HomeMy WebLinkAbout038-1017-95-100 § K } I
a 77 �
0 0
5 cc
; Qo � o
4 /a0
[
\
[ k
R 4) 00 .
/ .i ]/ƒC
G // C$
} 2 §] f
.
�_ § � « E§
E2
( ) ƒ 8] & �
Cco
L
Lo
/ : E
%
§ j 4)n § 0 a ■
�
B Z :!t
2
E �
Q � �
-� f a .
} k k °
i
a
0° ) k E
06 0.m
; § k 2 -0 k
U) § )
.� c k k §
k E a a a
0 U) 00 co 2 j 2 q % 0
� ' 2
@ G D
�
N M
# 0 2
» § 2 z m �
o ; )
� 2 § % � � ■ 2 � .
§
)
, ■ : 2 §
§ li
o \ ) } 0 z ) / z
� ■ �
a »
E k a §
/ JIL 2J
� ,
i Parcel #: 038-1018-10-000 02/17/2006 10:39 AM
PAGE 1 OF 1
Alt. Parcel#: 3.31.18.64 038-TOWN OF STAR PRAIRIE
Current FX_' 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
RICHARD W WURTINGER O-WURTINGER, RICHARD W
1172 CTY RD H
NEW RICHMOND WI 54017
Districts: SC=School SP=Special Property Address(es): *=Primary
Type Dist# Description * 1172 CTY RD H
SC 3962 NEW RICHMOND
SP 1700 WITC
SP 8055 CEDAR LAKE/N R
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 3 T31 N R1 8W PT GI-5 N OF HWY S OF Block/Condo Bldg:
CEDAR LK W OF LN 808.1 FT W OF CEN GI-6&
E OF LN 883.1 FT W OF C GI-6 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
03-31N-18W
Notes: Parcel History:
Date Doc# Vol/Page Type
05/03/1999 602453 1423/494 WD
07/23/1997 841/564
07/23/1997 738/162
2005 SUMMARY Bill#: Fair Market Value: Assessed with:
118672 214,100
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 82,100 128,300 210,400 NO
Totals for 2005:
General Property 0.000 82,100 128,300 210,400
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 82,100 128,300 210,400
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 134
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS
DIVISION
LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING
P.O.BOX 7969
MADISON,WI 53707
NA -R18W ❑CONVENTIONAL ❑ALTERNATIVE statePlanlD Number
Ilf asstgnedl
Town o6 STUB.. Pna itr i.e V Holding Tank ❑In-Ground Pressure ❑Mound S$$-02381
County Road H
NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Latvt Peabad Raute 2 New Richmond, W1 54017
BENCH MARK(Permanent reference bomt)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.P7.ELEV..
Name of Plumber. MP/MPRSW No County: Sanitary Permit Number
Kim A. O'ConneU 3258 St. Ctoix 112717
SEPTIC TANK/HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV_ WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
❑YES ONO OYES ONO
BEDDING: VENT DIA.. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. (VENT TO FRESH
ALARM FEET FROM LINE-. AIR INLET
EYES ONO DYES ON O NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. JLIOUID CAPACITY JPUNII MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED:
OYES ❑NO ❑YES ONO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TOETRESH
(DIFFERENCE BETWEEN FEET FROM LINE
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM.Check thesoilmoistureatthedepthofplowing LENGTH DIAMETER MATERIAL ANDMARKwG
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:
WIDTH'. LENGTH. NO.OF DISTR.PIPE SPACING COVER INSIDE CIA =PITS LIQUID
BED/TRENCH TRENCHES MATERIjNUMBER PIT DevTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTH PIPF DISTR.PIPE DISTR.PIPE MATERIAL. NO.DIST OF PR OPERTV WELL BUILDING VENT TO FHE5f1
BELOW PIPES ABOVE COVER. EL V.INLE7 ELEV.END'. PIPES EET 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-
meets the criteria for medium sand. TIONS MEASURED.
DYES 1:1 NO
SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WE LLS
❑YES El NO ❑YES ONO
JEPTH OVER TRENCH/BED DEP7H OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES.
❑
❑YES NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING
ELEV.. ELEV.. CIA.. ELEV. PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANSCAL LIFT CORRESPONDS TO APPROVED
❑YES ❑NO ❑YES ❑NO -
COMMENTS: PERMANENT MARKERS: JOBSIRVATION WELLS: NUMBER OF PROPERTY WELL'. BUILDING:
FEET FROM LINE
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SiGNAT URE. TITLE �
Zoning Adrnin iE6 tnatotc �
DILHR SBD 6710(R.01/82) I
"�ILHF� SANITARY PERMIT APPLICATION CO T �U/SC
In accord with ILHR 83.05,Wis.Ad m. Code
SAE SANITARY PERMIT#
—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. S
—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 IfIM
121e4 &4 I)Aj '/ '/4, S T.F , N, R 1,q E (or
PROP R WNER'S MAILING ADDRESS LOT NU BER BLOCK UMBER SUBDIVIS NAME
CI T ,STAT ZIP CODE PHONE NUMBER C Y NEAREST RO ,LA OR LANDMARK
? ❑ VILLAGE
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.t91 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. K 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 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minut s per inch): REQUIRE (Square Feet): PROPO D(Square Feet):
Feet N Private ❑Joint ❑ Public
CAPACITY
VI. TANK in gallons Total ##of Prefab. Site Fiber- Exper.
INFORMATION Manufacturer's Name Con- Steel Plastic
New xistinkg Gallons Tanks Concrete structed glass App.
Tanks Tan s
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
1,the undersigned,assume responsibility for install ion of;he private wage system shown on the attached plans.
Plumb 's Nam (Print): J Plu a Signat �: ps) MP/MPRSW No.: Business Phone Number:
/ - - T
I tuber's AddreYs(Street,City,State,Zip Co ): %.1-1 Name of Designer:
,3 .gip S , � � A)2-
VIII. SOIL TEST 114FORMATION
Certified S it Tester(CST)Name CST#
CST'§ADDRES9(Street,City; tats,Zip Code) Phone Number:
'51� IEA�f ,2_00 S/1 "I", Zta� jj..r _1�k Z (ZL- )22Z,1_,, 5'?L77
IX. COUNTY/DEPARTMENT USE LY
❑ Disapproved I Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No St ps)
Approved ❑ Owner Given Initial S harge Fee
Adverse Determination Ud a 1v
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;
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 81/2 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 'gips—
included the creation of surcharges (fees) for a number cf regulated practices which Wisco. Ert`s
can effect groundwater. The surchargf= took effect on July 1; 1984. All of the water.that Cursed trea. re
is used in your building is returned t,, the groundwater through your soil absorption o
system or the disposal site used by your holding tank purr:per.
a
Ttie ; ponies collected through these surcharges are cred led to the groundwater fund adminis-
tr-reo by the 7_epartment of Natural Resources. These funds are used for monitoring ground- t
if,ater, grour1watE:.�r czmtamination in,.estigations and est'ralishment of standards. Gro,jndwat=�',
i+'s worth protecting.
crap_ 398!R 03/:363)
,LxKy � J
GLI
S88 " 02381 _
11 ul�
i�
i
Sir
ONSITE SEWAGE SYSTEM
APPRU
NPARTME,NTOFIADI1SjAj.LABOR A D N `
SEE
.. � , :+ -
... _ ,.. .
t`
. .
�,
x �.
._ - - _� .:
. .� � ,
,$, - _
.. _.. - 5Y __, 1.,� .{
I
l NOLnING TANK CROSS-SECTION AND SPECIFICATIONS 4
88m 023 d
$ 1
Approved Approved Locking
Vent Cap Weather Proof Manhole Cover
Junction Box
4" C . 1 . 12" Min
Vent Pipe � „
Final Grade� � 4 Min II
717 � I
/Approved Joint `' 18 Min
i
Water Ti'yht
deal Nigh Water
` Alarm Switch��
N. SPECIFICATIONS 1 Approved {
} Joint /...
TANK Mnnuf ac turer : /.Y r C I
f� ' ten'
_._.... Tank Size : 'd6'q --•Gallons R.
`� 3a Onto
`i
ALARM_ Manuf ac.turer:
Model Number : .t
Switch Type
NUMBER OF BEDROOMS:
q
a
OWNER 'S NAME- ---- _ _.� _ ._..
ADRRESS 7 _
LEGAL DISCRIPTIO k, _k,Se .� _,TN ,R
TOWNSHIP/MUNICIPALITY :
COUNTY :_� LiZ
XGE SYSTEM
SIGNED :
_ S
LICENSE 11MISFR :
DATE :
VE
P FjO 710
Ap
U
OEPARTMENMyI 1ON of RY V ARD BU'
SEE��Sp�pEWCE
r
. �1 r
Document No. This space reserved for recording data
HOLDING TANK AGREEMENT
Agreement Data
This agreement is made between the
County or Local G vernmental Unit' I Holding Tank(s)Owner(s)
sT�r PruitiP Two. I Lary �rakoa/
Called Municipality below)I
We acknowledge that application is being made for the installation of(a)holding
tank(s)on the following property,(Provide legal land description:)
S03/T31/R18
PCL# 3,31,18,64
'SEC' 3 _T3Tff_R 8W PT"GL5 N..OF - —- -
___-__-AdY-Z-OF-CEDAR--LK._W..OF.I,N--.
808.1 FT W OF C GL6 Return To
or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of
sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under
Ch. ILHR 83,Wis.Adm.Code,or Ch.145,Slats.
As an inducement to the County of ST. CROIX to issue a sanitary permit for the above described property,
we agree to the following:
1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83,Wis.Adm.Code relating to holding tanks. If the owner fails to have the
holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and
146.14, Slats. the municipality may enter upon the property and service the tank or cause to have the tank serviced and charge the owner by
placing the charges on the tax bill as a special assessment for current services rendered. The chass911 be assessed as prescribed by
s.66.60,Slats. �J 8 - 02381
2. Owner agrees to pay'all charges and costs incurred by the municipality for inspection,pumping,hauling or otherwise servicing and maintaining
the holding tank in such a manner as to prevent or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify
the owner of any costs which shall be paid by the owner within thirty(30)days from the date of notice. In the event the owner does not pay the
costs within thirty(30)days,the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess-
ment for the abatement of a nuisance,and the tax shall be collected as provided by law.
3. The owner,except as provided by s. 146.20(30)(d),Slats.,agrees to contract with a person who is licensed under Ch.NR 113,Wis.Adm.Code to
have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county.The owner
further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within
ten(10)business days from the date of change to the service contract.
4. The owner agrees to contract with a person licensed under Ch.NR 113,Wis.Adm.Code who shall submit to the municipality and to the county a
report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under
s. 146.20(3)(d),Slats.,the owner shall submit the report to the municipality and the county.
5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that
the property is served by either a municipal sewer or a soil absorption system that complies with Ch.ILHR 83,Wis.Adm.Code. In addition,this
agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit
the existence of the certification to be determined by reference to the property.
6. This agreement shall be binding upon the owner,the heirs of the owner and assignees of-the owner. The owner shall submit the agreement to
the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement
to be determined by reference to the property where the holding tank is installed.
Owner(s)Name(s)(Print) I Owner(s)Signature(s)
LARRY PEABODY -- Subscribed and sworn to before me on this date:
.__.. _.
Municipal Official Name(Print) I Municipal Official Signature - - Notary Public
-f— I My commission vxpires:
C 119 17 1 l Z- I 411/1
Municipal Official f itle(Print)
12 ,Z;KZZZa- LZ 61 If
SBD4123(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
Con;racl Dale
This contract is made between the
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Holding Tank Owner(s)Name(s) and I Pumper's Name
� �Nr l�• �ea �o � � �
We acknowledge the installation of(a)holding tank(s)on the following property: (Provide legal description:)
sa 3 i T3l / If 1" 7
PC � � 3J �I� l Fr/ G Y-
S, c(a r
Sec-�3 T 3/ At if
/g uJ GL. s N of NW Y o C rG
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. The owner agrees to file a copy orthis contract with the local governmental unit hereinafter called the "municipality",which has
signed the pumping agreement required in Ch. ILHR 83.18(4) (b),Wis.Adm.Code and
with the County of S 7' G,�- U f S 8 8 ■+ O 2 3 V 1
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 ntimber 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) I Owner's Signalure(s)
LGr�Y wJ°eab0d%r c(J�
Subscribed and sworn to before me on this date:
s � I
Pumper's Name(Print) I mper's Sign re Notary Public
My commission expires: ---
Pumpers 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.
`
' ��=�� �� ��.Wisconsin vv������n []8p8rtm8ntOf Industry, 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 7069
Madison, Wisconsin 53707
KIM D'C0NNELL Owner: LARRY PEABQDY
368 EAST 2ND STREET ROUTE 2
NEW RICHMOND, WI 54017 NEW RICHMOND, WI 54017
RE: Plan Number: Date Approved: July 12, 1988
Gallons Per Day: 450 Date Received: June 27, 1988
Project Name: PEA80DY, LARRY — RESIDENCE Location: NW^SE,3,31, 18W
Town of STAR PRAIRIE County: ST CRDIX
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 in contingent upon compliance with
any stipulations shown an the plans. All items that are noted must be corrected.
All permits required by the city, village, township or ccuxty, ohall 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) 266-0056. �
JOEL. W. BECK
Section of Private Sewage
�
�
�
uzvzwzmn of Safety and Buildings
PPP031/0009n/13
co: LARRY PEABODY
---Private Sewage Consultant ___County SwMP ___Plumbing Consultant
Owner ___Plumber Environmental Health
K neo'6423(n.10/87)
HOLDING TANK SERVICING CONTRACT
Contract Date
/ _ O This contract is made between the
Holding Tank Owner(s)Name(s) and I Pumper's Name
ape F 4' b0 � � 1
I 1 v�
We acknowledge the installation of(a) holding tank(s)on the following property: (Provide legal description:)
03 / T3ll /f ( S
Se c.V3 T 3 N R,/g uJ /°T G L. S Af of N W S o C ru o(a L
_
go 7- - -c - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - -
1. The owner agrees to file a copy o(this contract with the local governmental unit hereinafter called the "municipality", which has
signed the pumping agreement required in Ch. ILHR 83.18(4) (b),Wis. Adm.Code and
with the County of 's �— C J a f
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.
I
Owner(s)Name(s)(Print) 1 Owner's Signature(s)
1_4 ,key °
� Subscribed and sworn to before me on this date:
9 I
!�
. _i t'4c! dr✓��i/iii/.�''.�' I fj..l.[�-C.,C.�C �/�yr�.
Pumper's Name(Print) 1 mper's Sign re Notary Public
My commission expires:
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.
E►OOK ��. �C__PA�E_���
Document No. Thls span rasarvad for recording data
• 4'39803 HOLDING TANK AGREEMENT
Agreement Date
This agreement is made between the REGISTERS OFFICE
County or Local G vernmental Unit I Holding Tanks)Owners), CRQIx CO., W(
-a Y i- 0 d Reed for RPcord
� � � � � �
Called Municipality below I JUL 2 5 i988
We acknowledge that application is being made for the installation of(a) holding of Y:15, P M
tank(s)on the following property, (Provide legal land description:)
S03/T31/R18
PCL# 3,31,18,64 Register of Deeds
SEC T N R1'$W PT GL5 N..OF
__.__.iWY S-OF_ CEDAR-LIB-W. OF-_114_
808.1 FT W OF C GL6 Return To
or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of
sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under
Ch. ILHR 83,Wis.Adm.Code,or Ch.145,Stats.
As an inducement to the County of ST. CROIX to issue a sanitary permit for the above described property,
we agree to the following:
1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83,Wis,Adm.Code relating to holding tanks. If the owner fails to have the
holding tank properly serviced in response to orders issued by the municipality to prevent or abate a nuisance as described in ss. 146.13 and
146.14, 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,Stats.
2. Owner agrees to pay'-all charges and costs incurred by the municipality for inspection,pumping,hauling or otherwise servicing and maintaining
the holding tank in such a manner as to prevent,or abate any nuisance or health hazard caused by the holding tank. The municipality shall notify
the owner of any costs which shall be paid by the owner within thirty(30)days from the date of notice. In the event the owner does not pay the
costs within thirty(30)days, the owner specifically agrees that all of the costs and charges may be placed on the tax roll as a special assess-
ment for the abatement of a nuisance,and the tax shall be collected as provided by law.
3. The owner,except as provided by s. 146.20(30)(d),Slats.,agrees to contract with a person who is licensed under Ch.NR 113,Wis.Adm.Code to
have the holding tank serviced and to file a copy of the contract or the owner's registration with the municipality and with the county.The owner
further agrees to file a copy of any changes to the service contract or a copy of a new service contract with the municipality and the county within
ten(10)business days from the date of change to the service contract.
4. The owner agrees to contract with a person licensed under Ch.NR 113,Wis.Adm.Code who shall submit to the municipality and to the county a
report in accord with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code for the servicing on a semiannual basis. In the case of registration under
s. 146.20(3) (d),Stats.,the owner shall submit the report to the municipality and the county.
5. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that
the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83,Wis.Adm.Code. In addition,this
agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit
the existence of the certification to be determined by reference to the property.
6. This agreement shall be binding upon the owner,the heirs of the owner and assignees of-the owner. The owner shall submit the agreement to
the register of deeds and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement
to be determined by reference to the property where the holding tank is installed.
Owner(s)Name(s)(Print) I Owner(s)Signature(s)
LARRY PEABODY I Subscribed and sworn to before me on this date:
Municipal Official Name(Print) I Municipal Official Signature Notary Public
/ / I My commission sxpires:
Municipal Official Title(Print) I ` /9
SBO-6123(R.10/85) This instrument was drafted by the Stale of Wisconsin Department of Industry.Labor and Human Relations,Bureau of Plumbing.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 7969
HUMAN RELATIONS
(H63.0911)& Chapter 145.045)
LO A I SECTION: TOWNSHIP/M NICIPALITY: OT 0 BLK. .: SUBDIVISION NAME:
I / /13 N/R E (or
COUNTY: OWNER'S BU E •S NAME: AI I A D L L' Zwdeia
USE DATES OBSERVATIONS MADE
NO.BEDRMS.: COM(N DESCRIPTION: New �Raplace A S :
5Q Residence r _
RATING:S-Site suitable for system U-Site unsuitable for system
ONVEN N : MOUND: IN-GROUND -FILL OLDING TANK:RECD E OED SYSTEM:(optional)
as u os ®u os u TEIS ®u s ❑u
If Percolation Tests are NOT require DESI ATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: , (Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH
NUMBER DEPTH Its ELEVATION OBSERVED H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.)
B. ..,1g
B-
B- S
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLIN INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD 3 PER INCH
P-
P- '
P-
P-
P-
P- _
4
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
- I
ISO
_
l
,
...........
. -
'
_
_ +
the soil-tests-reported-on_this.Jorm were made.by_me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME p nt : TESTS WERE COMPLETED ON:
_YIF
ADDRESS. CERTIFICAT N NUMBER: PHONE NUMBER(optional
l:
CST TU
e
I
DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER —
+' I
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 A"
Location of Property _ , Section , T3_?N-R ,)e W
Township SAV
Nailing Address
Address of Site ,¢s- Rd l),<
Subdivision Name
Lot Number
Previous Owner 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 ,L.=' 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 (toe) ceh.U.6y that att statement6 on his onm ace thue to the beh.t o6 my (ouh)
hnautedge; that I (we) am (ace) .the owneAk 1 o6 the phopehty deAc i_bed in -thiA
.in601mation 6oAm, by viAtue o6 a wavcanty deed kecokded in the 06 ice o6 the
Coemty Reg.i�s.teh o6 Deedss a�5 Document No. and that I pne�sentCy
aun the pnopoa¢d d e,t¢ bon .the �5ewage di�spos b yh em (on I (we) have obtained an
CdA t +ent, to hun with the above de c&tbed pnopeh ty, 6oh the eonAtAuc Lion o6 said
dyd.tem, and .the dame hae been duty neconded in the 066.ice 06 the County Reg•id.teA o6
VU4, ae Voement No. ) .
SIGNATURE 0 DOWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
DOCUMENT NO. wmmmw THIS S►AC4 11191119MV60 FOR
1119comine DATA
DUD
STATE BAR OF WISCONSIN FORK 2-1M
411320* • 16. REGISTERS OFF16F
L
Allen C. Bentley...and Lorraine ............ sr. (.1V_,;1X Co., WI&
.... .... ..
..h.usi�an.d...a.nd...w.i..ke Rec'd. fot Record ft 'A th
.......... ............................ ................................. ...... ...................... ....
.... ....................... ........... ........ y of Ap r LI_A D. 19 J6
... .. .................... . ....... ...... ........................................ 1 8:30 A b AL
conveys and warrants to JOAKT-Y-At.-P!4�41D.9cly.................................
. ..... ........ . ...... ... ........ ........ .........................
........................
........... ... . . .. .......... .... ...... .
.... . .
............... ....... ..........
. ........ .. ... .... 7"
...... ........ .................. ................ .. .... ....... ..........
PETt;PN TO
........ ............. ..... . .................... ...
C
the following described real estate in .....St.. ..........roix
...............................County,
State of Wisconsin: Tax Parcel No: ... .....................
Commencing 808. 1 feet West of a line North and South through
center of Government Lot Six (6) , in Section Three (3) ,
Township Thirty-one (31) North, of Range Eighteen (18) West;
thence West along the North line of County Trunk Highway "H" ,
as now traveled, about 75 feet; thence North to Cedar Lake;
thence East along said Cedar Lake to a point directly North
of point of beginning; thence South to beginning, intending
to convey a -3rcel of land between said Highway "H" and
Cedar Lake and 75 feet wide, East and West.
'Y.AN SFJK
This is............... homestead property.
(is) (is not)
t,xception to warranties:
Dated this 29th, ... day of April ig 86
(SEAL)
_01
(SEAL)
. Allen C. Bentle
(SEAL)
SEAL)
• Lorraine H. Bentle
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN
Signature(a) ............... .... ..... ..... ............... ........ �
................................................................................ County. i
authenticated this ........day of-- ----- ..... 19...... Personally came before me this ...29th. ..day of
APr.i 1 , the above named
.. ..................................... ............... ....... ... Allen Q. . �gqtjey an d _LQrrAine ,H-
... Bentley
TITLE: MEMBER STATE BAR OF WISCONSIN ..... ...
(if not. ..... ... . . ..... .. ....
authorized by § 706.06, Wis. Stats.) to me known to be the person-s who executed the
foregoing iQs TVment and ackn w e ge,the same.
THIS INSTRUMENT WAS DRAFTED BY
Reinstra,_Yar..py.k...&__Nqedham,. .S.C.
..............
New Richmond, WI 5401.7 Not:ry Pub
1 lie S /. Croi County. Wis.
..........11 ....... .
re
(Signatures may he authenticated or acknowledged. Both Mv Cnmmi-sinn is per nt•(If not, state expi ti"n
are not neceqsnry.) /3 . 19 9.)
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 L Gc r r v A ea k D
Govern* h•fi'Lof 6
Location of Property k �C, Section 3 , T 3 1 N-R / $^ W
Township �it p �� r /'`e .
Mailing Address --/-0 a X- 2 0 3
N
Address of Site Z
_ ft�•e c.cJ i r L1 o Yc
Subdivision Name
Lot Number
Previous Owner of Property 11-en 4 d'fZ ]L le-
Total
Size of Parcel s �
Date Parcel was Created b/^r'
Are all corners and lot lines identifiable? Yes _ No
Is this property being developed for resale (spec house) ? Yes _�- No
I'I Volume 7:3 r and Page Number s as recorded with the Register of Deeds..
W .
INCLUDE WITH THIS APPLICATION THE FOLLOWING.
A Warranty Deed which includes a Document number, volume and page number, and the
Seel 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
T (fuel coati 6y that aft bta,tementJS on thus ohm ahe thue to the but o6 my (ouh)
hnowtedge; that I (we) am (ahe) the owneA(,5) o6 the pnopeAty deAcAibed in .th,ia
i"40Amation 6onm, by viAtue 06 a waAAan.ty deed kecokded in the 06 ice o6 the
Cocoa Reg -steA o6 Deeds ass Document No. , and that I �We) pne.aentty
avn the pnoposed aite bon the bewage dispo.6 bY6 em fort I (we) have obtained an
eaeement, to nun with the above deg c&ibed phopenty, 6orc the conbtnuction o6 eaid
system, and the dame hae been du,t necoaded in the 066te-e 06 the County Reg.iateA o6
Veedd, a.b Document No. q11 3 Z ) .
j
SIGNATUV4 Oh OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED J