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HomeMy WebLinkAbout018-1055-60-000 0 y o - 3 r, m v m r ^ 0 3 _ 3 ~ Q Z 2 (r N = N O 7 O N v' CD 0 C) N A • ~ a o 0 0 < 3 N ~yli N° a p n 3 c° o (D o CD (D N N N II°. N P a W 11f~ Q a O n o ~~yy m 7 o ti c Ro ° m C m a o m 0 n a m rn m m CD Cn h O m N N O O ~ O O ;4 A~ O O Q A O co co N Z o (co _ w o N° a rn H w O O O Z wl"Ot o --a -1 -4 n N Q 3 N (p v v v M - (D co N : N G c y (D ~V D A o 3 m o° n O N N z z 2 D D o 7 a I 1L (r~ IU A ~ n .p Z O ~ O co v m N A o z A O - C/) ° m -4 m z (D o N Q3 a5'o > ° N C C G 7 ° N Q O W IS 7 _ 0° v m 3= o N SU c C Z-p D Q ~ O z 7 Z7 m v Q o a p Co ti ~o 0 O o n ? ? E ID _m-o _r-oo o o o v n 4t c v N O (D o 0 0_ - O D A N o 3 Q c _ am om o F ° . ca- Z3_ _ o c NJ a ° -o 0 0 cz~ cc x o .C m r, CD O 6 (D ST. CROI X COUNTY S C 0 N S I N ZONING OFFICE 796-2239 (HAMMOND) `°`~'✓r 425-8363 (RIVER FALLS) HAMMOND, WI 54015 Q U A R T E R L Y P U M P I N G REP O R T ST. CROIX COUNTY NAME: Baldwin Motors RETURN COMPLETED FORM TO: ADDRESS: ST. CROIX COUNTY ZONING OFFICE, P. 0. BOX 98 HAMMOND, WI 54015 715-796-2239 or 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) OCTOBER NOVEMBER DECEMBER DATE VOL. PUMPED DATE VOL. PUMPED DATE VOL. PUMPED THIS REPORT MUST BE RETURNED NO LATER THAN JANUARY 31, 1986. OWNERS SIGNATURE mj:12-83 STATEMENT LICKNESS CESSPOOL SERVICE Liquid Waste Pumped Rt. 1 Box 178A DATE BALDWIN, WISCONSIN 54002 (715) 684-3730 r TERMS; PLF_.:SS U l NIL) PS- URN W:IH YO R R FMi -ANC JJ $ DATE I INVOICE NUMBER / DESCRIPTION I CHARGES I CREDITS I BALANCE BALANCE FORWARD I 111 3 1. . PAY LAST AMOUNT LICKNESS CESSPOOL SERVICE v IN THIS COLUMN AS BUILT SANITARY SYSTEM REPORT OWNER q~(j~/s TOWNSHIP l SEC. T_N-R_W ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 W-UERYTHING WITHIN 100 FEET OF SYSTEM 1 Icy- 14p, : - - - T-F I I di a e oath Arrow I SC BENCHMARK: (Permanent reference Point) Describe: 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 cyc e- gallons; tot-a-l-capa~ity o distribution lines gallon: size o pump head; gallon per minute ; horsepower brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer l~/c~e.S / Number of gallons Y) Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: um er o pits feet diameter feet liquid dept seepage pit inee t pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines width length tile depth SEEPAGE TRENCH: width length _ PERCOLATION RATE --AREA REQUIRED AREA AS BUILT INSPECTOR DATED PLUMBER ON JO LICENSE NUMBER V ' SENDER: Co7inthe e ite;-.!s 1, 2, 3 and 4. o I Put your address "RETU RN TO" spacra on the 5 rreverse sale. Failure to do this will prevent this card from W being returned to you. The return receipt fee will Drovid 00 you the name of the person delivered to and the date of - - de•.wery. For additional fees the following services are avaiiabie. Consult postmaster for fees and check box(es) e for service(s) requested. K r9 1. Xyy Show to whom, date and address Of delivery. W W ❑ Restricted Delivery. 3. Article Addressed to: Mr. Wayne Kanis Baldwin Motors Baldwin, WI 54002 4. Type of Service: Article Number ❑ Registered ❑ Insured XlCertified ❑ COD 595 689 603 ❑ Express Mail Always obtain signature of addressee or agent and DATE DELIVERED. E6.Sigriator nature Addressee O m e - Agent 77. te of Deliverey i M S. Addressees Address (ONLY if requested and fee paid) Z M m 0 m ..l 595 689 603 y~ r)p ,SURANCE COVERAC,` ~T FOR INTERNATIC" (See Reversf ent, Wayne Kanis, Baldwin Mtrs I Streel P.O., State and ZIP Coc" Baldwin ~P.stagl tified Fee acial Delivery Fee stricted Delivery Fee ,turn Receipt Showing whom and Date Delivered aturn receipt showing to whom, ate, and Address of Delivery a TOTAL Postage and Fees $ 1st Quarter pumping Report Azril 15, 1985 KIPOR( Of INSPLCTION - INDIVIVUAL SLWAGL SYSTEM SanitaAit PEArn.( t C) Sate Sept,4.c- NAM Town~hc St. Cno~.x. County 1 ,~c-t<un v _-_S e .t~ c u nL o .t ~ ub d.c v.i.s i, a n I I' I IC I-A N K ~'x ya.~konZA b 4, m ~?ornl_,a~ctme-n t~ t<m,c 01?om: we4y , B4~Xd,Lnc 120 'sXope - - Hi ghwaten 0iMPING CHAMBER c' gattovie P mp``MayCu c,tu, co i Model- Numbers. 1 VINO IANK f S<ze__ d0 gakf'ons NurnbeA. o{ Cornpa, t t~ I' a rn p e A A e a A rn S y,6-t e. m t, P(, toocc 6nom: Wekf- 12% a~.ope NighwateA ABSORPTION SITE. 1~ e d T, ,t, 'c t-- Ui6tancc nom: LUe,ff I~ 8 uik -divvy 12 k Hi.ghwat c A1;tiORPTION SITL DIMENSION'. w( dth otnen.eh {~.t RequiAed aAea ~t (myth o6 each. Uvice _ vepth 06 A.uch betow r~Xe f.v~ Nurnbc~l o6 f4ne.6~- ;Depth 06 noeh oven :tile ~n Io ta.Y k. e.vc -th o ttines g 6 6:t Depth o6 -tile below gA.ade. 4 n L)-<.ti lance be:twee.n fin _6:t S tope o6 -trench tin. peA 100 6t lotccX absonpt4on area _{~-t Type. o6 Cove.A: Paper oA .s-tnaw I'll DIMENSIONS GnaveQ. ahound p~t~ yee nu Out,sx:de De-pth below 1' ~.nke_t t o ta.e abv onp,tx.on au),a - A i c a n c q u~. n d,t 1 NS PI C I I D BY T I T L E A I1I1ROVEV - DATE 19 I I C I I v VATE 198 I'll Ak ON 1 OR REJECTION t , C-) cn 0 n p d F ce, 3 +"y m ~ m -a cv ~ m m m ~ 1 n Z 2 (U o N = N o i "WA• O OJ CO ,C v A A (D O7 ? 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Parcel 24.29.17.382C 018 - TOWN OF HAMMOND 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 - HELLENDRUNG, JEFFREY W & NANCY J JEFFREY W & NANCY J HELLENDRUNG 1370 OAK ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ` 812 HWY 63 SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 1.720 Plat: N/A-NOT AVAILABLE SEC 24 T29N R1 7W 1.72 AC N 209 FT OF S Block/Condo Bldg: 1254 FT OF E 358 FT OF SE SE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-17W Notes: Parcel History: 7/ I° ,1 IV/? Ve n Date Doc # Vol/Page Type 10/17/2001 659270 1739/343 WD 'D'7/23T1,.997 719?568 07/23/1997 717/493 07/23/1997 710/313 2007 SUMMARY Bill Fair Market Value: Assessed with: 224414 295,700 Valuations: Last Changed: 07/19/2007 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 1.720 24,300 197,600 221,900 NO 05 Totals for 2007: General Property 1.720 24,300 197,600 221,900 Woodland 0.000 0 0 Totals for 2006: General Property 1.720 24,300 171,800 196,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60 00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 REPORT ON INSPECTION OF SANITARY PERMIT # (1) Name and Address of Permit Holder Person/Persons at Site 2 Date of Inspection ~-E-CC •C "il- u- V 1 Name, Adaress, icense o „ o Installing Plumber Time of Inspection (3 )INSTALLATION CONSISTS F: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System BENCHMARK: (Permanent reference Point) escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? ❑ YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115?~- ❑YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/80 Signature of Inspector: PLB 6 7 State and County State Permit # C (2 N u Permit Application County Permit # for Private Domestic Sewage Systems County -T-71% A(.~Q IX *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: Section/ T _;~c% N, R Fq (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 No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY _;00D Total gallons No. of tanks 011 C; 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. FLUENT 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: 1, 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 oil Tester, NAME ✓c~- / p/, C.S.T. # and other information obtained from (owner/builder). Plumber's Si nature Plumber's Address - MP/MPRSW# 721f~' ? l Phone #7/ 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. e ~T e , u a E i E e .s Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application 5' Fees Paid: State r.~Cl County 1 to i Permit Issued/Rejected (date) 9-,9 Issuing Agent Name Lam. ( t Ev Inspection Yes &_No State Valid# Date Rec'd 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 -EH 115 Rev. 9178 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: Y,, Section N,R_7IP(or) W, Township or Mvrriei h4i-ty Lot No. , Block No. County sf ' R O /X Subdivision s arr)~ dv 5/ Owner's/Buyers Name: - -R7 le o o . Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL- x DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM X OTHER DATES OBSERVATIONS MADE: SOIL BORINGS C? - Y0 PERCOLATION TESTS SOIL MAP SHEET `___-_.____-._.-NAME OF SOIL MAP UNIT 3,~A f~ A S~ 24)) PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES ^'UM INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIRATE N/IP. BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- J~ . I- M - tr M CS P- 3 lk 0 P_ e_~ 6 tI - P S ( II tl P if y Gi 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- a t If O" B- t/ it O ` B- /t it v t~ Q r B- h to )Z e rn O r. B- it 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 Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. ll~L-O I~fZO < I N E vA~ 402- - i El Vol biz y l r 1 N a rLpf ,A a Ps ©P2 el- AJV° F _ a j Y F 4* -4 f 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) ✓ Td Certification No. Address Z-V .Name of installer if known- L4 T Copy A -Local Authority CST Signatu..,a_ ~t_ _ T IV Q _ w L3 AZI ra f! Gm ~j 04 (Aj o e, K 115 ct ct, 1 ~ nKw° tih° ^ - 7(3Sil17t11 t w~ t Ul~ - v,' a c~ w ! A g' - _ .C7 i ~ to Z o p _ q► T. 70 ~ I fF'~ s j ! 14 + i 1 ~ ~ct, 4 lr Po L. G j Er) zoo r t ` Department of Industry, Labor & Human Relations of Division of Safety & Bldgs. State of Wisconsin $ of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 G 1` ' Tel. 608-266-3815 R£~F~VF OA(Mr, IN ALL CORRESPONDENCE REFER TO PLAN --`IDENTIFICATION NO. NAME OF PROJECT TYPE OF APPROVAL STREET AND NO. CITY OR TOWN COUNTY STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. 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. 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. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, c~/7fflQ~ James Sargent-Bureau Director PLANS REVIEWED BY: DATE: cc: DPS-OWS Owner DI LHR Local PI Plumber H & R (2) County Mfg. Rep. Bur. of Health Fac. & Services DI LHR SBD-6099 (N. 06/80) Rec. & Env. Services Plb 100a 12/78 State of Wisconsin Detach And Return Upper DIVISON OF HEALTH Portion Of This Form With SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS Any Return Correspondence MAIL ADDRESS: P.O. BOX 309 MADISON, WISCONSIN 53701 608-266-3815 DATE: PROJECT: I 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. ❑ Plans being returned. ❑ Additional information required. SEE BELOW. 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. 11. 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. 111. 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 certified soil 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 beg: rl). ❑ Depth and type of fill. ❑ Copy of onsite report by county or district plumbing supervisor. ❑ Length of time fill has been in place. AOFiEE.IViEr: This agreement, made and entered on this day of :X 19 by F ddress ai< 1,11 A,'t n r 5 and between the Township of 14 t,:i v,t c,s _ ` EEREP. S: E n application has been made for a sanitation system on the following described property: Vi EREF,S: Septic tank drainage does not meet the minimum standards of the ordinance of St. Croix County and state codes. - ViEEREAS: The owner agrees to install a holding tank for septic tank purposes purposes. NCV=`, THEREFORE: For and in consideration of the issuance by the Town- ship of lt of a permit for the above premises, the parties do hereby agree and bind themselves as follows: 1. Owner agrees that they will conform to all the rules and regulations pertaining to a holding tank system. They agree that anytime said township deems it necessary to pump out said tank, the owners shall have same pumped out in 24 hours, or township rjill have said work doneand charged to owners and place same on their tax bill as a special charge. 2. The Township reserves the right to assess a bond if they desire to cover any possible pumping charge in the sumo IT IS UNDERSTOOD that this agreement shall be binding on the owners, their heirs and assigns. IN VITNESS WEERLOF, the parties have hereunto set their hands and seals the day and year first above written. Township of by Developer or owner 7 "1 STATE OF V,ISCONSIN} SS: COUNTY CF ST. CRaX) ' _ :~C'. Subscribed and sworn to before me this /Z^ zitday of 19 Notary Fubl'c, St. Croix County ~r ST. CROI X COUNTY WI SC 0 N S I N ~rZONING OFFICE 796-2239 e 5:9 1!! ill . ilk li r c r s Poat 0666.ice Box 227 it t =ti Hammond, WI 54015 O W N E R P U M P E R A G R E L M E N T PLEASE BE ADVISED, T unt you ate again not.i6.ied, I wd.tt A// t contract with oi G1iAcond.in, (Pumper) , Got the purpose o6 temoving a.e.t wadte Jtom the Aan.itaty system to be toeated on the ptopetty and 6utute home A.ite .located in St. Cto.ix County, Wi,6con.6in, Townahd.p of zZ-1(4inm,~ t~ being .in the A l(= of the .S C % o f See. , T. N.-R. GI. (O)t mo he butt y deb et.ib ed as 6 ott owa : ) Dated th.ia - day o6 ~~,f~ c'%►iL- 14 'F-6 . K (OWNER) _ State o6 Wiz eo n.e.in ) b~ County o6 St. Cto.ix) Peraonnattya . ppeated berate me thisI 4"Vday o6 L 19 the above named J', to me nown to be the perzon who execute the 6otego.ing •inbttument and ack.nowtedged the .game. 0 aty Nu-5 c, St. toix County, T- tJ My Comm. (.id petmant) (Expiv ea) heteinbe6ote te6etted to a.a Pumpet, join in the above agreement to the extent that I have a contract with Owner as above atated. . (PUMPER) HOLDING TANK PUMPING REPORT Name of Residence Addnesb Tetephone Lega.t: % o6 % os Section T N-R W Townz hip - i Date Pumped Amount Pumped Location S Head Rematkz Pum en'S- S.i natune Zoning 06j ice Ube: Date I n.e pec.ted Conditions Found The above .in6o~Lmat,ion shah be sent to the St. Cno.ix County Zoning 064iee, Pobt 06jiee Box 227, Hammond, Wl 54015 monthly by the Pumpers. The .in6o)cmat.ion w.itt at that time be %ev.iewed by the Zoning 066 ice and placed .in'a permanent jite. Random inspect.ionb w.itt aao be made by the St. Cno.ix County Zoning 066.ice to .inepeet the bueces,s o6 the .bybtem at the above toeat.ion. A G R LL TVLE 1\- r! This agreement, made and ntered on this day of by ~ and between the Township of Address s WEEREA S: E n application has been made for a sanitation system on the following described property: V:EBREAS: Septic tank drainage does not meet the minimum standards of the ordinance of St. Croix County and state codes. %REREAS: The owner agrees to install a holding tank for septic tank purposes purposes. t " S NCV, T EREFG}RE: For and in consideration of the issuance by the Town- ship of ZQZ)/"d of a permit for the above premises, the parties do hereby agree and bind themselves as follows: 1. Owner agrees that they will conform to all the rules and regulatic: pertaining to a holding, tank system. They agree that anytime saia- township deems it necessary to pump out said tank, the owners sh,.-..L have same pumped out in 24 hours, or township .,rill have said work domeand charged to owners and place same on their tax bill as a: special charge. k The Township reserves the right to assess a bond if they desire to cover any possible pumping charge in the sum of $ IT 1S UNDERSTOOD that this agreement shall be binding on the owners, their heirs and assigns. IN V lTNESS WFER,EOF, the parties have hereunto set their hands and seals the day and year first above written. G~. Township of tot Developer State cf .,~in-L7 ar1~ e0 s.i~. Industry, Labor & Human Relations ~~~t~~~~~~1~~ or owner)( an of safety & Buildings `"STATE OF, iT`1SCONSIN) :document is a full, true and correct copy 3' or:3ina1 on fife and of record in my COUNTY CF ST. CRCX) :d V/ Subscribed and sworn to before me this /~fs r l da of 19 Y Notary Public, at. Croix County