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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS
P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION
MADISON, WI' 53707' BUREAU OF PLUMBING
ECONVENTIONAL RRALTERNATIVE State Planl.D.Number
KNHolding Tank ❑ In-Ground Pressure El mound 19502957
r
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Russell Webster Emerald, WI 54012 U- S .24030
BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN:
REF.PT.ELEV.: CST REF. PT. ELEV..
NE SE, Section 31, T31N-R15W, Town of Forest
Name of Plumber: MP/MPRSW No.: rn y : Sanitary Permit Number
Ste hen Aab 5184 t. Croix 64921
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
n ` ^ ! P 0
41 j DED: PROVIDED:
J V _ 'a 'YES ❑ NO YES ❑ NO
BEDDING: VENT DIA.. VENT MAIL HIGH WATER NUMBER O ROAD: PROPERT WELL: BUILDING: VENT TO FRESH
C ALARM. FEET FROM / LINE: LAIR INLET:
OYES NO~ OYES ONO NEAREST !1
DOSING C A BER:
MANUFACTU. ER-. BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP/SIPHOTNUMBER . WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
OYES ONO EYES ONO OYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: OF PROPERTY WELL. BUILDING: VENTTOFRESH
(DIFFERENCE BETWEEN M LINE' IAIR INLET'
PUMP ON AND OFF) OYES ONO ~
-
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing UTAMETER MATERIAL AND MARKING
or excav ation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH NO.OF DISTR PIPE SPACING COVER NSIUE DIA #PITS LIQUID
DIMENSIONS TRENCHES MATERIAL: PIT DEPTH.
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: IN DISTR. NUMBER OF PROPERTY WELL
BUILDING: VENT TO FRESH
BELOW PIPES. ABOVE COVER- ELEV. INLET ELEV. END. PIPES: LINE.
FEET FROM AIR INLET:
NEAREST--s
-1 1 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 PERMANENT MARKERS OBSERVATION WELLS.
OYES ONO OYES NO
DEPTH OVER 7RENCH/BE5TED EPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED. MULCHED:
CENTER. GES:
OYES ONO OYES ONO OYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH LENGTH NO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING.
ELEVATION AND ELEV. ELEV. DIA. ELEV. PIPES: DIA:
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS'.
OYES t OYES ONO
COMMENTS: PERMANENT MARKERS: ATIONWELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
OYES ONO OYES ONO NEAREST
Sketch System on 'R'etain in unty file for audit.
Reverse Side.
SIGNA W ,y TIT LE.
DILHR SBD 6710 (R. 01/82)
Form- S T C - 104
p AS BUILT SANITARY SYSTEM REPORT
OWNER ~1 u C 5 Ze t e 2 TOWNSHIP
le L:' S t SEC. ~ f T _,~_N-R 15--w
ADDRESS P 9 ~~I w 'r ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW ? 8
6
Distances and dimensions to meet requirements of I•IHR. 83 ~FcF~
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM,
I
2
t
( P
P ~ 1
P ~ P
t
I~
~ 4!
j
~NDICATE NORTH ARROW
C6.
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side feet
,O Rear, O
From nearest property line Front,0 Side,O Rear, O feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
Width: Lenjth: Number of Lines: Area Built:
Fill depth to top of pipe:
Number of feet from nearest property line: Front, O Side, O Rear, 0It.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box O been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
SG
Manufacturer: Capacity:
WQ
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, G"ide, O Rear, 0Ft.100
Number of feet from well: v
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer: Inspector:
2 - ~S Plumber on job: 0--t-
Dated: _
License Number : mf , Cv
3/84:mj
wlsconsn APPLICATION FOR SANITARY PERMIT DILHR 6-~~LcOUNTY
- OEPRRTTEfITOF (PLB 67)
- InOUSTRV,LRBOR&HUMPinRELRTII UNIF M SANITARY PERMIT #
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'hx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
PROPERTY LOCATION CITY:
,
X114S~i1A S 3j T 3 N, R 1~g (or)® VILLAGE:
TOWN OF: dJC.
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK
STATE PLAN I.D. NUMBER
G J7 Lv 4_0 OZ
TYPE OF BUILDING OR USE SERVED x
y'~J 1 or 2 Family Number of Bedrooms: ✓ ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System ❑ Tank Replacement ❑ Repair
X Replacement ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit Holding Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issuea
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capacity ~d
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure
Total #of Prefab. Site
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA
(Minutes per inchREQUIREDj(Square Feet): PROPOSED (Square Feet): WATER SUPPLY:
a Private ❑ Joint ❑ Public
1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: MP/fMPMWA4-No.: Phone Number:
STE A`2 A x4 L A7
h .~I~' ~7i~► yU7
Plumber's dress:
Name of Designer:
laZ ~ T ova ~~~r ~v " ad T
COUNTY/DEPARTMENT USE ONLY
Signat re of Issuing Agent: ee: Date:
❑ Disapproved
7 }ice( ❑ Owner Given Initial
d ~ (C! Approved
eason for Disapproval: Adverse Determination
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
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.
Division
DILHR PLAN APPROVAL Bu eau of Phu Plumbing
P.O Box 7%9
General Plumbing Plans Madison, WI 53707
Private Sewage Plans 7 Telephone: (608)266-3815
vG CE USE ONLY
O P dentification No.
onti Per Dad,
41
, 4-Y
V
PRIORITY PLAN REVIEW ONLY
Plan Review
Petition For Modification
Pr2iect Name Project Location -Street No. or Legal Description
A-J ~?C,~ ~ l°~..~. .1F>-.,•..•~-' /J'am` ~ ` i f
❑ city ❑ Village , ° County
Town of:
r S -
("3
C
The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. his 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.
O FOR GENERAL PLUMBING PLANS:
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:
This approval will expire two years from'the-dje approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary
permit expires.
Comments:
By:
James Sargent
Bureau Director 1
l
If Questions Plans Approved By:D'ie proved:
Contact
cc: ' OWS El DPS ❑ H&R & Rec. San. Section"
County 1 ❑ Local PI ❑ Facilities Need Analysis Section
❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture
DILHR-SBD-6099 (R. 01/84) ❑ Owner ❑ Other
SBD 6678 JR. 08/83) (Plb100a) (Wis Slats. S. 145.02) J
Detach And Return Upper STATE OF WISCONSIN DILHR
DIVISION OF SAFETY & BUILDINGS
Portion Of This Form With
BUREAU OF PLUMBING
Any Return Correspondence 2011 E. WASHINGTON AVE. RM 141
L ~ P.O. BOX 7969
D~ } MADISON, WI 53707
C 608-266-3815
DATE: 06/07/$5 Cl) c n PROJECT:
M rn
M= 7Z=+ Webster, Russel
01 co rn co 2
l cco NE,SE,31,31,15W
Forrest
Stephen baby `
St. Croix WI
box 254, 124 Main Street
Woodville W1 54023
PLAN ID. # 85-02957
- - - DETACH HERE
Webster, Russel 35-02957 -
PROJECT NAME PLAN ID: #
This is to acknowledge receipt of your plans and specifications for the above4ndicated project.
Preliminary review indicates the required fee is $Fee Received is $ 60.00
Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance.
r EN Plans being returned. *No verpayment-Refund forthcoming
~
❑ Additional information required. SEE BELOW. fee has been remitted. Plans will be held in abeyance.
1. Plan Submission ❑ Soil borin and
Additional information shall be submitted in du licate unless g _ percolation test data on 115 completed
p by Certified Soil Testes (1 copy) ' -
specifically noted. ❑ Petition For Modification signed by county, owner and
❑ Plans not clear, legible or permanent.
notarized. (1 copy)
❑ All information submitted shall be signed, dated and sealed or
stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin Deed E] restriction relative to anticipated use of building.
❑ restriction-equired. (1 copy)
Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. 1 c
❑ Plot plan showing location of land ( copy)
parcel- (distance from.
nearest road intersection, eta), lot size and all distances from IV. Holding Tanks
private -sewage system. to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole,, alarm,
course, swimming pools, water service piping, all weather ser- and manufacturer if state a
vice road, etc. Show benchmark with permanent elevation. pnsW Complete
construction details if site constructed
• ❑ Holding tank agreement signed by owner and local
11. Pressure Distribution Systems (Mound or Inground Pressure
unit of government (sample enclosed)..
Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from
and notarized. (1 copy) county or soil boring and percolation test data on
❑ County onsite required, (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system
❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel.
Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed).
❑ Cross section of system. ❑ Pipe lateral layout.
❑ Plan view of system.' V. Dosing Information
❑ Verification fo Exception Status Formby county. (1 copy) ❑ Calculations for total dynamic head and gallons
pumped per cycle. Private Sewage Systems ❑ Size, length and depth of force main.
❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of
system extending 25' minimumon all sides. Pump or automatic siphon, including
size, pump curves, drawdown, and average flow rate (GPM).
❑ Location of area suitable for replacement system- provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s).
data.
Construction details of septic, holding or dose tank if site Vl. , Systems in Fill (Fill must be placed prior to plan submission.)
constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge
Construction details "and cross section of soil absorption of trench before side slopes beg system. P~ e9 in.)
❑ Depth and type of fill
Copy of signed onsite report by county or district staff.
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~Un! 0 7 1995
CT H ,
UMB1NG BUREAU
~r
DEPARTMENT OF ~ - a
VDUSTRY, REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
DIVISION
ABOR AND P.O. BOX 7969
iUMAN RELATIONS
PERCOLATION TESTS {115)
.r (H63.090) & Chapter 145.045) MADISON, WI 53707
OCA ION: SE TION: TOWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION AME:
f / /T3/N/R ST(o om s 7"
OUNTY: - OWNER'S 8 E11 NrA,ME:
MAI I ADDR SS:
~ 1rG.co/x
SE u J x T Izr ivH X n 4~ Gv; S- Z/ ~
1
NO. BEDRMS : COMMER AL DES RIPTION: DATES OBSERVATIONS MADE j 11!1; 1111 1 `1 1
Residence PR
13 ` ONew EKReplaca 10 S: A N ESTS:
o- y-
ATING: S- Site suitable for system U= Site unsuitable for system
ON~V ~ TI NAL: MOUND: IN-GROUND?RESSUR :SYSTEM-IN-FI=[HZ&(jDS~1 DSzU DSsU U
Percolation Tests are NOT required r!~W= nder s.
H63.09(5) (bl, indicate: If any portion of the tested area is in the [Fl.odplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
UMBER DEPTH IN. ELEVATION OBSERVED
ORING TOTAL P HT R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
.3' C v T,
/ d , • y
700
Al e
We- 0 7S • d h7iV C.
V C L 0I T ~ v. Hm
3-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME
UMBER INCHES AFTERSWELLING INTERVAL-MIN. DROP WATER L V L-IN HES RATE MINUTES
- PER INCH
OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
,tal 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
land slope.
YSTEM ELEVATION ~ c.4' ed~ E e
r
' ; ~ w ~ ~ I I I I r t- +
i_
-
I I
.he 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
ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
MME print
TESTS WERE COMPLETED ON:
)DRESS: - RECEI yo
CERTIFI AT NU BER: PHONE NUMBERIoptionall:
1 7-
CST SIGN TU
Ath-111JZ PLLJME31 UG BUREA
-RIBUTION: Original and one copy to Local rty Owner and Soil Tester.
I-SBD-6395 (R. 02/82) t'9_5j
V /VER -
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NOTE: As spedified in H63.18 (4 A) Wisconsin Administrative
` 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 agreement, with the
recording dates and numher should be submitted to this office.
HOLDING TANK AGREEMENT
This Agreement is made and entered into this µ day of
by and between the , A.
- - , hereinafter called t - ,
an -1r~ *==14 hereinafter called t Fe
"Owner.
We hereby acknowledge that application has been made for a building
permit on the following described property, to wit: / a 9 _",.r tom.' j 1 ! • 1.
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 to
issue a sanitary permit for the above described pram sees, we hereby agree .
and bind ourselves-as follows.
t
1. Owner agrees to conform to all applicable requirements of the
Plumbing Code relating to holding tanks. Any time the Town or Municipality
of through its Plumbing Inspector or Health Offi-
cer, ems necessary EF`p~ump out the subject holding tank, the Owner
shall have same pumped out in twenty-four (24) hours, or will have said work done and charge same back to Owner and place same on
the tax bill as a special charger . The Owner further agrees that the Town
or Municipality of ,may enter upon the property des-
cribed above at any reasonable time, SO inspect, or pump and haul wastes
from the subject holding tank.
2. Owner agrees to pay all charges and costs incurred by the Town or
Municipality of 4-
go 1-,v r~ j~ for inspection, pumping, hauling-or
otherwise servicing an maintaining tTe subject holding tank in such a man-
ner as to prevent or abate any nuisance or health hazard caused by such
holding tank. ..,1-1.I% shall notify the Owner of any such
cost which shall be paid by the Qwner 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)
TA
r
Page 2
3. Owner agrees to have a quarterly pumping report submitted to the
local government and the county which will state the Owneer's name, location
of the property on which the holding tank is located, pumper's name,
report
the dates, volumes pumped and the disposal site. An annual pumping
or the fourth quarter report including a summary of the pumping history of
the previous year shall be submitted
ntal unit~responsiblef perusectiona145.01
and Nunn Relations by t 9
(15), Wisconsin Statutes.
4. We guarantee that the holding tank contents wills be Adisposed of at
dministrative
a site meeting the requirements of chapter NR 113, Code.
5. This agreement will remain in affect only until the sanitary permit
issuing agent in County certifies that the subject pro-
perty is served bye r 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 ex1cuthegfi and recording certification with re-
ference to this Agreement,
6. This agreement shall be binding upon the indicated governmental
unit and the Owner or heirs and assignees and shall run with the deed.
)MESS our hands and seals this „ day of 7 7~
TOWN OR MUNICIPALITY OF ~
OWNERS
by
by
STATE OF WISCONSIN
Personally came befo me this 3~N day of
1995' the above named R s'7-1 '
to me known to be the persons w execu e e orego ng in n an
ackncwledgted the same.
THIS INSTRUMENT
DRAFTED BY:
My commission expires :
.
k`= ST C R O 1z COUNTY
' 4V
W1SC0NSI N
~yll' 'c•,x~ ZONING OFFICE 796-2239
iui: to
• ' POe.t 0666ice Box 227
il`t~ `ti # Hammond, WI 54015
O W N E R
P U M P E R
A G R E E M E N T
PLEASE BE ADVISED, Tkat unt.it you ane again no.t.i6.ied, I wilt r
comtkact with ,fjrr~ C -G 06
NiA conb.in, (PumpeA), bon the punpob e o6 nemov.ing att wab.te 64om the
Ada.,taAy ayetem to be tocated on the pnopen.ty and 6utune home &it
Located in St. Cno.ix County, W" cone.in, Townah.ip o6 , L
being in the A/ , h o6 .the o6 Sec. T. N.-R._L:~W.
(04 mou Gutty deecnibed ad 60t.towd )
Vated thiA L day o6 19 & ' .
(OWNER)
State 04 W.ia cone.in )
ae
County 06 St. Cno.ix )
Penaonnattyappeaned be6one me. this day o6.
the above named to gffl~T AWf e
penbon who execute t e--~onego4.ng ina.tnumen.t and G~k edged eame.
UBLIC 2
o any u cc, y,
My COMM. (.i,e p enm QE aD~b1 ) 1 3~
I• r/"A-' heneinnbe6one ne6etted to ae Pumpers,
j o.in in t e a ove ag4eement to the extent that I 'hav e a con.tnac-t with
OwneK ae above .6 ta.-ted.
(PUMPER)
NOTE: As spedified in H63.18 (4 A) Wisconsin Administrative ~
• 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 agreement, with the
recording dates and number should be submitted to this office.
HOLDING TANK AGREEMENT
This Agreement is made and entered into this day of
19 ~Z'~• by and between the
i t hereinafter called /
and Owner.
l' rL-r' here na ter ca eTtFie
We hereby acknowledge that application has been made for a building
permit on the following described property, to wit.
~ V
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 c;'r
issue a sanitary permit for the above described prem ses, we ere y agree.
and bind ourselves as -ful°lows.-
Owner agrees to conform to all applicable requirements of the
Plumbing Code relating to holding tanks. Any time the Town or Municipality
of~ '
through its Plumbing Inspector or HealthOffi-
,eenis~ n e
cer, cessary to pump out the subject hold
shall have same in9 tank, the Owner
f pumped out in twenty-four (24) hours, or T
i will have said work done and charge same back to Owner and p~
o~n
the tax bill as a special charge. The Owner further agrees that theeTown
or Municipality of - T"
may enter upon the property des-
cribed above at any reasons a me, o nspect, or pump and haul wastes
from the subject holding tank.
2. Owner agrees to pay all charges and costs incurred by the Town or
Municipality of ~
Municiise tarok ng an ma n a n n for inspection, pumping, hauling or
ner as to prevent or abate any nuisance orbhealthohazardtcaused bycsuchn
holding tank. shall notify the Owner of any such
~l
cost which shall' e pa y t e ner w thin 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)
Page 2
in reporterus name, location
3, owner agrees to have a whichewillp state gthe Own
local government and the county tank is located, the pumper's name,
of the property op which the holding in report
the dates, volumes pumped and the disposal site. annual pumping
history of
or the fourth quarter report including a summary of f the pumping try, Labor
nd
the previous year shall be submitted o unit Dresponslblef per section 145.01
and Hunan Relations by the go
(15), Wisconsin Statutes. ts will be disposed of at.
4, We guarantee that the holding tank 113, Wisconsin Administrative
a site meeting the requirements of chapter NR
Code. permit
5. This agreement will remain in affect only until the sanitary p
County certifies that the subject pro-
issui in perty1gs seagent rved d by e r a pu c sewer or a septic tank soil this A
sys gree-
syste em that complies with ch. H 63, Wis. Adm. Code. In addition,
ment may be cancelled by executing and recording saidedertification with re-
ference to this Agreement, in the Tract index indi 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.
~I LITNESS our hands and seals this day of
19
TOWN OR MUNICIPALITY OF
OWNERS
l
by
by
STATE OF WISCONSIN
Personally came befor~ me this 3drm- day of
10 9-5' -the above named n umen an
to me known to be the persons who executed e orego.ng
i acknowledged the same.
THIS INSTRUMENT
DRAFTED BY:
My commission expires
p
-nl
~e t~„r~ ~ ~.t z 3r-v.. if~. s y I ~ a Y , s,:....•.- J- i.~ R '
ii -h i is
NUMBER n
5851 140561W4
T OF TITLE
A B S T R A C` ~hY F
z - - r 4 4
the fallowing described qW & . $ yN `x ' ` A
0
ST. CROIX COUNTY, WISCONSIN
i
i
j f
C
i.
SOUTH EAST CURTER. (SE4) OF SECTION THIRTY ONE
(31) TOWNSHIP THIRTY ONE (51) NORTH" OF" RANGE
NUMBER FIFTEEN (15) WEST.
7T 11,1-
-
The final judgement entered in the above entitled estate, on
Recites. that:
26, 197b, contains the following find'Q9s1~,~6fact and decisions,
October
1. The decedent died on February
and income taxes have been determined and paid and all
2. inheritance
143 lnd Chars have been Daid, were assigned as
3. Beat property and secured interest in real property Wissons n.
A -REAL E51~11E: St. lCounty AiQ-tutfieas Ouarter(SEY:) of Section 31-31-1 also known as Russell E. We - Webster, Also Other land. is hereby
assigned to Russell ` ster.
i
96
Land Contract.
Russell E. Webster and Con- $55,00ct
Lorraine C. Webster, husband Dated Dec. 15, 1976.
and wife, Ack. Dec. 15, 1976.
-to- Renc. Dec. 17 1
page 5136 #337177.
David A. Webster, a single
man.
e W rt
"R
The SEbof Section -15; and th'h of SE'k of ec
31-31
Y q 5..
Croix County, Wisconsin.
Recites. This is not 11coestow #rw i'•
4
97
Agreement
Doc. No. 350889
See Next Page.
(Relinquished, See No. 98),
98
h.
Relinquishment of Initial Farmland
State of Wisconsin, Preservation Agreement(No.97).
gust 19, 1982.
Department of Agriculture, Ack. Au 1982.
Trade and Consumer Protection, Rec. August 23,
by Director , Farmland Pres- In 11650" page 574, #379305.
ervation Program, Relinquishes Initial Farmland Pres
y: -to- ervation Agreement recorded in
11579 page 294.
David A. Webster.
}
e
a
7
a
r=
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State of Wisconsin
ss
County of St. Croix t
THE ST. CROIX COUNTY ABSTRACT COMPANY hereby certifies that the foregoing abstract consisting
90 100 both inclusive, is a correct abstract of title since
of entries No. to
April 28, 1948 at 10:00 o'clock in the A. M. of lands described in
Caption No. 90 hereof, to-wit:
SE'/4 of Section 31-31-15.
That, for the period covered by this certificate, said abstract no correctly s wsthll Register oafffecti
Deeds
in office of e
or relating to the said title which are recorded or filed for record
of said County, including Federal Tax Liens and Old Age Assistance Liens filed therein against the parties
listed below. ' bstr
ere For the period covered by this certificate, tto such Ponds docketed in'the offa a of the Clerk ofuCourts
fied mechanic or material liens affecting
in said county for the past two years.
That, except as shown in this abstract, there are n on unsatisfie wit hen tthe' pastd'ten yelars,uastand
come Taxes, docketed in the office of the Clerk of Courts I
against the following named persons which affects the title to the real estate above described to-wit:
Earl Webster
Miriam Webster
Russell Webster j
Russell E. Webster
Lorraine C. Webster
or
David A. Webster.
That for the period covered by this certificate, all instruments appearing in this abstract contain the
necessary number of witnesses and acknowledgments unless certificate that we have carefully examined 'i
We further certify that for the period covered by recor
d of the records in the office of the County Treasurr thfor t. e Seal Cestate described in th is absra'ctd, except as shown
paid taxes or assessments standing as a lien on ~
herein. Such examination covers up to and including the taxes for th certificates, i made b the un-
That this certificate and annexed abstract and also any prior any, Y
dcovering the some land, are furnished for
title, including benefit of any darll owners of the land
dersigned, {
described in said caption and their successors in tit mortgagees and gntors of title.
A.D. I
Dated at Hudson, Wisconsin, this
30th day of May 1984_ at 8:00 o'clock in the A M.
ST. CR COUNTY ABSTRACT COMPANY
By
Assit Secretary
i
O~\T LF, ,S9 j
O/
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ST. CROI X COUNTY
Nor,
r 1 tt~. w11ti f'' `"u Z O N I N G O F F I C E 796-2239
Poet 0 ce Box 227
Hammond, i Wl 54015
O W N E R
P U M P E R
A G R E E M E N T
PLEASE BE AOVISEVV That unt.it you ane again not.i6.ied, I witt
contatac# with o 6
Wi4CoKAis, (Pumpex), bon the punpoee o6 nemov.ing att waete 64om the
san.i.taxy eyetem to be toeated on the pnopen..ty and 6utune home e.ite
Located in St. Cnoix County, Wi4cone•.n, Townahip o6 L 0:~ f -
b eing in the ~4 06 the j ~ 4 o j Sec. T.* Ji-N . - R . _Ls--W ,
(Oa IOo Alt 6u.tty dee c-..i.bed ae` 6 ottowe . )
y
Dated th.c.e day o j 19 ~.5 .
(OWNER)
State 06 Wie cone.in )
ee
County 06 St. Cho.ix)
PeneonnattyappeaA be6o-te me th.ie 22-A~pday 06 19 J~
the above named ~o to me no to ~ Abe
--14 L14- peneon who execute the- oxegocng Fent
umnd ck edged the came.
y u ..c, t. noix
oun y,
mm . A ie pe~cmant )
iribe6on.e ne6 ea.)eed to as Pumpers,
loin 4.n t e above agheement to a extent that I have a contnact with
Ownea ae above 6tated.
~~aAX ' (PUMPER)
ST. CROI X COUNTY
W I S C O N S I N
13~~'19
ZONING OFFICE
'q4q > 796-2239 (HAMMOND)
'425-8363 (RIVER FALLS)
`°w z HAMMOND, WI 54015
Q 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:l RETURN COMPLETED FORM TO:
ADDRESS:', ST. CROIX COUNTY ZONING OFFICE.
P. 0. BOX 98
HAMMOND, WI 54015
~
TOWNSHIP: 715-796-2239 or 715-425-8363
PLEASE PROVIDE F LOWING ORMATION ACCOMPANIED
B RECEIPTS FROM YOUR PUMPER:-
NAME OF PUMPER:
t
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
STATEN ENT
Glenwood City, Wis. 54013
In Account With
Cassellius Sanitation Service
Robert Cassellius
Phone 265-4623 Glenwood City, Wis. 54013
64 !
3
~ ~ . 111IIIp
z_
~o
6~ I
Finance Charge of 11/2% per month, with a mi imum charge of 50c, will
be added to all accounts ove 30 days.
/
r ST. CROI X COUNTY
W I S C O N S I N
co
ZONING OFFICE
796-2239 (HAMMOND)
mss` 425-8363 (RIVER FALLS)
HAMMOND, WI 54015
Q U A R T E R L Y PUMPING R E P O R T
ST. CROIX COUNTY
NAME Dz'~ /z l d, 7C f RETURN COMPLETED FORM TO:
ADDRESS (If+ J ST. CROIX COUNTY ZONING OFFICE
P.O. BOX 98
HAMMOND, WI 54015
715-796-2239 on. 715-425-8363
TOWNSHIP
P EASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED
BY RECEIPTS FROM YOUR PUMPER:
NAME OF PUMPER:
LOCATION OF DISPOSAL SITE:
NUMBER OF PERSONS LIVING IN RESIDENCE:
USE: DEAR ROUND SEASONAL (CHECK ONE)
JULY AUGUST SEPTEMBER
DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED
u
THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15 1985.
OWNERS SIGNATURE
R
FLB-r Leroy Jansk
INSPECTION REPORT 13 E Spruce O. WS Department of industry,
Chippewa Falls', Labor & Human Relations
ame o remises (715) 723.8786 w' 54729 Safety & Buildings Division
Bureau of Plumbing
Sty t„ a e an
as a um e _ E oun y Sanitary. erm~
i rm ame ress . cRo~
occ.uf~nri,'~'
s
F 1~, res
ht
wner
AV K1 res 53A E L VtJ`r 544i
r~
Ole-
~.W._
i scusse wi
igna ure
~ )See Attached.
DILHR-SBD-6192 (R, 11/83)
Signature o is um in g p. n- a as p a is
jEPARTMENT aF REPORT ON SOIL BORING$ AND SAFETY & BUILDINGS
VDUST4?Y~, DIVISION
ABOO AND OLATION TESTS (115 P.O. BOX 7969
IUMAN RELATIONS \ MADISON, WI 53707
3.0911) & Chapter 145.045)
. S
AL --~a
-OCA ION: SECTION: TOWNS IP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION AME:
4 /T N R S'" I(o
:OUNTY: OWNER'S BUYER'S NAME: IMAILING ADDRESS: -
S T G~ o/ u s .E Jz. X A 7 c>✓ Gv i S' y O/
SE DATES OBSERVATIONS MADE '
NO. BEDRMS : COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
gResidence ❑New Weplace_
ATING: S= Site suitable for system U- Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: TEM-IN-FILL OLDING TANK: IRECOMMENDED SYSTEM: (optional)
DS 1AU D S ICU El S ZU rVS❑ S NU ';;;:;Or S DU
f Percolation Tests are NOT required DESIGN RAT : If any portion of the tested area is in the
nder s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PQP~3
PROFILE DESCRIPTIONS
ORING TOTAL _QgPIH TO GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
UMBER DEPTH IN. ELEVATION OBSERVED EST. HIG H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
Al AO . /o . y A8 A/ Q . S C fx, o T
ire N0 Al f . 0ay' 8y C~ - AY aL 4;z,41-4
r
, D N 1/9 Al L
rte 'ell a 4
. N e, HOT ,
3-
3-
s- I
PERCOLATION TESTS___,:,:? D 7
TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
=UMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD PERIOD PER INCH
OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
aal 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
land slope.
YSTEM ELEVATION 41114 ~-r-a C-/ eaO s k e e Y-'-
I
a a
,
,he 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
ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
MME (print) ~j TESTS WERE COMPLETED ON:
I 42 fin/ .L f~d 6e
)DRESS: ? CERTIFI AT NUMBER: PHONE NUMBER (optional):
O
CST SIGN TUR
STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
HR-SOD-6395 (R. 02/821 - OVER -
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Parcel 014-1067-20-100 12/19/2005 08:15 AM
PAGE 1 OF 1
Alt. Parcel ' 31.31.15.493A 014 - TOWN OF FOREST
Current XST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - WEBSTER, PAUL L & ROXANNE C
PAUL L & ROXANNE C WEBSTER
1840 CTY RD D
EMERALD WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1840 CTY RD D
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 25.000 Plat: N/A-NOT AVAILABLE
SEC 31 T31N R1 5W PT NE SE THAT PT OF Block/Condo Bldg:
PARCEL DESC IN 983/527
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 983/527 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
95161 146,000
Valuations: Last Changed: 10/18/2005
Description Class Acres Land Improve Total State Reason
PRODUCTIVE FORST LANDS G6 22.000 39,600 0 39,600 NO
OTHER G7 2.000 15,000 93,300 108,300 NO
ENTERED BEFORE 2005 OPE W7 1.000 1,100 0 1,100 NO
Totals for 2005:
General Property 24.000 54,600 93,300 147,900
Woodland 1.000 1,100 1,100
Totals for 2004:
General Property 24.000 10,000 54,500 64,500
Woodland 1.000 500 500
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
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DUS TMENT OF SAFETY & BUILDINGS
EPAT ME
REPORT ON SOIL BORINGS AND
ABOR AND PERCOLATION TESTS (115) DIVISION
iUMA MAN RELATIONS P.O. BOX 7969
,E - jr (1-163.090) & Chapter 145.045) MADISON, WI 53707
OCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK NO.: SUBDIVISION AME:
%U1 / /T3'/N/R S?(o ors rs "r V
:OUNTY: OWNER'S B ER'S NAME:
+ MA LI ADDR -SS:
~G.zo~x u s.E wt x n y Q/ Gvi s"yp/
SE
NO. BEDRMS : COMMER IAL DESCRIPTION: DATES OBSERVATIONS MADE
Residence ~ PR D S IPTIONS: R A ION TESTS:
❑ :New Replace
ATING: S= Site suitable for system U= Site unsuitable for system
ONVE(NTIONAL: MOUN~`D: IN-GROUNQD PRESSURE: SYSTEQM-IN-FILL HOLDIING TANK: RECOMMENDED SYSTEM: (optional-)
J ~7 EIS ZU EIS X0 "I EJU
Percolation Tests are NOT required DESIGN RAT
nder s.H63.09(51(bl, indicate: If any portion of the tested area is in the q
Floodplain, indicate Floodplain elevation: ~2tQBa`~ e 4
PROFILE DESCRIPTIONS 1T Le►
M TOTAL P H TO GR U'NDWATER-INCHES
U CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE,
UMBER BER DEPTH IN, ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) AND DEPTH
' ~ v 110 Al O . to
;2. lp iVa Al e
.~y .~yA9N C~ ,a- s-
wa A, r L
' S" ~N c L , ~8~ r✓ e L ,yv 7 frm
3-
3-
PERCOLATION TESTSD
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L-IN HES
UMBER INCHES AFTERSWELLING INTERVAL-MIN. RATE MINUTES
P RI D 1 PERT D PER INCH
- -
OT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate
land slope scale or distances. Describe what are the hori-
+tal 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
,
YSTEM ELEVATION
e e ~
1
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( _
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111
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{
-4- 11
:he 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
ministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
MME (print
TESTS WERE COMPLETED ON:
IZ-
)DRESS: J
CERT1FI AT NU BER: PHONE NUMBER (optional):
17
CST SIGN TU
RIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
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