HomeMy WebLinkAbout036-1008-90-000
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County z
d
r'' a
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number
CITY/STATE ZIP
PROPERTY LOCATION:, Section T N, R W,
Town of _ Y
St. Croix County,
Subdivision Lot number '
1
I
Improper u
se 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
three year expiration. H
0
E
I/WE, the undersigned, have read the above requirements and agree z
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart-
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 i
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
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Parcel 036-1008-80-000
Alt. Parcel 4.31.17.5381 01/10/2007 04:45 PM
PAGE 1 OF 1
Current X
036 - TOWN OF STANTON
ST.
Creation Date Historical Date Map # Sales Area Application # Permit # CROIX
Perm tOType Y, WISCONSIN
Tax Address: 00 0
Owner(s): O = Current Owner, C = Current Co-Owner
LARRY L & GRETCHEN J DEMULLING O - DEMULLING, LARRY L & GRETCHEN J
2398 CTY RD CC
STAR PRAIRIE WI 54026
Districts: SC =School SP =Special
Type Dist # Description Property Address(es): * = Prima
SC 3962 NEW RICHMOND * 2398 CTY RD CC Primary
SP 1700 WITC
Legal Description: Acres: SEC 4 T31 N R1 7W 8.OOA IN NE NW LOT 1 CSM 8 000 Plat: N/A-NOT AVAILABLE
VOL 3/873 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-31N-17W
Notes:
Parcel History:
Date Doc # Vol/Pa e
07/23/1997 1043/145 Type
07/23/1997 866/1_ WD
07/23/1997 _ 608/303 LC
2006 SUMMARY sill
Fair Market Value: Assessed with:
166387 271,400
Valuations:
Description Last Changed: 05/26/2004
UNDEVELOPED Class Acres Land
OTHER G5 6.000 Improve Total State Reason
G7 2.000 5,000 0 5,000 NO
20,000 203,400 223,400 NO
Totals for 2006:
General Property 8.000
Woodland 25,000 203,400 228,400
0.000 0
0
Totals for 2005:
General Property 8.000 25,000
Woodland 0.000 203,400 228,400
0 0
Lottery Credit:
Claim Count: 1 Certification Date:
Batch 140
Specials:
User Special Code
Category Amount
Special Assessments
Total 0.00 Special Charges Delinquent Charges
0.00 0.00
Form- S T C - 104
AS BUILT SANITARY SYSTEM REPORT
f
OWNER Y-\ `r TOWNSHIP SEC: T N-R 7 W
ADDRESS ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Ch
1
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: /C-L Proposed slope at site: rl4%
SEPTIC TANK: Manufacturer: Liquid Capacity:
JJ
Number of rings used: Tank manhole cover elevation: J
Tank Inlet Elevation: Tank Outlet Elevation: '
Number of feet from nearest Road: Front,O Side,0 Rear, O > feet
s
From nearest property line Front, Side,O Rear, /L feet
Number of feet from: well building:
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
w
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n SEP 28 1979
X» JMES Of COMMEII
)(X C9 R*ptthe Of Dill
ti, ti
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w,r
POLK COUNTY 4ST
3100,
ES
71&-_'~ NW cos. 6; N AOf fHF, NE (13 0' NORTH LINE SEC. 4
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. POX 796P BUREAU OF PLUMBING
MADISON, WI 53707
I-RONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number
(If assigned)
❑ Holding Tank El In-Ground Pressure D Mound
NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER'. INSPECTION DATE.
Frank Collins R. R., Star Prairie, WI BENCH MARK (Permanent refereni,e point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.'.
NE NW, Section 4, T31N-R17W, Town of Stanton
Name of Plumber. MP/MPRSW No Coumy_ Sanitary Permit Number.
Cal Powers 1563 St. Croix 58872
SEPTIC TANK/HOL ING TANK:
MANUFACTURER. LIOUID CAP ACITV. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCK,ING~CO ER
R VI ED PR D D/
VIVO P
~ t ~3 ~F YES ENO ES ENO
BEDDING. VENT CIA VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING. VENT TO FRESH
C r ALARM FEET FROM LIN'7w/~ AIINLET.
7 VVVV ~'I/
EYES NO 1 EYES ENO NEAREST 3110
DOSING CHAMBER:
MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON CTLIRER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ENO EYES Ey DYES ENO
V NUMBER OF PROPERTY [VELL ILDINT VENT TO FRESH
GALLONS PER CYCLE: rP AND CONTROLS OPERATION 1-
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) EYES NO NEAREST 10
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nc;rH DIAMETER MATERIAL AND MARKwc,
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF IDISTR PIPE SPACING COVER INSIUE DIA
BED/TRENCH C / TRENCHES , M 41AL. PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. R. NUMBER OF PROPER V , WELL. BUILDING. VENT TO FRESH
BELOW PIPES / ABOVE COVER El EV INLET ELEV. END'. PIPE
FEET O LINE AI -
V t 7 2_7 2-- / NEAREST-► ~ (1 ~C
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
EYES ENO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
EYES NO EYES ENO
DEPTH OVER TRENCH; BED DEPTH OVER TRENCH; BED DEPTH OF TOPSOIL SODDED [SEEDED MULCHED
CENTER EDGES
EYES ENO EYES DNO DYES ENO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.. ELEV.. DIA. ELEV.. PIPES. DIA.
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
EYES ENO DYES ENO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELL - NUMBER OF PROPERTY WELL BUILDING:
L IN
FEET FROM
v~ ❑ YES ❑ NO YES ❑ NO NEAREST )ll _j
11:1L , 70
l/.G®
Sketch System on Retain in county file for audit.
Reverse Side.
S„Id'iYh1Y? TITLE
DILHR SBD 6710 (R.01,182)
wlsconsln APPLICATION FOR SANITARY PERMIT 7
~ (PLB 67) COUNTY
UNIFORM SANITARY PERMIT #
EnT OF !!tt
InOUSTR4, LRBOR 6 HUMRn RELRTIOnS
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/zx 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROP~RTY OWNER MAIL}{VCzADDRESS
PROPERTY LOCATION C'f:
V44! 4AF :
1/4,S L , T N, R 1 10 (or) W TOWN OF: GL C~
F 1/4
A/ W
LOT MBER BLOCK UMBER SNAME NEAREST ROAD, LAKE OR LANDMARK STATE'P4AN I.D. NUMBER
N
TYPE OF BUILDING OR USE SERVED 4//,
1 or 2 Family Number of Bedrooms: ❑ Public (Specify):
THIS PERMIT IS FOR A:
❑ New System Tank Replacement ❑ Repair
Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
X Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny Tank
System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity /600
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
manufacturer: ti ✓ ~E C- n F
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total # of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
Ly Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of th rivate sewage system shown on the attached plans.
Name of Plumber (Pr t): e Signat~yGe~ j P=hhoo er:
y~! S~ S-
Plumber 's Address: Name of Desi ne,:
:
3 rr-1 0 v-.L4j i E o~
COUNTY/ DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
0 g-0 I~ ❑ Owner Given Initial
' fJ
TO (7 / / - Approved Adverse Determination
1
jda!~-u e ,
Reason for Disapproval:
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
APPLICATION FOR SANITARY PERMIT
S T C - 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 ~4 ) LL; ''L, Section T N - R W
Township
Mailing Address
Subdivision Name s`I
Lot Number
Previous Owner of Property U
Total Size of Parcel
Date Parcel was Created
r Are all corners and lot lines identifiable? Yes No
,/,.Is this property being developed for resale (spec house) ? Yes No
Volume ti. and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
In addition, a certified survey, if available, would be helpful so as to avoid delays
of the reviewing process. If the deed description references to a Certified Survey
Map, the the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPFRTy OWNER CERTIFICATION
I (We) eeAtiAy that at 5ta,tements on this ~wLm ane ; ue to the bust oA my (ouA)
knowtedge; that I (we) am (ahe) the owneh (6) o_4_...the..pngpeAty dac ibed in this
in4onmation Ao", by v~ihtue. o~ cc Wak.an' y,_ Zed hecohded i the OAOice. o6 the
County Regi,6teA o4 Deed6 " Document No. d that 1 (we)
pne~sentCy own the pn.opo6ed bite {ion the .a age CCU poA -,sytem (on 1 (we) have
obtained an easement, to nun with the above'cT drLu"bed pnopenty, {iolt the
con,6t,tuction o6 said /5y/stem, and the. /same hay been duP.y Aeeon.ded in the O6~.ice
o{ the County Reg.i~sten oA De.ed,s, ass Document No. (
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR
MV R
HU RELATIONS PERCOLATION TESTS (115) MADISON, W1 3707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ Y: LQT NO.: BLK O.: SUBD V SION NAME:
5 i ..n,_ i) T O i-)
COUNTY:' OWNER'S/' MAILING ADDRESS:
USE
DATES OBSERVATIONS MADE
NO. BEDRMS.: ICOMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence 3 IV/ ❑New Replace
r ~
RATING: S= Site suitable for system U= Site unsuitable for system _ d y C;
H
H
STC - 105 r
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H
SEPTIC TANK MAINTENANCE AGREEMENT r.
St. Croix County z
t)
9
OWNER/BUYER N
ROUTE/BOX NUMBERFire Number
CITY/STATE ZIP
PROPERTY LOCATION: 4, 4, Section I T N, R W,
Town of St. Croix County,
Subdivision Lot number
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
three year expiration. 00
E
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with x
the standards set forth, herein, as set by the Wisconsin Depart- u
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
i I
DATE
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
DI I_HR-SBD-6395 (H. 02/82)
--OVER
PACE OF
L r C) Z C~ i C) C) y S! n ~1
•
Fresh Air Inlolc^^And Obcervallon Pipe
C Approved vent Cap -~F
Minimum 12" Above
Flnal Grode
I
20- 42" Above Pipe -4" Cost Iron
To Final Grode Vent Pipe
Marsh Hay Or Sym hell. Covering
min 2° Aggregote -
Over Pipe
DletrlDulion
pips 0 0 0 0 0 -"lee
Beneath aPip Pip e 0 Perforated Pips Below
0 Coupling Terminating At
Bosom Of Syslem
~~eJ..,T tort
SOIL FILL
DISTkIBUTIOVI PIPE
APPP.OVED S41JT-HFTIC 10VEP
° MATERIAL- >f' q'' OF STRAW
2.OF AGGRIEGATE - OR MAVSU HA':j
^ nF!Z AGGREGATE
DISTRIai1-JT1'JIJ PI FE T(t BE AT LEAST 11CHES BELOW 0RIGIUAI GRADE
AKIL AT LEASTZO 1 U C H F SLIT I,In MIRE THA,KJ HL IAICHI- S BELOW FINAL GRADE
MAXIMUM DEPTH OF FXIAVATioij FRom bWINAL 6KADF- WILL BE "2- IIJCHE5
/At141MUM ®CP" of E•ACAVATIDN FROr\ 1*61NAL 6RADf- WILL AE S ~ INCHEs
SIGAlEO:
LICEUSE AJUMBER:
DATE: Z~~ / J~
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