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HomeMy WebLinkAbout040-1176-10-000 9 vote ss $ - 050 ,03 RECEIVED 1:11040T Z.-2.,1988 OfFitt;OE OiliiSiON h�N 00 � - �nust gd' Pcc �o (�es� Tip o i -404 OD 4ft� f lei( _ 8 y �� i �� Noo Is.All � �... \ •\ .' . � / ice � /� � / Cv ce .r o / ¥ \ \ o � & _ \ : \ J\) \ � � \/' � ® a E2 , c 7 _ / \/� (D ® \/$ �7 § k/ \ .j / ka/ / ) Ea } §)¢ =c ƒ k2 2— I % o o o- _# - � © m0k§ e) a 0 § \ {\§ §6)3 f \ n x � § / \ § .. o z \\ k k 4 § $ \ a m . / \ z ) $ f / 2 r ! _ � ca � » % m / ƒ k k � •• f � ; # co o x G � � ) 7 G 3 o a 04 k k \ � E _ / - # / a 2 2 , n j \ § \ \ z 2 - 1 I � \ § E _ o a 0 E . > oo J � 2 � \ J � � \ , a � _ � k O / § / ° k � [ 6@ 2 k k 2 § } § . k \ k ) 5 , - t @ ( § 7 k 2 § ' G e e o z _ e 2 ■ � 4) \ — a 3 CL `• k a k ° W k 3 o v� § t Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Cp(� � TOWNSHIP RQ SEC. T 0 N-RJLW ADDRESS S Y CRU) , Cob e ST. CROIX COUNTY, WISCONSIN c SUBDIVISION S•t Crzo�k COVe_ LOT a� LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Eft 54t y5°vKoF 5ft y5° aft _q6 DEC K !1' 9' ve_Nt 0 5000 11014'tjj TAU)�g lv' MANHOIE �---� INDICATE NORTH ARROW UI Noatk COILNer, off' N,K oN BENCHMARK: Describe the vertical reference point used _1�p of Cer"04 blz c Elevation of vertical reference point: 100,U Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,O Rear, O feet -From nearest property line Front,OSide10 Rear,0 feet Number of feet from: well building: (Include this information of 'the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0It . Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: , Liquid depth: Bottom of 'seepage pit elevation: Area Built: Has either a drop box O or distribution box been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Tin c- Capacity: Number of rings used: 10 Tt Elevation of bottom of tank: $ - Elevation of inlet: Number of feet from nearest property line: Front, n Side,-Rear, OFt. -Ft Number of feet from well: 13 ���t- Number of feet from building: Q8 Number of feet from nearest road: II Alarm Manufacturer: V tc�op' QQ Inspector: Dated: 5 0 7 Plumber on job: �yv; &Lkn) License Number: SPKS 037�ea 3/84:mj 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: S01-4,NW,',-,S24,T28N-R20W CONVENTIONAL ❑ ALTERATIVE (It assigned) Town a4 Tnoy ❑ Holding Tank ❑ In-Ground Pressure ❑ mound C;utl 62 E OL ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Wallace J. McCarthy 1900 west 78th Street, Minneapotis, MN 5 423 S-10 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: Richard Hopkinls 1059 St. ctoiX 119404 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER (� PROVIDED: PROVIDED: /'` ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER I NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST---* DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO [::]YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ED 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 DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE 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 TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: p� (� ❑YES El NO ❑YES El NO NEAREST- Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Zoning SANITARY PERMIT APPLICATION COUNTY C 0 DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PE MIT //9071 —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.o��MBER� 8%x 11 inches in size. � (2Sc +33.33+ —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO PROPEfiT,Y OWVJ R PROPERTY LOCATION I (,� 5 F_ % U'/a,S c� T c� N, R E(o W PROPERTYNERA�,ILSIADDRE�S� � n LOTU¢QBER BLO�IC NUMBER SUBDIVISION NAME \1 Q 78 CITY,STATE ZIP CODE PHON U ER CITY Y N /�11 NEAREST OAD,LAKE OR NVDMARK Kim N e,Ia b.) N �s T ❑ VILLAGE: �. (LQf ) II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): (� �3 A►V 1111. 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.El 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. D4AIternative c. ❑ Experimental 2. a. ❑System- b. LN 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 allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete strutted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank Q(SG 0 '�- 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's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: a oil �!�" Plumb is Address(Street,City,State,Zip ode: Name of De igner:FL VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,City,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee Groundwater ate �q Issuing Agent Signature(No rchar Fe / �� '-�/ s) A, _ JIC/ ✓ l�Approved ❑ Owner Given Initial t�W� , chars,Fee r �/•O�/Y�/'a' Adverse Determination °mil 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 m 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; 11. 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'/z 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 8 included the creation of surcharges (fees) for a number of regulated practices which Wisco can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reelt6 a is used in your building is returned to the groundwater through your soil absorption e system or the disposal site used by your holding tank pumper. 0 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- water, groundwater contamination investigations and establishment of standards. Groundwater, t it's worth protecting. SBD-6398(R.03/86) ����� ~� 0�` ^ ������ N� nY Department OfIndustry, Labor and Human Relations " SAFETY m BUILDINGS DIVISION PRIVATE SEWAGE PLAN APPROVAL � Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 � BAUMEESTER AND SONS EXCAVATING' INC Owner: WALLY MC CARTHY � 801 101H STREET 1900 WEST 78TH STREET HUDSON, WI 64O1b RICHFIELD WI 55423 � ' ' � RE: Plan Number: Date Approved: December 22, 1988 Gallons Per Day: 450 Date Received: December 21, 1988 Project Name: MC CARTHY, WALLY - RESIDENCE Location: RT. 8 Town of TROY County: ST CR0I% Fees Received (Priority Review) : 60.00 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 ou6m. This approval is for the following components only: - NEW HOLDING TANK Inquiries concerning thio approval may be made by calling (608) 266-288g. � Section of Pr ate Sewage Division of Safety and Buildings PPP013/0009n/ 4 cc: WALLY MC CARTHY _—...Private Sewage Consultant _-County SSWMP ___Plumbing Consultant -Owner Plumber Environmental Health aoo'oweo (n�oo�� __- ___ ___ '------ w i IE �T Q CJ O c, 4w a v : o �r 0 7 0 J > U- d a oL a ti a Z w a W r app t. ace T► F OTC F- OC Ul cn :2 W O c1 J 1- O p a oLo a F PL d 0 LA.VW Ow d F >W W F- W = O W C Q O J _-�— Q O > 100 OC W > N cYO � OLL a a W 0 L] a 0 a F- O O > a :2 `W ) W ? O> CC Z O O W Q %3 W � T ce Cie L) cr- > ao � a v> t�co tt► F- 0 j7, y W cruel CJ1 Q/ TM J �- Q? ,�V LJ LAJ 11 �� "o W ti ix t71 co O CC c Q ' v w o °° _ s 8s - 050 03 co :2_ So Q J 2 � (Y Z a � O J O W O > :2 2 Z 2 r W T-1 U -� l �N 1 1 . Yo` i Date: eSV .'a.�, �� ` Division of Safety and Buildings Office of Division Codes and Application 201 E. Washington Ave. . Rm. 141 P.O. Box 7969 Mad i son, NI 53707 In Person Rol — I ()-t--L S !Qej Mail In .a�-Ox SYO1 (,o Telephone No. ("1/9) aSV(Q- $4 cl R£: Priority Plan Review Appointment - Onsite Sewage fle� I Project or Owner's Name: City, Village or Town: County: b�1 . cil, Type of plan: Mound Petition included with plans In Ground Pressure Petition only X Holding Tank Other Dosed or °Gravity Soil Absorption System An appointment has been made for you to have your plan(s) reviewed on m� �-D . Ic( at CL (A.M.)P.M. by If you must cancel or reschedule please call (608) 266-9373. Please review the back of this notification for those items that are required for plan review submittal . Thank you 7 51 r'V,� N 0 V 2 1 1988 �- D" °os R C�rrECIW ��= �:►�>s,,.0 N *in=,; AND APPLICAT'r SBD-7778(R. 11/88) 0306v Onsite Sewage System Plan Submittal Requirements 1) Review s. ILHR 83.07, Wisconsin Administrative Code to make sure that your plan is required to be submitted to the Department. 2) All submittals must include a completed plan approval application form SBD-6748(R. 8/85) and two complete sets of properly signed plans and specifications. Plans shall include: A. Plot plan showing lot size and all lateral distances from the system to building, wells, water service piping, lot lines, watercourses, etc. Show permanent horizontal and vertical reference points (benchmark). Indicate direction and percent of slope or two foot contours extending 25 feet on all sides of initial and replacement systems. Provide system elevation and show area for replacement for new conventional construction. Include all-weather service road within ten feet of the service port on holding tank installation. B. Plan view of soil absorption system showing all dimensions, pipe lateral layout, pipe lengths, spacing, etc. Also show observation pipes and permanent markers when required. C. Cross section of soil absorption system showing system elevation; aggregate, cover material , depths, etc. D. Construction detail of septic tank, if site constructed, or manufacturer if prefabricated. Holding tank profile must show vent, manhole, alarm, and manufacturer, and multiple tanks with connections. E. Detail of lift pump tank or automatic siphon, tank size, gpm, gallons per cycle, vertical lift, friction loss, pump or siphon model and performance curve. F. Photocopy of soil test report by CST. G. Provide a county onsite verifying the site conditions for mounds and in-ground pressure systems designed for any site that is not suitable for a soil absorption system (less than 56" to limiting factor) . 3) All. plans that will be reviewed as a priority require an appointment time and date. These appointments can be made by contacting Vicki Smith at (608) 266-9375. 4) Plans that are mailed for a priority appointment in Madison also must have a scheduled appointment time and date. 5) If you are going to mail the plans to Madison, it would help us process them if they were received 3 days before the scheduled appointment date. SBD-7778(R.11/88) 0306v I 441,80 eooK 832 P.4,#1.95 )oCUmgnt No. This space reserved for recording data HOLING TANK AGREEMENT ,lgree ent D to This agreement is made between the _ RECISTERr ';ou ty or Local Governmental Unit Holding— Tanks)Owner(s) — S OFFICE ST. u� OIX CO, WI A. rF T Y 1 W.J. McCarthy McCarth Y Red d for Record CalledMunicipalit belowl 1Af11 19 2,3 198%9 We acknowledge that application is being made for the installation of(a)holding of . 10:1b A. M ank(s)on the following property, (Provide legal land description:) Lot 29, Parcel A, St. Croix Cove Subdivision Refitr<br of ' St. Croix County, Hudson, WT -- - Return To )r 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 'h. ILHR 83,Wis.Adm.Code,or Ch. 145,Slats. 4s an inducement to the County of R,_ C'rni x Ne agree to the following: to issue a sanitary permit for the above described property, I. 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, Stats. 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. ?. 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. f. 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. i. 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. 3: This agreement shall be binding upon the owner, the heirs of the owner and assignees of the owner. The owner shall submit the emeee�tR6 " 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. c )wner(s)Name CC s)(Print) ner s) natures W.J. McCarthy I r I h . ( l Subscribed and sworn to before me on this daeUlJl�r' 1 i C.4,rt:r x'11 �,"t Y�,6(,( Aunicipal Official Name(Print) (Municipal Official Signature �CA� � ( My commission expire .,:1 AtYNJ Au n' ipal Official Title(Print) �� (Lf, /'/ �7 j My commission expirn May ��-�A (Rm/� 'I 3BD-6123(R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry,Labor and Human Relations,Bureau of Plumbing. - HOLDING TANK SERVICING CONTRACT Con4'ract Date This contract is made between the — Holding Tank Owner(s)Name(s) and I Pumper's Name W.J. McCarthy Pinky's Crowww, hat. Y I 13535 South 33rd Stt:W Afton,MN 55001 We acknowledge the installation of(a)holding tank(s)on the following property: (Provide legal description:) Lot 29, Parcel A, St. Croix Cove Subdivision, St. Croix County, Hudson, WI — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1. The owner agrees to file a copy ofthis 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 St. Croix -D SD D 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; TWe _©n this c. The location of the property on which the holding tank is installed; e d. The sanitary permit number issued for the holding tank; t. tiAt �i8nt . The e dates on which the holding tank was serviced; w y k 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)(Print) (Owner's S' natures) W.J. McCarthy C scribed and sworn to before me on this date: I 3,e r,,s Name(Print) I Pumper's Signature Notary Public I My commission expires. AN!Tj w.., N0T,4.^."Y U_LIC .iA r Pumper's Registration Number RtNINLPIN COUN1 Y My commission expires May 19, SBD-7574(N.11/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. DEC 2 1 1988 H 'L U) y STC - 105 r r SEPTIC 'TANK MAINTENANCE AGItEE'MENT H 0 St . Croix County OWNER/BUYER Wallace J. McCarthy ROUTL/BOX NUMBER Fire Number None ( se str CITY/STATE Hudson, WI Z 11' 54016 addre s)et Per attached , PROPERTY LOCATION : c , _ a , Section 1' 28 r1 , !Z_20 -W , Town (if Troy St . Croix County , S u b d iv is ion—St. Croix Cove Lot number See attached deeds Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance cun- sists of pumping out the septic tank every Lhree years or sooner , if needed , by a licensed se )Lic tank LumLer . What. you put into the system can affect the function of the svptic tank as a treat- ment stage in the waste disposal systeirt . St . Croix County residents maw be eligible to receive a grant fur 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 cite requirement that owners of all new systems agree to keep their systems properly maintained ._— —_ — The property owner agrees to submit to SL . Croix County `Lowing a certification form, signed by the owner and by a master plumber , journeyman plumber , restricted plumber or a licensed pumper veri- fying that (1) cite on-site wastewater disposal systeu► 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. o I/WE , the undersigned , have read the above requirements and agree cn 1 to maintain the private sewage disposal system in accordance with H cite- standards set forth, herein , as set by Lite Wisconsin Depart- •v went 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 . SICNED DATE St . Croix C,tunty Zoning Office P . O. fox 98 Hammond , WI 54015 715-7S6-2239 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 Wallace J McC=thy See atta hed Location of Property , Section . 24 , T 28 N-R 20 W Township _ Town of Troy Mailing Address 1900 West 78th Street Minneapolis, MN 55423 ' Address of Site Subdivision Name St. Croix Cove Lot Number Per attached Previous Owner of Property Winford, Inc. Total Size of Parcel Per the attached Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes X No Volume Per attach PagesNumber 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 (We) cehtti,6 y that a t statements on this (VLT. --e ;btue :to the best o6 my (ouA) hnou.fedge; viat 1 (we) am (ahe) the owneh(.$) 06 the pnopexty deacA bed in this .in6oA-mat.ion 6onm, by Vi tue o6 a waAAanty deed )Leco d .i he 066.ice o6 the County Regc,6ten o6 Deeds as Document No. 3 w . at I (We) pnesentey own the pnopod ed site bon the sewage dia poe d yss em (o& I (we) have obtained an easement, to nun with the above de�sc i.bed pnopeAty, Son the conatAuction o6 said system, and the same has been duty neconded in the 046.ice o6 the County Reg.ia.ten o6 Deeds, ab Document No. ) , ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED L Quit Claitn Deed * ►' n Millet-Davie Co..Minneapolis Individual to Individual For No. 2iT,R'1 Minnesota Uniform Conveyancing Blanks(1931) (fi b Boos 1 ,�,�;, `�tJ Tbi5 Inbenture, .itade this /%` �L dart of April f9. 71- between. Norman .W.- -Telander and Georgia -Kathleen Telander, husband and wife, - -- of the County of . Rice-- _ _ _ _. _ . . (znd Stale of Minnesota part.- of the first part. and _Wallace J. McCarthy - - --- - - -of the County of_ St. Croix. and ,State of Wisconsin part-y.._ of the second part, Witil£tO£t'h, That the said ,a.rties of the first part, in. consideration of the su�nt of one dollar and other good and va�uable considerations 1�OII2RS --------- -- ------ --------to -..them ------ -----------._in hand paid by the said part y._ of the second part, the receipt whereof is hereby acknowledged,do---------- hereby Grant,Bargain, Qic-itclaiin, and Convey unto the said party-_.-_ __- of the second part,_-_.his..............._heirs and assigns, forever, all th.c tract.-_ or parcel.__ of land lying and being in the County of--St-• --Croix---.-- -- -------- - ----- and,`t� e�x�f�d avx< raK� atsxs tic/xile �l� �AS7t 3�c�i7iazt xx State of Wisconsin, described as follows, to-wit: A parcel of land located in Govern- ment Lot 2, NW'k of Section 24, T28N, R20W, Town of Troy, St. Croix County, Wisconsin described as follows: Beginning at the NW corner of Lot 29 in St. Croix Cove Subdi- vision, said NW corner being the intersection of the meander line of Lake St. Croix, as shown on the St. Croix Cove Subdivision plat, and the Westerly line of said Lot 29; thence S19°20'E 205.57 ' ; thence S29015'E 182.981 ; thence N24°00'W 387 .10' along the Westerly line of said Lot 29 to the point of beginning. } t To JI)abt anb t0 jbo[b tb£ *aide, •7'o4?ether with. all the h.creditarrz.ents and appi4-rtenanees thereunto belonging or in a>zyzvise appertaining, to the said pazrt_y._-oft he second pwrt,..his__ heirs and assigns, Forever. In Tlgtlinonp Mberlof, The said part,.ieSof the first part ha v.e- hereunto set_.-their i hands__ the day and year first,above written. j In Presence of Pdorman 1 i W. T! ( elander� , y!"h(Geor�;�ia K.ef'Eileen relander)� R' (Wilmer C. Brosz� -- - - - _.... . . - -- _. _. 1 c (Leo J. Fly nrt3�'c i i U UN cD 00 V) 0 (D o o p C+ j y Z. Y Q .Di, a) V't ZI 0 O O _ w EA co � I v A . a y �y I '0 R L y S H K r ti ; I ' 1 i 1 S {j t i l i i { I i I j i c i f ''1as!bt 6au7olls us dq pa;naaza s)luaujnjlsuc aq;uaq%asn.ioi aas„aaOH aaS„pa7lasw sauq ausiq aq.L:S LOX - s ,. i 1 •� ,, � • <<• -, . . --, .. uol AUJ (SSVJ?p,9@UU'E l 'Inpd :IS ganoS tr.714VA II fl"Iit �J r- _� ,� �•''ra7!Pu1 )?jgnd p.tnlo W A114PIing Aueg saanoaa OOZ - C)� `-- \ -., e1, ,� --,- ---- ---'-�7,�-t-- .._ AG a3lAVNa SVM 1N3v4n8.LSN1 SIH1 j --- ... - ---- - . - - ---- ---- - - ------ ),a r„n iv ddd - --------- -- ----_ ----sn azuvs a � � p 1 7� � aai.l� yl i 1 .. -. (a ION aas) I paln:r,xd A,vl l lrr+l1 pay�pol,ru,v:yav l,r,v _ - 1 'judurn.rls2,l;ulog,dtof dr{7 lydj,110,xa oilrn '„i p<rq?ros.�7, -- t1os.tdd dlf) af! o) Urr,01101 dU4 oa I °a;iM pup puegsnq l.zapuplaj uaalg3ex VTSao@D pup aapuelay •M uewaoN paivaddv rilpvuos.iad `112unoj p?vs ioj pun ui,ll?nt . . - - --- _ ------ ------ ----arlgnd--,Cxp:1o.N..v I `aw d[ofaq ---- 61 -- - ------ lad - -lo fivP y F /� ------ ----- sill) '110 jo i a�tu�W ;o i 1 u f f^t*5 '^ °f. MfYt01.1�lIM l tilATL eAR t)i' M'leCBNttflf-♦ORl1 1 WARRAWT vbi. X37 r�r 35 "al; VACt ft oi�w OROta)O DATA r• _: a V. J. ST. 0,4_;+x CO., Wis. k. Aec'd, for Record ft 19tt, AAMV4 ism or day of_DGf&Sr AX 19 81 Nam latiochit, Rifiew and�,. Wi t , at to Pa.1q1, Grantee, t said for le s ion lira CuaatoT s valuable ideeat riatset► T`st • con ttitt. r!!!�1 — reel !tl�9aa► awliumbtwt c±r+i+mJeu r'n ittn t1aM TO fa m"*M i0naleee do ledout E tisacrihad red estate in St• CL+Dix .:. AU1 thiE yeft of lot 29, St. Croix Coe Subdivision, n womfflaq to the pLtt thereof on file and of record in ,tho ffl of the Aegisber of Dads for St. Croix County, rrpaada, and a portiran of Qmm ernt Lot 2 in Section Tax Key No. :I= RCDOII, described as follow: aatnlencing at YA ift Sov*.nest noxrter cf said Lot 29, thence South 55 010' Wbst to the Southwest Cox, r of said Las 29, the ire North 31.10' Was 110.25 feet, thence North 49°57' West 11.4.56 !leer, Ittenoe North 29023134" Meet 73.22 feet, thence North 48°31'48" East to the east line of said Lot 29, thence earth alatq said east line to the Paint of Beginni.nq. li pt tip at pezVetual private roa dmly easement to provide access to Seller's beach house y_ ewtra100 as foloolw: at the Southwest corner of said Ict 29, thence North 3le16e Meet 11A.25 feet, thence North 49057' West 44.16 feet to the Point of Beclimtng: 13fettos N=tf 230261 Meet 108.92 feet, thence North 12 047' west 42.93 feet, thence North 41.31948' East 15.96 feet, thence South 12 047' East 49.28 fbet, thence South 23 026' " �a `00t L35.68 feet thence N 49 057' W 31.36' to Point of Begiming. f��`act t to counts, easwmts and restrictions of record.to the odstitg mortgage to Prudential Insurar e C olgmry which Grantor will pay TWA. homestead property. according to its terms. (is) (fir.ac) Jane L. McC ardiiy signs Illerely to release her homestead nq is and does T"ether with said singular the hereditament* and appurtenances thereunto bel raging;not join in any Aad J_ =111W.- W. J wavismo that the title is pod,Indefeasible in fee simple and free and clear of encumbrances except ' 170 td pa<obective sine mts, easements and restrictions of reomr.d, if any bra staff will wsrrest Bad defend the same. 3. `t d October 81 F��t ay of er _ —' 19 t r M A^RD N WICK.S��t TA UC +NNESOTA ! tNTV (SEAL) a. (SEAL? ' in (SEAL) N OTARVPUBLI I141N".ESO1A ( AL) fv a"E •a9. L. Y r, AUTHENTICATION ACKNOWLEDGMENT i tura authenticated ia_. day or STATE OF WISCONSIN ' 19 i ss. St. Croix County. _ 1 +Q Persona! y came before me, this_—Q __—day of 9� the above named 11alja�__J`_ t ? TITLE: MEMBER STATE BAR OF WISCONSIN W. J. McCarth Jame (If not, PbCart?iY.,__. — ?`' authorised by §706.06, Wis. Stats.) ---_-- L. McC:axthy,_hushand and wife, This instrument was drafted by _-- _.__-_-----.__ _ ----._---- ----�___—.—_ t a __---. .-_ __.._. --•--.._.____..--- Albert F. wall St., P:O. 522 §Riia —_Hoot 151 to me known to be the i 7erson 5. who executed the fore- �r going instrument and acknowledged the same. Hudson, WI 54016 N',' ' (&gestures may be authenticated or acknowledged. Both q are not necessary.) Notary Public,__,__ ___.–County. Wis. 3 - a, My Commission is permanent. ((f not, Si92e expiration date 19..—_. . "Ilataea Olpe►99n•sip►iaa in any capacity must be typed or printed below their c�Q.raturea WARRANTY DBKD–aT^TS BAR OF wlscoNSiN, rORY No 1_1997 - :.a • 't a t ,�_t tt i r . � � a•. e•, ham.:. n t 4a A' J BMW& t", Was , meet J.yK R tr �y as 4 Gram", s ��flM•tlow _ t 'thi4diagift dw ribed for eohft V 3oe . aooddq tD the plat ow eubdivis #M1 �`Md at vaned in d�a otfiae tad the ft is•- �"ft. CWd X 0=*Y. Mmomin. Tax Key No, 4 1 �:tc, MVWAMS, eafl nnta and lastrIctiam of record. tip 08 +3datirq Nor t go 9 to prujmntW Mmu anoe Cappany Which Gcw*oar Uill PAY to 4 la {, ftedAd s fan d» ra>aanties given by this deed any sec ersentati,on that Wff LLj� i><s ]located entizely than tote lot herein oonueyexl• fir L Illy sigm newly to release her hammteM riots a nd does not join in any 7 1SFER 4 Tog"ar with an sail sistslst the be and appurtenances thereunto belonging; ,� �� .7L tfrfi.r�l�y A./ ea.t 7�..s T tur!•�rt)'t�. >..vi -TaPYS T Mrs"s1+,�t� `(MIaI�M11MA1 1 IMt the title is pod iadefsssibie in fee simple and free and cleat of encambrances except Wb Cave CKYu cants, easntlsnts and restrictions of record, if any t .irabaan t#nrlottst"d dshed the"Ow. llsisA this day of October 19 81 . }` f UITH CKSA��j T Pt t' NNESOTA r (SEAL) (SEAL) t * - MOI�mo,�=i.ae .t• n ,aPS i t\ J• ,�_ +'�l labs J. mfg; (SEAL) �'` ( EAL) ', .•* NOTAity PUBLIC-MINNESOTA • e .. AUTHENTICATION ACKNOWLEDGMENT ,, . ^ sipfturesautbeaticated this __day of STATE OF WISCONSIN St. Croix — County. � Personally came before me, this day of a October, 1981 —the above named_ J. McCarthy v and Jane a TITLE: MEMBER STATE BAR OF WISCONSIN FT311a0e McCartJane L. ` (u not. _ � am J. M _ ' sathwis•d by 1706.06, Wis. Stats.) --_ - MaCartY ht d and wife. This instrument was drafted by ---- tome known to be the person.S_who executed the fore- a 522 SKcnd St.y P.O. BOX 151 going instrument and acknowledged the same. 11111% up Wt 501A r (Slanatnres may be authenticated or acknowledged. Both ' '4 « we not necessary.) Notary Public_--lit-& .t fo►vn y County, My Commission is permanent. (if not,'state expiration date .�._ _.-- --------- - . 19—_•1 Ira *Names of pansas signing in any e•pacity must be typed or printed below their signatures. Via. faARi; TT Dato-ViZ BAR Or •teCON9711a FORM No. 1-1977 `� ' ClOCUM�NT N!3 � 1 1 Y s��� a t *Y ,� pA�s�irrir'ammo • � gr 'tl�� Yf kvik !Mill'18 i 1 :T •276:��� t ,�� Irk }! � z��� 'fN��MAOt IK�tRVLC1 i�i1R 11Ye611GIN� bA'lA .. Z 1. �: ... 1 _W' 'YND81+tM1Ri�,1l�ade by�. . ,K' wV. .�� :. � ...�I�.?111 101I.N., _._.a.waw.ar. ...... i... . »..w.a .1.»....•N,i�1ifl,.:w.atl...a..1.. ,�+M�.a.w ., ..,.,y i a Corporation�dnl}r organled and etCistidg:uj�dtrsuid by 'vTrfue afEktl Ines deo'd for ttcord thid 2Ad4 the State of WisAiln, grantor, County, WisconsiA,.bereby:tonveyi std 6v![�rail It to `� ...... p►.D.1 .6�t ._.. .... ..�hG....J.}.'.pal n aC.i;. h1Y�..{s�n{1 et_. n .AL 1 irr {�V W Si ls4...N.N...lari}. hFMMA 1sSA Ih :w1l.�M..:M ,A. A! IRtlRQ. , of... ..5. ....�?i 4 �t . ..a..a. il-lroun WIsconsld,, lot the "t r as " sum of ..$!A..D.M.Ynd..a��.:.1a�i*TMits}J�: the following tract of land in .... «:. ...w..:-------.... ..»... County � y"`Y""N TO. r , i State of Wisconsin: _._ } Lots twenty-eight (28) and twenty-dine'(29) , St.. Croix Cove, according to the plat b £3 ereo£ on 16 .snd .of' record Ifi the office of the Register of Deeds in and .for,Said' County: . f SubJ6ct io. restrictiong `of record. tl 1 Y � y v ter Nzov"AnY,oop'nM i ameos ox.orr aervmstem e,bn)' k Witness Whereof,the said grantor has caused these presenti to be signed q. .......QV..:kl.»..CIOV.v ......�•.• :..» .. ..ita..nce.. .., i President, end countersigned by .R,...H....x n 4 .. w..w......» , s xwsecretary, at.... S t:....Pmt 1., ' �i .t]C1 1�tA,., , Wlst and its corporate seal to be hereunto affixed thl' 1 ................ISt ............day of........ ..,1ti].yi ............. e,o,vW"D BXAt D IN PRMeB NCE or ��• ......... 1.. ... T o r CC1tJNT13 , ti►: �s ,: 4. Thomose S1}A did ar. ...................... :�. County►. •' :� Personally tame before me, lh,s. clay of kl�...kl,►:»C ,�P.�.�... .. .._Y. fi .. �....».., N61jenE,�An R:. Ijj ,THomgsetu .Ass!t J,r•s r„ . ..r, Secteta y • of the above Corporatio '+' ' t,.persons W6 executed the foregoieg,ldsttument, and 4o me knows to 6 resident: t,bn, add ecicnowiddged-t1,at they executed the.forrgof'ng tcument as such Officers �' ►i tlthority+. AlN PI 4, '��.1Y Y't r r •Y t ,�