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• A S B U I L T S A N I T A R Y R E P O R T
OWNTER.: c P , Township ' Sec „LTn.~_N, Rxs- W.
P. 0. ADDRESS : dE e~ -Pb~ee County", Wisconsin
Subdivision , Lot, Lot size
PLAN =74 l
Distances & dimensions to meet requirements of Sec. F62.20
s
i..
le?
Septic tank(s) .ugr _ No rings, Dept to cover
Dry- well size Type of Aggregate Covered with
Depth of seepage system Vent caps in place , number used
DISCLAII.7R: The inspection of this system by Pierce County does not imply complete
co:Tmliance with State Administrative Codes. There are other areas that it is impossible
to inspect at this point of construction. Pierce County assu^qes no liability for system
operation.
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r' e
PLUMBER ON JOB:
DATED. LICENSE I:TUT•IBER:
Parcel 004-1063-95-000 01/08/2008 04 47 PM
PAGE 1 OF 1
Alt. Parcel 27 28,15.423C 004 - TOWN OF CADY
Current ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
12/05/2007 00 0
Tax Address: Owner(s): O = Current Owner C = Current Co-0,::
JANELLE TIMM
3029 20TH AVE
WILSON WI 54027
Districts: SC = School SP = Special Property Address(es): = Primary
Type Dist # Description ' 3029 20TH AVE
SC 5586 SPRING VALLEY
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.110 Plat: N/A-NOT AVAILABLE
SEC 27 T28N R1 5W 2.11A IN NE NW LOT 3 Block/Condo Bldg:
CSM VOL 3/875 ORD
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
27-28N-15W
Notes: Parcel History:
RETIRED 2008-CSM 23-5485 COMBINES PCLS Date Doc # Vol/Page Type
4238, 423C, 423D & CREATES NEW PCL'S LOT 12/18/2007 865841 T'
4 PCL 004-1063-95-010 (423C-10) & LOT 5 12/05/2007 865207 23/5485 CSM
PCL 004-1063-90-100 (4238-10) 12/03/2007 865069 TD
12/03/2007 865068 CT-TR
2007 SUMMARY Bill Fair Market Value: Assessed with:
198165 244,500
Valuations: Last Changed: 09/07/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.110 28,800 184,900 213,700 NO
Totals for 2007:
General Property 2.110 28,800 184,900 213,700
Woodland 0.000 0 0
Totals for 2006:
General Property 2.110 28,800 184,900 213,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 511
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
.
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REPORT dr" INSPECTf~iJ INDIVIDUAL SEWAGE SYSTEM
San.i-tan y PeAm.i.t
State Septic /-2771177-
Fownship - ! S$. Cno.ix County
NAME
Locatiox /I&/Section ~
SEPTIC TANK
S.izei. gattona. Numb en 06 Compantmentd i
Diztanee Fnom: Wett 12% ot gn.eaten tope 6t
Bu.itding - it. We eandd ~ .
H.ighwa.ten
DISPOSAL SYSTEM
D.iztanee Ftom: Wett 12% on gtceaten ztope 6t.
Su.i.Ld.ing 6.t. W ettands Ft.
• H.ighwaten 6z.
FIELD DIMENSIONS:
Width o6 trench it. Depth o6 rock betow z.i.te .in.
Length o6 each tine 5.t. Depth 06 tock oven ti.2e .in.
Numbeh o6 tine3 Depth o6 -tiZe betow grade .in.
Totat. .length o6 2.ineA t. S tope o trench in pen 100 4t.
D.catance between 2..ine,5 fit. Depth to bedrock it.
To.ta.L ab.aonbt.ion area 6x2 Depth to gnoundwaten 6-t.
Requ.ined area it2 Type o6 Coven: Papers on St&aw
PIT DIMENSIONS:
Number o6 pits Gnavet aAound pi tzs yez no
Out,6.ide d.iame.ten it. Depth betow .inZet 6t.
2
Totat abzonbt.ion a-tea SZ z
_A
2 m
Axea nequkAed it
INSPECTED BY TITL
APPROVED
rt DATE 197'
~ .
REJECTED DATE 197.
State and County State Permit #
PLB 67,
Permit Application County Permit #
~
for Private Domestic Sewage Systems County elf ! "
*DENOTES STATE APPROVAL REQUIRED - 1~
Date Approval Received from State if Required State Plan I.D. # r
A. OWNER OF PR ERTY Mailing Address:
'0 T
h!q 6S i
B. LOCATION: /4 /V W '/4, Section 12j, T_ N, RLJ E or) W Lot# =2- 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 No. of Persons
D. SEPTIC TANK CAPACITY Total gallons No. of tanks
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specifyV)
New Installation Cl 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 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 > C.S.T. # and other information
obtained from - (owner/builder).
Plumber's Signature s ~y. MP/MPRSW# 5 l Phone 4,3 j` -'-31
Plumber's Address ,
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.
"eJ
E
I e M _
E
,
5 Cot
~f"
~O ~60 ✓t I it `nk
r
WE
Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY r,
Date of Application Fees Paid: State County Date-
Permit Issued/Rejected (date) ' Issuing Agent Name
Inspection Yes~No State Valid# Date Recd
1, county ( iwfi to 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
EH. '115 Rev. 9/78
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
P.O. BOX 309, MADISON, WISCONSIN 53701
LOCATION: =''/a~w Section C. ,T Lr'N,R i ° E{ex) W, Township OF MWRiffli --U..
r
Lot No., Block No. C J} ' County J ~ [ X
Subdivision Name _
Owner's%BtptowName: ~ ~ C~Ivt -TI in m T~e~, i T1 t7 pi ~ Vz&: •-s
Mailing Address: 5 iz> %e lA-3C-, L.-ALL-(:-9 , kL '5/76'71
TYPE OF OCCUPANCY: Residence X No. of Bedrooms Z_ COMMERCIAL
EFFLUENT DISPOSAL SYSTEM: NEW K REPLACEMENT ALTERNATE SYSTEM OTHER
DATES OBSERVATIONS MADE: SOIL BORINGS 5/ S4, J2 B IV/ 72 PERCOLATION TESTS fftS 17~
l-r~►=
SOIL MAP SHEET NAME OF SOIL MAP UNIT XL
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P- I IL, 1 • n >E w1• s \ 'L -,c 3 c• 3 "-L 3'/Z 3 ~~z 3
P- 2 ` jb 5 h s ' (1Z' twh 11 2 `3 L/ r (/!/t, V 1l4
P- - 3 -3 t~ T " 5 \ ' : n cr 1~ s 1 2-~! a 3 si 3 :s/y 3 6,N8 P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,
NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK
OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
B- bit o i 6 '`bh t svh I( Y6
B- '7 Z Vk IS i' 0 26 it y&
B- 3 '72 3 1 •t t 'bu nS l ' b 3i,
B- S 7'L ~i 1 s' ~s !6' 13x I L-' V,&%Lf 4S
PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas.
Indicate number of square feet of absorption area needed for building type and occupancy ` Sv , TTML-Q Indicate scale or distances.
Give horizontal and vertical reference points. Indicate slope. 0~ Y'1L`i'T10 d ta~;~ ~`r7uh.
;Boo
i , -5; tz~i~C-~ $ ~l 1-)4 Z i"1 S i/-I ~ L All
C- V kA L- A T' G
C3~ 133 i~
- 'gi C?t7/?0A_' D L'' ~3 i ~ PJ
e t t L f3 a_ ti C~ ~"D 1A j S i 712 /11- FZ
e
-A I C~J L-
E 3 s ~ 1 1µ
E
s
g.„._.-a`,.....e.-....~-.~.--$s.-.,mom _ r ..f. m $P...,.. v....-.§-.
s n _x _
ay
x s s F
I ~
SCA LC tom(_eP; +S S#a%A 2
I, the undersigend, 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 location of test holes are correct to the best of my
knowledge and belief.
Name (print) Certification No.
Address 12!~'-ice
Name of installer if known
Copy A - Local Authority
' x
ST. CROI X COUNTY
~r yrs. W1 SC O N S I N
1 y
1h, 7 6 w.
ZONING OFFICE 796-2239
ti ~~11[~.tlfs Post 046jice Sax 227
Hammond, WI 54015
0 W N E R
P U M P E R
A G R E E M E N T
PLEASE BE ADVISED, Fhat it you ate again noti4ied, I wilt
04 ~ 4,ell ,
contract with- 1&47, V~1-, 0,
W i..b con,5t.n, (Pumper), Jot the putpose o j removing att waste 6tom the
aanitaty system to be .located on the ptopetty and jutute home site
.located in St. Ctoix County, Wisconsin, Township oj
-
67, being in the % of theof Sec. 2 _ T. -2 N - W.
. f
10t mate Gutty desvLibed a/s ~ot.Qows: )
r
?Dated this j day as k) , 19
(OWNER)
State of Wi,6conzin)
d is
County o6 St. Ctoix)
Pet,sonnatt yappeated be6ote me ,-this 3 day 06 J, 19 ,71a
the above named rz to me known to be the
person who execute t e 6otegoing insttument and ,acknowt'edged the same.
ataty u tic„-'St. Croix aunty, WI
My Comm. (i16/petman,t) (Bxpites) 12 -r~
heteinbe6ate te~etted to a/s Pumper,
join in the above agreement to the extent that I have a contract with
Owner a/s above stated.
t (PUMPER)
October 3, 1979
Mr. Edward F. Lechner
609 Main
Elmwood, WI 54740
Plan Identification No. 79-03732
Dear Mr. Lechner;
Re: Holding tank - 3,000 gallons
Dennis Timm - Residence
NE 1/4, Nw 1/4, Section 27, T28N, R15W
Town of Cady, St. Croix County, Wisconsin
Examination of plumbing plans and specifications for the above-mentioned
project has been completed.
In accord with Chapter 145, Wisconsin Statutes, and Chapter H 62, Wisconsin
Administrative Code, the plumbing plans and specifications are approved
contingent upon compliance with the following stipulations,
1. Our review of the holding tank plan has not been evaluated for
structural stability, only for compliance to design requirements of
Chapter H 62 of the Wisconsin Administrative Code.
2. The holding tank shall be maintained and the contents disposed of as
required under Section H 62.20 (7), Wisconsin Administrative Code.
3. The architect, professional engineer. registered designer, owner or
plumbing contractor shall keep at the construction site one set of plans
bearing the stamp of approval of the department.
4. In the event installation of the plumbing Improvements or system has
not commenced within two years from this date, this approval shall become
void and new application shall be made for approval of these plans before
work may commence.
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in! h mtMy "old ion and -ratp anal 0p0? its To tai;("'al'IS ..t
y?.°a `in'. (1:f: '~.,:j is
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t;:, vV I }'61J c lFl it:}::F, . „nA Q) U. " A'1 S . "i.,.??` U "=+:z'..'; imrs"S
`i `i. R4 v `"nc i eol V1 31 i':t z ~^3: s fFrftC'3<.`:aa.i:` q r3=14nin _:dT . ,
4aq:,a r° 'w gnu viler ;`foillulir Al `$fti "ynA t:i3Cle ryW:tr^i'°,in 9 ± i,t+`vfq
10, W al i`. 6 'C quote eel 'imid
y .J C$ .de fay i, "s oil: n is e!d': i'iLil-a'•7"smV aW nid`.lRn :..."a`enrof 10
rt""yin! :.i'sf y 5M: to 1 sv i, a w N 4w ate col ll' ,Vi`i' lob b1mv
-0 yep Alow
x
a . ~
Mr. Edward F. Lochner
Page 2
October 3, 1979
In granting thl's approval, the Division of Health does not hold itself
liable for any defects in plans or specifications, plan omissions,
examination oversight, construction or any damage that may result in
or after installation and reserves the right to order changes or additions
should conditions arise making this necessary.
This approval is based on Chapter H 62, 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 constructed. Failure to obtain local permits will
automatically void this acceptance.
Approved/issued By The Department
of Health and Social Services
Division of Health
fay :
James A. Sargent, Chief
Section of Plumbing and
Fire Protection Systems
JAS:PEP:bah
Enclosures
cc: Mr. Dennis Sorenson, OdS -.District 5 - La Crosse
Mr. Harold Berber, Zoning Administrator, St. Croix County
"ISCM Elect low eti€b OWN in nniviviv :)Fi; hu•pi;'tis.: 2161 i':3,aiOGI ni
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State of Wisconsin)
ss.
County of )
5t.LwCc;~.
Personally came before me this day of 19,
(Chairman) (C.-- of Town of
to me known to be the person who execute(:
the foregoing instrument and to me known to be such (Chairman),
(Clerk) of said Township, and acknowledged that he executed the
foregoing instrument as such officer as the deed of said Township,
by its authority.
sf. cra~~
rotary Public, County, Wis.
rty Co fission
State of Wisconsin)
ss.
County of )
51- C rc- C )
Personally came before me this L day of 19, ,
the above named to me kno CLtgEDbe the
~
person who executed "the foregoing instrument and acknjVmElp(We, --the
same. PLUMBING SECDUN
Notary Public, County, Wis.
My Commission
AGRE MEIIT
d
This AGRFEI', NT, made and enterer in this day of
J~=~ 1___..___.. lqi cy and between the Town of
a local municipality, with offices at
hereinafter called "Taen" and l7EVn/ n/ i s_, r,7 't A,)
hereinafter called 110.4ner".
WIMREAS, an application has been made for a building permit on the .fo]loWing
descri*:ed property to-oui.t: NF NF NF - Al StCT/I*At i Al f
11F;HERrA9, The percolation f.e;;t for cepl;ic: tLnk drainage does not rnc:t
the minimum standards of the ordin,:.nce of the Tcrgn of ~RD
and the County of Ydxwve. rat , L~'~.~
WHEREAS, the OVIZER egrees to nota.ll a, hcl_di»g tank for septic tank
purposes.
NUT, 1r;EIEF022, for and in ccnsideraticn of the issuance by the Toti
1'} /4 D of a building permit for the abc
-41
premises; th,0 i?aiIA--s do a. r ee a_::i iixid themselves a3 f0] r 4r3
1. ME'VERS agree th-a" J.v`* w-111 ccnform to all the-rul3s and
regulations of the Plumbing C ;as of the Tr7v n of
in the bti_ lding of their t!S e and septic system i icluding
the holding tank. Thvy agroo tint anyt::me the Town of
thrc,agh :i.ts Plumbing I.ZSti r, .;r or. Hsalth Officer, deems it ziecessary to
:p cut said holding tar.&, t):ce m~,iners shall have same pumped out in 24 hours,
Tmin will have said Merit done and chE:i ge s,-%mo back to craners and plac,7 V
on their own t.=x bi.'1_-L ~ V.S a ch=.--.--e. The owners fur hor - VEg _ g e" 1G
same i • o
11-hat t he Town of A1) V is hereby granted raAt;:
license and authc-rity to enter upon their prcp,.rty above descri
pump and i aut, i.f necc:ssar.11, from the e,.aid holding tank.
`The' Town of agrees to pump and transport the
contents of said sevi x-age holding teT.Jc to an approved disposal site, if
it becomes nccess,-)-y to prevent or abate a naisance as described in
Section 146.13 and 146.14 Wisconsin Statutes 1965, and if the oVmer does
not do so in response to ord3rs from the Town of y
provided by paragraph 1 of this agreement.
2. OlrXIERS shall deposit with the Tat-in a cash bond in the sum of
/lGc~
This bond shall guarantee to the Tozm
i. eimbursement for any and all expenses incurred by the Town all.evlat.inr. a.ny
nui~:anoe :;hi.ch may occur as a result of the permi.ssi.on granted by this
agreement for the o-aner to install a holding tank. The sum of
shall be no-intained at all times and if monies are expended, the owner
shall repieni.sh the cash bond and maintain the same constantly at
IT IS ITT) R,STCOD that t11.L5 "..GF'XF ',YP shall be binding on the c,J,ners,
their heirs and a--3i --n-.
IN WIT117,53 1E.-DE EEGF , the parties have hereunto set their hands and
seals the day and year ~,..bcve written.
The !'c;n ~-9oari has a.j.x-eed to authorize the proper officials to c).gn
an agreement with a px•a.vate ti-npany engaged in the servicing of septic tanks.
P1 '11TH, i ,SIB"3CF OF: W-EN OF
~ r
By I'I~GLce i(7~ct~it.~
Davelopcr
JUL 2 8 1979
ptLuMS9NG SECTION