HomeMy WebLinkAbout034-1090-40-025
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Parcel 034-1090-40-025 01/09/2006 09:32 AM
PAGE 1 OF 1
Alt. Parcel 28.29.15.583A-10 034 - TOWN OF SPRINGFIELD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
TRESA C CARSON O - LARSON, TRESA C
3236 75TH AVE
KNAPP WI 54749
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description ' 2910 HWY 12
SC 2198 GLENWOOD CITY
SP 1700 WITC
SP 7059 SPRINGFIELD SAN DIST #1
Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE
SEC 28 T29N R15 BLK 34,LOTS 1,2,3&4 BLK Block/Condo Bldg:
35, LOTS 4-8 BL 36 VIL HERSEY & THSE
PTS OF ABAND NED HAZEL, RED WHITE & BLUE ' Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
& MILL ST 28-29N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
04/16/2003 717488 2207/535 MISC
/ 1001/242 TI
2005 SUMMARY Bill Fair Market Value: Assessed with:
82631 90,600
Valuations: Last Changed: 05/26/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 11,100 67,150 78,250 NO
Totals for 2005:
General Property 0.000 11,100 67,150 78,250
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 11,100 67,150 78,250
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 302
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
IDOS , OF -REPORT ON SOIL BORINGS AND SAFETY 13UIL["N< S
INNDUSTRRYY, DIVISION
I_MA AND PERCOLATION TESTS (115) MADISON, WI 53707
HUMAN RELATIONS
(H63.09(1) & Chapter 145.045)
LOCATION E .71 N TOWNSHIP/MUNICIPALITY LOT NO.:BLK. NO.: SUBDIVISION NAME:
5 E_'/ V1 /Ta9 N/R 19 /
COUNTY VV
. vs/BUYoi NAME: (MAILING ADDRESS:
S7-Ckvix I LSa/Y_ _ GJI G,
USE DATES OBSERVATIONS MADE
- - - - -
NO. BfURMS. COMMERCIAL DESCRIPTION PROFILE DESCRIPTIONS: PERCOLATION TESTS:
~ ~~Residence FINew
ItA PING: S= Site suitable for system U= Site unsuitable for system So/ L 'SI / ` F • / •S' K
-
U
[-]S XU I XS F]U
NVEN710IVAL MOUND IN-GFtOUNL1PRE` ;URE SYSTEM IN 11E L HOLDING TANK RECOMMENDED SY'TEM:(opt onal)
~It f ercoliuon Tests are NOT required DESIGN RATE; If an -
--~(/J--- y portion of the tested at ea is in the
tundet s.H63 U9(5)(b) indicate: Floodplain, indicate Floodplain elevation:
TT PROFILE DESCRIPTIONS
I30RING 1rAlt - D -PTH TOGROUNDWATER-INCHESCHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER Ul PII1 I+ LLEVA]-ION
TO BEDHQCK IF OBSERVED (SEE ABBHV. ON BACK.)
33
'r -
T$B , ~~l3N d Y-4
-F~ PERCOLATION TESTS
TEST f)[11111 WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER Impoww q rEll WELLING INTERVAL MIN 77p E i _ PERIOD 2 _ PER D PER INCH
P-i
P_ -
P
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dirnensions of suitable soil areas. Indicate scale or distances. Describe what are the hori -
~untal 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
nl land slope.
SYSTEM ELEVATION
:517-E -BV 40CAL 6Fr1W44S MI~TA+G
Q Ko3 0 'f-3S' p SHE D
F'L EL)AT/o v AT Wo I - 99, 33 ,h a P.
ELfVATIM AP No - 99, 33 ~ 40 Q #OIL
L E 0A 701V AT M6.3
'
tya 1
O
I
i
1 ~ l i ~ O ~ I r
ExISr/.r G
~E t O a .BAD Roo M pRAid/N& ivoT s qtF
N pM E
130 I~ E7 D
PERk 0
5TTE y.
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 Ipnn1) - - TESTS WERE COMPLETED O
AD TESS CERTIFICATION UMBER: PHONE NUMBER (optiorial)
f26,5 23p2
CST SIGNATURE.
y u
r
DISTRIBUTION: Ornlinal a;td one cop,, to Local Authonty, Property Owner aril Soil Tester.
DILHH-SBD-6395 (8.02/82) --OVER -
Ile
HOLDING TANK AGREEMENT
This Agreement, made and entered into this day of
A.D., 19 by and between the
, 7ereinafter called "
an here na ter ca jo
the wner .
WHEREAS, application has been made for a building
permit on the following described property, to wit:
or that said property is not located in such a manner as to be
serviced by a municipal sewer system or on site soil absorption
system for domestic sewage, and continued use of the premises
requires that a holding tank be installed on the property for
the purpose of proper disposal of domestic sewage.
NOW, THEREFORE, in consideration and as an inducement
to the Town of to issue a holding tank permit
for the above described premises, t e Owners hereby agree and bind
ourselves as follows:
1. Owners agree that they will conform to all the rules
and regulations of the Plumbing Code in the building of their septic
"ding tank. They agree that any time the
through its Plumbing Inspector or
necessary to pump out said holding tank, the
umped out in twenty-four (24) hours, or
11 have said work done and charge same back
on their tax bill as a special charge. The
t the Town of is hereby
se and authority to enter upon their property
h; reasonable time, to inspect, pump and haul
aid holding tank.
3 F
r- harges and costs incurred by the Town of
inspection, pumping, hauling or otherwise
g said holding tank in such a manner as to
sance or health hazard caused by such holding
ie Owners. shall
such cost w c shall be pa by Owners.
shall notify the Owners of any such cost
which shall be paid by Owners within thirty (30) days from date of
notice and in the event that Owners shall not pay said cost within
thirty (30) days, Owners hereby specifically agree that all of said
costs and charges may be placed on the tax roll as a special assess-
ment for the abatement of nuisance, and said tax shall be collected
as provided by Statute of the State of Wisconsin.
DILHR-SBD-6123 (N.6/80)
Page 2
3. That a quarterly pumping report shall be submitted
by the Owner or his agent to the local government and the county
which shall state the Owner's name, location of the property on
which the holding tank is located, the pumper's name, the dates,
volumes pumped and the disposal site. An annual pumping report
or the fourth quarter report including a summary of the pumping
history of the previous year shall be submitted to the Department
by the governmental unit responsible, per s. 145.01 (15), Stats.
4. Owners further agree that in the event that municipal
sewers shall be installed so as to make the premises available to
such municipal sewer service they will pay all special assessments
levied against the premises as the property share of costs of the
installation of such sanitary sewer and shall not assert any claim
as to lack of benefit or reasonableness as to the installation of
municipal sewers by reason of the fact that the Owners have been
permitted to install a holding tank, and that upon municipal sewer
service becoming available, Owners will abandon use of the said
holding tank and connect the premises to the municipal sewer.
5. This agreement shall be binding upon the Owner, their
heirs and assignees and run with the deed.
WITNESS our hands and seals this day of ,
19
TOWN OF OWNERS
by
by
STATE OF WISCONSIN
Personally came before me this day of ,
19 the above named
Owners, to me known to e t e persons who executed the foregoing
instrument and acknowledged the same.
THIS INSTRUMENT NOTARY-PUBLIC
DRAFTED BY:
My commission expires:
7/80
SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILHR
Detach And Return Upper DIVISION OF SAFETY & BUILDINGS
Portion Of This Form With BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 141
Any Return Correspondence P.O. BOX 7969
MADISON, WI 53707
!'t1 608-266-3815
DATE: PROJECT:
C y
sFA 4
PLAN ID. #
DETACH HERE
PROJECT NAME PLAN ID. #
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $ Fee Received is $
❑ Plan accepted for review. ❑ Underpayment - Please submit additional fee. Plans will be held in abeyance.
❑ Plans being returned. ❑ Overpayment - Refund forthcoming.
❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance.
1. Plan Submission ❑ Soil boring and percolation test data on 115 completed
❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (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 ❑ Complete data relative to anticipated use of building.
stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy)
Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy)
❑ Plot plan showing location of land parcel (distance from
nearest road intersection, etc.), 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 approved. Complete
vice road, etc. Show benchmark with permanent elevation. construction details if site constructed.
❑ Holding tank agreement signed by owner and local
II. 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 cnsite 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 Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons
pumped per cycle.
III. 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 pump or automatic siphon, including
system extending 25' minimum on all sides. 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 VI. 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 begin.)
system. ❑ Depth and type of fill.
❑ Copy of signed onsite report by county or district staff.
SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02)
' Detach And Return STATE OF WISCONSIN DI_HR
Upper DIVISION OF SAFETY & BUILDINGS
Portion Of This Form With BUREAU OF PLUMBING
201 E. WASHINGTON AVE. RM 141
Any Return Correspondence P.O. BOX 7969
MADISON, WI 53707
.N 608-266-3815
DATE: PROJECT:
~t' 110
~V4, ,90
IV
PLAN ID.
DETACH HERE
- - - - - - - - - - - - - - - - - - - - - - - - -
PROJECT NAME PLAN ID.
This is to acknowledge receipt of your plans and specifications for the above-indicated project.
Preliminary review indicates the required fee is $ Fee Received is $
❑ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance.
❑ Plans being returned. ❑ Overpayment- Refund forthcoming.
❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance.
1. Plan Submission ❑ Soil boring and percolation test data on 115 completed
❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (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 ❑ Complete data relative to anticipated use of building.
stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy)
Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy)
❑ Plot plan showing location of land parcel (distance from
nearest road intersection, etc.), 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 approved. Complete
vice road, etc. Show benchmark with permanent elevation. construction details if site constructed.
❑ Holding tank agreement signed by owner and local
II. 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 cnsite 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 Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons
pumped per cycle.
III. 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 pump or automatic siphon, including
system extending 25' minimum on all sides. 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 VI. 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 begin.)
system.
Depth and type of fill.
❑ Copy of signed onsite report by county or district staff.
• Pr1,1...n lo, M,,d11,, il,nut 4n WISCONSIN DEPARTMENT OF Off1CE USE ONLY
Ad[ninjo-[,vv Rule INDUSI RY, LABOR AND HUMAN RELATIONS Petition No. DIVISION OF SAL t-1 Y & 13Ull_DINGS C ho__-
PRIVATL SL WAGE P.O- BOX 71769, MADISON, WI 53707 ID-No.
Agent. Archllrcl of Ent(ir rering Flrrn ue
tiamr of 0- -y I1uLld1ne [)CCU1,tlnCy ut Use
4V J L ES HfI
17.e1 Plumbu-_-.I JQ.~LEST 1 ~'A'jAN 1--A 04Y ~ -,EIE P Rom 14 0_M-E ~
cnn10.ny Tr Wont n,, ri~c, it rnv
No.
Strrr( L No. ISuil[Lne Loranun, Stirrt L No.
- _ _ - _ st.rr
C1 ty L Zu
Cny Stsrr L LiV city
t~~Rs y ~c1/S~ AAIAPP
(I n
Phona Plan Nurnbrrs 1 Known) Phoe
Type of Petition Set Becks (Soil Absorption 11 Fxperimental and
X Loading Ratcs ❑ Site Evaluations
ee S_ end Septic Systems) LEGAt_ DLSCRIPIION
%,Sccli[,n_ T_ N R_ L (or) W Township ___~.L11!1._~~1
Suhdivisiun Nernt wN ~.1)UntY------ - -
WISCONSIN AD,MINISTRAI IVI- RUt L HI ING III I I I IONt_D
-g -~_.Z3 I d)l the WIscunsin Adminislrative Lode cannot be cnurclY satisfied due to the toliuwinb reasons
1. Rule j_L
2. In lieu ul 1,01111 lyln~; cXactly with the rule, the Inllnwing illerimlive is pruptlx d as .i r7lt•e11, of pioviding an ['llUIVA10111 dc}rcv of
safety ur heaHh:
Llc~lc~lr ><~onCc-l 7" o n,c° _ ~u~_ . ~tJ JI be d~L~d_ 1,[L!er_ ~h~ beck a~
3. Supp[u tint; a.Kumcnu (For site evaluations, include Form 115 -"Report on Soil Boring and Percolation Tests")
- A /JIT -
)ItHK stit) 1,689 (ovik)
DETAILED PLAN OR DRAWING
J
4
i
i
being pctitionr;d
COUNI Y PLRSONNI-L AU 11-10RIZA I ION Rule_
C 4
On-site InSpeCtiUn Conducted (OdUo_ ~~Y -1 - -
1 _ _ 6-4, indicate the information recorded on this request form is accuiate and wrrect
the best of my knowledge and belief.
VF RIFICAIION BY OWNLR -I'L 114 ION IS VALID ONLY IF NOTARIZED
FOR INFORMAI ION CON-1 ACT 1 HL DLPAR I MLNT AT (608) 266-3815
being duly sworn, says he is petitioner herein, thus he has read
the foregoing petition and that the same is true, as tic verily believes.
Suhscribcd and sworn to me this- _.___day of 19_-._
Signature of uwncr,
County, Wisconsin.
s. Nutniy (Ublll - -
My iornniission cxpirrs
O1 f ICE USf ONLY -
UI_I'ARIMf Nf ACLION
_
f - - SLl MACK OR I.- XPL RIM[ N1 At
f Y l k I VAl UA I ION(, i _ - - -
Date Received Amount Paid Rcccipt No.
C).,rc Rtccived - Amount Paid Rrr.eipt No.
t i hU( p,ii tmcnt Action
r` ~!tru nt Anion
~L.URCAU L) I 1c~1~: u~ ~r51~r.rt D.1 tc
'>ikn1UR ~D.uc
WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING
P.O. BOX 7969, MADISON, WISCONSIN 53707
Verification of Exception Status for an Alternative Private Sewage System
In the County of St. ChLOix
Location SE 1/4, SE 1/4, Sec. 29 T 29 N, R 15 )EX~t,-4 W
Town WMMMOMU§ Sp4 ngiietd Street Address
Lot No. Block Subdivision
Landowner's Name: Nonrnan V. LaAson
The application for this site is for:
o new construction use.
_Xj rep] acemf.nt system use.
e.
Lx
If this is NEW CONSTRUCTION USE, the alternative private sewage system is:
Ito have one of the first five approvals guaranteed for this year. This is
numher - - of those applications. (Use one of the first five
quota numbers ss~ ued to you.)
I lone of the applications needing a quota number. The quota numher assigned to
this application is - -
Ifor one additional homesite on a farm to be occupied by a parent, child,
grandchild, sibling, niece, nephew, or first cousin.
i
for an individual lot for which a sanitary permit was issued but was later
ruled unsuitable due to new or changed soil criteria established by the
department.
for an application on file prior to February 1, 1980.
1_ifor a lot that meets the criteria for a conventional private sewage system.
If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is
replacing:
I_Xla failing conventional soil absorption system.
LIa holding tank that was installed and in use prior to February 1, 1980.
Ua privy that was installed and in use prior to February 1, 1980.
If this is a REPLACEMENT SYSTEM USE and-the lot meets the criteria for a
conventional private sewage system, check here
I certify that the above information is true and accurate to the bees of my
knowledge.
Name Thomas C. NeX~on Signat
County Official
Title Assiztawt. Zoning Adn~inwtAatok Date June 18, 1984
DILHR-SBD-6158 (R 12182)
~ PLAN APPROVAL Safety and Buildings Division
Bureau of Plumbing
P.O Box 7969
❑ General Plumbing Plans Madison, WI 53707
❑ Private Sewage Plans . Telephone: (608)266-3815
OFFICE USE ONLY
Plan Identification No.
Gallons Per Day
r ! 4 yti
! /,C L
PRIORITY PLAN REVIEW ONLY
Plan Review
Petition For Modification
$
Project Name Project Location - Street No. or Legal Description
County
i
❑ City ❑ Village ❑ Town of:
The plumbing plans and specifications for this project have been reviewed for compliance with app i ..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.
❑ 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 date 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
If Questions Plans Approved By: Date Approved:
Contact
cc: ❑ OWS ❑ DPS ❑ H&R & Rec. San. Section
❑ County ❑ Local PI ❑ Facilities Need Analysis Section
❑ UW-SSWMP ❑ Plumber ❑ Department of Agriculture
DILHR-SBD-6099 (R. 01;84) ❑ Owner ❑ Other
r p1
~r
State of Wisconsin \ Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
„i Cast Washington Avenue
Cox 7969
Bison, Wisconsin 53747
f3 ii y9?i! ~i F.C i y 51t, 4~n, TZY CA t.t r,',~/
ti t1G+Tt ho. 84-05626-P
.:::fit' =sr°• ~v2'31.::
rman Larson - ResiC enc e
a rivate Sewage Systo3.
SE, 9,29, I
il:jwn of Springfield. St. cr:=ix Cui:tity, i
z. r 145.24 (i), Wisconsin Statutes and s. i~~~ 63.C# ~ jL' nisconsfii
itiiriistrative Code, allow th-i fawner to petition Lhe 6epartiaer#L for a vari~r~y~
the Installation for a private sewage system to replace an existing pri,r416~.
-:wage systL-m at a site which is not in full co pliar,ce with the siting
tan 4ards in the administrative rule. The syste=ii design proposed sitouI
Y 4 otect the waters of the state from contamination. If this system oetu
.:f ling systev, oor, r-'•ijt-i.Jr.ates tint w',dters c the state, this vari :rice steal i "')ii
d'e yetitioi, t'oi, 118 va jufit;,
~Um. Code was coots i Qereru on Cc trader 2 ~'O, 1:164. They petition na s been
'i~,Nditiontally approved. The conjitiun of this approval is tttat if tree
_ istem begins to tail, it shall be imw0ately replaced with a depart r+.
proved private sewage systew.
4:e rule requires that there be at least 24 inches of unsaturatea natural SjIj
.,:live: estimated sign groundwater for t o instal lAtion of a Mound syste
ar? r~_ a~ 4~- 1L!i
r",el variarice requested was to install a skound system on a site
I I ' I r
0ILHR-SBD-6423 (N. 04/81)
- a
State of Wisconsin ` Department of Industry, Labor and Human Relations
SAFETY & BUILDINGS DIVISION
`.;tijic:er u, Inis variance is specit ic Pt Ci0`t.a
secs for >n f5ti~1-ii ior, F
i
:J HP.
{ k
r-i I L. aarber„ i.vr: i rig to i t i s tratur - St. f.-ru ix County
I to
DILHR-SBD-6423 (N. 04/81)
ST. CROI X COUNTY
WI SCO N S I N
O U ZONING O F F I C E
` ,,~f ll'► J~t~1~► 796-2239 (HAMMOND)
- - 425-8363 (RIVER FALLS)
HAMMOND, WI 54015
June 18, 1984
D,i,vi-6 ion o6 Sa6e.ty and BuiL'd ing
Bureau o6 P amb,ing
P. 0. Box 7969
Madibon, W1 53707
Dean Sin-
An onsite inv"tigation bon .the. Norman V. LwLson pnopenty ioea.ted in
the SE-14 o6 the SE%, ob Section 29, T29N-R15W, Town o6 Spking6.ietd, St.
Cn.o.ix County, n.eve".e.d sui ta.bte somas at a depth ob 1.42 6ee-t, betow
which seaeonabte high ghound wateh was noted.
This s shooed be suitabte bon a mound system.
Shooed you have any que.6tionz, ptease 6eet bnee to contact this o66.ice.
S,incene.Y y,
Thomab C. Na,6 on
Assiz tan t Zoning Adm n.i,s-t La ton.
TCN:mj
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STATE OF WISCONSIN-DtVW'tNT bF INDUSTRY, LABOR 6 HUMAN RELATIONS
DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING
P.O. BOX 7969 - MADISON, WI, 53707
APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM
Location: Township /1F1YiM}EK)i~:
SE SE 14 29 T 29 N/R 15 X( Ai~w SptLin i d St. Cn.o.CX
Street Address: Subdivision: County:
Landowners Name: Mailing Address:
Nonrnan V. LaA6on R. R. 1, Upon, W1
II
I (We), the undersigned, hereby make application for an alternative system on
the above-described premises. I recognize that the above premises are not
suited for a conventional private sewage system. If approval is granted, I
agree to have.the system installed in conformance with the Bureau's approval
of plans and specifications.
I further understand that an alternative system is more complex in nature than
a conventional private sewage system and as such will require detailed
inspection during construction and monitoring after the system is put into
use. I agree to permit both county officials charged with administering county
sanitary ordinances and Bureau employes or other authorized persons to have
access to the above described premises at any reasonable time for the purpose
of inspection the construction of or monitoring of the system. I further agree
to either personally or by my agent contact the proper county official to
arrange the time and date to begin construction of the system.
I understand that this application does not permit me (the applicant) or my
agent (the contractor) to begin installation. If the system is approved, the
Bureau will send the applicant a letter of approval which authorizes
construction of the alternative system after all necessary permits have been
obtained.
I agree to give notice to any subsequent buyer that an application for an
alternative system has been made and if installed, that the premises are served
by an alternative system and further agree to give the buyer a copy of this
application.
The Bureau accepts this application subject to this understanding and subject
to all the conditions and obligations set out in this application.
Signature of Applicant Date
STATE OF WISCONSIN Subscribed and sworn to before me
SS.
COUNTY OF This day of 19~
Notary Public, State of Wisconsin
My Commission Expires:
DII.HK-SBD-6413 (N. 05/81)