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HomeMy WebLinkAbout040-1170-10-005 � d o 4 0 3 0 o v g v wo ON °om o h 0 0 0 0 N 0 `p>>,�-0 4" N O y N m 0@ co C N C O '0 70 n a 3 0 0 y 2 C wp+ p a N N MO 0- f0 O 1� M C Ca 0� o c a 0 0)'0_ . � U C N N N C'> 0)CL 7C Ma .- 0 C O •N N Z LaEw -- 2 lic m o =a c~ ° ma _ c a ooc 0 ai2 ouav--, � c v -0 E c = a� a °oi6 � f6 a m E Q N 2 0 Ea. wZO m D. N E 0 O N Z -- CO O O d m M F- C7 c C7 I O Z m of y Z v c � I •1VN C t •i a O N = zz N � I E 0 CL ° v� <nm a ? § 000 .N aaa a L LL rn co rn 0 tiV O N to O 0 N N a 0 0 = a O M N (4 CO c d (o f0 N N Q Q a } Cn O oo Z y c o E E _ O O (O O O N .0 C U Q . O O O L O OC +N.+ p C -p N N N 3 C co CD N CS! H M y N a Z = (p f0 •7 Q1 O O N 2 0 0 O N M 0 g O M B �' V O Z N = cd E V� `m m a � •S L: (L • Q- d d c tt`�M�l E c c °+3 0 _1 A u (L 1 0 tU) U Parcel #: 040-1170-10-000 11/03/2010 03:05 PM PAGE 1 OF 1 Alt. Parcel#: 36.28.20.646F 040-TOWN OF TROY Current ❑X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner 0-WOOD,JONATHAN D JONATHAN D WOOD C-WOOD, MARY M BEENKEN MARY M BEENKEN WOOD 3099 NORTH VIEW LN WOODBURY MN 55125 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.250 Plat: N/A-NOT AVAILABLE SEC 36 T28N R20W PT G L 1 BEG 2,103 FT W Block/Condo Bldg: OF SE COR OF G L 1,TH W 25 FT M/O/L TO LAKE,TH NLY 360 FT M/O/L TO CEN LINE OF Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ROCKY GULLY TH SELY ALONG CEN LINE OF 36-28N-20W SAID ROCKY GULLY TO S LINE OF SD G L 1, TH W ALG S LINE OF G L 1 TOPOB Notes: Parcel History: Date Doc# Vol/Page Type 06/20/2008 877174 QC 06/20/2008 877173 TD 07/28/1998 583819 1343/475 QC 07/28/1998 583818 1343/474 WD more 2010 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.200 595,000 94,200 689,200 NO Totals for 2010: General Property 1.200 595,000 94,200 689,200 Woodland 0.000 0 0 Totals for 2009: General Property 1.200 595,000 94,200 689,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 12/13/2005 08:34 AM 1 Parcel #: 040-1170-10-000 PAGE 1 OF 2 Alt. Parcel#: 36.28.20.646F 040-TOWN OF TROY ST.CROIX COUNTY,WISCONSIN Current 'X' 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-STICH, LEAH TR LEAH TR STICH 206 IIWACO RD RIVER FALLS WI 54022 Districts: Sc=School SP=Special Property Address(es): `=Primary Type Dist# Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.250 Plat: N/A-NOT AVAILABLE SEC 36 T28N R20W PT G L 1 BEG 2,103 FT W Block/Condo Bldg: OF SE COR OF G L 1,TH W 25 FT M/O/L TO LAKE,TH NLY 360 FT M/O/L TO CEN LINE OF Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ROCKY GULLY TH SELY ALONG CEN LINE OF 36-28N-20W SAID ROCKY GULLY TO S LINE OF SD G L 1, THWALGS LINE OFGL1 TOPOB Notes: Parcel History: Date Doc# Vol/Page Type 07/28/1998 583819 1343/475 QC 07/28/1998 583818 1343/474 WD 07/23/1997 765/528 07/23/1997 more 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 103351 428,900 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.200 303,600 109,200 412,800 NO Totals for 2005: General Property 1.200 303,600 109,200 412,8000 Woodland 0.000 0 Totals for 2004: General Property 1.200 303,600 109,200 412,8000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: Category Amount User Special Code Special Assessments Special Charges Delinquent Cha 0 00 Total 0.00 0.00 PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model Pump/Siphon Manufactur Pump Size Elevation of in t: Bo m of tank elevation: Pump off switch eleva n: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from n rest prop line: Front, O Side, Rear,, Ft. Number of feet from wt�1 O Number of feet from building: nclude distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of e• Number of feet fro nearest pro line: Front, O Side, O Rear,0 Ft . Number of feet from we Number of feet from building: (Include distances on plot plan) . SEEPAGE PIT Size: Number o its: Diameter: Liquid depth: m of seepage pit elevation: Area Built: Has either drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK t!. A0 c Manufacturer: 5� Capacity: 2',�d FT, Z ,p/N Number of rings used: s..Q-D Elevation of bottom of tank: Elevation of inlet: er-. Number of feet from nearest property line: Front, O Side, O Rear, O Ft J 0 Number of feet from well: Number of feet from building: ZyFrCsKj`a �7OJy� Number of feet from nearest road: �� F7. Alarm Manufacturer: Inspector• HOMESITE SEPTIC PLUMBING CO. ROBERT ULBRICHT Dated• Plumber on job:: VVI AS7ER PLUMBER LIC.N0. 3307 MARS. MINN.INSTALLER&DESIGNER LIC.NO.00663 License Number: V84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ' 7E TOWNSHIP T-Roy SEC.3(�P T 21P N-R 20 W ADDRESS 1PjV_tA- T��lf "�j ST. CROIX COUNTY, WISCONSIN 0 SUBDIVISION r r 6rbdl rr LOT C20(0 LOT SIZE JL Gl/ C D )(?D. ��o� PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Se�S�.v�tL WTP G � 421-1 C CA hiW(Ill INDICATE NORTH ARROW 4 1 opmL BENCHMARK: Describe the vertical reference point used C,4siAU Cr-- Elevation of vertical reference point: 100-0 / Proposed slope at site: SEPTIC T urer: ].d Capacity: Number of rings used: Tan le cover elevation: Tank Islet Elev n: Tank Outlet Elevation: Number feet from nearest Road: Front 10 Side 0 Rear, O feet From nearest property line Front,0 Side 10 Rear,0 feet Number of feet from: well building: (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE STDE 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 S ❑CONVENTIONAL ®ALTERNATIVE Holding Tank ❑ In-Ground Pressure ❑Mound TREF.. ATE: NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: 1)�I. �a/tJee t ye 165 Skyti,ne 9n., Sedona, Ajc i.zona lo'�`� %�� V.: CST REF.PT.E LEV.'. BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN,. NW NW, Section 36,T28N-R20W, Town o6 Tnoy, Lot#1 Sanitary Permit Number: Name of Plumber: MP/MPRSW No.: County: 4743 Robert Utbx ch t 3307 St. Cnoi x SEPTIC TAN /HOLDING TANK: MANUFACTURE.: LIQUID CAPACITY: TANK INLET V/.: TANK/OUT,LE¢T ELEV,'. PRO IDEDLABEL PROVIDED:COVER v,-i, YES ❑NO ❑YES ❑NO NUMBER CIF ROAD: �R RTY WELL:OPE BUILDING: VENT TO FRBEDDING VENT DIA.: VENT MATL: HIGH WATER AIR INLET: LARM. FEET FROM /� INf�O l� �'( DYES ❑NO �\ ❑YES ONO NEAREST. L SS 2 /y DOSING CHAMBER: PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER MANUFACTURER. BEDDING: LIOUID CAPACI TV PUMPMODE L. PROVIDED PROVIDED ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PROPERTY WELL BUILDING (VENT TO FRESH PUMP AND N O PE ATIONA L: NUMBS Fl,EIF LINE. AIR IN LET. GALLONS PER CYCLE: FEET IPF (DIFFERENCE BETWEEN Y ❑NO NEAREST PUMP ON AND OFF) .LENGTH. DIAM ETER MATERIAL AND MA RKING SOIL ABSORPTION SYSTEM.Check the soil moisture at a depth of plo ing FORCE, or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: INSIDE DIA #PITS: LIQUID WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING COVER DEPTH pdt. E� , TRENCHES MATERIAL: PIT iIJiR1lIS .,, Merry OF PROPERTY WELL: BUILDING: AIER NLOET RESH GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: P PEDISTR FEET FROM LINE. BELOW PIPES. ABOVE COVER: ELEV.INLET ELEV.END. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the tex u of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound syste o mak certain that it ON REVERSE SIDE.SHOW ELEVA- meets the crit ria for medi m sand. TIONS MEASURED. El El NO PERMANENT MARKERS OBSERVATION WELLS. SOIL COVER TExruRE: ❑YES El NO El YES El NO SOLD D ISEEDED. D MULCHE : DEPTH OVER TRENCH/BED DEPTH OVER TRENCHIBED DEPTH OF TOPSOI CENTER, EDGES: ❑YES NO ❑YES El NO YES ❑NO El PRESSURIZED DISTRIBUTION SYSTEM: I FILL DEPTH ABOVE COVER. WIDTH. LENGTH: NO.OF LATE AL SPACING: GRAVEL D PTH BELOW PIPE Or TRENCHES: ,(MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: JPIOEDSI ST R. pDISATR.PIPE DIS rRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV.: DIA.: ELEV.. ^, COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED �I a HOLE SIZE HOLE SPACING. DRILLED CORRECT LV PLANS. DYES []NO DYES ❑NO M� RF PROPERTY WELL: BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: BEET FM r L� YES ONO DYES ❑NO �( tRST 0 \ r ` Retain n county file for audit. Sketch System on Reverse Side. TITLE: SIGNATURE: DILHR SBD 6710(R.01/82) INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment,30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report,the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system,circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis.Adm. Code will be applicable. 10. A new permit will be needed if there is a change in,estimated wastewater flow, (number of bedrooms,etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan,drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances,distances between beds if appropriate,tank locations,effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit.Private sewage systems must be properly maintained.Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years.If you have questions concerning your system,contact your local code administrator or the Bureau of Plumbing,DILHR,State of Wisconsin. wlsconsln APPLICATION FOR SANITARY PERMIT DILHR COUNTY —OEPFIRTTr1EnT OF (��� ��� UNIFORM SANITARY PERMIT# InDUSTRV,LRBOR 6 MUTRn gELRTlOnS -// ///3 —Attach complete plans in accord with s. H 63.05,Wis.Adm. Code for the system, on paper not less than 8'hx 11 inched in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS 2— AP AP t'ET PROPERTY LOCATION CITY: � 1/4 W114, $ �� , T 4N, R 20 E (or W vl,u. E IRQ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME MM-,AREST ROAD, LAKE OR LA DMARK STATE PLAN I.D. NUMBER G'OV'T 1oT 71M�a' �y�cbSZZ TYPE OF BUILDING OR USE SERVED -E,450AIAL 44,61N 1 or 2 Family Number of Bedrooms: Z-- ❑ Public (Specify): THIS PERMIT IS FOR - /AeIN y p,P�vy FIST/,J G— SE�}Sav^L SU.�1�rE Gam} /^/ X, New System` � I / / ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench Cl Seepage Pit Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity 2-000 X Manufacturer: 7W.C. Z/VG. O51t-1A.1 W/ S • $ C'e, IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): N Private ❑ Joint ❑ Public I,the undersigned,hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: jPhone Number: 5�o/3gwr " � ` 133a7,V?,^ 1115 ►3PG-�/�5 Plumber's Address: Name of Designer: /2T 3 D Nf-/L- R� &N S Sy6/ �, I Ss1M,2�7_ COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved &tAlo I,V/// L/ // r~iL� �{ ❑ Owner Given Initial (p(p i �f "7�G ��I Approved Adverse Determination Reason for Disapproval: Alternate course(s)of Action Available: DILHR-SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner,Plumber .r .; ST. CROI X COUNTY W I SC O N S I N �:'.,.:h. ��' .r.._:;�1��` `-.�a: 'r�l•,,''.�,,`',,''Pik 11'" '' 'r a• '^"u� ZONING OFF 1 C E 796- 2239 tl �" '" Poet 06 66ice Box 227 41- Hammond, WT 54015 h O W N E R P U M P E R A G R E E M E N T PLEASE BE ADVISED, That unt.it you are again not.i6.ied, 1 w.c.tt • a con..tAact with ������/G, i� o 6 i* fe :P NiA cona.in, (Pumper) , 6on. the purpoa e o6 removing att waate 6rom the Aanitary d yatem to be tocated on the pnopenty and 6utu4e home a.ite Located in St. Croix County, Wi4con4.in, Townah.ip o6 -1;0.L_ bang in the .L !4 o6 the N10 4 o6 Sec. T. 2-9 N. -R. W. (Or woAt 6ut.ty described as 6ottowa : 1 Dated .th.i,a day o6 19 h (OWNER) State o6 l AA County o6y. ) Peraonnatttyappeared be6o4e me th.i,6 day o6 19 the above named � _ � n;(� , to me known to - e the peKeon who executed the Jo4egCding inb.tn.ument and acknowledged the eame. Wo `aany u .cc St. C&oix County, WI, My Comm . (ie perman.t) ( Expi4ea ) My Commission Expires ►an, .I��7 Uu+C1L �l hen �,n n ebe6o4e ne6ehed to ab Pumper, join in the above agreement to tlTe extent that I have a contract with Owner a4 above stated. /�i!/S Q �,P•�. 70 ��•t'� Uj'�//!� ��UI��S�I �U/ll (PUMPER ) J ! , S 0& T/4 Department of Industry, Labor and Human Relations "15COf51 Division of Safety & Buildings Bureau of Plumbing D I L H R P.O. Box 7969 ■IMMTRY,LRBOi76MUfl%inRELaT3rM Madison, WI 53707 Tel. (608) 266-3815 —X//C7 V7,? er IN ALL CORRESPONDENCE / , REFER TO PLAN /2 IDENTIFICATION Q ,r NTIFICATION NO. S zj S Yin z g4-<n)oSZ � NAME OF PROJECT ❑ rKiVAlt SEWAGE ONLY - ❑ GENERAL) PLUMBING PLANS `z-- Fee Received: �ov LO Priority Plan Review`Only ITY OR TOWN COUNT �eD a sT- Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wher required inspections are to be made. Tn tha want installation has not begun within two years from this date _ of+l royal will ha void and new plan apnroyal shall be A-m-el-ined bef9re wer-k FRay.— In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, / For Private Sewage Systems Only: t t This approval is valid for two ;rr...lc'J f.? years or it will be valid until James Sargit the expiration date of the initial Bureau Dire or sanitary permit. rIN N REV I ED B DATE: :c: DPS OWS Owner H & R & Rec. San. Section Local PI Plumber Bur. of Health Fac. & Services County Other LHR SBD-6099 (R. 05/82) Vr . G T. CROI X COUNTY '.�c W I SC O N S I N ZONING OFFICE ...' T 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME: RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE . P. 0. BOX 98 HAMMOND, WI 54015 715-796-2239 or 715-425-8363 TOWNSHIP: PLEASE PROVIDE THE-FOLLOWING_ INFORMATION ACCOMPANIED BY �CEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31 1986. OWNERS SIGNATURE mj :12-83 / ��v �u too CROI X COUNTY W I S C O N S I N tip' ZONING OFFICE - - 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y PUMPING R E P O R T ST. CROI X COUNTY Nom, c RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 HAMMOND, WI 54015 �. 715-796-2239 or 715-425-8363 TOWNSHIP: PLEASE PROVIDE THE FOLLOWI INFORMATION ACCOMPANIED BY(I�i—CEIPTS FROM YOUR PUMPER: NAME OF PUMPER: — LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 312_198q. OWNERS SIGNATURE mj :12-83 4� / / '� !� /'� i �: c SZ• W� S�� FF��E MMO P0�Sl co 1� 19a5 1g6 a25$ �N 3631 `6�0 S�iplNNG ONp, � G Rti ti to C� 4L �ZNG �. �•: 4 � � U � � ti0 X C�uN�y �3y3 CR�1�� WZ �kn��l�,kti�'� . s��No�,��3a o r 40119 ACCpt� � A,EtipN F AT �� 4 �Vti ti Rti e '(��NS�Z yR 'Vol 4u�4�R• A� Sti��• vCti• Sti��NAL Sti���$�R 04 1S4�S NG V �4ti R UE�� O NU�BtiR V��•4U�,4 / N H � ,ENZS Rti4 TAN k yov A�uRti ., WNti� SIGN IT-I - ST. CR01X COUNTY ` WI SC N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 QUARTERLV PUMP INGREP0RT ST. C R 0 1 X COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. SOX 98 HAMMOND, WI 54015 715-796-2239 an 715-425-8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETUR NO LATER THAY JULY 30, 1985 OWNERS SIGNATURE �� 1/ ST. CROI X COUNTY WI SCO N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P 0 R T ST. C R 0 1 X COUNTY NAME ��- �J jr I� �� RETURN COMPLETED FORM TO: ADDRESS / /UC �ie ST. CROIX COUNTY ZONING OFFICE T`-- P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 on 715-425-8363 TOWNSHIP PLEASE PROVIDE HE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: 2,- USE: YEAR ROUND SEASONAL CHECK ONE) JANUARY FEBRUARY MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE TURNED NO LAT R THAN MAY 15 1985. OWNERS SIGNATURE JAI v' G N U i X 6 0 U 3 111 g wis+� nN 5 i N Tit I'll. 'Ut4 ` ' ' ^1,a: Z 0 N I N G 0 F F I C E 796-2.239 ` Poet 06664'ce Box 227 s Hammond, WI 54015 O W N E R P U M P E R A U R L t. M E N 1 PLEASE BE ADVISED, That un.t.it you arse again noti-6.ied, I Witt conta.act With P0%"1" lalwie,it7 7- 0 6 �p,y,G'�-fj�t2 .���..�' �Ti c &44eon4in, (Pumpers.) , bon the pun.po4e o6 nemoving att wa.6te 6aom the :r. 4anitany 4y4.tem to be toea.ted on the pnopen.ty and 6u.turs.e home a.i,.te tocated in St. Ckorix County, Wi4conzin, Townahip o6 being in the _L ___h o6 the /U14) 4 06 Sec. 31P T. 4 N.-R. 20 W. iOn wo u Gutty de4crs.•ibed a4 6ot..tow4 c ) y t� Voted .thi4 day o6 19 (OWNER) State o 6 �wf 64111ri ) Pend onnatt a �t y ppeaxed be6oKe me .th.i4 _ day v6 - - 19� ' the above named , •+ � to m e n Dion .r a o-e h e pcx40n who executed the Jo4e ing in.6t4umektt and aeknow.tedged 'the eame. •- s r' AfolaAy u tic-';�-t. no cx aun y, '-- My Comm , I:io PQnm(Int) ( fxp.i.a414 ) My Commission upires lan. 81 198/ .^.... �_ ` heaeir be604e %e6 e44ed to 44 Pumpers, join in the above agreement to t e extent that I have a contrs.ae.t with Owners. ad above eta.ted. S per., �JC�- r /" �� (PUMPER 1 Ae / SPX-0 U/__ Kt Tip -� �---, k' tib '1c t Owuer of Property Location of Property N4J NC() Sactiun T �, N ZG)W Townahtp � l�u 1 t t i►6 �.�t�r�:a:� f�y 2 S��G/�U'�___1��. d�°,�^ �:,��"�O-c>� �Z I Subdivision Name A910T aG 6!Q0 tot fl umber' . Previoue Owner of kroperty 5/7 '1�SD�tJ Total Size of Parcel 1" 2 4 OLe-S Date Parcel Was Created W'2-2-- k r Are all corners identifiable ? Yea No Include with thin up plicdCion one of the followinK : Certified Survey Map - Deed Land Contract , or 0 , Other . Cagal Document which describes the property PfiOPERTY OWN" CERTIFICATION � I (We) certify that alt statements on this form are true to the best of my (our) knowledge;'that I (WO am (are) the owners) of the property described in this information form,by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No.3 Q1, 6r) 4Q and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the constructio f cad system, and the same has been duly recorded in the Office of the Co y Register of ends, as Document No. ). ± y S►UNATURf OF OWNE R SIG ATUAg OF "WNER!F P1.IGl�e►.I:y PATE.SIGNED j DATE SIGNED ql 777 77777 a i z 13EoRovtil s�A5oV44 C46MI , (5k7571A)6- C,4, AV N,+-:57 IV S U , M� rl IIAWFF OPIP 4 G .3 �ol �iVCr T��II CAPOS.S SEC�rl,) ) BOB No 3 ?j 0 APPA55-5 NOMESITE TESTING CO, ROAD UUDSON, WIS. 54016 State of Wisconsin Department of Industry, Labor and Human Relations DATE: fj�`. tom- SAFETY&BUILDINGS DIVISION FF / Bureau of Plumbing B•2'71 201 East Washington Avenue I�N1NS g8¢ ,y P.O. Box 7969 Madison, Wisconsin 53707 d' ( Identification No. i 4 0"' 05 Owner: "�iQ i✓f✓�t '/�I%Tf= Plans and specifications have been received and assigned the above plan identification number. Preliminary review of these plans indicate that section ILHR 83.18 (7) (a), Wisconsin Administrative Code, has not been complied with. This section specifically indicates that all plans for holding tanks must show that the tank shall be so located to an all-weather access road or drive so that the pumper may drive pumping equipment to within 10 feet of the servicing manhole. Rather than return the plans at this time, you may have the owner of the property sign the affidavit, have it notarized, and return it to this office, or you may resubmit the plans and indicate the location of a road or drive. AFFIDAVIT I, the owner of the property described below, hereby certify that an all-weather access road or drive will be located within 10 feet of the servicing manhole of the holding tank. NAME 6,AkRET \/,E— (type or print) PROPERTY LOCATION C0 0 r. 1-6, r 3 61 L �� ZC� 7G J 72q ADDRESS y SIGNATURE DATE State of Wisconsin j County of Subscribed and sworn to before me this day of , 19 Notary My commission expires, , 19 DILHR-SBD N (R. 11/83) 13ILHRSBO-6423(N.04/81) in e Code this document is to e recor e cited at the County Register of Deeds . At the time of Sani- miry Permit Application, a copy of this a,;rcement , with the recording dates and number should be submitted to this o� 8 HOLDING TANK AGREEMENT j�� '%% Thi Agreement is made and entered into this day 19�, by and between the Z a hereinafter called Ir ` an d I/ here nafter c-alled t e "Owner. I We hereby acknowledge that application has been made for a building pemit' on the following described property, to wit: o A) 1z, �ac - 22�f A) R..2-0 remises requires that a holding or that cont lnued use of the existing p q 9 tank be installed on the property for the purpose of proper containment of sewage. We also acknowledge that said property cannot now be served by a municipal sewer or septic tank_— soil absorption system. Therefore, as an inducement to the County of7` - /Pf to issue a sanitary permit for the above described primes.we ere y agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbing Code�/relating to holding tanks. Any time the Town or Municipality of �/�DI through its Plumbing Inspector or Health Offi- cer, deems it necessary to pump out the subject holding tank, the Owner shall have same pumped out in twenty-four (24) hours, or D1Vo dF 7teO will have said work done and charge same back to Owner and place same on the tax bill as a special charge. The Owner further agrees that the Town or Municipality of f e&U) 0r— U64 may enter upon the property des- cribed above at any reasonable t me, o inspect, or pump and haul wastes from the subject holding tank. 2. -Owner agrees to ay all charges and costs incurred by the Town or Municipality of G for inspection, pumping, hauling or otherwise servic ng an ma ntain ng We subject holding tank in such a man- ner as to prevent or' abate any nuisance or health hazard caused by such holding tank. `� ttl � d shall notify the Owner of any such cost which shal`[-'be paid by�they ner within thirty (30) days from the date of notice and in the event`:thait ther Owner does not pay said cost within thirty (30) days, Owner'heireby specifically agrees that all of said costs and charges may be placed-on the ,tax' roli as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Wisconsin Statute. DILHR-SBD-6123 (R.3/81 JOB ULBRICHT, J HOMESITE TESTING Co. RT. , VNEIL ROAD w I �...�:::�.._;_ : ft!Lti�S�N- �1N-1�s.-�__..-y�►F�.__���__---___�___ __ .:._ _ __:� _ _ __ .W..._._., _._:.__�._..�: Page 2 3. Owner agrees to have a quarterly pumping report submitted to the local government and the county which will state the Owner's name. location of the property on which the holding tank is located, the pun4)er's name, the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a surmiary of the pumping history of the previous year shall be submitted to the Department of Industry, Labor and Human Relations by the governmental unit responsible, per section 145.01 . (15) , Wisconsin Statutes. 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code, 5. This agreement will remain in affect only until the sanitary permit , issuing agent in 5 i, G /} County certifies that the subject pro- perty is served by either a public sewer or a septic tank --- soil absorption system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agree- ment may be cancelled by executing and recording said certification with re- ference to this Agreement, in the Tract Index indicated above. 6. This agreement shall be binding upon the indicated governmental , unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this day of 19 f TOWN OR MUNICIPALITY Of 1 ` by '' V by (� t STATE OF �8r1 '�"flJ Jersonally came befor M this day of , 1g 7 -the &Wve named CtA to me to be the ttrw�wati t acknowledged the same THIS INSTRUMENT B C DRAFTED BY: My commission expires. wstacn, Whip Keturn Upper DIVISION OF SAFETY& BUILDINGS Porn+-n f This Form With BUREAU OF PLUMBING 201 E.WASHINGTON AVE. RM 178 Any Return Correspondence P.O. BOX 7969 i MADISON,Wl 53707 - � 608-266-3815 DATE: PROJECT: ` ��r/`�7�" �-@ /,' .._.. SPA.,-..�c , . PLAN ID. DETACH HERE PRfl�t�NAME x � e--��fi PLAN}ID:. -- This4>ts..ta'acknowledge receipt of your plans and specifications for the above-indicated project. ki Preliminary review indicat equired fee is$ Fee Received is$ Y.. nderpayment Pte u mil the additional°fee` a ❑ Overpayment- Refund forthcoming r � tan accepted for revs : ❑ Plans being returned. Ft fee has been rei i. lens submitted with no fees will be Additional information required.SEE BELOW r eti!'in-abeyance. 1 iartSubmission -- ❑ Complete data relative to anticipated use of bldg. Additional information shall be submitted i' duplicate un- ❑2 copies of PLB 60 enclosed. less specifically noted` ,. E3 Deed restriction required (1 copy). ❑5 Plans not clear,fegibt` &permanent. 'i v '❑ Condominium declaration. (1 copy) All information`submitted shall be signed,dated and sealed or stamped in acxord�with Section H 63.08(2)(a)Wisconsin Administrative Code;,+ ❑Affidavit enclosed IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and =1 ° ma nu#acturer if precast. Complete construction details if 1I y Pressurize Distribution (Mound or In Ground Pressure) site.constructed. ��,. lApplication for,use,o ranalternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of c f J and notarized O£cop `r, , _ �' �� 3 government(sample enclosed). „ County ons�te{requtred7(1 copy). ❑ Desjgn#calculations ❑.Reason- for installing holding tank.Soil test or statement for pressurize distcib tort ❑Soil boringF&percolation from county (1 copy), ' test data. ❑Plot_plan-showing location of holding tank with lateral dist s Cross section ems;❑Pipe lateral layout:. -- antes-to any building, wells,water service piping, .water Plait view of syst: Plot ptap. ry Y course,lot lines, swimming pools, all weather service"road, erificati( of E ption Status Form by Countyt(T eopy) Etc.P ovide benchmark with elevation reference point � k it Nate Sewage Disposa Systems x ,, w V Lift Pump 4.. ' 'Ground slope w; . ooh tours in entire area-of soil absorp- ❑ Calculations for total lift`pump discharge,head and gallons ion system exte`ter 25.,oil all sides. r Elevation of rmane reference pumped per cycle, d t t w pe"fr k point (benellmark} ❑:size,length.&depth of force main Location of area �te for replacement system provide .❑'Detail & model of pump or automatic siphons,mcludmg ail data. ... , _, r size,pump curves,drawdown and average flow rate GPM Plot plan show.i size •and all laterat�distances from ❑ Cross section of lift um tank showing um s)or sewage disposa "syste to.buildings, lot Imes;Well water t �,. v� siphon (s). (s). ,course,swimmirilt s�water service piping,;Etc - • P ". r COnstfUCtlon detai�yJof"septic;holding or I►#t pump tank if V1. Systems In Fill(Fill must be placed prior to plan sub site constructed'o�tank`manu#acturer if precast. R'� p mission) �,GOnstrUCtlon detaW hd"cross-section'of sort absorption ❑.Total area filled (fill to extend 20' beyond edge of trench system. ..... _. ...: .. ...... .; E, before side slope begin). �QxScil boring and;perco ation test on 115 completed by cer ❑ Depth and type of fill. , F,//,��tified soil testet+lo"`y � n w ❑ Copy of onsite report by county or district staff. . ;. i .e k ._ � ,� a• ��^ fir, ,� y, r 4 ..:_.' r .t i NOTE : As specified in 1-1b3 . 18 (4 A) Wisconsin AdwiniSLraLiive Code this document is to be recorded in the Tract Index , lo- '' cated at the County Register of Deeds . At the time of Sani- tary Permit Application, a copy of this a-reement , with the recording dates and number should be submitted to ffice . n VOL 682 PArr 14 REG14TUS OFFICE ST. C110IX CO., W16. Res' cord this d!, ;; s Re 27th i�9J.'�1.t� HOLDING TANK AGREEMENT day of Feb. A.D. 19 4 at 8:30 A , M. Thi Agreement is made and entered into this _ day of James O'Connell 19_1� , by and between the Ropblw of DNd1 hereinafter called _ �Ze- ✓ K thleen H. Walsh an .r here nafter ca e�t�ie deputy "Owner. We hereby acknowledge that application has been made for a building permit on the following described property, to wit: Pk91 0 Sec • 3 T ��' /tJ /� w ��.� 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. We also acknowledge that said property cannot now be served by a municipal sewer or septic tank_ — soil absorption system. , Therefore, as an inducement to the County of , S - rttoQ /X to issue a sanitary permit for the above described prem ses , we hereby agree and bind ourselves as follows. 1. Owner agrees to conform to all applicable requirements of the Plumbing Code relating to holding tanks. Any time the Town or Municipality of % 0 y through its Plumbing Inspector or Health Offi- cer, de-ems-it--necessary to pump out the subject holding tank , the Owner shall have same pumped out in twenty-four (24) hours , or 6l12.41 Of— Tiff/ will have said work done and charge same back to Owner and place same on the tax bill as a special charge. The Owner further agrees that the Town or Municipality of "%-010.0 0��_DV may enter upon the property des- cribed above at any reasonab e time or pump and haul wastes from the subject holding tank. 2. Owner agrees to ay all charges and costs incurred by the Town or Municipality of G for inspection, pumping, hauling or otherwise servic ng an ma nta n ng the subject holding tank in such a man- ner as to prevent or abate any nuisance or health hazard caused by such holding tank. 16�e1,cJ Ot- rl-y6� shall notify the Owner of any such cost which shall—be pai y the 'er within thirty (30) days from the date of notice and in the event that the Owner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by Wisconsin Statute. DILHR-SBD-6123 (R.3/81 ) � rl'..h "` A reel of land containing one and one-half News Riohmond,� WI- 54017 (l ) acres, more or less, lying in Government Lot TrrsntOne -eilht (28) , North,tR T Range Twenty 2011 West, fur ther described as . : follows: Beginning at' an iron pipe stake on the' South line of above Government Lot One (1) a distance of 2,103 feet West of the Southeast . corner of said Government Lot One (1) , thence West 25 feet, more or less, to Lake St. Croix, thence Northerly along the shore of Lake St. Croix 360 feet, more or less, to the centerline of a rocky gully, bearing Southeasterly, thence Southeasterly along the centerline of said rocky gully to the South line of said Government Lot One (1) , thence West along the South line of said Government Lot One (1) to point of beginning. VOL II I8.?PAGC t11 Page 2 3. Owner agrees to have a quarterly pumping report submitted to the ` local government and the county which will state the Owner's name, location of the property on which the holding tank is located, the pumper's name, the dates, volumes pumped and the disposal site. An annual pumping report or the fourth quarter report including a summary of the pumping history of the previous year shall be submitted' to the Department of Industry, Labor and Human Relations by the governmental unit responsible, per section 145.01 . (15) , Wisconsin Statutes. 4. We guarantee that the holding tank contents will be disposed of at a site meeting the requirements of chapter NR 113, Wisconsin Administrative Code, 5. This agreement will remain in affect only until the sanitary permit , issuing agent in G f}� County certifies that the subject pro- perty is served by either a p'ubl is sewer or a septic tank — soil absorption system that complies with ch. H 63, Wis. Adm. Code. In addition, this Agree- ment may be cancelled by executing and recording said certification with re- ference to this Agreement, in the Tract Index indicated above. 6. This agreement shall be binding upon the indicated governmental unit and the Owner or heirs and assignees and shall run with the deed. WITNESS our hands and seals this � day of ✓�`�1 , 19-L:,� TOWN OR MUNICIPALITY OF / by by .1 %' V? STATE OF 6f;� 19 ersonally came beforq this day of the above named to me tow s to be tUe awl 09 nstFawKi. and— acknowledged the same. THIS INSTRUMENT NOTARY PIJBLIC DRAFTED BY: My commission expires: �7Ls'LCa.t��' L s ht ST. CROIX COUNTY W I SC O N S I N �Fn ZONING OFFICE 796-2239 (HAMMOND) 425-6363 (RIVER FALLS) HAMMOND, VIII 54015 Febnuaay 15, 1984 To .Whom it May Concern: RE: GaAAett See pnopeAty Located in the NWT o6 the NW-1-4 ob Section 36, T28N-R20W, Pant o6 GoveAnment Lot#.l, Town o6 Troy, St. Cno.ix County. Due to the topography o6 the z to and the pnom,inence o6 bedrock, no eu✓itabte z to wad bound bon a convent onae on attennate 6y6tem on the above de6enibed pupexty, There6ore, a hotding Ja.nk i,6 recommended jon the exiAtZ.ng atnucatuAe. Shoutd you have any que6ti.on6 regarding tki6 6ub1ect, ptea6e feet 6nee -ta o o nta.c t th i6 o 6 6ice. S.incere.Ly, Thoma6 C. Nel4on A66.i.6atan,t Zoning Admini6t4ator TCN:mf STATE OF WISCONSIN DILHR DIVISION OF SAFETY&BUILDINGS DIL HR PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING ...... ,.. ....,,".,,,..,. 201 E.Washington Avenue,Rm 178 PLAN APPROVAL APPLICATION P.O.Box 7969,Madhon,W1 53707 A913?_8S 9815 INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all foes are received. The bark side of this form describes required plan information. Plumbing codes can be purchased from the Department of Administration,. Document Sales,202 South Thornton Ave.,Madison,Wisconsin 53703,Telephone (608)266-3358. C 1. PROJECT INFORMATION IType or print clearly Revision To Plan Number: A 3 Name of Submitting Party(Plans returned to tame) Project Name : Street&No.or Rural Route Project Location Street&No.or Leger Description �� '.-�G _ � .__ ..-..K -.r .. ,,�..,r. �qo.,m .•.+r,�k- ... _ .w..».«„�re,«i,.i,._� wn+j+n.+e}..� +*»s..-.».a..,.�.x+ City or Village Zip City County Village OF. Town 1� Telephone No,IInclude area code) .- 1 e 71 3 60 - P otnignar Telephone No.(Include area code) Ow ers Name l Telephone No.iinclude area code) Street&No Street&No. 165- Ste;/Gi iJ E f>iP City or Village State Zip City or Village State Zip 2. APPLICATION FOR: i� Conventional System -Public Building(1) El New Mound System (3a) Holding Tank (2) (7 Replacement Pressurized System (4b) ❑ Replacement Mound (4a) ❑ Petition For Modification (6) New Pressurized System (3b) ❑ System in Fill (1) ❑ Other Alternatives(5) ❑ System in Flood fringe (1) ❑ Groundwater Monitoring (7) 3. FEE COMPUTATIONS(Include existing tanks) 4. FEE SUBMITTED F FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR ; 3a. 750-'1,500 gallon septic tank -30-00 4a. 3b. 1,501 - 2,500 gallon septic tank -40.00 4b. 3c._ 2,501 - 4,000 gallon septic tank -55.00 4c. 3d. 4,001 8,000 gallon septic tank -70.00 4d. " 3e. 8,001 -12,000 gallon septic tank -85.00 4e. 3f. Over 12,000 gallon septic tank - 100.00 4f. 39. 600- 1,000 gallon dose chamber -30.00 4g. 3h. 1,001 - 2,000 gallon dose chamber -35.00 4h. r` 3i. 2,001 - 4,000 gallon dose chamber -50.00 4i. 31: 4,001 . 8,000 gallon dose chamber 65.00 4j. " 3k.{ 8,001 -12,000 gallon dose chamber -80.00 4k. 31. Over' 12,000 gallon dose chamber -95.00 41, 3m. 500- 5,000 gallon holding tank -30.60 4m, 3n. 5,001- 10,000 gallon holding tank -40.00 4n. 3o. Over 10,000 gallon holding tank -50.00 4o. 3p. Groundwater Monitoring Per Lot -32.00 4p. Q (other than a proposed subdivision) Subtotal ..�0 , Priority 3q. play review: (walk through) 4q. Q !w r Submittal of plans in person, ¢` by appointment,with double fee 3r. Petition for Modification Setback 20.00 4r, i` il'Nit)If�11 -SQ,f�Q � , a Total Fee , DIL!#1111-660414818.02/#3) NOTIE: Fees subject to change on July 1,annually: -OVER -�..- ...- .yam r^�7r- .-.T....-"'t4•-%�r"'"'"�"'^a y'."`- a_. � w^-. a- 5^- y@ `P�,x ;e � rB "'�!} v 0.f �'r d�'y ty^t *d ' ��s..• � p :h h. J� b �,° ��r �';Y<:;Ri ax,` t `�,�^9k' �.��F{3�i��..'g� ,.� a� r:,,'# � L��p. ����''�h.�,ia d 4 ✓"��#�� ;a +ilA v 'li fi: x ✓.�,� �.. �, h v^s',* e r^}n �'! �`y^ y�'� �i� � ' r' n 4 Xz NZ 4/1 IWAOX �^ 1 v ly Au I v 1 �r M� 3 rn ` 1P, J � . H � - v v4d ry 7 L - -. w yr I Iu Qc Ak F ti'3 Yll Q ku e 41 lb I IF X �` � '�`1 by f tl Cc�cie" thin docuiuent is to be recorded in the `Pratt lnd x, 1o." caged at the CQunty Register of Deeds . At the time of Sani y trzry Yer�ni.t Application, Fj cupy of this a4;ree ncn�. , with the` " * recording date$ and numh��r huuld be ' submitted to this off�.ce . Vv! PS" PAS?`i HOLDING TANK AGREEMENT _._..� . 39141- day Of, D. (9 Ira a f Th1 Agreement i s spade and entered into this �� ...._.d Hof,�J Auz t?"Corin E-.l 1 19 by and between the �- � +�« her called �2e�- ✓ Khleen H. ��31sh' an hereinafter ca e_ t e ' dcnut,G- hOwner. We hereby acknowledge that application has been made fora building permit on the following described property, to wit: . r_ +` / FBI / �e0/Y b . 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. We also acknowledge that said property cannot now be served -- soil absorptionsystem. by a municipal sev�:r or septic tank . ` Therefore. as an inducement to the County of . CA 10 � to . issue,& sanitary permit for the above described premises, we ere' y agree and bind ourselves as follows 1. Owner agrees to conform to all applicable requirements o€ the Plumbin Code relating to holding tanks. Any tiine the Town or Municipality of through its Plumbing Inspector or Health Off1_ cer, eem t necessary to pump out the subject holding tank, the Owner shall have smote pumped out in twenty-four (24) hours , or 76104i will have said work done and charge same back to Owner ana place, same on the tax bill as a special charge. The Owner further agrees that the 'Town or Municipality of /alv4J Or- 7W 69V may enter upon the property des- cribed above at any reasonable t me, to inspect, or pump and haul tastes from the subject holding tank. 2. -Owner agrees to ay all charges and costs incurred by the Town or Municipality Of ro 01 G ° for inspection, pumping',, hauf ng or otherwise servic ng an ttta' nta n ng a subJect holding tank in . sucha man- ner as to prevent or abate: any nuisance or health hazard caused by such holding tank, ice¢u1,y O F r"V 0/ shall notify the Owner of any. such .!cost which shall eeppai 'by the Owiner within thirty (30) days from the, date +of notice and in the event that the Owner does not pay said cost within thirty (30) days, Owner hereby specifically agrees that all of said costs and charges may be placed on the tax roll as a special assessment for the abatement of nuisance, and said tax shall be collected as provided by WiScbhsin Statute. DILHR-SBD-6123 (R, 3/$1 ) ' A reel of land containing one and one-half -.Ns + Riahmond,t-W1- 54017 } (1 acres, more or less, lying in Government Lot One (1) , Section Th irty-s ix (36) Towner h ip T&Parm No. , .... ..... , ...... �.. Twenty-eight (28),.:North, Range Twenty (201 West, further describ d as , oI laws a Beginning at are iron pipe stake on the South line of above ., 6overtte►At Lot One (1) a distance+ of 2,103 feet West of the Southes:~st corner of said Government Lot One (1), thence West 25 feat, more or " 1#641 to, St, 'Croix, thence Northerly along the ehofe of Lake 4t'11,'C 6t):feet, more3 or lose to the centerline of a rocky _gtally - " d# . x Lot,Sootheasrterly, thence Southeasterly along, the centerline' of rocky gully to the South line of said Government Lot One ( ; iz trace �iat "4long the South line of said Government Lot One (1) to, ink Qf beg inn ing .; r p 4 7� 3 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 1 Tribe a complete and accurate soil test,your report must inclucae: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; g. Complete all appropriate boxes as to dates,narnes,addresses,flood plain data,percolation test exemp- tion, if appropriate; 10. If 0he information (such as flood plain,elevation)does not apply, place N.A. in the appropriate box; 11. Sign the form and plane your current address and your certification numtter; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 GAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st --'Stone {over 10"} BR — Bedrock cob .._ Cobble (3- 10") SS - Sandstone gr — Gravel (under 3") LS Limestone s — Sand HGVV — High Groundwater cs — Coarse Sand Perc -- Percolation Rate reed s — Medium Sand W — t'teI 's — Fine Sand 'f «•'e °'Rtdg Building Is — Loamy Sand — Great& Than' sl - Sandy Loam Less Than I ._ Loarn i •E( Brown sil — Silt Loam BI -._ Black si Sift Gy — Gray cl — Clay Loam Y -- ' elicw sci — Sandy Clay Loarn R R P d sicl — Silty Clay Loam not Mottles sc Sandy Clay w' - vvit -` sic Silty Clay fff ._ fcvv, Fine, faint c -- Clay ec -- common,coarse P! _ Neat rnrn — Ma�,�; Medium ni [,luck d — distinct p — protninertt HWL — High vv:tter level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP -- Vertical Reference Point TO THE OWNER: This soli test report is the first st,p in securing a sanitary permit. The county or tiie Department r-rtay rerluest vt ' `'itlati€7 flf this soil test ifs the field prior to pe'rnit issuance, A cczrupl�te se%,of plans,Vr the private wagc �'stern and a permit apinlicatics,n must he submitted to th= a4#)rof-�+iatc iocal authority it, order to ,.iE.-;Tilt. the sanitaryy pet=rnit nllt,t- oc,obt')ined and posted orior to zh(2 start of any construction. Y [DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS DUSTRY, DIVISION ZLABOR AND G P.O. BOX 7969 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 (H63.090)&Chapter 145.045) LOCATION: 41W SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: K.NO.: SUBDIVISION NAME: NW 1/4 1/ 36 /T18N/R16E ( )W T�Po GsJ�T 0 o U"-P 61 T- Lore/ COUNTY: , OWNER'S BUYER'S NAME: MAILING ADDRESS: ' SEDo,)rf 111P/ZD��+ Sl Cedl)( �R. ��R�Er Yom- i�,� s,�y/NE R. T y �J USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: R A ION TESTS: I Residence N� ❑New Replace I NQv� ��— P 3 T QiJ/f1,f;ez> RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) El U I ❑S ®U ❑S ©U I ❑S DU ©S ❑U H61-411A) 6- r,4A), If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: r�]] IN FT PROFILE DESCRIPTIONS SC S 3(p 12j+C k s y Si I BORING TOTAL DEPTH TO GROUNDWATER-INC CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.O/N BACK.) B- / �U�� //3,/� -� ��� '�f /3,v. —Ole. I *44." 7�' �.vS,00�P rEO B- 33 ' a, S/ wet, f,f o.E'- Gy. �to7`s ogs&;rv&D B- S, oe,. G 6 'oiP. fret e S. o' o,,0-13.v cs /. 6 'LYI I&J B-Z- 3. 3 )4�1- 3. 3 s. w E B- 3, 3 j FT _ �ftJ�l O�/E•�4�O/� LiH�S7b.J�- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI00 2 PERIOD PER INCH P- P- P- P-_ P- P- _ 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. �L!'(r. ,y� ,� To of SYSTEM ELEVATION /' 9�,S fT I f TM € S 0- 0 C'e -, IOU , _ Scv�, ► ' �rl 'ti —�' 0,0 c 5 .4 - �1 Lam_ *40 U LE E f'). ' _ 4 OA , E _ , I TN c.R 0 f S a �O.V1.0 G- d f � vti L-A---1-1- A-1- I,the undersigned, hereby certify that the soil tests reported on this form 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. 400B ULBRIM NAME(print): " TESTS WERE COMPLETED ON: ADDRESS: CO. CERTIFICATION NUMBER: PHONE NUMBER(optional): 5 S'oZ CST SIGNATURE: HUDSON, Wl$, -,. saga .ze i DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — REPORT ON $OIL SORIN &S � ��� �. � �� � �� � .� � ��► � PROTEC d � ' ' ,ATE' NOMESITE TESTING CO. RT-3, O'NEIL ROAD $OB ULBRlcA.x' ;.. iiU0SON, WIS,. 54016 C5T PROPOSED HOUSE MUST LIE 2, FT p,, 41-1 nrfr ovr4s. PROPOSE o WELL M VST we so FT IyDiPE FiPOrt A<< TEST �9�E/fS, x AA Pir„f = alfrlAi e, DELL � r X = PEQG /4rC�y'�GNlf � �' fl�i4Al�D �d9E�PED ` o,Q S�alrlE[. CAPES � M vrpric, ,t �erQ-,ftwcr Poi)r' f So%1.� �- y dtJ L©cvES T` 13o 170,A-t 6� )rj o,,= r LE GE 14, E/AVArro v of I/o .' Rn$.. P1•' %0, o 160 z, � Z r N'� of • shca RIOGi/ rUl� f l y P�PopQ fwd 5/©�tf ✓rd Lo , LDS' \ ' f Giu ..,: �.: .. p 1=e f . S170 17 tar r.� v