The URL can be used to link to this page

Home My WebLink About004-1005-80-100 t ~ n to O 3 v n C~ c 0 p CD m CD V CD d fD 3 - r. o o rn O °w °o °C • v n o m S Cv CD CL N ? O O (D -C co o-~. C 1 d Cl- ~ C.0 (M 7 - co 7 O cn O \ N 0- 0 O O N (D (.J 7 O O Q (0 00 0 A 7 N 7 c7 a O W y o A fT O 7 N ? O 00 N J ~ cn Z D a I (D (D O N d ~ 7 W N n ~ co 0 CD O O o N 0 r C O O O c d N -0 T z O O O a ry~~r• o Vl Vl Vl N o D (D r'3= o O W 7 L L u. ! -a !r N I N 3 N CD (D Q - N Z ° o - D D o O a m CD ~ i Q (D 1 lp Z p Z C O rn n A z 0 G 7 O 7 (n --I ca W CD W c z 0 3 p 0 z c~ CD W N n N 7 -p n O 0 d a~.c 2' 7 N :I T 4) 7 N C CL z O (D O 0 ` N 7' = fi p 3 N 0 3• a O cn O o c a p m I m t 7 <O o w CD v N 77 N O (D O a O b l+a CD DO O '69 0 h. 00 rL ti %W 'fl KtFOK7 OF INSPECTION CND1UlUUAL SFwAGE SVS1t Mj Sank taAq PonIIi t// State So p Q c A~/~.3 .5 1 /L U( A 1 U fA YI J lj w ~i 9 rl 4 - i a-( on c on'-to-t 0--------,-Sub I !Jullona Numben o6 ~urripu~~.trn~na &NAMH1 k ^yaxxoaa Pump Manu6actuwt___Model Numboi I ANK gaflona Numbers o6 Compat men-ta AlaAm S~ t .to.m Met 12% slope II,yh.wuten I I I 1~,en~lr W 0 f f Bra4x.diynq 12% exopo ( ghwa to n i I I)IMI Nti10Nti 1 taVnch t RVquIavd anerA h~ vak Une At Depth oA 40ch below t, ek, „A fInes Dvpth 06 nuch oven ti pc fvHgth u6 f-tinea 64 Depth oh We below gnadc by twven l4 nv,5 At Slope 06 -tn.ench i a . PV N 100 h ~ P t Wave V anoun.d pits Itw rrl tV 6t DVp.th bvkow (.n(G',t w 1 t _ _ liv - r I~ OATt 1y 1 171: I:! JL-('7 t ~N DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 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: I Property Location: City, Village or Township- County: Il,1 i,,.? %S T yC KN IR J _ E.(Ur ) W G- " / JC1 Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: 11F (If assigned -~-s Y 1'2_ TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. D' TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specif 1 SEPTIC TANK CAPACITY HOLDING TANK CAPACITY J / LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: ir" A7 c~ t(1 rte ji EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): 5Z, Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name, of Plumber: Signat e f MP/MPRSW No.: Phone Number: Plumber's Address: Name f Designer: k t5 C., k j COUNTY/DEPARTMENT USE ONLY Signa re of Issuing Agent: f Fee: Date: APPROVED Sanitary Permit Number: I /V- i L_J DISAPPROVED Reason for Disapproval: i Alternate course(s) of Action Available: E Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to i:^- 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) REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION 4NDUSTRY,' P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS .:BLK. NO.: SUBDIVION NAME: TOWNSHIP/MUNICIPA~TY LOCATION: OT NO SECTION : MAILING ADDRSS: /4~11a Tz; N/Ri>-{~) W c~ COUNTY: WNER'S BUYER'S NAME: T C/z6 X C r G 12 r_ l G DATES OBSERVATIONS MADE USE ILE T NS: ER / L - N TESTS: s NO. BEDRMS.: COMMERCIAL DESCRIPTION: New Replace .Residence RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHt~INGTANK-RECOMMENDED SYSTEM:~ptiioa`li, O S ❑U ❑ S 11U El DU ❑ $ ❑U S UU i DESIGN RATE: SYSTEM EL If any portion of the lot is in the If Percolation Tests are NOT required under s.1-163.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE jABBR .OIN BA X.) e• 1 36 `h" d.vc 12- b -tz i3.25, i z -may B- 2 9 0 c - e4s,1 3 do //u vF= 7 ~13~s(a ? -/S Fsn s 1 /If 60 -Mo B- d ./o S _'E 1-4 s, t 9-- A o_7,,. 1A? 11. B- yIS 2 A,,7' LJ Si B- &0 Zy q 76 /o t/ 3 X07- 23 -36 /17or B 125, -2 -Z 44,4_ 5,, Z3_ B 1 3 g y ~tlosY PERCOLATION TESTS DROP IN WATER LEVEL-INCHES RATE MINUTES TEST DE PTH WATER IN HOLE TESTTIME NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIODt PERI002 PERIOD PERINCH P- P- P- P- P- LP.__ 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 Qat all Vor"inngs& and the direction and percent of land slop. Scale 1" = f_ l SYSTEM ELEVATION a = Bore Holes = Perc Holes I Notes. 10 mst ~ t .E-- 2e 1 - Vertical and horizontal reference point is ~~-~5',~ Fi) v9v D T IDN.. r'~pv5~ W.. _ . e 2 - Red flags are at k - bore holes pN,::! A-kili-a- 2j k r, z ^C'Y 1, 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. fTE STS W ERE COMPLETED ON: NAME (print): Gordon N. Wing P RTIFICATION NUMBER: HONE N UMBER optional): ADDRESS: 541 715-832-2315 3508 Nimitz Street, Eau Claire, WI 54701 55- T 55-5 ZAFRRE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) f` x State of Wisconsin ` D rtment of Industry, Labor and Human Relations (-tea"~• ==tlxk z~, ts~.~"~ SAFETY & BUILDINGS DIVISION fla ~,'t~G a LTE M'i~f €.~.`~•z~. 5fi~~ t~#§a~~~ts x 1p~IN6 P.O. Box T t ie«td'+#s3~«til,j~ L*, 0, VI) i , s s7t taaF ni t. Croix d..jtin? Si 3 iaczti tr of p1llAi)inq plans and s iF `L",,i.lcw p e(,e" x, +.q g~ g^~ g £ tarn , iLh chapter 145, Wisconsin scat?tw,',. afi6 cll 4.ijJf.6,~ _~~inistrative wae, the ple a alas ana specif icat oias are approve 't t i 5ak'r14 ;3i; . t:ct;rk)li"'nco t n wi~c f=fl iu0n stip")I tint's iftdketeiW on L: . 4:'bility, o f, .,:~3• i~Utir • °t. aired uwj r s. 63.i[L. (t°), Wis. of;. o p. u is approval is not t bl4nket -pp, i; y5r ka F;k to curistructet for the aLove-mentioned installation t (Ay. 5it~ l he tark sh a i l ccnf ors wit -a the coil i t i I-s Specified € zi u struct d as stiown on tie approved design plens. Js tangy , !4ia,l l c liw.arl x iajr~., t' si.+ l iyuij Capacity WlL the -atfacturer's iii- asrw ad r ss-. The rkin s shall bye i tsr:ri od fray or -Jasseo On U* ojtsire d l l of ti: tan! 1welulate iy i 3 aiui ed'it i;3tC+'ri. 4Fvicr,, eJr i`.'3m- or iura it contractor shall keep at tt;e constructiofi sitL i i s4i ~ i t l~r; DILHR-SBD-6423 (N. 04/81) • Yom? State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION i ccsnaaence within two ears from trtis ;date, tilis approval shah bez&uv-- vivid and oew app. . -r;or may c nc i=ns ~r°aistin _tnis apps i p : its if liable for any defects in plans ort s eciiications, p74#i vwissivni. t€" atiE'n overt --ia,, construction or any LFEat~~ ir~d 61'aj reio l i s= ~ w m t . V seal lat.i +n and reserves the right to order ctidnyes or a dd1t1io; - itions arise Qakin, this ns-ce-~sary. P' yft t r i r is approval is rased on 5; n. Wis. n { . U ac., s,,:c(lssary to obtain and fulfill the pemit requirements of Vie 3ti'Y}or a k~i'..ZA 1'3t;04 j=i v{z rki i*..,\}4 r.r'+ r;k,.. s [ e si'Fe,6L VF Y' 4t. 't DILHR-SBD-6423 (N. 04/81) PIb 100a 12/78 Detach And' Return 'Upper State of Wisconsin DIVISON OF HEALTH Portion Of This Form With SECTION OF PLUMBING Any Return Correspondence AND FIRE PROTECTION SYSTEMS ~ MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: 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 plan review fee required is $ ❑ Plan accepted for review. Fee received is $ Fee is being returned because of ❑ Overpayment ❑ Underpayment. Providing one of the two catagories above is checked, remit correct fee in one payment. ❑ No fee has been remitted. Plans submitted with no fees will be held in abeyance. Lail ❑ Plans being returned. H r- ~ ❑ = _O Additional information required. SEE BELOW. e~JR C f CQ 1. Plan Submission ❑ Additional information shall be submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ❑ All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. II. Alternate sewage Disposal Systems (Mound Systems) ❑ PLB 108 (Application for use of an alternate system). ❑ County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. ❑ Pipe lateral layout. ❑ Plan view of alternate. III. Private Sewage Disposal Systems ❑ Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system - provide soil test data. ❑ Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldgs, lot lines, well, watercourse, etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. ❑ Construction detail and cross-section of soil absorption system. ❑ Soil boring and percolation test on EH 115 completed by certifiedsoil tester (1 copy). ❑ Complete data relative to anticipated use of bldg. ❑ 3 copies of PLB 60 enclosed. ❑ Deed restriction required (1 copy). IV. Holding Tanks ❑ Profile of holding tank. ❑ Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ Reason for installing holding tank soil test or statement from county (1 copy). V. Lift Pump ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Size, length & depth of force main. ❑ Detail & model of pump or automatic siphons including size, pump curves, drawdown and average flow rate GPM. ❑ Cross section of lift pump tank showing pump(s) or siphon(s). VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Total area filled (fill to extend 20' beyond edge of trench before side slope begin). Depth and type of fill. ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. Do- Plb. 1-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Systems ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises Street City County Master Plumber Address Owner Address ❑ County Permits ❑ Appropriate State Permits Type of Building: ❑ Public ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer ❑ Conventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH- f [ f E E i E E I I ~ # # t ' , ` i ¥ 3 E , # E # 3 , e z . _ 3.. 4 1 2 # 3 ~ 3 E ` ® s , Pm # F _ c..... m e N i . _ e . _ e w 1 , r E # # q F.. n_.. , E 4 , 3 , y $ j _a y _ z F....e. s.. - _ , _ _ _ 3 ; i f . .b f # 3 # t , E a s _ = E ~ E I j f~ ~ e i ~ ~ e P d i ❑SEE ATTACHED DISCUSSED WITH PLUMBER ( ) Yes ( ) No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of Inspector White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party NOT : As spec^i_f.i.ed in 1163.18(4 A) Wi.s.consin .Admi.nistral_ive Coda this document is to be recorded in the Tract. Index, 1o- cated at. the CVunty Regi.st_er of Deed:;. At tltcr Linte of Sani_- t,try PLrwit Application, a copy of this a-reement, with the recording dates and numl-,-r should be submitted to this office. HOLDING TANK AGREEMENT This Agreement is made and entered into this day of 19by and between the T , hereinafter called -7 an t 1 ( hereinafter cMed the "Owner. We hereby acknowledge that application has been made for a building permit on the following described property, to wit: 'lam S, or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment 1~CPOVPp of sewage. We also acknowledge that said property cannot now be servec9 , by a municipal sewer or septic tank soil absorption system. > Therefore, as an inducement to the County of 4f1`0i P1L issue a sanitary permit for the above described premises, we hereby agree S'ectla4, 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 Municipalit,) of C+ , through its Plumbing Inspector or Health Oft' cer, aems t n essary to pump out the subject holding tank, the Owner shall have same pumped out in twenty-four (24) hours, or f_~/ Aee will have said work done and charge same back to Owner and lace s on - the.tax bill as a special charge. The Owner further agrees that the Town or Municipality of ( 11 o may enter upon the property des- cribed above at any reasonme, to aspect, or pump and haul wastes froet the subject holding tank. 2. Owner agrees to pay all charges and costs incurred by the Town or Municipality of C_. L for inspection, pumping, hauling or otherwise servicing an ma ntain ig tFe subject holding tank in such a man- ner as to prevent or abate any nuisance or health hazard caused by such holding tank. P ~w{_+T shall notify the Owner of any such cost which shat a aic Ely-t a ner 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. ai cf 'b%,cconsln t7e~artrnen1 0 In Cu try, Labor & Kumar, RelaUoris DILHR-SBD-6123 ( R. 3/81 ) s,on of safety & Buildings This document is a full, true and correct co,,-y of the original on file and of record in my office k-2i D 19S 7 certified 1~ 11 - 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 0 /2( _-County certifies that the subject pro- perty is served by aitaer 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 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 TOWN OR MUNICIPALITY OF ~J y f[ OWNEn S by STATE OF WISCONSIN Personally carne before me this J day of 19, / j the above named to me known to be the persons who execute t e oregoyng nstrument an acknowledged the same. All/ f' THIS INSTRUMENT N-MRY PUBLIC DRAFTED BY ~tyrm+aarerft~ti, My commission expires: 7 - .n s 9 3 f Cry ~S ti•'11'y'° 0~' ST. CROI X COUNTY _4=, a /Ia,✓i`~ ,9~;~s WI SC O 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 REPORT ST. C R O I X C O U N T Y i NAME : RETURN COMPLETED FORM TO : ADDRESS: 1~y ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 HAMMOND, WI 54015 _ 715-796-2239 or 715-425-8363 TOWNSHIP : w IA A PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED B~RECEIPTS FROM YOLTR~Pi E NAME OF PUMPER:, LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: r'. USE: YEAR ROUND_ SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED t~j THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1986. OWNERS SIGNATURE j.;~,- y 1 mj:12-83 Ability Business Co. A*B*C Complete Sewer Services Telephone 665-2112 Route 1 KNAPP, WISCONSIN 54749 Date_ i 1 Work Pexfor ec J i TOTAL COST Signature ST. CROI X COUNTY 7 j W I S C O N S I N { -i f wt, y..'' On/F~f jv ZONING OFFICE r ~a o`'o~`~~Gt~. ;4N 796-2239 (HAMMOND) 25-8363 (RIVER FALLS) HAMMOND, WI 54015 Q 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 NAME S nt_ j _ _ RETURN COMPLETED FORM TO: 1 Q ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 Ld~~ > HAMMOND, WI 54015 715-796-2239 of 715-425-8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM N-UR PUMPER: NAME OF PUMPER: LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND XSEASONAL (CHECK ONE) JULY AUGUST SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 15, 1985. OWNERS SIGNATURE - ten 4 ~ 2~~ ST. CROIX COUNTY WI SC O N S I N r _ ~ t~r Ski Q '1.'14f2 t .X~' T s"✓ ,1 , a,:~~~♦ n ZONING OFFICE 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L V P U M P I N G R E P 0 R T ST. C R 0 1 X COUNTY NAME I.~ RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. SOX 98 HAMMOND, WI 54015 715-796-2239 vac 715-425-8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: CY Ili, tan ~LOCATION OF DISPOSAL SITE: (-k A Qr,r._ NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND SEASONAL (CHECK ONE) APRIL MAV JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JULY 30, 1985 OWNERS SIGNATURE rl Ability Business Co. AeBoc Complete Sewer Services Telephone 665-2112 Route 1 KNAPP, WISCONSIN 54749 Date r- Work Performedt -t' TOTAL COST $ Signature k x,l ST. C R 0 1 X COUNTY W l SC O N S I N ZONING OFFICE G~ 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. C R 0 1 X COUNTY NAME RETURN COMPLETED FORM TO: ADDRESS ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 I HAMMOND, WI 54015 715-796-2239 an 715-425-8363 TOWNSHIP PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BV RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: j> LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND 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 t Llj 4,<,, ST. CROI X COUNTY ~;r WI SC O N S I N 21 r^?' ~FI►~.~c ~JC~/!J ZONING OFFICE - 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) ~TT~, 1 HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G REP O R T ST. C R O I X C O U N T Y NAME: RETURN COMPLETED FORM TO: ADDRESS: _ C- 2,- ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 HAMMOND, WI 54015 715-796-2239 or 715-425-8363 TOWNSHIP : C" PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: z LOCATION OF DISPOSAL SITE: { C Lz~! _ ~,_tizr NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND y / SEASONAL (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED s c~ , O c> THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1985. OWNERS SIGNATURE; mj:12-83 .1 4 Ability Business Co. A*B*C Complete Sewer Services Telephone 665-2112 Route 1 KNAPP, WISCONSIN 54749 Date_ r~' 2y d~ i Work Perf rmed~ TOTAL COST Signature . z} ST. CROI X COUNTY ~ j 6 4 WI SC 0 N S I N Rl" ZONING OFFICE r. w F_ 19~ 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) i% HAMMOND, WI 54015 U A R T E R L Y P U M P I N G R E P O R T ST. C R 0 1 X COUNTY NAME n n e- 6- r e- I y RETURN COMPLETED FORM TO: ADDRESSi J 130 x 3 ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 S,) el y ~ 7 HAMMOND, WI 54015 1 715-796-2239 an 115-425-8363 TOWNSHIP -G c/ PLEASE PROVIDE THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER: ,J c-- LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: 5 USE: YEAR ROUND SEASONAL (CHECK ONE) JULY AUGUST SEPTEMBER DATE VOL.PUMPED DATE VOL.PUMPED DATE VOL.PUMPED lJ THIS REPORT MUST BE RETURNED NO LATER THAN OCTOBER 151 1984. r OWNERS SIGNATURE ti T. CROI X COUNTY W l SC O N S I N { 1 ZONING OFFICE 96-2239 (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 , 1 \ P.O. BOX 98 - L(G,.9 7 HAMMOND, GPI 54015 Ll 715-796-2239 on 715-425-8363 TOWNSHIP - ( , PLEASE PROVIDE 7-11E FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER. LOCATION OF DISPOSAL SITE: NUMBER OF PERSONS LIVING IN RESIDENCE: USE: YEAR ROUND S1ASONAL (CHECK ONE) APRIL MAY JUNE DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPEP THIS REPORT MUST BE RETURNED NO LATER THAN JULY 15, 1984 OWNERS SIGNATURE -ev Ability Business Co. AOBOC Complete Sewer Services Telephone 665-2112 Route 1 KNAPP, WISCONSIN 54749 ate ---1~ 141 Work Performed O e~ 'fi 'fi COST $ Signature ST. CR01 X COUNTY 'r Ap A~ W I SC O N S I N 14aj9l98 ZONING OFFICE 1!Ll'gri ' 796-2239 (HAMMOND) c"• 425-8363 (RIVER FALLS) HAMMOND, WI 54015 n U A R T E R L y P U M P I N G R-1 P O R T ST. C R 0 1 X COUNTY NAME " J RETURN COMPLETED FORM TO: ADDRESS x 3 ST. CROIX COUNTY ZONING OFFICE P.O. BOX 98 1J w - HAMMOND, WI 54015 715-796-2239 on. 715-425-8363 TOWNSHIP 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) JANUARY FEBRUARY MARCH DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED 1-141S REPORT MUST BE RETURNED NO LATER THAN APRIL 15, 1984. )DINERS SIGNATURE 0 V/7 T. CROI X COUNTY ~K r~~~~ WISCONSIN ZONING OFFICE K TT re 'l i I k~ I ~ '~I ~~„1q ?t, 796 2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, W1 54015 Q U A R T E R L Y P U M P I N G R E P O R T S T . C R O I X C O U N T Y NAME: / C' i cr l:E'TURN COMPLETED FORM TO: r` ADDRESS: ST. CROIX COUNTY ZONING OFFICE. P. 0. BOX 98 LIJI ~Sa h j D HAMMOND, WI 54015 T715-796-2239 or 715-425-8363 TOWNSHIP: G~ ~ y PLEASE PROVIDE, THE FOLLOWING INFORMATION ACCOMPANIED BY RECEIPTS FROM YOUR PUMPER: NAME OF PUMPER:./~,~,/l,f~„~~~ _ LOCATION OF DISPOSAL, SITE.: jitJ yv` LJ.C r'. NUMBER OF PERSONS LIVING IN RESIDENCE: ~j USE: YEAR ROUND SEASONI~ 1, (CHECK ONE) OCTOBER NOVEMBER DECEMBER DATE Vol- PUMPED DA'Z'E VOL. PUMPED DATE VOL. PUMPED THIS REPORT "`.,ST BE I?}~ T'U°""'. ^rn f ATVTR THAN TAPdllftFY- i 1984- OWNERS SIGNATURE mj : 1.2-83 Ability Business Co. AeBoC Complete Sewer Services Route 1 Telephone 665-2112 KNAPP, WISCONSIN 54749 'mil 1 y ~ j(~ l ~i ~D ate 'f Work Performed' r ~ 19 . iCs i ~ a f „ b `Gds - - - Signature HOLDING TANK PUMPING REPORT Name o6 Re4idence',t=, Addne4e -'-r 1 < < j Tetephone Lega.t: y o6 o6 Section T N-R W Towne h.i p i 1 J Vate Pumped Amount Pumped Location S head Remanka Pum en'a,. S.L natwte 1 i 1 Zoning 066ice u4 e: ' Date I n4 pected Cond.iti.on4 Found The above in6o4mati.on shah be 4ent to the St. Cnoi.x County Zoning 066ice, Poet 066i,ce Box 227, Hammond, WI 54015 monthty by the Pumpers. The i.njonmation wilt at that time be neviewed by the Zoning 066ice and ptaced in a penmanen.t 6.ite. . Random in4pection:4 w.itt atAo be made by the St. Choix County Zoning 066ice to i.n4pect the eu.cce44 o6 the 4 yatem at the above Location. n fA O 3 V n d ~1 o 0 f c o m c 0 3 fD v v v m 3 co o o v o m W o Oo ~C 0• 3 d c -M 0. (D d d (D (D ~ 00 K = O d. CD CD N L., c, \ 3 (D (D 7 p Ul Fl w CD CD 0 O, CD N N n O W y 3 d Q O = O y S O cn O O !r CD (n z D A 2 1 CD o D N 4 r 7 co c a 0 1 3 O N by w C) z m N n r to o CO o ti o c En ^ _ z o O O 5 ~r c D < z aQ N D o 0- v v v o O ~ CAD ~ <D y W (D (D (D P N N) S~ 0) N ~ O a I N c /7 0 D D a o. ( CD o CD v 0 X CL c < CD n ~ z CD 0 , Z CD I p ~ .n. N A z = G) O td 7 cn --i w W v 4 a ` CC) s z 0 3 a \ O ~ zz< ~C (D A W fll 0 O a 3 (D 0 Q (D 3. 3 CD :3 N =3 w C m a O a 0 _ cn ~ L N S S O o 3 O N (D I ~ j O <n . S O fl, a c a) 5- D O O N O 7 O N q 0- A I O_ N aQ A O O 0 ti Oo O I ~ O Q O . ti Parcel 004-1005-80-100 10/02/2006 11:18 AM PAGE 1 OF 1 Alt. Parcel 3.28.15.398-10 004 - TOWN OF CADY 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 - NELSON, JOHN C & DOROTHY R JOHN C & DOROTHY R NELSON 567 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 567 HWY 128 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH J Legal Description: Acres: 17.820 Plat: 0729-CSM 03/0729 SEC 3 T28N R15W 9.76A IN SW NW LOT 1 CSM Block/Condo Bldg: LOT 1 VOL 3/729 ORD INC N 266FT OF SW NW(39A-10) 004-1005-70-100 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 03-28N-15W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 08/11/2000 628002 1533/534 AFF 08/11/2000 628001 1533/533 WD 07/23/1997 1175/212 WD 07/23/1997 1080/233 WD more... 2006 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/17/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 28,000 144,900 172,900 NO AGRICULTURAL G4 15.820 2,900 0 2,900 NO Totals for 2006: General Property 17.820 30,900 144,900 175,800 Woodland 0.000 0 0 Totals for 2005: General Property 17.820 30,700 144,900 175,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 568 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 004-1005-70-100 10/02/2006 11:18 AM PAGE 1 OF 1 Alt. Parcel 3.28.15.39A-10 004 - TOWN OF CADY 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 - NELSON, JOHN C & DOROTHY R JOHN C & DOROTHY R NELSON 567 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 8.060 Plat: N/A-NOT AVAILABLE SEC 3 T28N R15W PT SW NW N 266FT OF SW Block/Condo Bldg: NW ADDED TO 004-1005-80-100 (39B-10) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 08/11/2000 628002 1533/534 AFF 08/11/2000 628001 1533/533 WD 04/25/2000 621795 1505/201 WD 06/19/1998 581409 1333/388 LC more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 004-1005-80-100 Valuations: Last Changed: 09/25/2000 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 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