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HomeMy WebLinkAbout032-2050-30-001 o 7 7 / Q % @ w 0 k $75 / -1 cu e in I $]G� 2 3r CU }\\kƒ � St � i Sgtee b2kaG E=] !u CD §777 § z Ee ; LL g)k §\ jk / 3 cc t ) —C < 0400 04 2 # [ 0 a m q \ § k } ) k k ! Cl) J � � - E k ` 0 } 5 < < � Lo z \ � � k c 2 \ § 2 ) 0 E E ] 2 a § % � § , � ■ ■ ■ _ k0 0 0 7 a a a CL ; > S \ k k k o . 2 z _ = i % B o § / § g \ E $ G r = / � % m ; 2 k \ k § ) k G = 6 S = \ n $ . e § _ o k + @ \ ƒ C \ r. E i § , f \ a - 0 � cl ° C-4 k \ 1 ] f o 2 / k k 2 \ 2 .. � f § I IL E ) ) k a g & v a t i0 2 2 Form - STC - 106 AS BUILT SANITARY SYSTEM REPORT 'OWNER'' �'I L C{/�lGT�,f TOWNSHIP I_r 0P"IL��Ee' SEC. � _.2Q N—R _ T W ADDRESS � `�D �C�L� ST. CROIX COUNTY] WISCONSIN �- ,,,,.i SUBDIVISION __I � _ LOT ,IV A LOT SIZE PLAN VIEW ti Distances and dimensions to meet requirements of ILUR 83 i SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0. -'�_.3 7C •, fry �y.. i r i . 12A f �y•...i.�t� r..� j •�✓ . b/:j r _..._w__..._...� . .. •. 1 ;.j• INDICATE NORTH ARROW BENC1iMM: . Describe the vertical reference point used .13o T • ..r. .. r Tl%J .•,. Elevation of vertical reference points _ ,Q_0 _ Proposed slope at sites ' S AUK: Manufacturer: ____zLiquid Capacitys {•• "Numbee of rings used:g �'`'�—.�_•Tank manhole_ evations Tank Inlet Elevations ank � Outlet ations Number of feet nearest Roads Front,O Side,O Rea , feet • . . . rao nearest property line s Front Rear, feet . . Number of feet from:• well ��, buildings (Include this information of -the above plot plan)( 2 reference dimensions to septic tank) SEE, REVERSE SIDE P CNA? BER nufacturer: Liquid Capacity: ' "` %Pum Hodel: Pump/Siphon Manufacturer: P Size El'evat%nof inlet: Bottom of tank elevation: Pump oitch elevation: Gallons per cycles Alarm Hanufac rer: Alarm Switch Ty A1- ,,-.- .Number of feet f r nearest property line i• • Front,�O Side, O Rear,Q Ft.�,. ` • ` r 'gum r of feet from wells Number of at from building: (Include distances on lot plan). SOIL ABSORPTION-SYSTEM.�✓ �� Bddr Trenchs Width: t Lengths ' .-Number 'of Linea:__ Area Built: Fill depth to top of pipes r' Number of feet f �om nearest,/property lines Front, Side, Rear, It ._,., O O �Number�af feet from wells N or of` feet from building: (Include di tarries on plot plan). SEEPAGE PIT Sisal Number of pitas Diameters :' Liquid dapt`h: Bottom of seepage pit elevation: Area B Its t Has sit r a drop box O or distribution box been used on any of the ova soil absor ion sytems? (C eck one). HOLDING TANK Manufacturers /�/�1� �-S Capacity: QOQ Number of'.rings used: - ,— Elevation of bottom of tank: 9OL • Elevation of inlet: Number of feet from.nearest property lines Front, ® Side,©Rear, Oft. 17 Number of feet from well: No a)4! -L_ L Number of feet from buildings X23- E> Number of feet from.nearest roads Alarm Manufacturer: L 4-7 c a• p Inspectors. ' Dateds �Z4 -y°-- Plumber an fob: License Numbers 3 ®s i /84aa •' 14 � 3 j .i , 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 SlU%,SE%,S 14,T30N-R 19(U Slats Plan I.D.Number: CONVENTIONAL ❑ ALTERATIVE 2945 Town o4 Someue. ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PEHMI I HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Tom Lau.meyetL Route 4, New Richmond, DUI 54017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Donavin Schmitt 3205 St. Ctcoix 119399 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING:I VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO I NEAREST--- DOSING CHAMBER: MANUFACTURER: I BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVDED: ❑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 [__1 NO NEAREST---11110- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: I 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 DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE I DISTR.PIPE DISTR.PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: 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 I 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 Retain in county file for audit. t Reverse Side. SIGNATURE: ITLE:Zoning Admin"t.�LatotL SBD-6710(R.06/88) -- SANITARY PERMIT APPLICATION COUNTY n y .( C DILHR In accord with ILHR 83.05,Wis.Adm.Code STAT77NLF�4F�'PF-RMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN IIJD.NUIVII ,_ 8%x 11 inches in size. U T�`/—t� —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES t NO PROPERTY OWNER PROPERTY LOCATION T-= ZA4etz1;FvAeQ '/4 /a, S T Q, N, R E (o W PROPERTY OWNEWS MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISIO NAME CITY,STATE ZIP CODE PHONE NUMBER 77 CITY NEAREST ROAD,LAKE OR LANDMARK O 13 E TOWN VILLAGE :IL II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. � New b. ❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ❑Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. C< Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ seepage Bed b. ❑seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet ❑Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total ##of Manufacturer's Prefab. Con- Steel Fiber- plastic Exper. anuac Name INFORMATION New xisting Gallons Tanks Concrete stCon- glass App. Tanks Tanks Septic Tank or Holding Tank f Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber' ignature:(No Stamps M PRSW N • Business Phone Number: i PI umber's Address(Street,City,State, ip Code): Name of Designer: - T Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## etc - /i J CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved ary Permit Fee Groundwater ate Is ing Agent Signature(No Stamps) Approved ❑ Owner Given Initial J'� T char�c a Fee Adverse Determination (J (� `CAL Jam^�► X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT, APPLICATION TO THE APPLICANT: 1. This 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. A new,permit may be needed if there is a change in your building plans, system location, estimated wastewater flow number of bed-., rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed - pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal;description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank.Material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. ---------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground _$ttr�— included the creation of surcharges (fees) for a number of regulated practices which Wisco in can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried feasurQ is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) k ST. CROIX COUNTY WISCONSIN y'a ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) - - HAMMOND, WI 54015 August 24, 1987 Division of Safety and Buildings Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Thomas Laumeyer property, located at the SW ;4 of the SE k of Section 14, T30N-R19W, Town of Somerset, St. Croix County, revealed that their is a groundwater restriction within 6 inches of the surface of the ground. I feel this should be more than sufficient, and, therefore, would not require a soil tester's EH115 From. Should you have any questions, please feel free to contact this office. Sincerely, U���✓j C. OLJ4-6v�J r--Q . Thomas C. Nelson Zoning Administrator TCN:rmc BOARD OF ADJUSTMENT DECISION Request of Walter J . and Thomas Laumeyer for a special exception use, Article 3 . 7 B, 3 . 4 B, 6 . 3 C( 1 ) (c) and 8 . 4 B( 4 ) (b) , ST. CROIX A-56-86 COUNTY ZONING ORDINANCE. Location: SW1/4 of August 26, 1986 the SE1/4 of Section 14, T30N-R19W, Town of Somerset . The St . Croix County Board of Adjustment conducted a public hearing ' on August 26, 1986 to consider the request of Walter J . and Thomas Laumeyer for a special exception use, Article 3 . 7B, Setback from the water, 3 . 4B, Filling and grading, 6 . 3C( 1) (c) , Holding Tank, and 8 . 4B( 4 ) (b) , Setback from a Town road, ST. CROIX COUNTY ZONING ORDINANCE. The St . Croix County Board of Adjustment conducted an on- site inspection of the site in question. After inspection, the St . Croix County Board of Adjustment , entered an executive session to discuss the request . After returning to open session, the following decision was rendered : Motion by Supervisor Kinney to approve with the following conditions : 1 . Setback from centerline 42 feet with the building exteding an additional 18 feet . 2 . Building grade shall be raised no more than 2 . 5 feet above present grade . 3 . Holding tanks shall have state approval and not installed in the right of way. 4 . Old structure shall be removed prior to new construction. 5 . By accepting this special exception Mr . Laumeyer or any future owner shall not hold the township or county liable for any future damage . G . Consultation and cooperation with the town board is requested. 7 . Zoning Administrator shall follow up on this to ensure all the above have been followed . Seconded by Supervisor Sweitzer . Motion carried . Vote to approve : Kinney, yes; Meinke, yes; Sweitzer, yes . All variances approved must be acted on or constructed within one year from date of approval or they shall be null and void . Edith Sweitzer, Secreta y St. Croix County Board of Adjustment ES :HB:mj Walter and Thomas Laumeyer Town Clerk Dan Koich, DNR State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE.SEWAGE PLAN APPROVAL SAFETY&BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 DONAUIN SCHMI7T Owner: THOMAS LAUMI_YER ROUTE 2 80X 295A ROUTE" 4 SOMERSET, WI 54025 NEW RICHMOND, WI 54017 RE: Plan Number: $88-02945 Date Approved: December 13, 1988 Gallons Per Day: 300 Date Received: December 12, 1988 Project Name: l_AUMEYER, THOMAS Location: SW,SE, 14,30, 1.9W Town of SOMERSET" 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: — NEW HOLDING TANK Inquiries concerning this approval may be made by calling (608) 266--3937. Sincerely, MES QUINL..AN Section of Private Sewage Division of Safety and Buildings PPPO12/0009n/ 1 cc: THOMAS LAUMEYER .._Private Sewage Consultant County __...__UW: SSWMP Plumbing Consultant _Owner __._P.lumber __Environmental Health SBD-6423 (R.08/88) 'J NOISI p d S NI 0 , Qj 'OLD ` 0 to j� i OJ i c2 n a � Q CQ tck Q �I K a b bO U '.'S'9 z; - o M _ do cz \rh I 4 � � •r, r � sue. 0 • L U.. O V go r ►• a r \ \ ..... 1••1 V it _� f J Q• W -C rfS . , wo Q yY L s ei is 10 W" VAO gal O O � = V p Y•' C A7 � � � ~• � f � �••� 4 r• i 6oa M YON � ,. /�' 1, M i v 'W (1 O c ` F Iii • , � .. ei 1V 16 r'= Ap 1 i c ..A .•. m O K O• w A Y M Y ¢< Y Y ♦ 1�M ~ • Y+• P Y • r iAw• 64 as 1" 0 O N s • ! e N 0 O V o • • 61 ��• '•+• F1 �1 ow AV w 1 C Y ` • 0 O •, Y 8 � O V � • �i �i . a v ft i m f.A •• •. 1 d 9.+ Y a r < Id N =_ Ti i ••. Ic to __ • e» b IM •• « ~ ad�js • o' Iesxa vur LD OJ cc r+ 94 AC Oi � MV M •iQ Document No This space reserved for recording data 4. 0�►7ss HOLDING TANK AGREEMENT c �r %Agreement Date REGIS I -R'S OFFICE This agreement is made between the ST. CROIX CO., W) County or Lo Governmental Unit I Holding Tank(s)Owner(s) ReC�d f r+r R�COfCI I �c)�► `�L'r i� �� �. ILYC�Z MAY 2 `7 1988 (Called Municipality below) I of 1:00 P, M We acknowledge that application is being made for the installation of (a) holding 0 ell� tank(s) on the following property, (Provide legal land description:) Rogister 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 c' sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted unde- Ch. ILHR 83,Wis.Adm.Code,or Ch. 145.Slats. As an inducement to the County of `- � 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 anc 146.14, Slats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owne- by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribes b: s. 66.60,Slats. 2. Owner agrees to pay a!!charges and costs incurred by the municipality for inspection,pumping,hauling or otherwise servicing and maintainin.a 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 nct;`,/ 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;he 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.Coce •� 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 ov.-e 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 v, n 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 coup;i 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 u­_1, 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 =_t the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83,:hs. Adm.Code. in addilior i-vs agreement may be cancelled by executing and recording said certification with reference to this agreement such manner which will p, — 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 agree dr the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will perr.-a the existence o�Ae agree—- to be determined by reference to the property where the holding tank is installed. Owner(s)Name(s)(Print) r(s)Sip e(s) f3 �e'1lti- Subscribed and sworn to before me on t 0 Municipal Official Name(Print) Municipal Official Signature �� lary P, +: My commission expires: , /j/� ) �'rr� IJ /�L` N �`��- ► NOTARY PU LIC STATE f-,J iRt1DA Municipal O licial Title(Print) MY COMMISS72N EXP. FEB.2O,1992' / . % i " + ,nom a HH U. SBD-6123(R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry,Labor and Human Relations.Bureau of Plumbing. APPLICATION FOR DEVELOPMENT OF FLOOD PLAIN DEPARTrU1-'NT OF INDUSTRY, LABOR & HUMAN itrU IONS When the installation of a new, replacement or expanded private sewage disposal system is proposed for a flood P lain area, this form must be completed and submitted to the Department of Industry, Labor b Human Relations along with plans and other necessary data. OWNER'S NAME yM E y DATE Z b -30-20 ADDRESS ADDRESS OF BUILDING OR LOCATION OF PROPERTY tA.3 S/V /1q .se //y S&C. /L,/, T_. 0 , R )4w Q`NST OF -)sue ST C LZ�• E,b aEFZflSS L LEGAL DESCRIPTION TOWNSHIP kFr'_s-u-` COUNTY ST' GhZO !X Is this system new ✓ replacement expanded is area: In regional floodway? yes no not determined In regional fringe flood area? yes _ no not determined Contiguous to ground higher than any of the above? yes no What is the established regional flood elevation? f S"P, / 1{S L Are flood plain maps published and available or determined by the Department of Natural Resources? Has or will permission be ted for the following: Fill required for building? yes no Building permit? yes no Sewage disposal system (sanitary permit)? yes no Action taken locally by Comments regardin development (zoning administrator, board of appeals, etc.) : Favorable Unfavorable Special Reco ndations : 1- Setback bnom eentenUen 42 beet with the bu tding extending an add t ionat 18 beet. Su=cng g a e ZhM be &MM no mote than ght nb uwa- 4_ afd RtAu.ct rho h afl be o.m ovod ppt_iom to new o.on6tuAction. 5. B(j a cLoting thus .speciat exception Mt. Laumeyen qn any butune owner sha,U not hold the townlship an county V-0 5.7-'e. tva any e a'amage. 6. e above have been bottowed. Signatures: *County Representati a �- ---�1� Department of Nat Resources Deb:;!r.ment of Industry, Labor S Human �i4jf) �j ELA-T/�rG 10 C�SE� 4 OaIC OiivG- TAOI 7,4s L .gc(^7c yg 1e A /3Elo Room C,4 rrc c X sci r7, lne/r IVAM U 03,-70.5- SEP 0 17 198s �F p�V1S14N,. ST. CROIX COUNTY WISCONSIN Y: ZONING OFFICE 796-2239(HAMMOND) 425-8363(FVVER FALLS) HAMMOND, W154015 August 24, 1987 Division of Safety and Buildings Bureau of Plumbing -� P.O. Box 7969 Madison, WI 53707 1 01 Dear Sir: An on site investigation for the Thomas Laumeyer property, located at the SW of the SE of Section 14 T30N-R19W Town of Somerset, St. Croix County, revealed th a t the i r is a groundwater restriction within 6 inches of the surface of the ground. I feel this should be more than sufficient, and, therefore, would not require a soil tester's EH115 From. Should you have any questions, please feel free to contact this office. Sincerely, 1`�U►� C. Thomas C. Nelson Zoning Administrator TCN:rmc . H H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT c St . Croix County z d _ a H OWNER/BUYER f ptl Z AG/N \lam= t ROUTE/BOX NUMBER I?7t 41 Fire Number .CITY/STATE /( /C#//-0/V0 ��/ • ZIP PROPERTY LOCATION: L56U Ix, S L k, Section P/ , T 30 N , R �i_W, Town of `S��'/ '' �T , St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper. What you pdt 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 N to maintain the private sewage disposal system in accordance with x 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 Offkre within 30 days of the three year expiration date. SIGNED DATE �J 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. r 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 Location of Property �k ,�. ' , Section T `3o N-R 9 W c Township _ � nP21eRIZf- T ZVI . !tailing Address __33,2 q 7- Address of Site Subdivision Name A . Lot Number s��/�,/l/ .0, -- Previous Amer of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume 19 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page 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 (Wel ceJtti.6y that aQ.e statements on zlu�s bohrn ane fiJcue to the but o6 my loon) hnowtedge; that I (we) am (ane) the owneh(�5) o6 the phopehty deAcAi.bed in .thiA .in601mailon 6onm, by viAtue o6 a waAAanty deed iceeonded in the 066.ice o6 the Count RegiAten o6 Ueed�s ah Document No. '22' and .that I (We) pnebentty aun t1�e pnopoaed atite bon the �5ewage di�spo�5 ayes em (ore I (we) have obtained an eaAcmftnt, to hun with the above deAuL bed phopehty, 6orc the com&tnuc.Li,on 06 &a,i,d e0temp and the game hae been duty neconded Xn the 066ice o6 the County Regi.6ten. o6 Veede, ae Ooement No. AM A114""I jjj SIGMA Old OWN SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED y� �B 5 d,t '4 T ER CF � s�= J yy ry �aR Me�MlMllM YY� { aT » 4s II ,th, �,,: ,0�7 "ag,� - ), f y R1 + � 7 X . ��(/6 S m i, X� Al MAI 3 ht N` t ' � 1 **AT_E GEED TAX Ott f yy �. 'S ! " ,g r y `