T:36)N, R/5?_W, Town of f`/~ ~fC,I~MIONC3 , St. Croix County, &P V. 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 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. 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. yo E I/WE, the undersigned, have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x H 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. SIGNED DATE 9 /-5- St. Croix County Zoning Office P.O. Box 98.. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property M A 2k R, Location of Property u.) __L 6 14, Section T_3 0 N-R_Z~L W Township S 1 ao Pfd ,4 13 f7RE550F S1? Met-1-ink mss 4/ Rl~ r~ MO ti w EIRE 7.53 ~hA~L ~y~ ~4~En Addr s. o€-&"e OF OfoLE, _;2310 &A tQ k F / o 5F/"emu- L 4`~1:~►r. S~S"~l ~ S Subdivision Name Lot Number 6-D y _ ko ( 1 Previous Owner of Property 8AA A 6-AR 1VE 1, Total Size of Parcel ~d X 1.2 Date Parcel was Created Zo bg / 195F Are all corners and lot lines identifiable? Yes _ No Is this property being developed for resale (spec house) ? Yes _ V No Volume -750 and Page Number 51-7 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and pagie number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ceAti.6y that a,P.e. atatement6 on this Sanm ahe tn.ue to the best o4 my (our) knowledge; that I (we) am ( cute) the owner (.a) o4 the pnopen ty des cn,ibed in thi.6 .in4onmat.ion 4ohm, by viAtue ob a warranty deed neconded in the 044.ice ob the County Reg.c.sten o4 Deeds as Document No. ; and that I (We) ones end y own the pnopoaed 6 to 4on the sewage dizpo.s zyd em (on I (we) have obtained an easement, to nun with the above du nibed pnopeAtN, 4on the constnuct%on a4 said .6y6tem, and the .tame has been duty neconded in the 04jice o6 the County Regi4ten o6 Deeds, as Document No. SIGNATURE OF O ER SIGNATURE OF CO-OWNER (IF APPLICABLE) /9Ce DATE SIGNED DATE SIGNED f 4 ..bocuMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 nDArr KK d STHt5 OFFlC E i Emma Lee Gardner, a widow _ ST. CROIX CO. WIS. Rec'd. for Record TMs 14th OCY bf_ ug A. NA. D. 19_86 . ~ Mark R . . Montbrian.. . c~ and Rita A. t ti:0 A conve a11d wa rants to Monirianc I.. husband and wife,__ as__marital pro~erty~ with ..rights of survivorship N o..+. i RETURN TO ...............................e.' the following described real estate in ..._.~.._GA~.X :...County, State of Wisconsin: Tax Parcel No: A parcel of land located in the Southwest Quarter of the Southeast Quarter (SWh of M), Section Twenty-three 23 and in the Northwest Quarter of the Northeast Quarter (NW4 of NE34), Section Twenty-six (26), ALL in Township Thirty (30) North, Range Nineteen (19) West, further described as follows: Fran the Northeast corner of said Northwest Quarter of of Northeast Quarter (NW% of NE%) go West along the Section line, a distance of 1024.0 , • thence South 43 20' West, a distance of 60.7 feet to the Point of Beginning; feet, thence continue South 430 20' West, a distance of 64.7 feet; thence North 680 04' West, a distance of 185.6 feet to an iron pipe stake on the shore of Bass Lake; thence North 120 52' East on a meander line along the shore, a distance of 60.7 feet; thence South 68° 04' East, a distance.of 219.0 feet to the Point of Beginning, TOGEMER WITH all land between said meander line and Bass Lake, AND ALSO an Easement for an access road from the above described parcel to the Town Road, as now opened and traveled. TRANSM 3 b-s-0 ZM' This g...ng.t........ homestead property. (is) (is not) Exception to warranties : Dated this ............13.'tll day of Ail.gust........................................... 19.8b.-.. 14. ?lrtwr4-A...--.. (SEAL) (SEAL) i * . Kmma-Lee...Gardner--• * (SEAL) ----...-----•---•-•--....._..........---...----.........._....-----.(SEAL) AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(tlg RI.-FA]>JUa..Jaee...GaxdJlex !i SS. County. 19-H Personally came before me this ................day of authe ' tb aj)l... )OR i 119.... the above named i --HenArik..7^.1_ Y.n..PY.k - TITLE: MEMBER STATE BAR OF WISCONSIN (I4aat; 'authorized'-bl'$i96:(!8,-W:arSt~r6s'~ to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Reinstra, Van Dyk & Needham, S. C. ii AttrJrrnelrs--at Law I Richmond W' cons'n 54017 0127 I~ N..I^1e.. Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) i~ I date: 19-----••-•) I ~i •Nams of persons signing is any capacity should be typed or printed below their signatures. STATB BAR OF WISCONSIN KQMNtarCo "PSIV® FORM No. f - 1982 - StOCI( No. 13002 rx.