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HomeMy WebLinkAbout034-1048-60-000 0 (no ~m0 (Ob rn 3 A~ ~ O CD ? -9 N N N O V 0'~ N) c eC • \F3- w (fin o° w m (a (D N o = (ED n a CD CD 1 v rn co W 5 ~3 C. a Cy, . N I- N D) N d <.J 00 r.ti l Chi I""' Q Q N C (n W m O W O O W O K 3 m _ O c w o O : D a a= !y N a N I ry :3 W CL o I N N lot O - to Z 00 co In O. N . r i (/J ~ Z W W 7~ Q ~ ~ Arn ~ II ~ ` K• G\ ° c~ ` ~rl rn 3 ai ai N C) go CD (D m (D e w 1 0 D D o ~ O a CD c ~c- m -1 N Z CD \ ( \ A z (n N oo v m (D (D z r. c 3 Z ° m Cr y < ((D N C (n {y \ r(~~. N \ (n O CD CL a) z o ~ CD m CD 7 U . I Yv y m o = m y 1 C CD O ft )CD o o A q ti CD DO v o O v I ~ Parcel 034-1048-60-000 09/18/2006 04:50 PM PAGE 1 OF 1 Alt. Parcel 21.29.15.333B 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 LINDA D & EUGENE D FORTUNE O - FORTUNE, LINDA D & EUGENE D 6380 BIRCHWOOD RD WOODBURY MN 55125 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC - Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 21 T29N R15W S 1/2 OF NE SE 20A Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1164/457 WD 07/23/1997 1073/580 TI r t 1 ~ t 7-1:j 61 -7 07/23/1997 712/173 I 07/23/1997 5794 2006 SUMMARY Bill Fair Market Value: A sed with: 0 Valuations: Last Changed: 06/24/2003 Description Class Acres Land Improve- Total State Reason RESIDENTIAL G1 2.000 12,950 16,750 29,700 NO PRODUCTIVE FORST LANDS G6 18.000 32,400 4 0 32,400 NO Totals for 2006: General Property 20.000 45,350 16,750 62,100 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 45,350 16,750 62,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 034-1048-50-000 09/18/2006 04:49 PM PAGE 1 OF 1 Alt. Parcel 21.29.15.333A Current X 034 - TOWN OF SPRINGFIELD ST. 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 ANDREW CARLSON O - CARLSON, ANDREW GRANT POLLY C -GRANT POLLY 840 HWY 128 GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 840 HWY 128 SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 21 T29N R15W N 1/2 NE SE 20A Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 06/05/2003 724518 2264/124 WD 920/67 677/37 444/198 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/14/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,950 114,350 127,300 NO PRODUCTIVE FORST LANDS G6 18.000 32,400 0 32,400 NO Totals for 2006: General Property 20.000 45,350 114,350 159,700 Woodland 0.000 0 0 Totals for 2005: General Property 20.000 45,350 111,500 156,850 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 152 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of industry, INSPECTION REPORT Labor & Human Relations PLB-1 Safety & Buildings Division Bureau of Plumbing a e an . o. ame o remises y y{ y g 5 _ q oun y Sanitary Perms t~ Street y -Ad as er 1' um E er arm ame dress -Journeyman um er ress wner ress Di scussed -w-1 re )See Attached. r~'~ DILHR-SBD-6192 (R.10/82) Signature o Dist.-Plumbing ,_a n- i e as e pec1a s Plumber or Responsible Party Owfret Inspector Local Inspector -I~ 0 d `t C M O co `~1 o m m \ 1 co S S v z p w s w c p `C s d v v v o -4 o ~ Q 7 O N O C N ~p N O CO Cn ~h co FD N C 03~` O F O N CL W O N W 00 O 0 -u CF) O N N n (Nn O co CA) C) O N O O N N 00 p !r CO O C N O ° m D co ° CD o m a 73 N m W O N N N m rn °rn L O p p co co w C j. 3 Cr CC '0 Z o 0 0 cn ~y,~,,~1 o• v v o m N E CD M _ m N o 3 m D m _ 0 CL 7 N Z N o D D o 0 m s a 0 CD 0 m ° h• C CD Pt,~ W cn n 3. Z co m -I cn o z m N cn ~a n CD A Z o Q cn --i N N W M N 7 m , 1 j a z N C r: Z Z 3 M 0 N N A N I i CD (n S o) 3 N Q Ili m Q F N N N K (D N 3 Q Q N C v N a S a d Z Q 7 (O O (Q N n N -J ~ p O W N N = N 7 ._O CD O A CL 7 r0j• 0) j = V N Q ( (D m O 3 V o 5' cc d O m N O ? O O Z ti N d N A CL (D Q N p0-j N 0) ~ 7 a S 57 R ti O_ b N ro dQ O o p c„ v, C) m C) 0' I ti AS BUILT SANITARY SYSTEM REPORT OWNER ~3 TOWNSHIP L SEC -;2/T-2~N-R/7W ADDRESS,/7 ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 O-W__E_yERYTHING WITHIN 100 FEET OF SYSTEM r -A J~ - - I di n e Nott Arrow BENCHMARK: (Permanent reference Point) Describe: 7f~iYj c'/ f Elevation of vertical reference point: Slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: _ Number of rings on cover : Tan manhole cover elevation.:. Tank Inlet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle _ gallons; total capacity o distribution lines gallon: size o7 pump head; gallon per minute horsepower ran name of pump and model number Type of warning device HOLDING TANK: Manufacturer & Mr Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number f pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width leTigth_ the depth_ SEEPAGE TRENCH: width length PERCOLATION RATE REA REQUIRED --KR---EA AS BUILT INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER Xp 5l j` Pw PLB 6 7 State and County State Permit # A y_3 Z Z6 Permit Application County Per i # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: e /V B. LOCATION: '/4 5~= '/4, Section T N, R./%jfOW (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms 2 No. of Persons 7 D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY 2 Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME t!%~~C~- Lv SAl C.S.T. # d,7and other information obtained from 11), U -S fc-; T~lr; .S f~- (owner/builder). _ Plumber's Signature MP/MPRSW# /4//' t~L Phone #~&1-~-~~' 1`` Plumber's Address--,A PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. i 1 . 3 m~ :.as ..r E E E m 3 m _ . E E ) Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application A/Z-44-3 Fees Paid: State County ate Permit Issued/Rejected (date) Issuing Agent Name eElu,& inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2, state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, LABOR AND P.O. BOX 7969 PERCOLATION TESTS `115l DIVISION HUMAN RELATIONS / MADISON, WI 53707 3707 ELOCA TIH/4 CTIONLOT NO.:. N/T N/R E (or) W SUB D NAME: NTYNER'S BUYER' S NAME: =bb: USE NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE ONS: R LA ION TESTS: ❑ResAence ❑New ❑Replace L RATING: S= Site suitable for system U= Site unsuitable for system CONVETIONAL: M ND IN-GROUNND-PRESSURE: SYSTEMM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) Et'' OS DU OS OU CAS DU LJS OU If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL under s.H63.09(5►(b►, indicate: If any portion of the lot is in the Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PT I TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 13- B- B- B- PERCOLATION TESTS NUMBER D CHES AFTER ER IN HOI E INTER VA MIN. SWELLNG DROP IN WATER LEVEL-INCHES RATE MINUTES PERIOD 1 PERIOD 2 PERIOD. PER INCH P- P- P- P- P- P- PLAN VIEW: 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 slop. SYSTEM ELEVATION z . - _ x f a - , r i 4 r i x s E TN F E d~ x r a x t^ s t = r f a , x , I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optionall: CST SIGNATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page :foil Tester. DILHR-SBD-6395 (N. 03/81) , BR - Beds- < SS Sands - Gravel (Under 3") LS L€meston, z Sand HG 11V iglu Grp: Coarse Sarni Perc Percolation Medium Sarni W Well Drained Pine Sand MWD Moderately V',,, Loamy Sarni SP - Somewhat Poorly Drained Sandy Loam P Poo! - Loam W - Well Silt Loam Bldg - f uib, ; Silt > C'ares' - Clay loam -less - Sandy Clay Loam Bn - Broe Silty Clay Loam Sl - Place - Sandy Clay Gy - Cray Silty Clay Y - Yello , - Clay R - tied peat mot - Motu nr, vv,' with few, GQrttlYiCars, CC (Many, rnp i , - distinct - - p promine,. is High wa.,,, Surface WISCOnSIn Department of Industry, Labor and Human Relations D'L~ Division of Safety & Buildings ~J R 6~ 7) Bureau of Plumbing - OEPRRTmEnTOF ~.a P.O. BOX 7969 MIIMWM~ InOUSTRV, LRBOR 6 HUMRn RELPTIOns Bison, WI 53707 (608) 266-3815 V Ij~y/s~F A, CORRESPONDENCE `Avg FER TO PLAN TIFICATION NO. 17-01 NAME OF PROJECT- Ii ATE SEWA E ONLY - ❑ GENERAL PLUMBING PLANS LOCATION Fee Received: Priority Plan Review Only CI~Y OR T N 0 N Y -xamination of plumbing lans and specifications for this project has been ompleted. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin dministrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of when required inspections are to be made. I ap11C.0Y a 1 w_ _--_7 1 h a 4 y-0 In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, S, se, Or l I For Privat Valid for James Sarg i ~ ThiS years approval is initial oe Valid or J it .,On date of "het, Bureau Dire or tt,° e,<piration sa; :``any permit. PLANS REVIEWED BY: - DATE: cc: DIPS Owner H & R & Rec. San. Section Local Plumber Bur. of Health Fac. & Services ounty Other DILHR SBD-6099 (R. 05/82) 1"'o rIII - 5 T C 10 0 Owner of Property _ .Location of Property~/~ S,,-' 5ectior►,"129 N RW TownehiP ~P,9/~ Mailing Address. Subdivision Name Lot Number Previous Owner of Property tZAV*/e 11i4A P,4-1e1y Total Size of Parcel 20 4e Date Parcel Was Created Ald Are all corners identifiable? Yes No Include with this application one of the following; .Certified Survey Map .Dead XLand Contract, or Other Tvegal Document which de8cribes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No.3 7f f : I ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. GNATURE Of OWNER 4NA~FO WNER(IF APPLICABLE) l7, /l~3 2 DATE SIGNED DATE SIGNED .4 ~T' ST. CROI X COUNTY WI SC0 N S I N Z O N I N G O F F I C E Yamm 796-2239 (HAMMOND) 4258363 (RIVER FALLS) HAMMOND, WI 54015 November 9, 1983 To Whom it May Concern: RE: Russell Thorsen property located in the NE%4 of the SE-i, of Section 21, T29N-R15W, Town of Springfield. Dear sir: An on. Site inspection on the above mentioned property revealed a site suitable only for a holding tank due to soil lim-nations at .83 feet. This site limitation was determined by mottled soil conditions. Mr. Thorsen has come before the St. Croix County Board of Adjustment, requesting that he be able to place a holding tank on new construction, with the Board giving approval. Sincerely, Thomas C. Nelson Assistant Zoning Administrator mj I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W 53707 LOCATION: SECTION: OWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: -W14 4/ /T~9N/R/'11 4FT T oj'J11 _PIE1 COUNTY: OWNER'S BUYER'S NAME: AILING ADDRESS: 1 4 ` \i ' 1. / /s7 TG USE DATES OBSE ATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: r{~ R TONS: PERCOLATION TESTS: Residence ~i tpNew ❑Re lace. Zd le, RATING: S= Site suitable for system U= Site unsuitable for system CON~VENTIO~NAL: MOUND:®~ IN-GROUND-PFjESSURE:SYSTEM-I®ILLH©INGTANK:RECOMME DEDSYSTEM:(optional) SS UU S SS ((L~~LC~JJ UU S U S U C~ L ~2 If Percolation Tests are NOT re wired DESIGN RATE: SYSTEM EL 4 I If any portion of the lot is in the s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13- B- . %Z co 9 ` i 3 9 1, -3;L 4161 ~J 5 J, B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 ~PERIOD PER INCH P- / or J'r ?/d- b P- c S f//6 % P-, r . P- P- P- PLAN VIEW: 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 slop. SYSTEM ELEVATION _J30 J. w _ Y3 J _m qtr N i~c o ke _oL' x'u ti,~ € , ► I76 Zo ` /C'S' ea 48A P.2 e2 _-I I Ake -)t3C-- I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED.ON: ..r(- ADDRESS: CERTIFICATIO NUM R: PHONE NUMBER optional): Y _ CST SIGNA URE: !mar/ DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) PLB-1 INSPECTION REPORT Wisconsin Department of Industry, Labor & Human Relations Safety & Buildings Division ame o remises Bureau of Plumbin , Platting & Fire Protection a e an No. Street Cit y oun y Sanitary Permit as er um er irm ame dress Journeyman um er ress wner ress i scusse with igna ure ( )See Attached, DILHIZ-SBD-6192(N.09/80) Signature o is um ing up. n- i e as e iv'hite-Inspector Yellow-Local Inspector Pink-Plumber or Responsible Pa Pe-Ois rty Green-Owner BOARD OF ADJUSTMENT DECISION Request of Mr. Russel Thorsen ) for a variance to Article 6.3 Clc, ) Holding Tank, ST. CROIX COUNTY ) 30-82 ZONING ORDINANCE. Location: NE'-4 ) August 24, 1982 SEQ, Section 21, T29N-R15W, Spring- ) field Township. ) The St. Croix County Board of Adjustment conducted a public hearing on August 24, 1982 to consider the request of Mr. Russell Thorsen for a variance to Article 6.3 Clc, Holding Tank, ST. CROIX COUNTY ZONING ORDINANCE. The St. Croix County Board of Adjustment conducted an on-site inspec- tion-of the site in question. After inspection, the St. Croix County Board of Adjustment entered cQ Executive Session to discuss the request. After returning to open session, the following decision was rendered. Mr. Russell Thorsen sha-11 complete construction one year from this date. Motion by Supervisor George to approve the holding tank. Mr. Thorsen shall have this tank pumped monthly. Seconded by Supervisor Stephens. Motion carried. Vote to approve: George, yes; Stephens, yes; Meinke, yes. Robert Stephens, Secretary St. Croix County Board of Adjustment HB:RS:wjo Mr. Russel Thorsen Edith Sweitzer, Clerk e.r 0 BOARD OF ADJUSTMENT NOTICE OF APPEAL NUMBER A. I/WE hereby appeal to the St. Croix County Board of Adjustment from the decision of the Zoning Administrator. Whereby the Zoning Administrator did: 1. Deny an application to: se land only for use as family`residence erect structure o bui din accessory building alter other -business add to c~ industry occupy other or: 2. Incorrectly interpret the (Ordinance) (Map) number B. LOCATION ~y ~J JSectionTAN, R 1&5 W. Subdivision Name Lot 4l City Village Township r 1r1c -1 ►~~C~ C. A variance of section_~ of St. Croix County Zoning Ordinance is requested-be-cause: (Undue hardship, unique situtation, etc.) i i U. List all adjoining landowners names and addresses: dime Address Town State zip r- a c .lr 4 . Date Fi,'Led S ned Appellant(s) or Agent rr ~r ST. CROI X COUNTY WISC0NSI N tv t r4 ZONING OFFICE eyi ti 796-2239 (HAMMOND) (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y PUMP I N G R E P O R T ST. CROIX COUNTY NAME: c L k RETURN COMPLETED FORM TO: ADDRESS: _ R ST. CROIX COUNTY ZONING OFFICE P. 0. BOX 98 t ` rte, r (f , L HAMMOND, WI 54 015 TOWNSHIP: 715-796-2239 or 715-425-8363 PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED ©c%R/Z- / yDo a ~r- S d r THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1985. T,7 OWNERS SIGNATURE mj:12-83 STATEMENT Glenwood City, Wis. 54013 .S.._~ In Account With Cassellius Sanitation Service Robert Cassellius Phone 265-4623 Glenwood City, Wis. 54013 E `S `r E z~ I E I i G V9 1 I Finance Charge of 11/2% per month, with a minimum charge of 50c, will be added to all accounts over 30 days. STATEMENT Glenwood City, Wis. 54013 . 19__..1.'. In Account With Cassellius Sanitation Service Robert Cassellius Phone 265-4623 Glenwood City, Wis. 54013 `I i i w 1 Finance Charge of 11/2% per month, with a minimum charge of 50c, will be added to all accounts over 30 days. STATEMENT 7 Glenwood City, Wis. 54013 1! 2. .................19 . In Account With Cassellius Sanitation Service Robert Cassellius Phone 265-4623 Glenwood City, Wis. 54013 I iI I E~ r b Finance Charge of 11/2% per month, with a minimum charge of 50c, will be added to all accounts over 30 days. ST. CROI X COUNTY 1. tv, tr WI SC O N S I N ZONING OFFICE M IV, IM9, In 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 DEAR HOLDING TANK OWNER: Enclosed is the quarterly "Pumping Report" for your holding tank system. This report must be completed by you and returned to this department no later than the date specified at the bottom of the report form. In addition, we have included a copy of the "Holding Tank Agreement" you signed when approval was granted to install the system. Failure to submit timely and properly completed pumping reports would be a violation of your agreement and H63.18 (4) (a), Wisconsin Administrative Code. The County does have the authority under section 145.20 (2) (f), Wisconsin Statutes to gain compliance in circuit court. To complete the report, please fill in your name, address and township in the areas provided. In addition, provide the name of your pumper(s) and the location of the disposal site(s). Information pertaining to the disposal site can be obtained from your pumper. If wastes are disposed of at a municipal treatment plant, indicate the name of the plant. When wastes are field applied, we need to know the legal description of the disposal site to the nearest 40 acres. (e.g. SW-4, SW-4, Section 20, T29N, R10W). Occupancy and use sections are self explanatory. Lastly, the date and volume pumped must be reported for each pumping event. Enough spaces are provided to report five separate pumpings each month. Sign the report and return it to this department by the date indicated. If you have any questions regarding this matter, please feel free to contact this office at 796-2239 or 425-8363. Yours ver A Thomas C. Nelson Assistant Zoning Administrator TCN:mj 4 ~,ry { ,r, 13 ST. CROI X COUNTY } WI SC0 N S I N ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G R E P O R T ST. CROIX COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 an 115-425-8363 TOWNSHIP PLEASE PROVID THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: jr,--?~ l- -r- LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND 4' SEASONAL (CHECK ONE) JANUARY FEBRUARY MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN MAY 15, 1985. OWNERS SIGNATURE ' c SrA7ZA,NT Glenwood City. Wis. S4013 2- G 19,5- cassellicrs In Account w. onitc, - PhOne 265.4623 Robert Casselli n Se/'v// us ece Glen►,y , ood City, Ws- 54013 I f 1 t' 'I 7:r r P lnance Chi, 1 ge of 11 25, 1 be added Per to all aac~ With a minimum charge over wft 01M.- 30 days of 50c, will a STATEMMVT _.-~tenwood City, Wis. • 54013 19_C:5~- in Account With Cassellius Sani Cation Ser ' Phone 265.4623 Robert Cassellius vice Glenwood City, Wis. 54013 le I 6 ~ i I Finance Charge of 112 % be added Per month, with a mini to all accounts over 30 um charge of 50c days. ,will ~Mmm d ST. CROI X COUNTY s '~y r W I S C O N S I N tier ; - ZONING OFFICE ' F 796-2239 (HAMMOND) /y~d~v i 425-8363 (RIVER FALLS) HAMMOND, WI 54015 QUARTERLY PUMPING REPORT ST. CROIX COUNTY RETURN COMPLETED FORM TO: NAME 91 7ZP4_d~ ADDRESS / c l3 e7'4 / •7 ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMONV, WI 54015 r h-4,0 73 715-796-2239 vn 715-425-8363 TOWNSHIP LEASE ;ROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: A . NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND 1_,"' SEASONAL (CHECK ONE) APRIL MAV JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED A/ q THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30,._1985 OWNERS SIGNATURE r t , ST. C R O I X COUNTY WI SC O N S I N ZONING OFFICE v~. 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 U A R T E R L V P U M P I N G R E P O R T ST. C R 0 1 X COUNTY rf_ NAME RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 HAMMOND, WI 54015 715-796-2239 on 715-425-8363 TOUlNSH1 P e PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: , , A-, LOCATION OF DISPOSAL SITE: ?l NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND / SEASONAL (CHECK ONE) e) JULY AUGUST S -€MgF-R DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1984. OWNERS SIGNATURE °'f C f STATEMENT Glenwood City, Wis. 54013 ---Z ,Y ...............19-grr In Account With Cassellius Sanitation Service Robert Cassellius Phone 265-4623 Glenwood City, Wis. 54013 t Finance Charge of 11/2% per month, with a minimum cha,-~, of 70'' be added to all accounts over 30 days. STATEMENT Glenwood City, Wis. 54013 --..------y 19_ r In Account With Cassellius Sanitation Service Robert Cassellius Phone 265-4623 Glenwood City, Wis. 54013 f 'I ! I I E I~ II 1 ! i Finance Charge of 11/2% per month, with a minimum charge of 50c, will be added to all accounts over 30 days. STATEMENT Glenwood City, Wis. 54013 ,y In Account With Cassellius Sanitation Service Robert Cassellius Phone 265-4623 Glenwood City, Wis. 54013 t 6 "f 1 1 i i Finance Charge of 1112% per month, with a minimum charge of 50c, will be added to all accounts over 30 days.