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008-1082-95-100
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Parcel#: 29.28.16.440A-10 008-TOWN OF EAU GALLE Current X 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 O-SWINDLE,JAMES P JAMES P SWINDLE C-EDIN APRIL E EDIN APRIL E 173 222ND ST BALDWIN WI 54002 Districts: SC = School SP=Special Property Address(es): '=Primary Type Dist# Description * 173 222ND ST SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 29 T28N R16W PT SE NW BEING THE W Block/Condo Bldg: 1/2& INC THE N 1/2 NE SW Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-28N-16W NW Notes: Parcel History: Date Doc# Vol/Page Type 07/03/2000 625799 1524/031 TD 07/23/1997 869/497 07/23/1997 860/367 07/23/1997 721/164 2007 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 22,500 69,100 91,600 NO AGRICULTURAL G4 12.000 1,000 0 1,000 NO UNDEVELOPED G5 22.000 9,200 0 9,200 NO AGRICULTURAL FOREST G5M 4.000 2,100 0 2,100 NO Totals for 2007: General Property 40.000 34,800 69,100 103,900 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 34,800 69,100 103,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 SANITARY PERMIT APPLICATION Cou" 7 DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY��MIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. _ y 'n —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO PROPERTY OWNER PROPERTY LOCATION 6eor? � "r sv , S°� %N4/%, S T ��, N, R E (or)W PROPERTY OW ER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISI N NAME /?,? I N /,1- 1 Nl/-�- 0 CITYg,TA7� ZIP CODE PHONE NUMBER CITY _ NEAREST ROAD,LAKE OR LANDMARK tr l/ 4i '?/5 ..c. 35 ❑ VILLAGE: �/�� rir���� �' `2 Sr• 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. N New b.IN 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. N 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. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 15.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUI ED(Square Feet): PROPOSED(Square Feet): N�'4_ �J / 4 Feet ❑Private ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank (, 3b G o �J.e s c' ❑ El 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): P7r- Plumber's 's Signat (No Stamps) /MPR/SW No.:/ Business Phone Number: / �Address(Street,City,State,Zip Code�. y Name of Designer: � VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST#jj _ CST's ADDRESS(Street,Cit ,State,Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY lH Disapproved S itary Permit Fee Groundwater ate Iss ng Agent Signature(No Stamps) Approved Owner Given Initial ^,� "� SuiQharRe Fee //� �} Adverse Determination �v'�'UL) .W !`'�EE ®i 7 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: 't. 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; II. 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; Ill. 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. Thi change in statutes was the € result. of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater -�- ncluded the creation of surcharges (tees) for a number of regulated practices which Wiscor4in'$ can effect groundwater. The surcharge took effect on Juiv 1, 1984. All of the water that buried reasure is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. c The e;,onies collected through these surcharges are credited to the groundwater f:_,nd adminis- tered by the :department of Natural R asource->. These furcds are used for monitoring ground- T Water, groundwater contamination in estigations and estrjblishrrw ?t of standards Groundwate it s worth protecting. c3D-�3yR(R.03if.;6j REPORT ON SOIL BORINGS SAFETY& BUILDING` AND DIVISION" R Y I I) - P.U. BOX 79&'- uOR t�N, 1l ;1-PR(-',"01-, AT10N TFSTS (115) MADISON, WI 1�3/0? IVIA N R E L A, IONS (IL{-3R 83,09(1) & Chapter 145) - --7— UNICIPA Ll-T Y- T-C-T f46- Ii4LR-—N SUBDIVISION NAME: -- - i)! AT S ECI ION G Y� L- ------ OUNTY —WN FR'S UYER'S NAME: MAILING ADDRESS: : T - -I- , OZ DATES OBSERVATIONS MADE USE \0. BEDRMS.: COMMERCIAL DESCRIPTION: -- -------,- .-- - PROFILE-- -g-E-SC-RIPT-1-0 �S5E-R—COLA-T-IO--N-T-EST-§ rf L I Nevv, --<R place 5)-L T -0dence - RA ING: ST Sitrsuitable for system U=Site unsuitable for system TIN --mF-i CL-r4ci-L-D-1 NG TAN-KTFi EC-6-MV,--ND ED SYST EM:(optional) % 4 L IJ N IN-GROUND-PRESSURE: SYSTEM-IN-FILL S T-T,. i I, j G L L-1 <u X,U 0S XU 1:1 S 1A I ®S CCU I jj NOT any portion of the Test�are DESIGN-GN RATE I area is in the required P 82 09(5)(b).indicate IEoodpIain, indicate Floodplain elevation: PROFILE DESCRIPTIONS P1 TOTAL CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DIE R D,R!-NG! DEPTH TO N-11BEF DEPTH ;*]ELEVATION- OBSERVED EST. Hl?,7--HEST- TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) j+-ftTJ',ZZ ft-Pi 11:1 M07 Q2 Z-Z- ' B- 10.�' \�s,, (2 N-cbl I km OT C> -S _ 1 Si l.y F3v% IB 3 �t °1 �,5'_l `� Yn�T l, �' °.8'o1zp,. silJs,r ).-6 b-x,PLh-T1e I S,S) C M19'11k E 11B • YN 6'r � l t4 o b-,x S -rS TS S v b- ge S ?!)-VQ TIln B- �.9 6' r Bn Ij 0,9 L�h S j 6 —, t)Aj G L Y 92&-E�'J St B---- 7 ry, j* S j 7� iF�,n L i 1.s' PERCOLATION TESTS -�-----DROPTT\—VVATER LEVEL INCHES MINUTES aT -T-DEPTH �T—ER 11 LE TEST TINAE PERIOD 3 CH 7"Jr,!BERj INCHES AFTERSWELLING -INTERVAL-MIN. I--PERIOD 1-- rb� L/ L 141 N) PILOT P-AN S percolation tests soil borings and the dimensions of suitable soil areas. Indicate scale or distances Describe what are the hori .at ior- reference points and shoN their location on the plot plan. Show the surface eievation at all borings and the direction and nercent r Z I L L - try F-LE VA'rION u Ti ti 1"r 3 M- OL- Z T-, I y- S kZ 'A-'r. F:' -1,-t L1 S L F.S CDtIm y3 ki e- iz T`rl ct= –K I t nt.I Z. TN 4 JN u OPT' �n; r- or, es and methods specified in the Wisconsin ,�J�Isli,ied, hereby certify that the sci; to *,-< P, 0 "or c'cl, tor h-st of �-v Im j d belief. Code,and that the data recorded and L!)� ---- --- -;-ESTS v%,ERE CCVIPLETED ON: -IZ--T)4 01-e- 1AJ 'F`S. -ri Fi rl A 1 10%NIT)% 5;-)1 QS-3 S, A T UR t. F C -,i So,i T-ster. -�' ---r=-`�'-�-____._._._ R. 0:83) OVER DEPAR"I'MENT OF SAFETY & BUILDINGS REPORT ON SOIL BORINGS AND DIVISION I "j T R Y, P.O. BOX 7969 'j PERCOLATION TESTS (115) MADISON, WI 53707 L�'�,B OSR AND D HUMAN RELAI IONS (I LHR 8109(1) & Chapter 145) ------ Sui�[FIVISiON NAME� LOCATION. ',,,_�10.�LNSHIP- �UNICIPALITY: I � _�_9 /T —,��N/R ,;�, Etd`Lw /4 1/4 - -l_� COUNTY: 10�WWNERW'�SUYER'S NAME: MAILING ADDRESS: L'i ij L""j I e vo 0 z C_ Y_ Im• USE DATES OBSERVATION'S MADE 1O N TES-fS PTION: IF �O.BEDRMS.: C0MMERC1'AL__EFESCM PROFf1_LEDEEZ_R 5T LKT Ne, Residence _T1 New _?-,Replace z RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSOR=: SYSTEM-IN-FILL HOLCING TANK: RECOMMENDED SYSTEM:(optionali Percolation Tests are NOT required �ESIGN RATE: any portion of the tested area is in the o 'c 'a der s. ILHR 83.09(5)(b) indicate: [Flinodplain, indicate Fioodplam eievation PROFILE DESCRIPTIONS 'BORINGS TOTAL DEPTH TO GROUNDWATER-1 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBEJRDEPTH -1*ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B Bn S i It TS 0 C 3 .-4,7, 7-5 -S C_' l S' yn C.'r a I I c' S' t'j A- yylt)'t (E 7-17 , 1B- N-A- L4 N-'N' 15r% Si is Br's o. 6' ft�r' B-_ 2.L4 0- B- 7T, PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME j DROP IN WATER LEVEL-INCHES RATE MINUTES PER NUMBER INCHES AFTER SWELLING INTERVAL-MIN. �ERIQD 1 OD 3 RINCH _PERIOD 2 P_ P_ P_ P_ PLOT PLAN: Show iocations of )ercoia-zion tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances Describe what are the nori- zortal and vertical elevation reference points and show thei• location on the plot plan. Show the surface elevation at all borings and the direction and percent o- end s,�)oE- SYST EM ELEVATION TN 1, the -;igc.d, hereby certify that the soil tests reported on this form were made by me in ac,-.jTc!-,r ith the�rocedures and methods specified in the Wis.,:,,nsin be ct,aiive Code,and that the data TELOIJeC'and the location of the tests are correct to the best of rn�, kr..,.,::Ed'2e and belief. U- TE-1 DIMIPL IEDON: (p i i n t): L/ 1 < HTIF)CAT;0% NU:_11BER_-P-40NE NUMBER(,-,p-,, al): Lif Lj 1 5 i ri 3U1 ION: & id z>rre copy to Luca', Aut 1,u,ov,P;0;-elzy Ovvne,and Soil Tester. C-- 13 F Dl!_HR-SBD-6295 (R. 10/83) —OVER . ~ ,� State N� Wisconsin Department (]fIOdUStry. Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL� SAFETY m BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 � Madison, Wisconsin 53707 � WEGERER, WEBER & ASSOCIATES Owner: GEORGE A. I.-ARSON P.O. 80X 74 RIVER FALLS, WI 54022 BALDWIN, WI 54002 RE: Plan Number: Date Approved: October 14, 1088 Qallono Per Day: 450 Date Received: October 14, 1988 Proj,eot Name: I.-ARSON, GEORGE A. Location: SE^0W,SEC.29'20^ 16W Town of EAU GALLE County: 8T CROIX 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 146, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved' . This approval in 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 oite. The installer shall notify the appropriate inspector when inspections can be made. � This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code � requirements only. These plans have not been reviewed for the code requirements � set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the � � Wisconsin Administrative code. � This approval is for the following components only- - REPLACEMENT HOLDING TANK Inquiries concerning this approval may be made by calling (608) 266-3037. Sincerely, AAM E S 70 U I N L A IN Section of Private Sewage Division of Safety and Buildings 13PP012/0009n/19 cc: GEORGE' A. LARSON -Private Sewage Consultant __{�ounty ___UW_'SSWMP ___Plumbing Consultant -----Owner Plumber Envirunmental Health noo'6423 m.10/87) | BOLDING TA14Y aL,e c,r 3 For A 3 Bedroom residency for LOCATED IN' THE sE 4 OF THE NW 4 OF SECTION -z.9 ,T 7-6 N, R__!._6 W., TCtviv OF �P.v Gg��� , s-r. cCZ.o vx COUNTY, WISCONSIN. INDEY PAGE 1 of 3 TITLE SHEET PAGE 2 -of 3 PLOT PLAN PAGE 3 of 3 - HOLDING TANK SECTION PREPARED FOR 2 i PREPARED BY WEGERER, WEBER AND ASSOCIATES BOX 74 421 N. MAIN STREET RIVER FALLS, WISCONSIN 54022 colvs • • ARTHUR L. WEGERER Z 0.915 P ELLSWORTH. • WIS. • s •t � /d-lO-� y �1 • Scale 1"= zlet 7 r' I :S M EXIST�AIG Ztt'h+�-1'0 8� Ms►�l�p0►u� 'RS P� aoa6. � � t�Si'►•ctk CI PtP� L�J b LS1vt2L3�l I'CRL'�'R 02 V �°r •e4ou .. �V�rV• y2,. Ali: , " 'S'I�i ST a 4PJ To lsPJft 1371 UA® O +rip 'SOIL aT E'j.1jj of rpbu k. fj F, o SI O • ntt.tuewh,-r .�t2ov��E ALL W%Sfa"GR A ccczss \2or,p Tp wtr•IIt� C3AFZN r �f PNGE 3 of 3 HOLDING TANK CROSS-SECTION Approved Weather Proof Vent Cap Junction Box ___F /Approved Locking Manhole Cover 4" C. I. - With Warning Label Attached Vent Pipe Minimum 12" /Final Grade 4" Minimum rApproved Joint 18" Minimum , Water Tight—'' Seal High Water ' Alarm Switch SPECIFICATIONS -- _ -- - - t TANK New _'� Existing Approved Joint Manufacturer:i.vxEZ5e, C,pn,C¢ �RoD�cy-S w/ C.I. Pipe Blind C.I. Tank Size: 3 0 0 o Gallons Extending 3" Plug Onto Solid Soi' ALARM Manufacturer: 5.3. ELECO SYS7L�-1s Model Number: Switch Types-�ccY NUMBER OF BEDROOMS: 3 GALLONS PER DAY: 4So 3" of _Bed+Am Under Thi►t atr rei ervea lur re•orb, ca': 1 j REGISTER'S OFFICE the ST. CROIX-CO., WI - - - - nc Tanrts`.Owrer;s) Recd for Record rc , E:nta lJnli �+ 4{� �-�C `t��L i����iO� DUI 1 988 ct 12/:10 P. �M/J - --- --------- _doc t'-a, appiicaiion is being made for the Installation o` (al holding RP Rivet ofDeeds following bperty. (Provide legal land descripfiona i O/-- -- �J Fz 16 -, f Lu OF - -- -- - ---- - f Return 7a irk ST. C�fZ�U -7x t? ,GcJI S'C'CXs!/v Or that continued use of the existing premises requires that a holding tank be insta!led on the property for the purpnse o' proper cnntainrnew o' sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system: as pair-';tec ^e' Ch. ILHR 83,Wis. Adm.Code,or Ch.145,Stats. �.s an inducement to the County of X to issue a sanitary permit for the above oescribeo properly we aciree to the following. all applicable requirements of Ch. ILHR 83,Wis. Adm. Code relating to holding tanks. If the owner fails to have the caner agrees to conform to pP c;,nc tans properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.1 an ;ee municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by r On the lax Dili 25 2 SD?Cia a5S°_Ssmen' for current ser�''c?S renOered Tne [narge_ wll'' of ?RS�:S'SBG as prescribes by ..- ._ r. CtIC riy .a rInc; �.•. c-•.I .t &nC r,;.c,- c- an CCS'.5 In UrrBC C 'rie mums La�' 7C s 72rCeE lceG w le iDto ny -.ant .,l_ ' LimCtpant} sna' n ..•r'i'te" as t0;;revert o• a✓ale am•nu'sanCe•O' '?Laltn na arg Cd ♦ L ;a. r ...•, 'c +h date o' notice ire , .e ewe-)- •ne C'wne'_a,,)es no' ;.a. _ r IN the o cane within thirty :30 oa�l_ fl Dm e o' ar) -is wnicr 5na.l bE ua c nln 1� ttr'30 Days. the owne sc:e salty ac•ees nai alt of the costs anG charges may be placeo on the ta} roil as c s;ie a a - r coliectec a�provided by law e .ne ar =n,ern o`a nuaance,ant t.. lax s'�a ., P 3 The ,:caner ex ✓t as provided by s 146.20:301 ld±, Stats,_ agrees to contract with a person who is licensed under Ch. NR 113.Wis Adrr. C nk serviced and to file- a copy of the contractor the owner's registration with the municipality and with the county Tne ,w U w� the holding :a contract with the municipality and the county wtlnir a ,� r r copy of a new service P Y . service .....t act o a r iiie a copy of any changes to the se P. iu � e. _ , ten r10! business days from the date of ct,anae to the service contract Tne owner agrees to contract with a person licensed under Ch. NR 113,Wis. Aom. Code who shall submit to the mun c �ality and to the count, a repot, in accord with s. ILHR 83.16 (4) (a) 2-. Wls. Adm. Code for the servicing on a semiannual basis in the rase of registratior• ur Ger ,,4E 2r, ,3, id Stats the owner steall submit tree repot:tc the municipality and:ne county - O❑O Irtva'E sBwaUe 5}Sic rc ovmai uni rC pC'slble for in efieCi only until the tOCa pe .. oc � ` o- W!S AcnT i oDe. t a- d.1!G Tiinj,.o'a, sewe,O" a ;G a ,J'[ 2,1 r .'.a _ ,I ✓.• _-T. c DE - a T el,eo by execullnc- ant; a tE�c !S-FnCr of the Certification To be delermirle.d D� ele'e 1G tie prJilerty. 6. This agreement shall be binding upon the owner,the heirs of the owner and assignees of the owne-. Tne owner shall submit the aD-eeme-;to the r2aaier of Beds and the agreement shall be regorged by the register of deeds in a marine,w'rilcn wile permit the existence of tne. agree,`en: to be determined by reference to the property where the holding tank is installed. —---- — Owner( Sig nature(s) Gwner(s)harne(s)(Print) '� _ Subscribed and sworn to before me on this ;a1E � r -- _. ottl to `>ICj`.aiUiQ� t L P•.,n. ;.ai Oth.-.,e Neirne,Punt! i My commissicm expires , -2 = - ' f ir.. �,qc �',..♦�) - C,_ C .. c._ s ' ., .. .. . .+) ... _ r gnu'rig^•an r+Pinll Or" ,fdG O1 c; mpinry -r - DEPARTMENT OF INDU6TRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 SB,14-,NW 4,S29,T28N-R16w [AXONVENTIONAL ❑ALTERNATIVE IState Plan l.D.Number, (lf ass�gneAl Town a6 Eau GaUe ❑Holding Tank ❑ In-Ground Pressure ❑Mound 2 2 2th. S meet NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSPECTION DATE: Geat e A. Lax6on Route 1, Baldwin, W1 54002 1 1`,`3a 16 —M BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.ELEV.: CST REF.PT.ELEV Name of Plumbe.. MPIMPR SW No.. County Sanitary Permit Number Jae Stang G646 St. cuix 112842 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED- ❑YES ONO ❑YES ❑NO BEDDING VENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING JVENTTOFRE SH ALARM FEET FROM LINE: AIR INLET. DYES LINO L]YES C�NO I NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIOUIDCAPACITV PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED- PROVIDED: OYES ❑NO ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING I 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 LFNGTH DIAMETER [MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF D SPACING COVER JINIIDE DIA -PITS LIQUID iF{FNCI{ES MATERIAL' PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH UI$7H PIPE DISTR PIPE DISTR.PIPE MATERIAL: NO DISTR. NUMBER OF PROPERTY WELL BUILDWG VENT TO FRESH BELOW PIPES ABOVE COVER FI F V INLF I ELEV END PIPES FEET FROM LINE AIR INLET. NEAREST-� MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE JPIIIMANINI MAHKER$ OBSERVATION WELLS ❑YES IONO ❑YES ❑NO DEPTH OVER TRENCH BED DEPTH OVER TRENCH.RFD DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES ❑YES ❑NO EYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATERAL SPACING JGII DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL-. NO DI STR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEVATION AND ELEV. ELEV DIA ELEV. PIPES DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS 1:1 YES ONO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINE' ❑YES 1:1 NO DYES El NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE DILHR SBD 6710(R.01/82) Zon 'ng Admc.vi6 IThis space reserved for recording cialin. HOLDING TANK AGREEMENT REGISTERS OFFICE 4 ee rne nf.Date This aoreerrient is made between the C v or Local Governmental Unit Holding Tank( )Own r(s Reed for Record OCT 111988 Of 12:10 P M Alfuniotpality below) We j�_knowledge that application is being made for the installation of(a) holding rp ,arik(s on the following perty, (Provide legal land description:) Return To or that continued use of the existing premises ,oqu)eu that a holding tank be \ns�Uou on me property for the purpose � proper containment m sewage. Also, the property cannot now be served by u municipal sewer, or any other type of private sewage system as permitted under Ch. |LHR83.Wis.Adm.Code,o,Ch. 145.Stats. ooissunasunn for Avun inducement to the County,d wo agree»u the following: 1. Owner agrees m conform m all applicable requirements of Ch. |LHR83'xo f~dm Code relating m holding tanks. x the owner fails m have the holding tank properly serviced in response m orders issued by the municipality~prevent nr abate o nuisance a described inss. 146.13 and cause � �� me���m�u a� charge the »w»m' � 146.14 S,�o. the municipality nnoy *»«n' »P»» the PmP*�y and service the tank or nov The charges will be assessed an prescribed by piamng me charges opmptax oi|' as aaper/a| assessment for current services ,00uv n*d s �-66C Sists z owner agrees to pav ali&iarges and costs incurred by the municipality for inspection,purnping nauling or otherwise servicing and maintaining the 'io'"/"y tank mauctia manner uomp,ovemo,uboeany nuisance v, hea/m hazard caused oymexominommx The mun.opaxry shah nmny the owner m any comswhich onaUbep aid oymoowne, wnmn,m�Y (3O) days oomthe date Wnotice mmoevemme owner�oeenmpay me costs within thirty (3U) days.the owner specifically agrees that all of the costs and charges n"ay be placed on the tax ,ox as a spec/a/ onsens ment for the abatement of a nuisance,and the tax shai': oe toliected as provided by law. �� m �with rnnnwho io licensed under Ch NR 113,wm Adm.Cnoo,c 3 Th*owne,.excopuonpmvidedbys� �48�2O<30)<d}'Eu��`ag'*�s�»c» 'uc .w uP��iun*n»�»nmuniuipa|i�yanUwh��»—cou.�y T'n »�»«' have the xnmingumxserviced and m«�u copy mm*c»»�ac »rm»ow»»'smoc«'anoiu000n�ao with the within m�xor agrees»omeu copy m any changes m the service oont,ac o,u copy mu new snry ^ ~.., .,_ ._, ten(1o) business days from the date m change*o the service contract. | 4 The owner agrees to contract with o person licensed under Ch.NR113.VVis.Adm.Code who nhaxsubmit»o the municipuhryand to the county a � � report in accord with a. \LHR 83.18 (4) (u) 2, Wis. Adm. Code for the servicing on a semiannual basis. In the 000e of ,eg.at,unnn uoon, � s. 146.20(3) (d}. Stalls.,the owner shall submit the report to the municipality and the county. � 5 This ao,e*mem will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that | � the property .sso,vodbvenxora �uni�.pa|o�wororasoi| a�sorphonsystem�a�mmpooswhnC»,�Hnna.'wo. AumeCnuo "aoo.om� ,ms � ag,nomo^'nnaybocanceUvdbyoxecuunyuno ,ecord.ngxaidcemn��mnwuh ,,�enencnno,nmuoee".e". " ="^" ,. ,.= which, _,. p`.,., � the existence of the certification to be determined by reference to the property. � O 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 m the agreement � »oue determined uy reference m the property where the holding tank/sinstalled. Owner(s)Name(s)(Print)� --� |v*"°, � Li C,0 � C; \ � ' . /m (Print) /Municipal~''— —" Municipa My commission expires: SBD-6123(R,10/85) This instrument was drafted by the State of/ -- � n ommIndustry,Labor an«Human Relations,Bureau of Plumbing | HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the to-a - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Holding Tank Owner(s)Name(s) and Pumper's Name We acknowledge the installation of(a) holding tank(s)on the following property: (Provide legal description:) - - - yy - -�- - -- - - - - - 1� - - - - - - - - - - - - - - - - - 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 J t C '2 " " Y' 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s)as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18(4) (b),Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract. the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten(10) business days from the date of change to this service contract. Owner(s)Name(s)(Print) Owner's Signature(s) 6C 0 J Subscribed and sworn to before me on this date: Pumper's Name(Print) Pumper's Signature p 9 /Notary Public M `com fission expires: j MTO)M / Pumper's Registration Number SBD-7574(N.11/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. cn H a r ST C - 105 a . H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z t7 a / H OWNER/BUYER ROUTE/BOX NUMBER 136 -S Fire Number CITY/STATE j�4 ��4 wl 5 ZIP �:-ge62 PROPERTY LOCATION : 5t 14, N - t-1 Section acl , T QS�- N , R W, Town of z__1 4, L-<< � , St . Croix County , Subdivision , Lot numberN,,"l- Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix . County residents m_ y 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 . H 0 • E z I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- �v ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Office within 30 days of the three year expiration date . SIGNED DATE c 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 . f 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 G ec � e �. L 4 rzs "L - J Location of Property SC 1% h;, Section j , T N-R l to W Township Z l� ��l dt Mailing Address %C , Address of Site Subdivision Name (� . Lot Number Previous Owner of Property Cl/L�c 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 [ =_ and Page Number Ce L 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) ee ti,6y that att htatements on thin tponm an.e t.ue to the best 06 my (oun) hnowtedg e; that 1 (we) am (ahe) the owner(s 1 06 the pnopen ty des cA i.bed in .th,ia .in6o,tmati.on 6onm, by vii tue 06 a waAAawty deed a Aded in the 066.iee o6 the County Reg.iAtex o6 Deus as Voeument No. 0 S 0 ; and that I (we) pnesentty own a proposed .bite bon the sewage dj,6pozat bys em (on I (we) have obtained an eaaement, to nun with the above de cAibed pnopenty, bon the cona.tAuction o6 6ai.d aya.tem, and the dame has been duty neeonded in the 066.iee o6 the County Reg.ia.ten o6 Deed&, eA Document No. ) , SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SI D DATE SIGNED • ....lain...............:....._ tt99' »-- ..:..,-• ----------------------------- ---------------------- -----......... . ........ ............. .................................... +� . . like Said Grantor,.for a wake s MMlieatiea_.._._ # i Ba�1.a11 y Is,fieaatBe tiw tailswillFdeBeeiks/nal eatab is ' ..Mw* Be WlBmnwa: . xrt r - i mss;. NMt (s 1/2) of the Northwest Quarter Tae llaiwi ill 00 009th one-half (N 1/2) of the Northeest Quarter''Zvi' iogt�MSt Quarter (SE 1/4)s the East one-half (E 1/2) of the r (M 1/00 escept the hest 18 rods of the East 49 rods of, tM ,ids thereof; and a one-third interest (undivided) in tha wait ° 2) of the Northeast Quarter (NE 1/4) all in section 29. F � taage 15 Mast. is given in satisfaction of that certain Land Contralct5 July le 1977 and recorded January 9, 1978 in Volume 557 page 546,'- i , ` Oeeiwat 345M between the above named Grantor and Grantee. ' 111• {ri { r" This AS..}At,............ hsmsatsad property. . wifi aU "d siBaular the hereditameate and appurtenances thereunto belonging; � Aed.........se9AAtor � -- . !. '`f° 1lrarlB�ii1 tliit t11s title is a•ed. indefil�k in tae simple and free and clear of eneum►rance e3oept we was Bad defend the same. Se tesber day of _. ...................... • lt.......'.. halal this 9th..... . y P ---• 85 Z ......... . ... .... (SEAL) ) r:,' Alvera Lars n to # Y ' .... ..................................... .... ,F ..... ...... .............. ............ . ....(SEAL) t k t ....................... .... .................... -•._-. • _. .. -.. ....-. ....... ...... ......... ,y Y t AQTBI<NTICATION ACKNOWL111DOMBUT �+ (4 ............41X4.1r.0---TA0.r ................ STATE OF WISCONSIN F ...... .......................•. ML fr . of.... !lp.t.e®ber- 19-05 Personally came before me this ......... .. ........... ...I..... .............................................. ........................................... 19........ the ................ e G....Nalt�r w.....,�: ..- 'rl'lLi:-PEER STATE EAR OF WISCONSIN -. (� .......... ---- ...................... ed hy ; ?Od.Oa.Wis. Slats.) -• -- - - ----------- -,M _ to me known to be the perms .. wba satyr forarming instrument Bad , # m r 1"*1 tIMt11T WAS CRAR[D BY { Jtttorne ,ask Lav .. s�a1w4i�esi er , Beth Nvlar .....ianeat. #Mi' 1* 1ipw nr"ftw NI... 4 NlpMagww. k �f ` Wisoonsin Department of Health end Social Services. l,b. X67 370 Division of Health SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. OWNER OF PROPERTY Name Address (Street, City, Zip Cods) �� •.i �JZ�_ -.ti<,,.„/ A�:f%�l7:ate . -� ::�.� .�J -�:�{''�' .1--- C?ia, B. LOCATION OF PROPERTY WF:r:RE SYSTEM WILL BE CONSTRUCTED ALTERED :)R EXTENDED COUNTY +� ��f�-r_ i r Check Ones JJ —AIW CITY VILLAGE LEGAL DESCRIPTION G //_ {'fir ' //_ TOWNSHIP C. IS LOCAL PERNLIT REQUIRED FOR THIS WORK? T YES NO PERMIT NUMBER D. SEPTIC TANK CAPACITY ^: Gallons NEW INSTALLATION /T• REPLACEMENT ADDITION MATERIALS: Prefab Concrete ^ Poured' in Place _ Steel Other NUMBER OF TANKS ?0 BE INSTALLED: E. TYPE OF OCCUPANCY Cheak One: One or Two Family Residence Commercial Industrial Other Specify Number of Persons to be Accommodated _ Number of-Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES t NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES X NO Other (Specify) G. MASTER PLUnER MAKING INSTALLATION '.'. License Number: Name Address= i. t+ HP Signature of Applicant: ti.,tir� -' ��' J Address: H. (To be Completed by Issuing Agent) Date of Application Al/ J ! Fee Paid - Permit Issued ,(date) r/ l 17 /� Permit")(umber I/l' 6 Agent (Name) '�l /�i,• rt_ �yj I 7 ;; /J For: y Town, Village, City,'County, stc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tanx and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED /O— '-_0 ACCEPTED BY RETURNED / (Initials) D (Date) Sea Cures. FEE RECEIVED Y VALID. No. 0 -7-7 a PERMIT 90. es or No REVIEWED BY APPROVED DATE (Initials) Yes or No COMPLETE OTHER SIDE or SEPTIC TANK PERMIT N0, R Z P 0 R T ON SOIL PS RC0LATI0N TZST AND S 0 1 L BORINGS TO DIVISION OF HEALTH - PLUMBING SSCTI6N P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Administrative Code P E R C O L A T I O N T Z S T Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches utes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to I Last To Fall lst Wetted Overnight in Minutes Last Period Last Period Period One Inch Example P - 0 361 To Soil 10" Clay 261* 25 Yes or No 30 112 1A 112 60 RECORD DATA FROM MINIMUM OF 3 TEST HOLES I Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 I-L B 0 R I N G S - Minimum 3611 Below Pro osed Absorption System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed Estimated Observedl Estimated Character of Soil with Thickness in Inches Example B — 0 72 72" / Black Top Soil 12l' Clay 18111 Sand 18" Gravel 2410 RECORD DATA FROM MINLMLIM OF 3 BORE HOLES TYPE OF OCCUPANCYt RESIDENCE# Number of Bedrooms ' OTHER: (Specify) Number of Persons FOOD WASTE GRLYDERt Yes No Dishwashers Yes No ``, Automatic Clothes Washers Yes k -No EFFLUENT DISPOSAL SYSTEM: NEW A EXTENSION ADDITION REPLACL4 T Tile Size �_ No.Lin.Fset�Qg. Trench Width 7! Depth G c� Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pit# Inside Diameter � �Liquid Depth ," Is the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H'62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME std r F 5 (Type or Print) REGISTRATION NO. Q 'l `J or MASTER PLUMBER LICENSE NO. ADDRESS DATE $IGNA'NAZ EAU GALLE T . 28 N:- R. 16 W SEE PAGE 33 ✓°ode- \ i[s �'¢/h . 5c.- 0�,� � �h ode s� � �� Hey/nd 0 n Dona/d �.�1.y �-'� • B 4o Gosse a'9'e vahn si C hit a � •�. 39s �Tenf%nE F a 4/c3 • am Q V 0 0 v ����eo Si°ne u Pe sow T/�e es Flnde 17 • ° P• � •/o �° �Q /79 s Lee � / >• • �.y 6'2 �k� M v n�• 'uQ •�e;. 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JORG£N S£N'S MADSON SKELL GAS LUMBER CO. Jacobson 's Skelly BULK & BOTTLE GAS BUYERS OF LOGS, COMPLETE SERVICE STATION, TIMBER & TOWING AND ROAD SERVICE New Richmond TIMBER LANDS & Baldwin SPRING VALLEY, WI`. 698-2438 WOODVILLE, Phone: 246-4633 TELEPHONE: NITS - 698-2630 WIS. 54028 after hours 246-5134 778-5533