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HomeMy WebLinkAbout026-1001-20-000 O N O � ti C H O N O ti h d O Z C LL 3 v a y CO Z C Z d N ° ce) a m z e (9 O Z u � r N H r �^ r C co • C O m z z N y v n m c � E C 0 _ L w d) a c a E t000 • � aaa FL w o w 9 0 0 N � N T O � o O (3) H v o a FO- U N co m c d w p '7 O a O> ~ (6 M U j OV •� � O O Cl) O Cd r 4) a U a r A 8 (ML m o S) (.) N 0 Oa N O 0 � w N ts Y h C ti +� N � O � 0 v c° rn 00 N 0 Cc G O O O Z o N C Ol Co O C(CJ '6 y N 'O X C Q W O � U .LO a) w L 00 Z O Cl) � W N r e � Q Z > 2.2 r F- Z N U N C N�O 7 C z O.O O O Z ULL U r l y 0 >, m E N N N C_ 4-) C O >L .O 0 N jE co rf O C C (n N y 0 0` 0 0 00 O ~ N zz � N C � O co � L N E O E a 'm CL U) °'rr a a ) o N ft (n J V e- p .O U) 00 00 00 CO 00 co 00 00 O) O) O O) O) O) O O O O O O O O O O O p 0 0 0 0 0 0 0 0 0 0 0 0 C) 0 a" 0 � C) O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Q N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N .-• O -p j co to M Lo M m O M N O N N M Lo n 0 n O O (O O M CO N ;;- �7 a M N N N M M N M fM ` CV M r N N N M M ^ Z' O M I O O N r N LO (O N M CO O N 00 Q A (D 0 1� �+ O O 0 O C O O j 0 0 00 R "t "r 0 O m ~ N m O U d o 0 0 0 o O o 0 0 0 0 0 0 o O o 0 0 0 0 0 0 0 0 0 0 0 O O O O V N to N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N Q o 06 C C C N C O (� M Q4 M M M O S a V' N O N N Q Q f- 0 I-- Oo M (O M M 00 N 4.i O r O y N M M N M M \ N N N N M uy h 0 (� (p L `y C C = y ao N (C O> N r" M I� 00 O N 00 O N CO r r O o h Z w 0 0 cn O C� S � v CO � +O•' ik Q .:w 7 •V a y , �1 A ciao M Q M ti N d 4 � I h N O u I C � I I I I I I I , I � z 0 FM- z I O z a v I O N ' y 7 06 N 11N� E CL o N O U) -i � N N N N_ N M N 0 0 0 0 0 0 N N N N N N N M O 4 N co N N � O C O co,0 o U C NO MF- 000000 000 O - Q N N N N O co O M N N N M r E v c0 aO 01 f� FBI M U O O d' CL � I 3 � a rw y c r A C) (L 1-- 0 ( l 040( ' { Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar PermitNo.: Personal information you provice may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. 74919 Permit Holder's Name: ❑ City ❑ Village Town of: tate Plan ID No.: Rivard, Price I ❑Richmond Township ' : itt3E1CST BM Elev.:- , Insp.BM Elev.: BM Des ription: . CrEANS arcel Tax No.: 0 l a 6 4 6 026-1001-20-000 TANK INFORMATION LEVATION DATA TYPE MANUFACTURER C PACITY STATION BS HI FS ELEV. Septic 'e 544C1 IMO Benchmark 'F' 6 I aa, a BotFiiirei Alt. BM ASetZdiell Bldg.Sewer _ —, C ,-J Holding (L,- 2_col) St/Ht Inlet `_ _— - ) TANK SETBACK INFORMATION St/Ht Outlet V,(Z_ %-7-`f ' TANK TO P/L WELL BLDG. Aelntake ROAD ii14 7'(�o �(p,� 0r Septic 3 ,i;,/ 7 NA - (Bottom — Dosing - — — NA Header/Man. N Aeration NA Dist. Pipe Holding f >y.lj' II ' 7 lc' Bot.System PUMP/SIPHON INFORMATION — Final Grade Man acturer Demand St cover Model Num GPM TDH Lift Frictio _ System TDH Ft Loss �fea F emain Length Dia. Dist.To SOIL ABSORPTION SYSTEM BED Width Length No.Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth DIMENSIONS —"�� DIMENSIONS SYSTEM TO P-/L BLDG -WELL LAKE/STREAM LEACHING Manufacturer: SETBACK -- CHAMBER INFORMATION Type Of Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold ibution Pipe(s) ole Size I x ]7I" le Spacing I Vent To Air Intake Length Dia. L ngth Dia- Spacing > t r 7 SO L COVER x ressure Syst ms 0 ly xx M nd Or t-Grade Sy ems Only Depth Over De th Over xx D pth Of xx S eded/Sodded xx Mulched Bed/Trench Center Bed Trench E ges T soil Yes ❑ No ❑ Yes ❑ No COI MENTS: (Include code disc ncies, persons pr nt,etc.) Inspection#1: O /u/ Inspection#2: / / Location: 1419 County Road K,New Richmond, WI 54017 (NW 1/4 NW 1/4 1 T3ON R18W)- 0130186B 1.) Alt BM Description= A//4 2.) Bldg sewer length= ��7) v yt5 a - -amount of cover= 3) S:T cesue7weisUAA,Ce up -f . A62-- c&- Plan revision required? ❑ Yes r. Noc )4,41).0_, 3- I 5 214 Use other side for additional information. 08 Z WcU.1Aist SBD-6710(R.3/97) Date Inspector's Signature Cert.No. X Ih Sanitary Permit Application Safety&Buildings Division In accord with Comm 83.21,Wis.Adm. Code 201 W.Washington Ave. 'Wisconsin See reverse side for instructions for completing this application PO 7302 Box Madison,WI Box 7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law,s.15.04(I)(m)] Sa,� N-A- state owned.) Attach complete plans(to the county copy only)for the system,on paper not less than 8-1/2 x 11 inches in size. County State C�/x an Per mit Number 0 Check revision to previous application State Plan I.D.Number [7( y -TV 4,s ii = Ili' 385 I.Application Information-Please Print all Inform tion iA Location: ,, Property Location Property er Name C,'L�✓L/ •t`S (t+' _ 1/4, /4,S / T�4'1,N,X(6(Q 1 ) `"G V.,. LQt Number Block Number Property Owner's Mailing Address /1/�%V / /7 (:'',AL//f-- 1.04 City,State Zip Code %Aral . Subdivision Name or CSM Number lyxG�/ ��i/ 7�/ ❑city /IL Type of Building: (check one) 0 Villagey 1 or 2 Family Dwelling-No.of Bedrooms: 5Towg of/' Stat -Owned Public/Commercial(describe use):_ ��i a, C9/2�` 0 State-Owned Nearest RoadD ��� Parcel Tax umber(s)0 //,p0% III.T pe of Permit: (Check only one box on line A. Check box on line B if applicable) I'30 ❑Addition to A) 1. 0 New 2. )'Replacement 3. 0 Replacement of 4. . 5. System System Tank Only Existing System B) Permit Number Date Issued 0 A Sanitary Permit was previously issued IV.Type of POWT System:(Check all that apply) ❑Non-pressurized In-ground 0 1/41,.1 1 0 Sand Filter 0 Constructed Wetland ❑Pressurized In-ground 10 olding Tank 0 Single Pass 0 Drip Line ❑At-grade • Aerobic Treatment Unit 0 Recirculating 0 Other: V.Dispersal/Treatment Area Information: nal ' 1.Design Flow(gpd) 2.Dispersal Area 3.Dispersal Area 4.Soil Application • 5.Percolation Rate 6.System Elevation 7.Finaon Grade Required Proposed Rate(GalsJday/sq.ft.) (Min/inch) VII.Tank Capacity in Total #of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks %��l use r' A ❑ ❑ ❑ ❑ _ ,„ e.,47/.77, ../ fre,e9 / V II.Respon ' ility Statement I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Business Phone Number PI is Name(print) Plumber's • cure(no stamps): MP/MPRS No. P ber's Address(Street,City,State,Zip Code) .6 / --`—e. `i/A2 2 Pew ' 4' --4 Z' IX.County/Department Use Only 0 Disapproved Issuing Agent Su��Pt Fee(Includes Groundwater Date Issued Fee)14 ent Signature(No stamps) Approved ❑Owner Given Initial Adverse g_Z —'Lpvl� l 4,2„.,_ Determination _..AfA)N______ r X.Co itions of pprovaal/R�eassoonns for DiVsapprpval: II._ ),Cnk — M� c 2 c"`- 6 Se - it( (14tA) Nver-.cam fi► d4; ��,� >l o `er"` o it-to n_U"_a�.r� ��ts.,s n �}-7� ,/ C7.G�D. l ' q• , .1 rv,M,�-�;tW�A2 i� a s C,„,,.w- - catia 4"t�`.t6�—1 � J L s. gam-, . Y 1 Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD#: (608)264-8777 NViSconsin www.commerce.state.wi.us Department of Commerce Tommy G.Thompson,Governor Brenda J.Blanchard,Secretary August 15,2000 CUST ID No.220527 ATTN: POWTS INSPECTOR ZONING OFFICE BYRON BIRD JR ST CROIX COUNTY SPIA 896 68TH AVE 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identificatio ers PLAN APPROVAL EXPIRES: 08/15/2002 Transaction ID N .41438 Site ID No. 197101 SITE: Please refer to both identification numbers, Site ID: 197101, PRICE RIVARD above, in all correspondence with the agency. ST CROIX County,Town of RICHMOND; 1419 CO HWY K,NEW RICHMOND 54017 FOR: vv�►J Description: Holding Tanl 0gpd at.Q,�.o w'�< < i6afl SR '"' 1 Object Type: POWT System Re aced Object ID No.: 756026 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10),Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • Correspondence Notes: This plan action is based upon designer comments on the plan. 1. A meter,with remote reading device,shall be installed by a properly licensed plumber,on the water system,that adequately measures the amount of water used by the structure,excluding hose bibs and wall hydrants,which do not discharge into the sanitary system. 2. Comm 83.33 Abandon the existing failed system as per this section. 3. Comm 83.43(8)(g),Anchor tank as necessary to negate buoyant forces. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address 0‘44 on this letterhead. '• Sincerely, DATE RECEIVED 08/04/2000 C°" 7 FEE REQUIRED$ 60.00P ott FEE RECEIVED $ 60.00 J OF THOMAS E DEVEREAUX,PLUMBING/POWTS REVIEWER BALANCE DUE $ 0.00 0 `c Integrated Services (715)634-3026,7:45 AM-4:45 PM MON. -FRI. TDEVEREAUX@COMMERCE.STATE.WI.US WiSMART code: 7633 cc:PRICE RIVARD • PLOT PLAN PROJECT Price Rivard ADDRESS 1419 Co Rd K New Richmond Wi 54017 NE 1/4 NW 1/4s 1 /T 30 N/R 18 w TOWN Richmond COUNTY ST. CROIX 7 27 00 3 MPRS Byron Bird Jr. 220527 ''' ��� DATE BEDROOM CONVENTIONAL IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK XXX MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 3000gaI LOAD RATE ABSORPTION AREA # of r.hambers lk BENCHMARK V.R.P. bvase of sideing • ASSUME ELEVATION 100' ❑ BOREHOLE 0 WELL *H.R.P. same as Bm SYSTEM ELEVATION to be determind at instalation \ 4 0'."'n V Willow River W 111 25' 0 w R 70' garage 1 30'3 bed house • 74' PL Pi 10 � driveway 25' ! ' ht 30 --, 150' (10)— CoRdK f-A i'.7 A7 A ic,er,/ 0n lly ONO ZaO ,�M EA-1NGS V AN �1t� • O NG�t,GE ZR�sP till`f3e/ • . .. Page ip �maw.af__ - OMB F. 1 G Ew 1. a.> IN.:1- r •p 7 'p gypp- `�v U - .%\k/ . s. L to {{ „ ,pp_ 'a .1 - CC 0 F • Q � � v J [ + TV m C J ,AL C \*()\\ 4.5:.! • fC J ` C •0' \ Iii‘ 1 a>oo V , m C,v. � y ar. "1 CI\ 4\1 rz . d VI , a � .• � R „ ` asi _ , .. c, 4) I-- . 0 N V z a 4 } " O r0 N 44- r y W 4.1 CU a 0 • U. W O c.c. T _.1. i JP 11. 1 , . , i f •••1k • 5.,,F,,, . . ,k �- G g. v • \) g0 V V 1-4 ,� 1 . ? 0 ' \\4 ••••, % \*\•1 a U+ I O U IY <t 7• •• Id . 1 El v, . , .,i l rn �' °0ca ', ab -(------ . _ ... . . . av c. src E 8. m ?• Ew I -c cxoab .� ., o. c p, v+t a Wisconsin Department of Industry, HOLDING TANK AGREEMENT Safety and Rut' Labor-and Human Relations Bureau of Rui',''ngt • Document fJ 'Plan Identification No. This space reserved fa- - . This agreement is made between the governmental unit and holding tank Aprnr.-,r,n• � owner(s) ot,n• ernmental Unit j!ioldrnc Tank Owner(s) -tto Ica fled Mun,r ality below) We acknowledge that application is being made for the installation of(a) holding tank(s) on the following property: (Provide legal land description) — I —L + c r : __� 5 W v c r tj # fir II; , � Return To or that continuer!use of the existing premises requires that a holding tank be installed on the property for the purpose of prop.. Also,the property cannot now be served by a municipal sewer,or any other type of private sewage system as permitted und-- Code,or Ch. 145,Stats. • As an inducement to the County of 5' • C ro t x to issue a sanitary permit for the above described property,we a,n Owner aprers to conform to all applicable requirements of Ch. ILHR 83,Wis.Adm. Code relating to holding tanks If t` holdinn tar k properly serviced in response to orders issued t'v the municipality to prevent or abate a human health hazard' Stats . "-e municipality may enter upon the property and se'v,ce the tank or cause to have the tank to be serviced and cha `,, • r�„•• •�,e tar hill as a special assessment for current .arvices rendered. The charges will he assessed as precc,,hod b. ass, :atrsuant to s fr.), 19(10),Wis.Adm. ode,to have installed in a new building or new stru re a State. The water meter shall be installed by a plumber authorized by the State to conduct such inst allatin oState regulations and manufacturers specifications. The owner agrees to be financially responsible for p'.r • . aintt: and repair of the water meter,and agrees to allow the municipality to enter the above described property a r^ andror 'nsaa—t the water meter. ? Owner t.-tat to pay all charges and cost incurred by the municipality for inspection,pumping,hauling,or other. ,,,r� ,�.c; •a�, �n such a manner as to prevent or abate any human health hazard caused by the holding tank. The r or , n, :, ch shall he paid by the owner within thirty("?)days from the date of notice. In the event the ow th •he owner specifically agrees that al!the cost' and charges may he placed on the tay roll as a specia �rarr' nod thn tan „linrtnd ;nr,'r ,rid by law to contract with a Demo ha it '^sed under C' e .d and to file the co,ntract r he owner's registration with the municipality. The a n�1`rr service contract ' a ropy of a new ervice contract,with the municipality within ten (1r us��.•" • service contract. S. The owner ::',tees to contract with a person licensed under C .NR 113,Wis.Adm.Code,who shall submit to the mu- report in accordance with s.ILHR 83.18 (4)(a)2.,Wis.Adm.Code,for the servicing of the holding tank. In the case c`reglst (d),Star, ' e owner shall submit the report to the municipality. The municipality may enter upon the property to 'nvest'' holdinc. • ,.' when pumping reports and meter readings may Indicate that the holding tank is not being properly ma tarn, 6 Th s an- will remain in effect only until the local gove-nmental unit responsible for the regulation of privatr s prune" ,ved by either a municipal sewer nr a soil a 'nrption system that complies will Ch. ILHR 83, W' afire,-. . .'v he cancelled by executing and recording sa ' certification with reference to this• agreement in t ' rr,s•:. rt�firat!on to he de';nr-;nud by reference' 'he property- 7 This act' -,t shall he binding upon the owner,the heirs o' 'he owner,and assignees of the owner. The owner s'"il su1 rea!stc •r.hc,and the agreement shall he recorded by the, register of deeds in a manner which will permit the evisten ' dot eterence to the property where the holding tank is installed. Owner's, -ant NtltrizechOwarr(s)Signature(s) r/ G 4- / t Subscribed an.' _. // ;!gnat,. (___ ��l/�Y CC� v cem ,ss!c • t ,,nicmn :e mt C t e it! ,,, ro,,y ba .r.r n -nont ^cy programs iPrivary i aw, . 0 -}I- S e .. Byron Bird Jr. Plumb! Inc. .ti User MOO 4-Owner= firI c- f r e VC( Locationflf 1/4 /1/V1/4 S / T C i 'R, /4 w Township L.ot — ,Subd name or CSM County 5 The owner is responsible for operation Ad maintenance of the system, locking device, alarm, and must maintain an accessaccessfoiti. The county Is responsible for inspection of the site before, during, and after constr ion. The holding tank must be serviced by a licensed pumper. An alarm system le in ailed to activate when the tank Is 90%full. At the time of the servicing, the service provider files a report with the department or designated agent. A remote reading Waitir meter must be Installed on the water supply of the facility that discharges Into the Wiling tank. Phone Number Installer a IL.fr, .No. 7/ Sl?L4. Pumper No. ?/4�6 5(?61' Health Authoriy"" � e Contingency Plan: • If the tank were to fail, the owner shall hive the tank pumped and properly abandoned by license provider. The tank than must be replaced by a licensed Master Plumber or Restricted Master Plumber: Wisconsin Department of Commerce SOIL EVALUATION REPORT Page_ of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County 5/ /�,,,� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must '� include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. r / percent slope,scale or dimensions,north arrow,and location and distance to nearest road. e ,2 / - e 490/a O Please print all information. Reviewed by Date Personal information you provideov may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I Property Owner 7 1-e,J 6_ 2u e.� Property Location / Pr1 G e/ //Gf ,^G Govt.Lot /(- 1/41P1,6A4 SlipT.30 N R E(o Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# /47(iy - City.�, Stat , 5 p Code Phone Number ❑City ❑Village Blow Nearest Road //. &144./ id' � JI Vi��aS/174235r i:�i-raj r7 s i� 1 ��./K�,17 ❑ New Construction Use:[ Residential/Number of bedrooms Code derived design flow rate_ y J E) _GPD 'Replacement ❑ Public or commercial-Describe: 1 Parent material_ Flood Plain elevation if applicable ?I ft. General comments and recommendations: /D/� ,7 / /5 o 1 co r' d7 1 / M 7, Boring# 111 Boring ❑ Pit ,Ground surface elev. ft. Depth to limiting factor _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 Boring# ❑ Boring ❑ Pit Ground surface elev._ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffz in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>30<220 mg/L and TSS� >30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L CST Name se�nnt) iz - 7 �� `SignatureG' i �_ CST Number j l/r ,mac(? r, c79cP-0.) -� Address Date Evaluation Conducted Telephone Number i.�� .' `c- /1%91 a z% J cLco1 7/,2 ���� Soil Test Plot Plan Project Name Price Rivard By Bird Jr. Address 1419 co. rd. K i 411 New Richmond Wi, 54017 TM #220527 Lot Subdivision Date 7/27/00 NE 1/4 NW 1/4 S 1 T 30 N/R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX ,BM or VRP Assume Elevation 100 ft.base of sideing System Elevation to be determind H.R.P. same as BM Willow River 15' 24' 3 bed house 45' g 30' ar 63' well 74' PL a B.M. e et 150' Co Rd K E s_ Page Of a E E L E a V c0 w r 4- d' 0 I -..•-y I r Id S- L-\\,4-1 c- c�• CD -' o (1) N h -CN a U a W ° C ` S b ro ro - V ro _Cc6 c ` a Q3dMN o Vr^\ m� ` J \ a m "r a ro �J -17 •r J C U' 1 U U 01 c O C p) J •r C w C S - \ ‘� S- ) CI] 0).N v 1 M` Cl+-I E �� 4- •r \ \ \ �� Q 3 E O N i v •r - .• •• •• �0 S �, X .. 9 L s •'- w S_ a a a V) 1 Z �— - S- •` 7 E >> O •• C) CV '� a) +- 1— O >— 1- r V) N U Z Q U O RS V) 4- r U O O w - I--I c7 4- 7 a) +- m cn U� V - ¢ 3 C C ( 0 3 LU aw. v1 ja2) 1-+ Z i 1- L N OV)1 10 I ��.. c 7cU 'b c__) ]G C' ma w Z Q Z JZ 0 S-.> a) -'} V) {- Q Z UQ :ca. •rl~ + I co z ' 1 II C) I 1 J kl 1 t. 1 = 1 I , 1 (1 , 4 • t\ , . 1 4> S_ u 4- X \.(CS V)O m U ` o. c c E b0 V 1 L +° ) U i • ,a 'G U A) i > /-I \k '. .V Ni 4-) a d U C co +4 U �+ Z L. Z a S- Z / N N � •r •• CC ID CL 1�t - to -C w +) M a ro g) 1 S- a r to •1-) CD MS C •• > U r a s- ro C C C a a 0 C -a O) 31: O r U i-I S- +•) C a 0 0 J •c •r -) n- C L C) Q JF-- U Q. V) JC) aC) a MI a 3 V) • HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owner(s)Name(s) and I Pumper's Name We acknowledge the installation of(a) holding tank(s)an on the followinglo property: (Provide legal description:) J1/.A /yGLJ ICE -7�-e L ` / 3d zz/l/ ���` `f �‘f2> P/2 ©626'e C / 7 ' 1. The owner agrees to file a copy of 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 1' - C fo x X 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. • wner(s)Name(s)(Print) Owge s Signature s Le Ni rC� Subscribed and sworn to before me on this date: ION Tholsktk .s.._ :Ad-ka-) Q.-?/ dif-0 Pumper's Name(Print) Pumper's Sign ture Notary Public My corn lion expires: 0 Is. s 25 a O a 7 Pumper's Registration Number V. , SBD-7 74(R.09/88) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify hat I have inspected the septic tank presently serving the -, ,, -s% residence located at: /AWA , 7ri ; , Sec ion . / , N, R /' ' W, Town of . Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: '— � e7c3 Did flow back occur from absorption system? Yes >(. No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete X Steel Other Manufacturer: (If known) : Age of Tank (If known) ,: &,r1--s? n ) (Name) Please print 5 7 (Title)` (License Number) Date Form to be completed by licensed plumber (s. 145. 06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83 , Wis. Adm. Code (except for inspection opening over outlet baffle) . Name `B L� �� V Y Signature nature �� � � e MP/MPRS ' g py /O,& 571637 STATE BAR OF WISCONSIN FORM 2-1982 DOCUMENT NO. _ Gayle D. Jens & single , IA.GISCA7X1 -.CC-04r-V ST F,tr.'d ter R.tctrr� conveys warrants t6 Price S. Rivard, a single perms:, __ JAN 2 3 1998 8:00 044 P.-*ter of Nods THIS SF..CE RESERVED FOR RECORDING DATA NAME ANC RETURN ADDRESS the following described real estate in St. Croix County D State of Wisconsin: - 400 y 1 . a syoul • 026-1001-20-000 PARCEL IDENTIFICATION NUMBER All that part of the NW 1/4 NW 1/4, Sec. 1-T3ON-R18W which lies Nly of the Willow River. TR NSF # i FEE This is homestead property. (is) Meet E 'ep kn to warranties: easements, restrictions and rights-of-way of record, if any. Dated this 1& day of January ,A.D.,1998 (SEAL) 1 0471 P (SEAL) • Gayle D. Jenness (SEAL) (SEAL) -' AUTHENTICATION ACKNOWLEDGMENT Signanue(s)— Gayle D. Jagless State of Wisconsin, ss. County authenticated this day of January , 19_98__ Personally came before me this_ day of ,lit ,the above named • Kristina Oql 1lTLE MEMBER STATE BAR OF WISCONSIN (H not, authorized by§706.06,Wis.Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY 1101 Carmichael Road Phone 54016 St. Croix County Phone::((711 5)386-4680 Fax:(715)386-4686 Zoning Department Fax To: Pam O'Keefe From: Shawna Moe Fax: 386-9281 Date: August 25,2000 Phone: 381-5000 Pages: 2 Re: Septic verification-1419 Cty Rd K CC: ❑ Urgent x For Review 0 Please Comment 0 Please Reply 0 Please Recycle •Comments: f ST. CROIX COUNTY WISCONSIN ZONING OFFICE "`y�li , ,n a x u n u Il u/ '�y�moil,,; ST. CROIX COUNTY GOVERNMENT CENTER ■ P(f. i p, ' l i�i '. 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 Fax (715)386-4686 August 25, 2000 First Federal Attn: Pam O'Keefe 201 S. 2nd Street Hudson, WI 54016 RE: Septic Inspection for Price Rivard located at 1419 County Road K, Richmond Township, St. Croix County, Wisconsin Dear Ms. O'Keefe: A septic inspection of the above referenced property was conducted on 08/22/00. This property is located in the NW 1/4 NW 1/4 of Section 1, T3ON R18W, Richmond Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, Kean Crx-b-kv- Kevin Grabau Zoning staff /sm cc: file