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030-1051-60-000
Pam Quinn Jennifer Shillcox From: Monday, July 31, 2006 7:50 AM Sent: Judy Kahler To: Pam Quinn; Ryan Yarrington; Robert Bezek Cc: RE: Bass Lake property owner Subject: to schedule a options he g regarding his propeethelpful for us Thanks, Judy. IT be happy to talk to him about zoning issues an, it might b might have for his sanitary system, so I'm copying this to Pam & Ry him to better answer all of his questions and provide him with o e direction. J~zv~ with Jenny -----Original Message--- From: Judy Kahler Friday, July 28, 2006 4:54 PM Sent: Jennifer Shillcox J To: Bass Lake Property owner Subject: while you were at BOA------- A yesterday A little background on this man that stopp Y Town of St. Joseph the house was ordeed moved by he tank nr which he d'dtThe ells our resence, a property on Bass Lake, put a holding he s Long before y p tic he was ordered to of what is going to happ en when gentleman that is now thinking um ed as often as County. 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He would have to explore adjacent properties and obtain an easement if there were a area available for POWTS construction. I can meet with the owner, but he won't like the answers. designed t l fits his compensate for Mother Nature0 potential off-site sanitary We can't always Pamela Quinn, Zoning Specialist (POWTS) St. Croix County Planning & Zoning Dept. Nyr' 1101 Carmichael Road Hudson, WI am co. saint-cr I p~ orx. wi us <mailtopamanr`0. sa; <<fcrvix wr uS> From: Jennifer Shillcox Sent: Monday, July 31, 2006 7:50 AM To: Judy Kahler Cc: Pam Quinn; Ryan Yarrington; Robert Bezek Subject: RE: Bass Lake Property Owner Thanks, Judy. I'll be happy to talk to him about zoning issues regarding his property. I don't know what other might have for his sanitary system, so I'm copying this to Pam & Ryan. It might be helpful for us to schedule a meeting with him to better answer all of his questions and provide him with some direction. options he Jenny -----Original Message----- From: Judy Kahler Sent: Friday, July 28, 2006 4:54 PM To: Jennifer Shillcox Subject: Bass Lake Property Owner A little background on this man that stopped yesterday while you were at BOA------- Long before your presence, a property on Bass Lake, Town of St. Joseph the house was ordered moved by the County. Because the house was so close to the septic he was ordered to put a holding tank in, which he did. The owner of the home is Donald Teske, an older gentleman that is now thinking of what is going to happen when he sells the property, and has concerns about the sale because a family could not afford to have the tank pumped as often as it should be. He would like to speak to you about what his options for expansion, etc and feels that his lot may be unable to be sold (ha ha) because of the DNR, and the County's deal with having everything moved. This all happened in the later 80's. Tom Nelson was the Zoning Director. y He's summer's here and can be reached at 715-246-3831. He seems very nice and would like to meet with you about his concerns. His PID # is 030-1051060-000. The property address is 1420 Hidden Oak Trail. He has a hearing problem but wears an aide, but I don't know if his phone is enhanced. y I am sure this is a mute issue but if you could call him he would appreciate it. Thanks for all. I only know this info from his conversation with me yesterday. Jude 1 Pam Quinn From: Sent: Pam Quinn To: Monday, Jul 31 2006 Subject: Jennifer Shil cox 9:05 AM RE: Bass Lake Property Owner I pulled the sanitary report and due to lack of soils on ac property. He would have to explore adjacent area available for PO ceptable slopes, no mound system can be designed to fit on his Nat construction. WTS construction. I can properties and obtain an easement if there were a potential off-site sanitary compensate for Mother meet with the owner, but he won't like he Pamela Quinn answers. We can't t always Zoning St. Croix County Plannin & Zoni pecZoni g Dept. ) 1101 Carmichael Road g ng Dept. Hudson, . am co. saint-Croix. wi. US From: Jennifer Shillcox Sent: Monday, July 31, 2006 7:50 AM To: Judy Kahler CC: Pam Quinn; Ryan Yarrington; Robert Bezek Subject: RE: Bass Lake Property Owner Thanks, Judy. IT be happy to talk to him about zoning issues regarding his property. might have for his sanitary system, h I'm copying him to better answer all of his questions pymg this to Pam & Ryan. It Might I don't know what other options he and provide him with some direction. Jenny ht be helpful for us to schedule a meeting -----original Message----- From: Judy Kahler Sent: FridaTo: y, July 28, 2006 4:54 PM Subject: Jennifer Shillcox Bass Lake Property Owner A little background on this man that stopped yesterday while ou Long before y were at BOA your presence, a property on Bass Lake, Town of St. Joseph the house w County. Because the house' was so close to the septic he was ordered owner of the home is Donald Teske, an older gentleman that as ordered moved b the the property, and has concerns about the sale because a family t is could now to thinking put of f what is holding tank in, which he dien he should be. He would like to speak to going to ha you about what his options for expansion d eto have the tc and feels thaph Sped as often as ha) tunable to be sold (ha because of the DNR, and the County's deal with having happened in the later 801s. Tom Nelson was the Zoning Director. lot may be everything moved. This all He's summer's here and can be reached at 715-246-3831. He seems his concerns. His PID # is an be 030-1051060-000. The problem but wears an aide, but I don't know if his is 1420 Hidden phone is enhanced. Very nice and would like to meet with you about property s address Oak Trail. He has a hearing I am sure this is a mute issue but if you could call him he would ap recia his conversation with me yesterday. p to it. Thanks for all. I only know this Jude info from 1 ST. CROIX COUNTY msk ; s WISCONSIN ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 TO: Holding Tank Users FROM: Thomas C. Nelson, St. Croix County Zoning Administrator DATE: December 8, 1987 RE: Holding Tank Pumping Agreements As you know, in the past, you were required to submit a Quarterly Pumping Report to the St. Croix County Zoning Office. However, you now can change your reporting to a semi-annual basis. In order to do this, you would need to cancel out the old Holding Tank Agreement by filling out the enclosed Cancellation of a Holding Tank Agreement Form and having it notarized and recorded at the Register of Deed's Office. You would also need to fill out a new Holding Tank Agreement and Holding Tank Servicing Contract which are also enclosed. If you so chose to change to the semi-annual report, we request that you send us copies of the above-mentioned recorded documents for our files by February 1, 1988. In 1988 we will again be sending out Quarterly Pumping Reports at the end of the 1st Quarter or Semi-Annual Pumping Reports at the end of the 2nd Quarter depending on which report you chose. If we do not hear from you by February 1, 1988, we will presume you are keeping the Quarterly Pumping Report Agreement. If you should have any questions regarding this matter, please feel free to give this office a call. Also, we will be doing onsite visits periodically starting in 1988 to inspect holding tank septic systems. TCN:rmc THIS SPACE RESERVED FOR RECORDING DATA CANCELLATION OF A HOLDING TANK AGREEMENT As the sanitary permit issuing agent in the county stated below, I hereby certify that the following described property is now under a new Holding Tank Maintenance and Service Contract that complies with ILHR 83.18 (4), Wis. Adm. Code. RETURN TO: In addition, I understand that execution and recording of this document cancels a holding tank agreement between the and that was recorded on the day of 19 in volume page as document number Witness my hand and seal this day of 19 County of St. Croix by Thomas C. Nelson, Zoning Administrator i Owner(s) Name(s) (Print) i Owner(s) Signature(s) i Subscribed and sworn to before me on this date: Notary Public My Commission Expires: i NOTE: This document to be recorded in the Tract Index at the office of Register of Deeds. cument No. This apace reserved for recording data HOLDING TANK AGREEMENT greement Date This agreement is made between the unty or Local Governmental Unit I Holding Tank(s) Owner(s) I I (Called Municipality below) We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property, (Provide legal land description:) 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 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 charges will be assessed as prescribed by s. 66.60, Slats. 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) Subscribed and sworn to before me on this date: I Municipal Official Name (Print) I Municipal Official Signature Notary Public My commission expires: Municipal Official Title (Print) I SBD-6123 (R. 10/85) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. HOLDING TANK SERVI ontractDate LING CONTRACT olding Tank Owner(s) Name(s) This contract is made between the - - - - - - - - - - and Pumper's Name e acknowledge the installation of I (a) holding tank(s) on the following Property: (Provide legal description:) 1. The owner agrees to file a co signed the Pumping PY of this contract with the local agreement required in Ch. ILHR the local 4 governmental unit hereinafter called the " With the County of 83.18 (b), Wis. Adm Code and municipality", which has 2. The owner agrees to have the enter upon the holding tank (s road property have for the serviced by the or drive so that the Purpose of servicin Pumper and guarantees to the pumper for pumper can service the g the holding tank(s). Permit the all char holding tanks The owner a pumper to have access and to in o charges incurred servicing the holding ()with the agrees t Pumpin maintain the all-weather The g tank(s) as mutual) g equipment. The owner further agrees mutually to pay Adm. Code, and to the count y the owner and pumper. 3. municipality which has si to include the gree y a re signed the following in the Semiannual retie servicing of the holding pumping agreement iann required by s. ILHR 83 rfur port: , for a. The 9 tank(s) on a semiannual basis. The Pumper furth4er b). Wis. name and address of the person responsible b. The name of the owner of the holdin agrees c• The location of the for servicing the holding d. The nit propert 9 tank; g tank; Y Permit number issued or the holding on which the e. The dates on holding tank is installed; I The volumes in gallons the holding tank was serviced, tank; g• The volumes gallons of the contents pumped from the holding tank for each servicing posal sites to which the contents from the holding This agreement will re 9 tank were delivered. the owner a main in effect until the and the gr to the a copy of any changes or Pumper terminates this contract. In County named above within ten to this service (10) business contract or a copy change of a new service contract with the Municipality owner(s) Name(s) (print) contract, to this service contract. munici I Owner's Si Pality I gnature(s) _ I Subscribed and sworn to I before me on this date: 'nper's Name (Print) I I Pumpers Signature I 'Per s Registration Number I MY commission expires: ovary ub is 7574 IN. I i/85) This instrument was drafted by the State of Wisconsin Depar Human Relations, Bureau of Plumbinntment W~ - ! 1 Form -STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TKO TOWNSHIP SEC. - T '?0 S N-R~ ADDRESS I ~3~QQ,q f~/ CROIX COUNTY WISCONSIN f SUBDIVISION I LOT LO PLAN VIEW i Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i J INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 4-- 06We, Elevation of vertical reference point: / /00-C) Proposed slope at sit SE Manufacturer: Liquid Capacity: Number of rings u Tank manhole cover elevation: Tank Inlet Elevation: Outlet Elevation- Number of feet from nearest Road: a Side, ar O t From nearest pro line : feet Front ,OSide,ORear, O Number of feet t from: well ~_building: (Include this information of the above plot plan)( 2 reference-dimensions to sentie r„`,U~ A PUMP CHAMBER Liquid pacity: Manufacturer: pump Size pump Model: Pump/Siphon nufacturer: Elevation of inlet: Bottom of tank elevation: Gallons per cycle: Pump off switch elevatio Alarm Switch Type: Alarm Manufacturer: ' O Rear, Q•.~.~_ m nearest property line: Front, O Side, Number of feet ro Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Area Built Number of Lines.___ Width: Length-__-. Fill depth-.,to top of e: • Front O Side, O Rear, 0 It Number of feet m nearest property line: Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Number o ts: Diameter: Size: Bottom of seepage pit elevation: Liquid depth: Area Built: been used on any of the above soil Has either drop box O or distribution box O ~ 3/ ~ - absor ion sytems? (Check one). HOLDING TANK / Manufacturer: Capacity: Number of rings used:- Elevation of bottom of tank: Elevation of inlet: ~ O~ide, Rear, OFt.~ line: Front, Number of feet from nearest property Of 0 d Number of feet from well: dy) ~ r / h is f~ Number of feet from building: road 6U 7 Number of feet from nearest : ~~2 Manufacturer : ,1.~~~- Alarm 71^O Inspector: Plumber on job: Dated: License Number: HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 64016 ROBERT ULBRIGHT M p,R.S. •,uIS. MASTER PLUMBER UC. N0.3307 ar vN. INSTALLER & DESIGNER UC. NO- 0060 3/84:mj i r ► IsP ~t OP 1 YV{ yF 10 u 1 SIB 'I i~ ~ r ~ ab l { i 1 77 W }u r f. .d A 4 A l l r J' q 1 ~J ) S; ,J14 Ln er C► rig, f fit" l F X Q +4 ~r f , c _ O C3.M L E '7 E .r a Cn •r- a C 'a a .C V) E r O 4J •r > C7 N a r_ S •r L U a) o •rl , l.1 OD CL 4J 4J 0 r V d\ x r- Q W $WO 4- V O O u o v 2 'a a) u 04-) O v d <4 t ri C . C Q e fd t0 ro c rn.o A. c _c .v v o _o -X J co r- u go O C~ C C7 ._J •r v sc. V 0 > 3 L^ oL E L-' m M~ W d Q3 E o W J 4 i o W L L O (1) . (V ~ a y O U N Z [4-) bQ C:l Q N 4-~ V W Q V) (1) 4J IM Ix C) Q 3 C G C b 3 a ~ ^d o ; LL. d LLJ v O z~Fro Y C9 W O FQ- b O V th a Z a• J C9 N F-- I Q Lr) Z LA- o l~ O Cf) I ~ I G. I ~ Oo ~p _ W ° L- u 4- a) 4-) M 1p_ ? `tWn 0 m 3N h r1 w p a ez _ `U v cn ¢ w c 3 L N W J S- o +J rn.c L •N •r to vl W `A b c Q (u \y o al a 2 1~n f-~ _ ~ d N L; 4J > o \A d 0. ~-r Q U O C O R' \ M ~ • V W co Q. 4J 4) >U N'n W 4 d C aJ S- C C 00 ro ~u4i d-) 7facu QJ N J Q> 4tiL) a J p 3 to DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 MADISON, 1 53707 BUREAU OF PLUMBING . 2%ONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number 14,4 ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Ilrassigoedl TANK REPLAC NT NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE. Don Teske Rt. 1, Lake DriVe, St. Joseph, WI 5408, BENCH MARK IPermanem reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REE PT. ELEV. SW SE, Section 23, T30N-R19W, Town of St. Joseph Name of Plumber: MP/MPRSW Nn.. Cou my Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 79179 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL JLOCKING COVER PROVIDED: PROVIDED: _ OYES ONO DYES ONO BEDDING: VENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD: fROPERTY I I WELL BUILDING: VENT TO FRESH ALARM FEET FROM INE. AIR INLET: EYES ONO OYES NO NEAREST DOSING CHAMBER: MANUFACTURER 7_NGLIQUID CAPACI7V PUMP MOUEL PU MP;SIPHON MANl1F AC 1lIHEft WARNING LABEL LOCKING COVER PROVIDEDPROVIDED YES NO OYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTY WELL BUILDING ENT TO FRESH (DIFFERENCE BETWEEN FEET FROM "E AIRINLET PUMP ON AND OFF) OYES ONO _ NEAREST V SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing E': I~ 1,IAME rE ll naATE HIAL n D MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH IND.OF UISTR PIPE SPACING CoVEH INSIDE )IA SPITS JLIQUID DIMENSIONS TRENCHES MATERIAj PIT DEPTH. ,H .`2F1. '.)EPTH FILL DEPTH 1H. PIPE UISTR PIPE DISTR PIPE MATERIAL NO DISTUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER V. INLf J ELEV. END PIPES LINE. AIR INLET: ET FROM EAREST-s 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- OYES NO meets the criteria for medium sand. TIONS MEASURED. O SOIL COVER TEXTURE PFlIMANI NT MAHKEHS OBSEHVAnDN WELLS OYES ONO OYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED =--7) U[ F D SFF UFD MULCHED CENTER EDGES OYES. ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH NIOTH LENGTH NO.OF LATERAL SPACING GHAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MISTR. PIPE MANIFOLD MATERIAL NO UISTH UISTR. PIPE ELEVATION AND UISTNIBUTION PIPE MATERIAL & MARKING ELEV.'. ELEV.. LEV. PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING Y COVER MATERIALVERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL BUILDING: FEET FROM L, OYES ONO DYES ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. TITLEDILHR SBD 6710 (R. 01/82) [NATURE DILH SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code 441- -Attach complete plans (to the count copy only) for the system, on STATE SANITARY PERMIT# -See reverse side for instructions for completing this a paper not less than #7 pplication. 1. APPLICANT INFORMATION - srAT~L 3 I.D. NUMB PROPERTY OWNER PLEASE PRINT ALL INFORMATION. PETITION PROPERTY OWNER'S MAILING ADDRESS PROPERTY LOCATION FOR VARIANCE ❑ YES NO ~v 4.l3 5&j '/a Ste' S L.~ T 30 1 CITY, STATE LOT NU N, R MBER BLOCK NUMBER SUBDIVISIN N, (Or~ f~~/tv~iT~ ZSSO E PHONE NUMBER O CITY VILLAGE If. TYPE OF BUILDING OR USE SERVED: zpZ f ZQWN ST. Jas h" LAKE ORt'A}p Number of Bedrooms if 1 or 2 Family Z III. PURPOSE OF AppLICATION: OR ❑ Public (S (Check only one in (Specify). #1. Check # 2,3 or 4, if applicable) 1. a. E1 New b ~~st X Replacement c. ❑ Replacement of 2. A 5an►fary F'v~'tiK ~EP/4CEtic Tank Only d Reconnection of e- E] Repair of an erm'w previously Issued. Per' xlsting System 3 An Existing System has been ins t # 17 9 Existing System 4. 1:1 The System is shared b inspected and soil co Date Issued Q-p6 f itions more meet minimum requirements. than one owner/b IV. TYPE OF SYSTEM: E ding. cVCommon Ownershi (Check only one in #1 and only one in #2) P Agreement to County Copy 1• a• ❑Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. In-Fill Holding c. ❑ Pit Privy d V. ABSORPTION SYSTEM INFORMATION: Vault Privy e. ❑ Mound f• ❑ IGP 1• a• ❑ See a e Bed (Check one) 2. PERCOLATION RATE b. El See a e Trench (Minutes 3. ABSORPTION AREA c' See a e pit per inch): REQUIRED (Square Feet): pROPOORPTION AREA /t/. 4 ED (Square Feet): 5. SYSTEM ELEVATION 6. WATER SUPPLY: VI. TANK CAPACITY ' ~a~s ,voT INFORMATION ~ST in allons Total # of Feet ®Private ❑ Joint New xisting Gallons Tanks Manufacturer's Name Prefab. Site Se tic Tank or Holding Tank Concrete Con- Steel Fiber- Lift Pum 7 M structed glass Plastic App. VII. RESPONSIBILITY STA 17:: -11 - 1 -11111111 TEMENT NG I, the undersigned, assume responsibility for installation of the ❑ ❑ ❑ ❑ ❑ Plumber's mT Prin-&~ ❑ Plumb is Signature: (No Sta private ps) swage system shown on the attached plans. bXrek T- MP/MPRSW No. Plumber's Address (Street, city, state Business Phone N tuber: VIII. SOIL TEST 10, Name of De~ r: Name ON ip f•C Certified Soil Tester (CST) Name ~l ~►l. CST's ADDRESS (Street, City, State' HOME&TE SEPTIC PLUM81NG G0. WT. 3 O'NEIL RD.; HU CST # , Zip Code) Q$Q S y 11 W13. MASTER PLUMBER L MI LIC. NO. Phone Number: COUNTY/DEPARTMENT USE ONLY 3307 M•pf~~ Lr Q / ❑ Disapproved 3 ! - 'pproved ❑ Owner Given initial Sanitary Permit Fee F6 Groundwater Adverse Determination Surcharge Fee ate Issuing Agent 9MENTS/REASONS FOR DISAPPROVAL: Signature (No Stamps) r ry Plb-67) (R, 03/86 DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber COMPLETING A SANITARY PERMIT INFORMATION & iNSTRUCTlOAPP ICAT ON TO THE APPLICANT: permit is valid for two (2) years; and at the time of renewal any new be renewed before the expiration date, 1. This sanitary permit may licable; q new permit may be needed 2_ Your sanitary p permit issuing authority. roved by the ted wastewater flow (number of bed- criteria in the Wiscone~~dmust be ative pp Code will be a your building plans, system location, estima 3• All revisions to this permit to be if there is a chang or type of system; (S6D 6399} - , depth of system, permit TransferlRenewal Form rooms, etc.) or lumber requires a Sanitary ed by a licensed tank(s) should be pump 4. Changes in ownership por to installation; se p submitted to the county p pr( lerly maintained. The see 5. Private sewage systems must be P Pevery 2 to 3 years; CPtar I ycj;.If, iocal code adnlinistra°or or the pumper whenever necessary, usualy sewage sYste F ur private se~~ questions c,)ncer+ incj Yo 381 6. If you have q Bureau of Plumbing, 608-266-5• State of Wisconsin, ermit application must include: complete and accurate this sanitary' p stem is be To be comp tion where the sy Property owner's name and mailing address. Provide the legal descrsp ~ e 10 Unit apartment, 3(} seat ! indicate type of use (i. installed; is a one or two family dwelling; or Use served: If public is chebkb uild,ding lacement, reconnection or bedrooms if b 11. Type of building restaurant, etc.). Fill in number of Complete #2 if permit is for tank rep application: Check only one in $#I• if project Ill. Purpose of on system type. Check experimental only P repair; ro riate boxes depending IV. Type of system: check all app P 1 6; is in conjunction with University of Wisconsin; new and/or existing tank, list the total gallons to be installade bsor tion system information: Provide all information requested in 41-6; structed and tank material. Complete approval only V q p of every ne r site Check experimental Vl. Tank information: Fill in the capacity /si hon chamber and holding tanks for this system. number of tanks and manufacturer's name. Indicate prefab, for all septic, Irft P product approval from DILHR; prefix (e.g. tanks received experimental license number with appropriate statement: Installing plumber is to fill in n form. Fill in designer name if VII. Responsibility hone number. Plumber must sign application hone number. MP, etc.), address and p applicable; certification number, address, and p Vl11. Soil test information: Certified soil tester's name, lication is disapproved. IX. County/Department Use Only; or resaon given when app X. Comment area for use by county not smaller than 8'/z x 11 inches must be submitted to the county. The ecifications plan, drawn to scale or with complete dimensi Complete plans and sp q lot we►Is; water mains/water service; other treatment tanks; ons, location of building sewers; stems; replacement plans must include the following: points; distribution boxes; soil absorption sy holding tank(s), septic tank( } served; B) horizontal and vertical elevation etionreoss; PUMP dosing or pumping chambers; streams and lakes; elevation differences; Lion system if system areas; and the location u the and controls; dose volume; complete specifications for pump manufacturer', D} cross section of the soil absorption C) model and pump performance curve; pump fsoil test data on a 115 form. required by the county; ) - - - GROUNDWATER SURCHARGE red into law This legislation is rr ore On May 4, 1984, 1983, Wisconsin Act 410 was sig 1 c n as the groundwater- protection raw. This change in statutes was the n, know tian ;aad piabiit debate The' groundwatewhichr ll s of steady negot a WiscorlS ais f commo y year a number of regulated p a ifeesi f or , included the over 2 y creation of surcharges , 1984. All of the water than: buried ti (.as,ire / took effect on The surcharc; ~ roundwater through your soil absorptica^ can eff ect groundwater- ulY 1 in building is returnFd t the 9( tank pumper. ~e our holding rv is used in Your osal site used by y or the d{sp .er cnd adminis- system o to the grourcd wat r1"Our.d- The r;~onies collected thr:;ugh the `e ~,rr rcarges are efunre terec by These funad~s are used far r,con,tors u e Department of tiaatu ac P ls° rce~~. rou ati >ns establishment of standards. G Yh water, ndwater, er c°ntaminatio, and ir, . est g , groundwat it's worth protecting. ~,-_tSD-6398 (R.03186) 0 N O 3-0 n O ` m O > > 3 F rr p o a o ° o m F- w c° °C . CL m 0, 4 c- w ° CD 0, CD -;l CD 0 0 OD rp c) ID CC Pr~ A~ CD a o . O CL y j C d c CD o CD c z D c = CQ, O CD W a CL = m rn rn Z;3 o o o co o0D v n 0 to z 0 0 O N. O O O A l!`il C O vQ ~y c y N N CD O Q M G G m 7 i. N CL O I m a 90 X cr o CD w 3 cn m CD N v N z D o O 2 c m m CO) z z 35 a A z o I W T O W W M, Z o I y ~ ~ CD N N o p (O OD'D _S d 3 M-0 CL CD O CD N C) 3 rnm a o a v ' D m-I-so <0jfD~=< CD O m w O CD n t07 E p m V O CD N y O C04 C N O O CD , o m fi O 3 7 y CO ID 0 CD c V o D m m a CD C p m < cn ~n A 7 N O' M• CO, (D O.Co O< Cc m k-4 CD a; O VO CD a O Obi a 70c : p qN O p A O O 0 ti CD ~ b ti • Parcel 030-1051-60-000 03/24/2005 11:25 AM PAGE 1 OF 1 Alt. Parcel 23.30.19.197D 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner DONALD C TESKE * TESKE, DONALD C 1806 BROADWAY ST N STILLWATER MN 55082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1420 HIDDEN OAK TRL SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 23 T30N R1 9W PRT GL 1 COM 1981.4 FT Block/Condo Bldg: W & 1700 FT S OF E 1/2 COR SEC 23, S 1DEG E 161.9 FT, N 69DEG W 261.1 FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) LK, N 21 DEG ON LK 150 FT S 69DEG E 200 23-30N-19W FT TO POB Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 5152 182,700 Valuations: Last Changed: 09/0712004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 140,800 38,900 179,700 NO Totals for 2004: General Property 0.000 140,800 38,900 179,700 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 77,900 31,700 109,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 432.49 Special Assessments Special Charges Delinquent Charges Total 432.49 0.00 0.00 *w 1 1 a I 4~ Y, 9b HOLDING TANK AGREEMENT This Agreement is made and entered into this ✓ day of 19 by and between the 4hS hereinafter called the "municipality" and 7257T!`jr- hereinafter called the "owner." We hereby acknowledge that application is being made for the installation of (a) holding tank(s) on the following described property: fi r 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, any other type of private sewage system as permitted under ch. ILHR 83, Wis. Adm. Code, or ch. 145, Stats., and that the property does not contain an area of soil suitable for any other type of private sewage system as permitted by ch. ILHR 83, Wis. Adm. Code. Therefore, as an inducement to the County of to issue a sanitary permit for the above described premises, we hereby agree and bind ourselves as follows. 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. and 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 wner within thirty (30) days from the date of notice. In the event the owner does not pay tie costs within thirty (30) days, the owner hereby specifically agrees that all of the co is and charges may be placed on the tax roll as a special assessment for the abatement if a nuisance, and the tax shall be collected as provided by Wisconsin Statute. 3. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under ch. NR113, Wis. Adm. Code to have the holding tank serviced and to file a copy of the contract or their 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 frees the date of change to the service contract. y. , The owner agrees to ' who shalt submit to the contract with a person lice `(4) (a) 2 Wis Adm cipality and to the count used under ch. NR 113 . Code Code for the servicin s. I R .18 registration under s. 146.20 g on a s county a re rt in accord with s, LHR 83.18 municipalit (3) (d). Stats. emiannuai'> basis. In the case of y and the county. , the owner shall submit the report to the S. This agreement will remain o T' n`' served b regulation of private sewage Y untithe local by either a municipal s sYst governmental unit 83, Wis. Adm Code ewer or a Boil -certifies that the r In ad said certification with referen a to this atsor,'ptjQn System that co p OPerty is dition, this agreement may be cancelled b exec mp)les with existence of the certifi y utin ch. ILHR cation recording agreement in such manner which ch wil) Permit to be determined by reference to the the 6• This agreement shall be bindin property. assignees of the owner. 9 upon the shall be recorded b owner,:the heirs of the owner and The owner shall file the agreement with agreement to be det rtnhned register of deeds in a the register Of deeds which manner which by reference to thePr Permit t the existence of the SIGNATURE OF oper will a where the holding tank is installed. SIGNATURE OF MUNICIPAL OFFIC- (Include Title): r State of r came- afore me his County °f )to me known to be of A.D. lns be the person who 19 ument and_acknow9edged the same. the foregoing Subscribed and sworn to before Me this Y of pi- lei Ca Glyn a ette Notar P tdr f RO'ER7 ` ' Y ubl c !/pF H t W. McGARRY i MY CorRlll SslOn f r Notary Public, Minnesota State Of Wisconsin _ expires Washington County )f2~ MY Commission Expires December 26, 1989 mac RECEIVED FOR RECORD 73 day of June A.D., 1986 at 1`0_30o,clock A and recorded in Volume 743 - M. of Recj;r 387-388 of Deeds St. Croix County This instrument was drafted b Relations, Bureau of P1 Y the State of Wisconsin Depart urnbing, rrent of Industry, Labor and Human i N m P) Cf C+ A) M c+ C+ C+ C (D A (D (D (D w t7V .o y .'l7 Po 0 0 93 C.+ vu Z73• 7 cn (D C1 (D (D (D CD Cf- n 8 0 icn 1H. ¢t O A O O O O A O N 1-j r~ (D 0 C+ '.7 (D c+ C+ c+ O F'• O :O O N C'(' Ul '.r' .7 •.3' y M ~A CD I Cm29 O c-F \p ~O O y O N aS N oti i~ i¢ ! ix fU e~-i- d ~i N F O c+ w ^ O O O O 'd A-. ~ i(D C) iQ, ;A O N M F'• co i;W 10 z C+ _ CD s~ o vi o M N o 5 H y k (U , C-F i ° ct W M O Cr7 tx' w O i0 ico i. Ef) ~ r C+ o En o w C C :co _ 93 P3 CL M CD C+ cF CL I N PL) O N C+ CO+ CC-F cn ~ :(D i c~F w~ (D CD O P. w w N w ~ 'd o M m o w o Fl. (Al 'O3 H. ? o 0 M w H (CD CDC + n i0 i(D s ICE) O+ c 0 w F'' N. , i N C+ C (D (D w A (D A ca O i (D N w ' S (D (D 0 i Cl) c+ (D N M O M (D co w CD \40 'o N ((D N A y i. i in to w (D N 00 O O~ (D H 9 11 En It 1 F'. w C+ `.3 O N O CD i V1 i ' ?1A+ 'I Cm 91) CD CA I :C) :(D i CD CD C+. 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"C+' ON 0 HOLDING TANK SERVICING CONTRACT a This Agreement is made an! entered into this - day of 19 O by and between e:DOti -T',&~ hereinafter called the "owner" and ?';Ue 'S 0O/X14,,d ✓ sti~ll,~tu-hereinafter called the "pumper., We hereby acknowledge the installation of (a) holding tank(s) on the following described property: 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 _ ' ; eX6 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 submit a report which shall include: 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 prner agrees to file a copy of any charges to this service contract or a copy of a new service contract with the municipality and the County ofS Q,/x within ten (10) business days from the date of change to this service contract. r M n SIGNATURE OF 06WER(S); E SIGNATURE OF PUMPER (Include License Number ; T3 State o )cane before me thi~ County o )to me known to be the y of ~•0.~ 19 g~ )instrument and acknowldgedrson the who executed the foregoing Subscribed and sworn same, to before Me i s,5 of 19 N a- otary ROB:;;T W. /~cGgRRY E« Notary Public, My commission exp' S Minnesota rr Washington County my commission Expires December 26, 1989 This instrument was drafted b Relations, Bureau of pl~i y the State of Wisconsin Plumbing. DePart+aent of Industry, Labor and Human ~ D 1 L HqR Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 6 7 Plan Identification No' .....,...._.w._.. _ d~ Y~ C"--' 3G 4 (1 f r Gallons Per Day lay FO j 1+ ~ PRIORITY PLAN REVIEW ONLY Plan Rev [ve cceiviecl Petition For Variance I ee Re( Project Name Project Location - Street No. or Legal Description `f r f 1-4 W ounty ❑ City ❑ Village X C Town of: -F, I .3 a f The plumbing plans and specifications for this project have been reviewe for compliant s~Tp~pproval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. y FOR PRIVATE SEWAGE PLANS: O (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years from ate approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: James Sargent Bureau Director r~ If Questions Plans Approved By: - Date Ap roved: r- Ool Contact y - cc: Private-mow e Consultant El Plumbing Consultant L1 Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other ST. CROIX COUNTY WISCONSIN Sysx a ' ZONING OFFICE I 796-2239 (HAMMOND) ~i 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 27, 1986 <J State of Wisconsin, DILHR Bureau of Plumbing ~J P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of located at the SW1 the soils on the Don Teske to Jose h 4 of the SE, of Section 23 Property, St, p, was conducted on June 10, 1986, by Town Nelson, Assistant Zoning Administrator at the re' by Thomas C. Certified Soil Tester, quest of Robert Ulbricht, The determination made was that the site is suitable only tank. for a Should you have any questions regardin free to contact this office, g this subJ'ect please feel Sincerely. Thomas / C. Nelson Assistant Zoning Administrator TCN/mj ~Nri~E <a7- s~TS /N sit &-4 y . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS fNDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RF`LATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LSECTION: OWNSHIP LOT NO.: BLK. NO.: SUBDIISON NA1/a ~3 /TaO N/R /9 E Sr , .7•• d s E P H--4 - d i5~- 1W, OWNER'S/tYER'S NAME: ING 4Lg os>p' / ,/S c//O Z~ ESS: USE NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE (PROFILE ESCRIPTIONS: ER OLATIONTESTS: ~esidence 2 ~ ~ ❑ New Replace ~~vvE., fOt~ /9 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM : (optional) ❑s oU Cis ®u os ©U os NU ©S ❑U ~ E><CfSS%~ SLd S - W/NL oA.) GU - L C. 0 O4M If Percolation Tests are NOT required DESIGN RATE: any portion of the tested area is in the under s.H63.09(5) (b), indicate: Findicate Floodplain elevation: PROFILE DESCRIPTIONS ~;v _A-)2Ci.4A1_ ~f BORING TOTAL_ ELEVATION D LOBS TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST.. HIGHEST TO BEDROCK IF OBSERVED EE ABBRV. ON BACK.) , / /7' "9vo It 1& OR ;e- f 0 4t 94 - 15' B-l 3. J03 •83 S.L . a,rti- f or- G.. Hods o G,~>,y IS w f f-~- o je- G. na-FS. in A w' fff ox-G hoY S . w-p- ;q 7- B- .3 D• Ili A/ 4SAI, B- iNA ► aN . s o~~N~ s w ;emsa~ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIO 3 PER INCH PP- a f/i9 N/~ vhf 14U Op ~-S ' 984,0-- eg fJ1fT" RNs P_ = l3ACKGr o~- /D/ i P t&,Pr t4f PT. I'S 56r"kE SLT <iv/ het✓- f 75oq MM aq /oo.a 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. (5CALE „ = 3 10' SYSTEM ELEVATION o e~ o Jr . 7.5 - - . . tip E i 'x i N Q ,,u AAVe[ ~,pl~jtwr~y - y _ F 3 3 _ t !D&jr - w '`~~a ro ~I ' G~iu ' w9TE Jr4ff.G iiG.. o ~p9z - 40, 3090 s _ 13 M, 1 46p: -A'v pr t _ T 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. NAME (print): HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: RT. 3O'NEIL RD., HUDSON: WIS. 54016 `fume I ci, /f RLD ADDRESS: U RIGHT CERTIFICATION NUMBER: PHONE NU,MBER(optional): W MINN. MOMELER & DES MILK 1.110. NO-. OM IS. MASTER PLUMBER LIC. NO. 3307 M.PRB. 2 y? Z CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - t, -IONS FOR _DRM 115 l--~ 1e c 2. r _ 3, ` ALL. 1 iL 5( C ;J'1~ Y--- WARRAn fY DEED - - STA•fE OF WISCONSIN-FORM No. 9 .c.., W N...,W Waaa NUMBER This Indenture, n2 adobY..George_J..Schueler•and Esther Schueler, husband and wife and e?ch in their ow inc y ual•._c3pacity_-..._.-_._._-- grantor......, of...-.....xuasoni 9t.t._CroiX County, Wisconsin, hereby conveys and warrants to _ __--_•,_Donald C. Teske Stilly+at er. 1Yashineton one of _ _...grantee of..._.._.._......_.._......_.s..._....._..._..,. County. 01 the sum of..._.._.___e._thousand_,five, hundred (ls$00~ .and n~100 the following tract of land 1n......... SL-.•-_CTOiX .County, State of Wisconsin: A parcel of land located in Section 23, Township 30 North of Range 19 hest, described as fol_owss Beginn• • ing at an iron pipe stake which is 1981.4 feet Viest and 1700.0 feet South of an iron stake at the East quarter corner of said Section 23; thence South 1° 301 East a distance of 161.9 feet to an iron stake; thence North 69°201 West a distance of 261.1 feet to an iron pipe stake on the shore of Bass Lake; thence North 21°051 East along the shore of said lake, a distance of 150.0 feet to an iron pipe stake; thence South 69°201 East a distance of 200.0 feet to the place of beginning. Together with an easement for an access road to the above parcel Aver a strip of land 33 feet in width lying immediately east of and adjacent to the following line; beginning at the Northeast corner of the arst above described tract; ' thence South 1 o 30' East a distance of 498.9 feet to an iron pipe stake; thence South 26°071 Last a dis- tance of 122.9 feet to an iron pipe stake; thence South 0°271 East a distance of 327.4 feet to an iron pipe stake an the North line of the town road located along the South line of said Section 23. All the above bearings are true from polar observation; ($1.65) (R. S.) (can. ) IN WITS WHEREOF, the said grantor.S....ha--V& -hereunto set_._t.hei day or..._....._. Aril - saa seal.. ..sh>s . __Tw~aY-tl i x~d _ _ A. 5.5 Signed and Sealed in Presence of eo.Lgg...JJ:._achyg~ex • eorge Harold 'rlalbrand~ Harold ysthPr c i"ialbranclt ghueler Estfier Gertrude Pure- e Gertrude Burnley (SF") STATE OF WISCONSIN, SEAL Sts.-,Croix ss. Personally came before me, this. , .._...._....__......._..19th..._......__.........._........_. ........nay or..._......_..___..__npri]...•_...._._..__ the above named........... George... J....S.chueler.. A. D., 19...5 and..kfxk~tler....Scheeler.,...hi.s...lyife...._.._.._.._......_......_. o me known to be the person........ who executed the foregoing instrument and acknowledged the same. Received for Record this 23rd...... day of ....-....A. D., 19.1..5.-.. ut......ll..._.... A. o clock......M. _ . Harolci ivalbrandt ...............................................David Hope............. H...........arol :ti.....d..-.....a..lbrattdt Register or Deeds. S ) Notary Public...$x.....-rir01.1G County. Wis.. Deputy. _ MY Commission expires ......1!...~{....... A. D.. 19._~_.. H • H 9 r ST C- 105 r 9 H H SEPTIC TANK MAINTENANCE AGREEMENT 0 z St. Croix County d 9 H 16eS 72SA,-le OWNER/ ROUTE/BOX NUMBER Fire Number .CITY/STATE ZIB'Sw SE Z-3 PROPERTY LOCATION: 14, Section T 3O N, R /7 W, Town of St. Croix County, Subdivision'- I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to y three year expiration. ° E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- 'b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 9&' Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. w 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 Location of Property S ` SE 1, , Section 23 ~ T ~y N-RZy W Township ' j r /a Mailing Address lel 14: o f ~v/.s . yak Address of Site Subdivision Name Lot Number Previous Owner of Property /JeOr'x .SCkvr Lz- /0, k Total Size of Parcel Date Parcel was Created ~~~UfOV~~~'L l Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes J!~ ~ No Volume 'g 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 2aEe number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) ceAt 6y that aU :statements on this gonm ane -tAue to the best og my (ouA knowledge; that I (we) am (cute) the owneJtk) og the pnopehty desct bedin this ) ingonmation gonm, by viAtue og a warvtanty deed neconded in the Oggice og the County RegisteA og Deeds ass Document No. own the pnopod ed site gore, the sewage digs pas 3~s ys em_ (ondl that I hacve) obtained an easement, to nun with the above descAibed pnoperrty, Ran the constAuc ion og said ,system, and the same has been duty neconded in the Oggice og the County Regi6tett og Deeds, as Document No. L NATURE F ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE S GN DATE SIGNED L _7 ~ DILHgR Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. 1~z GO 11-3 ® r., 3 Gallonti Per Day iy0 / f ~1 , V L PRIORITY PLAN REVIEW ONLY Kin Rtwicw Iee Received Petition I nr Variance Fee Re( Project Name Project Location - Street No. or Legal Description 1 e S = o I ounty ❑ City ❑ Village L own of: C ` The plumbing plans and specifications for this project have been reviewe for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 13g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: (1 n(2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years fromN4@-bate approved below or if a sanitary permit is obtained it will expire the day the mrtlal sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: 1/ emu. yJ~~ - vri7 James Sargent Bureau Director If Questions Plans Approved By: , Date A roved: Contact y V 7, cc: Priva ew e Consultant ❑ Plumbing Consultant ❑ Environmental Health County , 11 Local PI 11 Facilities Need Analysis Section ❑ U -SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other V PROJECT T1I1D" ~ SHEET Q6 - 03 S 4 g r , OWNER : S Lv/N G--~/ Jt~ ADDRESS: R(q. Q ox q3 STi/)wh?Ek Mi tw . S,WZL SITE LOCATION: s w ~y sE ~y S-ec , z 3 7.73 OA) /14.) PROJECT DESCRIPTION: liiV X/S;rl -2 ~.CG~iC~DO C~~G ~ tris r/.v s t'i'c r FT /'s SeAl Z!/l1Svl fi/~/ D,~ 707pflo PAGE 1. PLOT PLAN VIEWS P-/tG 2. m tfo~0/N~ .~r~~~ , T S 4 P P- T D TUTT~)TT SPECS PLUMBER : SITE' EVALUATE HOMESITE SEPTIC PLUMBING Co or DESIGNER RL a O'NEIL RD., HUDSON, WIS. 5416 ROBERT ULBRICHT' WI& IMAS N TER PLR 8, ER LIC.ER NO. N7O. A~ HOWWR SEPTIC ~UM~NG CQ R1.3 0'N IL D R0 VA& 5016 R8iI!<N T U L9R!l~iT WIS. MASTER PLUMUR LIC, NO. 3307 N.P.R.I I WAN. INSTALLER & DINNER LIC. N0, gO 0 lop lP DATE : IF SIGNATURE 1 RECEIVED JUN `0 1986 P UM.3 j1G 13UREAU _---Y-- Ass /-AkE- j u,,, c 15 f a oIle 1 ` z o a ~ o 0 0\9 CP Ilk RN OeL- / CP ~ • v O O • ` ~ ~ R1 Od I f ~ m : ~ A kn a. CS -c` 10 -3 z a'a N -a ~ o z ~ pG c 1e ~ ~ V1 G CN b R► ~~j un C-1 cz~ C C ` vV m PO 1 °V N ~ Q