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Parcel 012-1047-40-000 01/12/2007 10:28 AM
PAGE 1 OF 1
Alt. Parcel 21.30.17.317B 012 - TOWN OF ERIN PRAIRIE
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
O - MICHELS, MARY J
MARY J MICHELS
1797 CTY RD G
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1797 CTY RD G
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE
SEC 21 T30N R17W 1 AC IN NE NE COM 33 FT Block/Condo Bldg:
W& 82.5 FT S OF NE COR, TH S 67 FT, W
142.5 FT, N 116.5 FT, TH E 93 FT, S 45 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
DEG E 70 FT TO POB 21-30N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1013/227 JF
07/23/1997 877/19
07/23/1997 867/456
07/23/1997 785/159
2006 SUMMARY Bill Fair Market Value: Assessed with:
156019 133,300
Valuations: Last Changed: 11/07/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 1.000 15,000 115,500 130,500 NO
Totals for 2006:
General Property 1.000 15,000 115,500 130,500
Woodland 0.000 0 0
Totals for 2005:
General Property 1.000 15,000 115,500 130,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 545
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel 012-1048-10-000 01/12/2007 10:08 AM
PAGE 1 OF 1
Alt. Parcel 21.30.17.323 012 - TOWN OF ERIN PRAIRIE
Current X 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
AS BUILT SANITARY SYSTEM RLPOI'T
OWNER Ti, /A / C. J1 IF TOWN SHIP S!~1c; ;7, / 1,940h - I< i 7w
ADDRESS ST. CRO Lx COUNTY, WISCONSIN.
L,e~~k
SUBDIVISION LOT__ _ LO'l.' SILL"
~~1~~G lvl~-~~
PLAN VIEW
Distances and dimensions to meet requirement:; of 116i -71Z
(~C 1~ to (o ~
W-.EVER1lTHING WITHIN 100 FL.L:T OF SYSTEM
I
I dlLire Lrwth~ Arrow I
- SCIALJ~ ~ ~ I I _
BENCHMARK: (Permanent, reference Point) 1) esc1i1)
Elevation of vertical reference po.iiit : :;Iola(' ul :s i
SEPTIC TANK: Manufacturer: ~ f. iyl i d i i y
Number of rings on cover Tailn ncanho k..• c•ovel I c~v;11 i o,n
Tank Inlet Elevation; T1111k Out I c• t f,: E c•vi1t i c+++
PUMP CHAMBER
Manufacturer: Nutnh(,r (,1 ~.+I I()n:,
Number of gal. pump set for a cycle del T on:: , 1 oI', l (IP-W i i y
distribution lines ga l 1011: s of p11111l) I+~ .<<I
gallon per minute--_ horsepower I,i,inl u.+u,1 I,uml,
and model number
Type of warning evice
HOLDING TANK: Manufacturer Nun IWI (11 1-,A 1 1()11:,
Elevation of manhole cover
Type of warning device
SEEPAGE PIT SIZE: Numberof pits 1-ec t i rink i i
feet liquid depp~ seepage pit. iniet_ pipe-elevai
bottom of seepage pit. ovation _ f cuI
SEEPAGE BED SIZE: number of lines width - Le[[ l h i i l 1, lei
SEEPAGE TRENCH width _ _ _leugtl~
PERCOLATION RA'Z'E REA REQUIRED - --AREA AS ]~UTLT
DATED _ PLUMIiI-JK•-f) TnI~
LICENSt: NUMbFK
_ A _ `
C
• ~ M
f
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DEPARTMH`JT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O.,BOX 7969 BUREAU OF PLUMBING
MADISON, W1 5D07
❑CONVENTIONAL ❑ALTE R NATI VE crate Plan LD. Number
(lf assigned)
❑ Holding Tank In Ground Pressure ❑ Mound
NA PERMIT HOLDE ADDRESS OF P RMIT HOLDER'. INSPECTION DATE:
B CH MARK (Permanent reference pomtl ESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.. CST REF. PT. ELEV.
Na- of Flu.r_ rP/MPRSW No.. Counry • Sanitary Permir Number'.
SE TIC TANK/ DING TANK:
MANUFACTURER. LIQUID CAP ACITV. ]TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
❑YES LINO ❑YES LINO
BEDDING: VENT CIA VENT MAT L.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL'. BUILDING. JVENTTOFRESH
ALARM
FEET FROM LINE: AIR INLET.
❑YES LINO ❑YES LINO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING. LIQUID CAPACI IV PUMP MODEL. JPUMP/SIPHON MANUFACTURER WARNING LABEL JLOCKING COVER
PROVIDED'. PROVIDED:
❑YES LINO ❑YES LINO ❑YES LINO
GALLONS PER CYCLE: FP AND CONTROLS OPERATIONAL NUMBER OF I'4i OPERTV WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM VE AIR"LET
PUMP ON AND OFF) ❑YES LINO INEAREST->
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing r F nrc,TH nAC°FTEH MATERIAL AND MARKING
or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH. LENGTH NO. OF DISTR. PIPE SPACINfi. COVER INSIDE DIA. -PITS LIQUID
BED/TRENCH TRENCHES MATERIAL: PIT DEPTH
DIMENSIONS
(;RAVF L DF. PTH FILL DEPTH JUISTH. PIF F DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUM I
BER OF PHOPERTV WELL. BUILDING. VENT To FRESH
BC Lt1W PIPF', At3I)VE COVER ELEV INLET ELEV. END PIPES FEET FROM LINE. AIR INLET.
NEAREST-sl
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.
YES NO
SOIL .`OVER. TEXTURE PERMANENT MARKERS. OBSER /ATION WELLS.
❑YES LINO ❑YES LINO
DEPTH OVER TRENCH BED DEPTH OVER TRENCH. BED DEPTH OF TOPSOI L. SODDED ISEEDED MULCHED
CFNTFH EDGES
❑YES LINO ❑YES LINO ❑YES LINO
PRESSURIZED DISTRIBUTION SYSTEM:
w'I DT II I FNGTH NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR PIPE JMANIFOLD MATERIAL. NO. DISTR. JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING
Et EvFLEVDIAELEV. PIPES DA.:
ELEVATION AND
DISTRIBUTION F{OIL SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL
INFORMATION VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES LINO ❑YES LINO
COMMENTS: PERMANENT MARKERS OBSERVATION WELLS NUMBER OF {PR OP ERTV WELL 1 BUILDING
FEET FROM LINE
I
Sketch System on Retain in county file for audit.
Reverse Side.
S R.Ey TITLE.
DILHR SBD 6710 M. 01/82)
D'EPARTPOENT OF APPLICATION SAFETY & BUILDINGS
INDUSTRY, FOR SANITARY DIVISION
LABOR AND, PERMIT P.O. BOX 7969
HUMAN RELATIONS (PL13 67) MADISON, WI 53707
Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address:
Property Location: image o ownshi • County:
F t/a /YF'/aS ; T Y N R / ' JIE
T, C. r
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
M, I "I (If assigned)
TYPE OF BUILDING G~
Number of
❑ Public* ❑ Variance* Other (specify)* oeL J, r Bedrooms:
❑ 1 or 2 Family *State Approval Required. /Y
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY
HOLDING TANK CAPACITY y 6•~ S
LIFT PUMP TANK/SIPHON CHAMBE
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): JU New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
❑ Altern specify) ❑ Seepage Trench
r
Water Supply: Owner's Name as Listilld on Report er than present o 1:
El Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the ~m shown on the attached plans.
Name f Plumber: Signatu ~
A MP RS o.: Phone Number:
e 3 (71 s) 7Y
Plumber's A ress: Name of De 'gner:
Ac 1
Z COUNTY/DEPARTMENT USE ONLY
Sign ure of Issuin Age Fee: , / Date: APPROVED Sanitary Permi1t Number:
.1 -II g
L! DISAPPROVED T
'Reason for Disapproval: 17
Alternate course(s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03/81)
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ST. CR0I X COUNTY
w i s c o N S I H
'
Z Q N I N G O F F I C E 796-2239
Ni.
z Post 0 ice Box 227
fi 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, chat until you arse again noti.6.ied, I w.itt
1 r
co ntnact with o / ~i °
WiAcon6.in, (Pumpers) , bon the purpose o6 rsemov.ing at t waste 6n.om the
aan.ita.ny system to be .located on the prsopenty and 6utune home site
Located in St. Cno.ix County, Wisconsin, Township o6 E1, jj1
being in the ~ 4 o6 the !I o6 Sec. T. T'`/ N.-R._.zz
(On mo ate 6 utty d e6 cn.ib ed as 6 o.ttows : )
2~z
Dated .th.iA day o6 / 19 S
(OWNER)
State o6 Wisconsin)
66
County 06 St. Cno.ix)
Pen6onna2Cya
ppean d be6orse me this day 06 ~ 19 the above named to met nawn to ~e the
pen6on who exec. the orsegokng instnume-W and acknowte_dged the same.
o any Nub-,.cc? t. CAoix` County,
My Comm. (is pe)Lnant) (ExpiAes )_:f
- - hene.inbe6orse ne6 ersrsed to as Pumpers,
join in the above agreement to t 2lf ent that 1 have a contract with
Owner as above stated.
(PUMPER)
r
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 Perulit Application, a copy of this agreement, with the
recording dates and nuriher should be submitted to this office.
HOLDING TANK AGREEMENT
This Agreement is made and entered into this day of
19 , by and between the
hereinafter called an 7 c= t hereinafter ca e t e
"owner.
We hereby acknowledge that application has been made for a building
permit on the following described property, to wit:
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 J;~~~. C J"l'~ to
issue a sanitary permit for the above described premises, wehereby agree
and bind ourselves as follows.
1. Owner agrees to conform to all applicable requirements of the
Plumbing Code relating to holding tanks. Any time the Town or Municipality
of /mar,;/^R~.~ , through its Plumbing Inspector or Health Offi-
cer, deems necessary to pump out the subject holding tank, the Owner
shall have same pumped out in twenty-four (24) hours, or /-,7~_~~
will have said work done and charge same back to Owner and place on
the tax bill as a special charge., The Owner further agrees that the Town
or Municipality of ,"J/ may enter upon the property des-
cribed above at any reasonable time, to 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 ~ ~ cs for inspection, pumping, hauling or
otherwise servic n- g and ma nta n n g the subject holding tank in such a man-
ner as to prevent or abate any nuisance or health hazard caused by such
holding tank. shall notify the Owner of any such
cost which shall be pay the weer 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
3. Owner agrees to have a quarterly pumping report submitted to the
local government and the county which will 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 of Industry, Labor
and Human Relations by the governmental unit responsible, per section 145.01
(15), Wisconsin Statutes.
4. We guarantee that the holding tank contents will be disposed of at
a site meeting the requirements of chapter NR 113, Wisconsin Administrative
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 by either 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 executing and recording said certification with re-
ference to this Agreement, in the Tract Index indicated 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.
WITNESS our hands and seals this ' day of 4Q_1J ,
19:
TOWN OR MUNICIPALITY OF + t , N f f~ : t r
OWNERS
by
a 1 G 1 J
by ~A,
STATE OF WISCONSIN
Personally came before me this day of ,
19~. the above named -j 4 i- -A e T
to me known to be the persons who execute the foregoing instrument and
acknowledged the same.
THIS INSTRUMENT PUBLIC
DRAFTED BY:
My commission expires:
.
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