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HomeMy WebLinkAbout038-1036-80-000 ~ I o C) o a o ~ I Y N Co Co °p Y cU m N _ m (D c 1 iLO o c T a oases t I a)cE 0 rn _(D 3.E~~ a O 0 3 > v a) a z c U s > LL c c m-,- O O m 0 'j C O O 'D N mO:3E: E Q U N p1 a7 U N CL N co cW E o z m d 1 CL m H co 0 o z r 0 4) z o (n 1- CD z E M 7 c (D N CD L O c I o Q = z z 0 z I N N N d m }~y N O. 06 w U C (n i u G G a` g v N E m w m a s 0 Nooo (L CL CL O V1 O O O W W J U y rn rn } c J N N _ O C r Q co a _ U v m d p d Q > <n 04 ~ri O 7 \j O N f~yA C 0 j: O p co f' ! L U O O d p ao Lo a 1 w Q a a a 0 O O N ci a 5 co .y0. a) H N c a) O O O fn Q O Z N '7 i9 mU) r \ ~t E v E d '2 ` a a 1 m m y c «s E c ~ « o a~ = 1 r ) r A ciCL I0UL Parcel 038-1036-80-000 04/28/2006 08:33 AM PAGE 1 OF 1 Alt. Parcel 8.31.15.158J 038 - TOWN OF STAR PRAIRIE Current L x1 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 JOY A & PAUL W MUELLER 0 - MUELLER, JOY A & PAUL W 2206 CABIN LN SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8050 SQUAW LAKE RHAB & MANAGE SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 8 T31 N R18W N 75 FT OF S 375 FT OF W Block/Condo Bldg: 720 FT OF SE SE ALSO N 88 FT OF S 375 FT OF E 600 FT OF SE SE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 08-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 11/23/2005 812761 2933/140 WD 03/11/1999 599234 1410/49 WD 07/30/1998 583961 1344/177 WD 07/23/1997 427/68 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 86,800 34,700 121,500 NO Totals for 2006: General Property 0.000 86,800 34,700 121,500 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 86,800 34,700 121,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 207 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 l ~-ya ` FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION-&_T 5' / N-R_~W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION_Z LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1.44f x_1760. , INDICATE NORTH ARROW BENCHMARK:Elevation and description: Ah,yrnate benchmark 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 s~ 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 fron6 building HOLDING TANK Manufacturer:- Capacity: No. of rings used: Elevation of bottom tank i Elevation of inlet: 'Y9 D,y i No. feet from nearest prop. line:Front , Side-(, Rear Ft..-,~/Q No. feet from: Well, building /4,,o / , nearest road Alarm Manufacturer: INSPECTOR: DATE : PLUMBER ON JOB : _~S"~~ LICENSE NUMBER: 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 MADISON, WI 53707 State Plan I.D. Number: ❑ CONVENTIONAL ❑ ALTERATIVE (It assigned) Holding Tank ❑ In-Ground Pressure ❑ Mound NAME AAFF/ PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION TIE: lf~.Cc.S i t7 l o? (P C~ BENCH MARK (Permanent reference point ESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE Name of Plumber: /MPRSW No.: County: Sanitary Permit Number: w~r'S /s C4 3 , SEPINK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET TANK OUT ET EL V.: WARNINU BEL LOCKING COVER c~ - 7 / PROVIDED: PROVIDED: V ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT [)IA.: VENT MATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH A : FEET FROM f LINE: /F Of AIR INLET: / YES E] NO CLA YES ❑ NO NEAREST '/(A s f (p OSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: JPUMP 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: BED/TRENCH WIDTH: LENGTH: NO. OF EDISTR.PIPE PACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHMATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPRIAL: NO. DISTR. N UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: I ELEV. NLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: 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: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST--♦ Sketch System on a In in county file for audit. Reverse Side. SIGN URE: TIT SBD-6710 (R. 06/88) / ~'nt R SANITARY PERMIT APPLICATION QI H B In accord with ILHR 83.05, Wis. Adm. Code CouN STATE SANI~YP~RM -Attach complete plans (to the county copy only) for the system, on paper not less than p 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROP TY OWNER PROPERTY LOCATION S S T_?/, N, R (or dsa PROPERTY OWNER'S MAILING ~4DDRESS LOT # BLOCK # 'd -3 Z CITY, STATE ZIP CODE PHONE-NUMBER SUBDIVISION NA OR CSM NUMBER of-2, II. TYPE OF BUILDING: (Check one) CITY NE ST ROAD State Owned VILLAGE ❑ - Public 21 or 2 Fam. Dwelling4 of bedrooms c,- PARCEL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 15 3~~ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 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 4.0 Reconnection of 5.0 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 419 Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 420 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 ATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sc: ft.) (Min./inch) ELEVATION 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 Holding Tank cQ2".---?z20n I Z Q 1 7- Ll Lift Pump Tank/Si hon Chamber 0 r-1 Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's ame (Print): PI tier's Sig tur . (N Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, 'p Co e): S XgS 14 IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued issuing ent sign re (No Sta s) Approved El Owner Given Initial Surcharge Fee) Adverse D rmin ion 1K 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 county prior to installation. 5. Onsitd 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, 608-266-3115. 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) DEPARTIIP.ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IN6IJSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 76 HUMAN RELATIONS N WI 3707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MditM?A-CITY: LOT N .:BLK. SUBDIV SION NAME: 'ILI '1 - V4 /T N/R I (o COLIN Y: OWNER'S/BUYER'S NAME: [TAWLING ADDRESS: ` J USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER I LDESCRIPTION: PROFILE I NS: <y ON TESTS: tc~Residence ❑New Replace /il X79 q~ d Y RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IIV-GROUND•PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOM EN ED SYSTEM:(optional) osau as ®u os[.u ❑s®u ®sou - If Percolation Tests are NOT required DESIGN RATE: ~Floodplain, If any portion of the tested area is in the under s. ILHR 83.09(5)(b)indicate: indicate Floodplain elevation: a PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER O OIL WITH HICKNES OLO , TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED ES I HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- B- 1 B- IB- TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INT R AL-MIN. P RI DI PERIOD 2 R PER INCH P P- P- 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 t .0064 t ~ S.+r• i ~.l/~S TN E i 1, the undersigned, her y ertify 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 th the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME In. TESTS WERE COMPLETED ON: J", ADORE S: CERTIFICATION NUMBER: PHONE NUMBER (optional): r CST S AT RE: ION: Original and one copy to Local Authority, Property Owner and Soil Tester. 10/83) - OVER - SZOV C~f3clNDGN 'TZl~ ~Xti i lNG SC!'fl~ i~SrGM l~ty 't'om Il.!-NR $'3. C j (2) S~U~~J ~ !c' als.~c. B~rvJE~.► S~~~k~ Z,cAD AND `Ta.iK oc~~t'E MdN1r{C►.~. •2 9 76 ` s~ 890-4069.1 P~Zcv bF Fti;csT ~Fi:eTli-L WN AS wPG. oy...,r 1 °j a i 11OLnING TANK CROSS-SECTION AND SPECIFICATIONS A: - R Approved Approved Locking Vent Cap Weather Proof Manhole Cover twt> Junction Box N►~~ ~N 4" C.I. 12" Min C.c4C.K Vent Pipe i Final Crade~ 4" Min i 71 -77-777 /Approved Joint Y IS." Min Tlater Tight ,Seal 4 High Water ,.4 Alarm Switch s SPECIFICATIONS Approved Joint". TANK Manuf ac tuner • C,:I . !!Rq Tank Size C2,PWto rallona 4tendinR k Onlo ` ALARM Manufact.urer:~ ~1, ~`l.E sec ,,.c n Solid .Sa1, - Model Number: Switch Type t, -4 Q NU MR ER OF BEDROOMS: y}t r- y. 3 A PRo%jC~ gib OWNER'S NAME! r•'~ LEGAL DISC Oh: 5Z It ,Se N,R W, " ry' r TOWNSiIIP/M1>•N EI-@ LITY: j~j°i0i~►'i~ . COUNTY } SICNEn: Ll crNS F. NUMTSFR : +~S~13 DATE: Document No. This apace reserved for recording data HOLDING TANK AGREEMENT w Agreement Date This agreement is made between the - - - - - - - - - - - - County or Local Governmental Unit Holdin g Tank(s) Owner(s) ~f . . i4ln i5 7a' U G[J/I ~C~Cch Y' T`Y'CO-/ /'r i ~ I Called Municipalif below We acknowledge that application Is being made for the installation of (a) holding tank(s) on the followin property, (Provide Ie al land description:) p~ 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 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 1 CV` o \ )c to issue a sanitary permit for the above described property, we agree to the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. It the owner fails to have the holding lank 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 lank 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 lank 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 servicin, 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 properly 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 shalt 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(s) (Print) I Owner(s) Signature(s) Subscribed and sworn to before me on this date: l3 ah~ a-v . 5 ~ ~rt Sfi~ 11 w der I"~ r~ sso~~ I ~ /9 D I Municipal Official Name (Print) Municipal 011a1 S I t 'T ure Notary Public Ve-~n7-, m I c My commission expires: " Municipal Official Title (Print) I /,,2 .57J 19 D J .1 01 v HOLDING TANK SERVICING CONTRACT ontract'Date - _ w This contract is made between the - olding Tank Owner(s) Name(s) and -I er - - - /J- L_ A .STS r' /Z ! = ,L / f" I Pumper's Name Q S `✓6ZLl /Q k/~1T~ /~6A1T i SSTs Q(~~t' 4UE I N Ew RICA W&A,1O e acknowledge the Installation of (a) holding tank(s) on the following property: (Provide legal description:) JA/ 7 k_kA_-r ~-Q S 3 r7-, ot L.Q ? A L( 3 l N , fZ c~.vi~ / j LAU - sr C ~t C o u-T ; The owner agrees to file a copy orthis contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and with the County of S+- ` 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. 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: t 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 ntimber issued for the holding tank; e. The dates on which the holding tank was serviced; 1. 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. { 0, ro 4 6) t " 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. wner(s) Name(s) (Print) ( Owner's Signature(s) Subscribed and sworn to before me on this date: N.. c U I mper's Name (Print) I Pn:: 1~-'~~ DwLks L/tlrr0 wA-sr~A'1(yr(i, INC, I gnatur otary ublic I aA*VL ~ My commission expires: mper's Registration Number zz/ D•7574 (N. 11/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. 4 Wisconsin Department of Industry, ONSITE SEWAGE SYSTEMS Office of Division Codes and Application 'Labor and Human Relations Onsite Sewage Section Safety and Buildings Division 201 E. Washington Ave., Rm. 141 PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 (608) 266-3815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison, WI 53707, Telephone (608) 266-3358. Plan Number Previously Assigned 1. PROJECT INFORMATION T e or print clearly) Nam f ubmittin arty (plans returned to same) Proje ame Stre t Address, P.O. Box # or Rural Route Project Address or Legal Description i YJ All City VillaK..) St to Zip Code City County JJ Village ❑ of a elephone No. (include area code) - Town [g Designer Nam o Owner At C, Telephone No. (inc d area code) Telephone No. (include area code)` r Street Address, P.O. Box # or Rural Route Street Address, P.O. Box or Rural Route City or Village State Zip Code it or Village tate Zip Code 2. APPLICATION FOR;, ❑ Experimental ❑ Mound System ~ Holding Tank ❑ New Construction ❑ Large System ❑ Conventional Gravity System stem y y ❑ Groundwater Monitoring D1 Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ Pre!surized System ❑ System in Flood Plain (attach SBD-6698) ❑ Other Alternatives 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION. a. 750- 1,500 gallon septic tank $ 50.00 b. 1,501- 2,500 gallon septic tank $ 60.00 C. 2,501- 5,000 gallon septic tank $ 80.00 d. 5,001- 9,000 gallon septic tank . $100.00 e. 9,001- 15,000 gallon septic tank $150.00 f. Over 15,000 gallon septic tank $250.00 g. 500- 1,000 gallon dose chamber $ 30.00 h. 1,001- 2,000 gallon dose chamber $ 50.00 i. 2,001- 4,000 gallon dose chamber $ 70.00 j. 4,001- 8,000 gallon dose chamber $ 90.00 k. 8,001- 12,000 gallon dose chamber $110.00 1. Over 12,000 gallon dose chamber $150.00 M. 500- 5,000 gallon holding tank $ 30.00 n. 5,001- 10,000 gallon holding tank $ 55.00 o. Over 10,000 gallon holding tank $100.00 p. Revisions $ 20.00 q. Groundwater Monitoring - Per Site $ 32.00 (other than a proposed subdivision) r. Petition For Variance: Setback $ 25.00 Site Evaluation $ 50.00 Subtotal: s. Priority Plan Review: Enter same amount as Subtotal V Total Fee: SBD-6748 (R. 04/88) NOTE., Fees are pursuant to Wis. Adm. Code, Chapter Ind. 69, and OVER . are subject to change annually. 'V01. C'S1 PAGE 321 Document No. This space reserved for recording data 4624414 HOLDING TANK AGREEMENT Agreement Date This agreement is made between the REGISTERS OFFICE County or Local Governmental Unit ( Holding Tank(s) Owner(s) ST. CROIX CO., W)'Il- (IL"' Recd for Record ~ 6 hr~ 1__r SEP 171990 alled Muniapalil below) ) at 2:15 P tC5 We acknowledge that application is being made for the installation of (a) holding /Y► 17 „ tank(s) on the following property, (Provide legal land description:) V (•'a' 5 ~ 7 0~~ Register of Deeds 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 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 5 C'V'` © 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(s) (Print) Owner(s) Signature(s) Alks7~'c~ir~ rG, Lw c^vC7t-Qa-.ti:,,,t Subscribed and sworn to beforele drt-this date: 41 Municipal Official Name (Print) I Munici aI Offietal Sign lure ,r Notary Public V 'cfi' p ` .U I ✓9 N My commission expires: Municipal Official Title (Print) I 112 Aq D SBD-6123 (R. 10185) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations Bureau of Plumbing. 1324 So. th Street 612-439-7411 Stillwater. Minnesota 55082 November 16s 1990 Cal, I do not understand what has happened or is happening. When I first contacted you# the lot part of Septembers about installirta a holding tanks you were very prompt and helpful# ex- plainingust what had to be done for the installation of the tank. On September 17th. I spent a good part of the day getting forms signed by driving from my home to New Richmonde then driving to Hudson, then driving to your home and then back to my homes trying to save a little time by not mailing them. After not hearing from you for over a months I called your home on October 22nd to ask how things were coming. Your WNW* said siie' would have you call use No return call. On October 29th. I talked to Rick at construction call* sites and asked him to tell you to call ms. On November lots ditto the 10-22 call - two weeks latere still no return call. I can understand emergency works breakdownsp eta.o but I can not understand =1 returning a phone call. With all the good weather we have been having. I could have had all the dirt work done and reseeded. and some of the inside work done. I cannot let things ride any longer. I need some answers to my qusstional I do not even know if you have started the paperwork. If I do not hear from you after 7 days of your receipt of this letter. I will assume that you are terminating our ofreement and I will contact someone else to install the tank. If this is the case. please return the papers that I brought to your home on September 17th so I can forward them to Jim Thomp- son at the Zoning Office in Hudson. Disappointed. Al Ehnert ` O 00 coo Al Ehnert File % Zoning Office St. Croix County ~o~ y , Hudson. A. 54016 S '1 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER VI I A 5-,:TA I k I C E PV E ROUTE/BOX NUMBER Q C & N %C L+ TA Ly FIRE NO. CITY/STATE we ZIP .~'!V~ ;2Y PROPERTY LOCATION: SG 1/9 5.1f 1/4, Section, T,3 _N, Rjg?~_W, Town of St. Croix County, Subdivision /U/~-- , Lot No. N Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), 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. 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 Department 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. o.2J~cs..n SIGNED DATE l 7, Z 7 2 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT STC-100 This application form Is to be completed In full and atgned by the owner(s) of the property being developed. Any tnadequacles will only result in delays of the pirmlt Issuance. -Should this development be intended Lot tetale by owner/contractot,(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 o4 t-. p a ?A `a F H pf T Location of property _F- 1/4 S 1=_.1M, Section T -AJ_E_-w Township b-& Mailing address 9 ~ ~G :5,-t- t-1 ~P SST C~ Address of alto edbdlvlslon name.„ Lot number rtx&V%4 Previous owner of property yya-'~ A~ Total size of parcel "Z 5- ' X u Date parcel was created k) AAA Ara all corners and lot lines identifiable? -Yes __J10 I$ this property being developed for resale tepee house)? of Kpe Yoluwe ,.and Page Number _ as recorded with the Register of Deeds. •----------------••---i-------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DIRD which Includes a DOCUMENT NUMBER, VOLUME AND PAOE NUMBER, and the SEAL OF THE RROIBTRR OF DRRDS. In addltlon, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Ceitifled Survey Map, the Cettltled Survey lisp shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (out) Rnowledgej that I (we) am (ate) the owner(s) of the property described In this Information form, by virtue of a warranty deed recorded In the Office of the County Register of Deeds as Document No. ) and that t (We) Presently own the proposed alto for the sewage disposal system (or I (we) have obtained an easement, to tun with the above described ptoperty, for the construction of said system, and the same has been duly recorded In the office of the County Register of voodoo as Document No. itgnatute of Owner Signature of Co-owner (11 Applicable) 17 I l 0 Data of 1119nature Date of Signature I No. 200. arrsrntp Deed=-To Hush awl and Wife as Joint 'I'cno..i;''• Published by tau Wake Book 4Btatl 2'7 2 ` bibenture, Made this 27th day of August ,-,6o between Arnold Brevold, a single man; Elaine Lueck and Margaret Lundy' +k*► parti e s of the first part, and Alastaire E. Ehnert and Carol 0. Ehnert husband and wife, as joint tenants, parties of the second part. Ujftntootttj, That the said part 183 of the first part, for aria, in consideration of the sum of • Six Hundred and no/100 Dollars, to them in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, have given, granted., bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of the second part, as joint tenants, the following described real estate situated in the County of St. Croix , Wisconsin, to-wit: Commencing Six Hundred (600) feet West and Three Hundred (300) Feet North of the Southeast corner of the Southeast quarter of Southeast quarter (SE-,:3E!4) of Section Eight (8), Township Thirty- one (31) North, of Range Eighteen (18) West; thence West to the West line of said Southeast quarter of Southeast quarter (SE;'_SEk); thence North at right angles seventy-five (75) feet; thence East at right angles to a point directly North of the place of beginning; thence South at right angles seventy-five (75) feet to the place of beginning; together with the right to use the trail across first parties land for right of ingress and egress; and all riparian rights. Cogttber, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part i e s of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. Co babt anb to Volb, the said premises as above described with the hereditaments and appurtenances, unto the said parties of the second part, as joint tenants. Anb tbt %af0, Arnold Brevold, Elaine Lueck and Margaret Lundy part 1es of the first part, for themselves, their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said parties of the second part, and to and with the survivor of them, his or her heirs and assigns, that at the time of the ensealing and delivery of these presents they are well seized of the premises above described, VOL PAt'E • Vol 394 PALE 2 as of a good, sure, perfect absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever. and that the above bargained premises, in the quiet and peaceable possession of the said parties of the second part, as joint tenants, a+ ,7st all and every person or persons lawfully claiming the whole or any part thereof they ever WARRANT AND DEFEND. In MitMOO Mbfrtot, the said part ies of the first ha vehereunto set their hands and seal s this 27th day of August , 19 60• (Seal) Signed, Sealed and Delivered in Presence of Arnold BreVOld _ W (Seal) Elaine Lue k Joseph W. Humh~c . - ~ ........(Seal) rgaret undy Lillian N. Hughes %tatt of 2 foronoin, St. Croix ss. _ County. On this the 27th day of August , 1960 , before me, Joseph W. Hu,l-hes the undersigned officer, personally appeared Arnold Brevold, Elaine Lueek and/Ma f§r a ne~or sat sfactorily proven) to be the person swhose name ssubscribed to the within ins,rument and acknowledged that the y executed the same for the purposes therein contained. In witness whereof I hereunto et my hand and official seal. ^ __..Hti yhe s otary Public, ~t • Croix Cot{1sly, yWi>c9n, My Commission expires J' , r19 = (To be fllled in It signed by a Notary Public. ti This instrument drafted by Hughes & Hughes, Attorneys *#,'.a*a,.•~~'' New Richmond, Wisconsin. fiey~ (N.H.-Ch. 59 Win. 9tata. provides that all fnatrnmenta to be recorded shall have plainly printed or typewritten thereon the names of the Rrantors. Grantees, witnesses and notary.) w 44 m a01E ~ ~ 10 N 'tl b of € q) 't'~ ~ i W y tY't l C O iris i V } ro q l vi ; Al. U M+1 NN f O : e W O Ci r