Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
026-1048-90-000
A(AO n(ao 0(A 3y o d °c c 5, f °c A I � ea � I � o W o ro � � �• � v i hl. s m o o cb o a I B o coo 3 I w 4' ►.i S r j l p a to m CD u tD i �' y s CD y N I z a N N 3 o C) � � = 90 � n a N m 3 N CD N p1 N O a N Cb 0 3 ter Co CD CD CD o�c o CD Sao y� I a O gym CD 1 ° g�,�! IA X X (^ x fD (Q N l N O. O. 0 I (Q m N Q a O CO y N CL a y Nc a IW o� n IW �� a I� �0 0 1v N 3 O O � O I �I 0 CD Arno co CO p I OO�D `D O CL y N og ° c I $ocll y,or„e Z ?« cr "A • p z O 00 00 O $, 0 0 0 0 ! a o C/) v a N a Z! a c co N CO) '� I c N fN N 3 CO) CO) N Z D OI Q ° o a �� A p O CD W p p I (D •�0 p y CD fu o CD N 0 3' CL m a .• n m o z z zaoz� I zooz� ='R D 0 I D a 0 D a 0 o. p o N o I N a j N N N N __ I m N d 7 C N C N N C CD N I W n a a I n O O I 7 O I A J N n N a N a z 7 I ? I f cn -•i e�D ewD v ego m ° rn 0 . 0 R 0 m N Z N I N Z j CD CD N A O 0 C 7 N Q I C nn+ N CD a CD O N N W G I O 4 C a o CL m o a jCD CD I coo CD N N s 3 N N m CD CD n' g N O N f y A CD c C� u CD CD CC H O I I o I °• AA qb I f) O CD ti co O O O b m I O O 1 W 0 0 C, Q H C oa o:. o: Parcel #: 026- 1048 -90 -000 01/05/2007 10:39 AM PAGE 1 OF 1 Alt. Parcel M 16.30.18.246B 026 - TOWN OF RICHMOND 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 - CEMSTONE READY MIX INC, #300 #300 CEMSTONE READY MIX INC C - % CEMSTONE PRODUCTS CO % CEMSTONE PRODUCTS CO 2025 CENTRE POINTE BLVD MENDOTA HTS MN 55120 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1190 CTY RD G SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 28.000 Plat: N/A -NOT AVAILABLE SEC 16 T30N R18W S 56 RDS SE SE ASSESSED Block/Condo Bldg: BY DEPT OF REV MFG EZ -U- 1413/406 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 04/09/2003 716483 2199/421 SAD 04/09/2003 716482 2199/419 TI 06/14/1979 357554 595/371 LC 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 176981 588,300 Valuations: Last Changed: 10/18/2006 Description Class Acres Land Improve Total State Reason MANUFACTURING G3 28.000 58,900 399,800 458,700 YES Totals for 2006: General Property 28.000 58,900 399,800 458,700 Woodland 0.000 0 0 Totals for 2005: General Property 28.000 62,400 438,900 501,300 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 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399645 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1 )(m)]. Permit Holder's Name: City Village x Township Parcel Tax No: Cemstone Ready Mix Corp. Richmond Township 026- 1048 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: O TANK INFORMATION FELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark !e U v / 0 0 Dosing °- ° — Alt. BM 2 S Aeration Bldg. Sewer Holdi, t Inlet s - 3 100 6S TANK SETBACK INFORMATION �YH Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inl Septic r ? Dosing Header /Man. /O y Aeration Dist. Pipe la, 9 S- o ding Bot. System Final Grade � PUMP /SIPHON INFORMATION k p q d Ma cturer Demand St Cover Model Number TDH Lift l / Friction Los System Head TDH Ft F main Length Dia. to well SOIL ABSORPTION SYSTEM j BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS z I 7 ' / SETBACK SYSTEM TO P!L JBLDG IWELL LAKEISTREAM L NG Manuf ctu r: INFORMATION Type Of System: AMB R R / v Model mbar: DISTRIBUTION SYSTEM Header /Manifold Distribution �J x Hole Size x Hole Spacing Vent to Air Intake g / Len th Dia ;S l / Spacing Dia SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of eeded/Sodded xx Mulched xx S Bed/Trench Center Bed/Trench Edges Topsoil [W Yes [11] No ® Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l !! OZ Inspection #2: Location: 1190 County Road G New Richmond, WI 54017 (SE 114 SE 11416 T30N R18W) Lot Parcel) No: 16.30.18.2468 �* C✓e 1.} Alt BM Description = {r t+ Goer S y , )NE we /� /C r o�,u►ti r' f i o / < tv;P4 / & , ", l l 2.) Bldg sewer length =) Z ` -, SY s �ats ,`R S 4a.lf,/ S4`9 rk1�y �Q e�oc✓ - / amounto / fcover u l e /&.&v 40 1 4, �� OIOSe,� �4- tOY Plan rev quire C r._ ' 1 r revision R g q J Y I es o Use other side for additional information _ Y I72J 111 ate Insepctoes Sin ure CeR No. SBD -6710 (R.3/97) 1 � Safety and Buildings Division County 201 W. Washington Ave,, P.O. Box 7162 %� Madison, WI 537 ; �(/ »consin Site Addrrs /z a De artment of Commerce � S Permit Number Sanitary Permit Application 2. q6 �� In accord with Cornw 83.21, Wis. Adm. Code, personal information you provide C1 Check if Revision ma be used for secon ses Privac Law, s15. 1 m ,State Plan I.D. Number I. Application Information - Please Print All Information 17 Parcel Number 02 10 $ Property Owner's Name roperty Location Property Owner's Mailing Address N, R 1 City, State Zip Code Phone Number / ti; . `TK', 1... Block Number �� - bdi ision l9'e CSM Number Cr J <O II, a of Building (check all that apply) TYIt � i ❑ 1 or 2 Family Dwelling - Number of Bedrooms c, ° ' t - --- ---- XPublidCommercial - Describe Use P • '� �� -� ' 7C?I•f est ❑ State owned a.w a AeK al I B applicable) ' e iF PP M. Type of permit-. (Check only one box on line A (ntrm ring fiche for intern }• �.____ A ' I .New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑Addition W For County use S stow Tanis onl Eris S stem Date Issued B. ❑ Check if Sa Permit Previously Issued Permit Numb N. Type oP permit: (Check all first apply)(numheringscheme Is for internal » RW Ullt.S (s1 v- W � 44 ,Non - Pressurized In- Gha-Ground 21[1 Mound ti 47 ❑ Sand Filter 50 11 Cons cted Wetland %4 +b 72 d Pressuriud hs Ground 41 ❑ Holding Tank 48 0 Single Pass 51 C1 Drip Line 450 At Grade 46 0 Aerobic Treatu►ent Unit 49 0 Rec' 300 Other V, Dis raai/ Treatment Area Information: IV4 a Flow (gpd) Dispersal Area Dispersal Area So' Application Percolation Rate System Elevation Final Grade ° _r .IDs .Ft.) (M Ruch ) Elevation 11.25 Requir Proposed Rate(Gals Y�S9 0loop /$8• S`� g�j.,fd` ors 33, S '�r� -tom � �•a ��-- � f Steel Fiber Plastic Ntttntber Manufacturer Prefab Site Capac Conc rete Constructed Glass VI. Tank Infa Cone j Gallons Gallons of Tanks New lrxistti Tanlca ?ears N • orifefe&eETaAle - Q j �B /1, D"4 Chamber w �.t?+ ' 4 •� VII. lbIlitY Statement I, the undersigned, assume respotts3bURRY for on of the pOWTS shown on the attached plans. Plumber's Nate (Print) Plumber's Signature MP RS Number Busiimas Phone Number b�, fns Y 7 ��� ?l5 -3g6 �l0 Plumber's Address (Street, City. State, Zip Code) VIII. Count IDe artrnent Use OnI nature Si (Ivo Stamps) � Sanitary Permit Fee (includes Groundwater Date issued /�+g ent 8 '.Approved ❑ Disapproved Surcharge Fee) �/ (2- L& 1 6 40 601?A— ❑ owner Given Initial Adverse 4 s 0 Leo Determination _ r `� IX. Conditions of Approval/Reasons for Disapproval - F! - '�I- t47!t (rtc{Iq*� j (to dVC q UUj Y ed7) for the system oo paper not ion than Elt2 :11 ruches In sire &cat k4 u SBD -6398 (R. 05101) PLOT PLAN Scale 1 "_ - Page of �O i s , N -- - -- $S�oF t7 A ( 4 k PVC Ft L_L_11__� Su'L Lp Uv G ' y'tpuc y J o � - .2 cwrt- �z- [c�v.o'�r__c`��ciPS'PLP. Tin G NOTES: I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be `ZSO gallon capacity manufactured by ' V,3 V�SNM CMj C.2k)_L_ W Pr 1 ho Zv�S L- F= L 4. Bench mark SEiE7 1 VE. *�. Divert surface water around system to prevent ponding at the uphill side. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264-8777 N*Ifisconsin www.commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Actin cretary 11i November 14, 2001 (R ECEIVED CUST ID No.691727 A7TN: POW7S Inspector ARTHUR L WEGERER ZONING OFFICE T CRDXa WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA OOU% PO BOX 74 1101 CARMICHAEL RD tNGOFFiG'E RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/14/2003 Ident ification Numbers Transaction ID No. 690074 SITE: Site ID No. 60872 Cemstone Ready Mix Corp - 1190 County Rd G Please refer to both identification numbers, St. Croix County, Town of Richmond above, in all correspondence with the agency. SE1 /4, SE1 /4, S16, T30N, R18W FOR: Description: Commercial Non - Pressurized In- Ground System - 133.5 gpd Object Type: POWT System Regulated Object ID No.: 820739 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (8.6/99). • The leaching hambers must be installed in accordance with the manufacturer's printed instructions, the plan g P P approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The plumbing for this project discharges to a private sewage system. The approval covers only domestic /sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic /sanitary wastes. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. ARTHUR L WEGERER Page 2 11 /14/01 • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation /operation. Owner Responsibilities • A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)789-7892, Mon - Fri, 7:15 AM - 4:00 PM WiSMART code: 7633 jswim@commerce.state.wi.us TITLE SHEET Page I of Conventional soil absorption system for This plan has been prepared in accordance with the Conventional Soil Absorption Component:..i•Ianual SBD- 10567 -P (R.6/99) Located in - the S QE - 1/4 of the SG-7 1/4 of Section �6 , T 30 N R W Town of Z.LC�•{h S``-•, County,'-Wisconsin. � � . INDEX Page 1 of 6 TITLE SHEET Page 2 of 6 SYSTEM MANAGEMENT PLAN 9� Page 3 of 6 PROJECT DATA Page 4 of 6 PLOT PLAN Page 5 of 6 PLAN VIEW -CROSS SECTION Page 6 of 6 LEACH CHAMBER DETAIL l4 Gj PREPARED FOR PREPARED BY L.IEGEF<ER SC3 L- TEST !V G AND . DE S_; Gfii S1EF?V I CE P.O. Box 74 421 N.Main St. �a �'.' "• ®�'�, River Falls, WI 54022 " Phone 715 -42 ' ,. � ....M, � 5 -0165 ; •'`' Fax 715- 425 -6864. '�VEi.ERER t I c -xis r • EtiswoR �c rs P.O.W.T.S. Conditionally 1 c , APPROVED DEPARTMENT Of COMMERCE ptVISIQN f Y BUILDINGS SEE CORRESPONDENCE JOB NO. - �$ 6 Conventional Soil Absorption System tlanagement Plan Pursuant to Comm 83.54, Wis.Adm. Code Page Z of b Secdc Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the'owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.' Dispersal cells No trees or shrubs should be planted or allowed to grow on the component. Plantings may be made around the perimeter and the component shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the A system*'may not exceed 220mg /L BODS, 150 mg /L TSS and 30 mg /L FOG. Influent flow may not exceed the maximum design flow specified in the permit for this installation. Observation pipes within the dispersal cell shall be for effluent ponding. Ponding levels should be reported to the owner and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with 83.52 (2). General This system shall be operated in" accordance with Comm 82-84 Wis.Adm.Code and shall be maintained in accordance with it's component manual SBD 10567- P(R.6/99)1 and local and state rules pertaining to system maintenance and maintenance reporting._ No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. - Any opening deemed unsound, defective, or subject'to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component ContinQencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dispersal cells fail _to accept wastewater, additional soil and site evaluation may be required with plans being submitted to the Department of Commerce, Safety and Buildings Division. Questions about the operation or maintenance of this system should be directed for The, County Zoning at 1 S— 3b' 6 68 C�' S T: L - The system installer at — 1 I _ 3 �'6 _ ZI Se Uhi)f� RITZ The tank manufacturer at % 5 — $_qs 6 WYe The effluent filter manufacturer at a`bo— _LZA - S qZ LT7_ The leach chamber, manufacturer at i PROJECT DATA Page 3 of This non - pressurized in ground system will serve a shop and maintenance building with 3 employees and 2 floor drains. ANTICIPATED WASTEWATER 3 employees X 13 X 1.5 = ---------------- - - - - -- 58.5 gpd 2 floor drains X 25 X 1.5 = --------------- - - - - -- 75.0 gpd Total = 133.5 gpd 11 units of High Capacity Sidewinder leach chambers will be installed to provide a wastewater flow of up to 226 gpd. r SEPTIC TANK —LZ � Co 226 +(11.61X3.O1X3) + (46.77X3.01) = 471.62 gal minimum capacity required. A 750 gal Wieser Concrete septic tank with a Model A -1800 Zabel-filter will be installed. Note All hazardous wastes (gas,oil,grease,etc) will be discharged to a precast concrete holding tank and disposed of by a licensed pumper. The Department of Natural Resources must be contacted for this permit. c � PLOT PLAN Scale 1 "= Page of �TLg1 S L-� t arl 5 I Ft U_v_� PRo ?a Sip IO�oF � l ' iPoc y J �• `ni ST. 2 G +' NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be `ZSO gallon capacity manufactured by tiy � �Z C0�1 CCt- - w l l gflo _DM EL P L-` eR 4. Bench marks SE4E7 pE$o UE, 5. Divert surface water around system to prevent ponding at the uphill side. �zt 11- v fv_C o r-: L+16 [ - e�`r�(_St ,p�R s � e `tfi�►►2 a it T7 - -- � O S cPrL�, QL OCI.5 e1.1tN. qq. � Pt� 6 or 6 a co -) L'�� _ � 6, t m a W ��I 0 z cr o m T CD n sA o N 1 ° W 4 U l ► (C I�1 �+ O co � ■ m� o � iN po i IT N � N � ;� I TT 5 Rul li I f i i 0 C c CD (Q C p c X n -7 C (D = G CLz Q C CD Lo CD RVE � I y CL N CD Z3 W I ID �fl- 00 m CO tD -� vi r o � Q � N I �l Iii wcc� x ZT � a33 ID ` ' -3 0 3 w � m 3a { � I it _ 0 n cQ @ off s � 0 invert 11' --}t , CD A w n !� C 0 r t ,^ N � Q f WlsconSir •,.DepartmentofCommerce SOIL EVALUATION REPORT Page of 'Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County r C Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan mutt eo include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Q2v'! y� 9 ° percent slope, scale or dimensions, north arrow, and location and distance to nearest road. b • 3 o / vA 3 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G ?a ✓1C. to Govt. Lot CC, — 1 /4 S/: 1/4 S T �j N R J E (or )6 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village (9Town Nearest Road New Construction Use: ❑ Residential / Number of bedrooms "ritrr��gp rate GPD ❑ Replacement Public or commercial - Describe: Parent material a.S (•t ood P � if applicably General comments s S tt r» C l •c V • 9y �a and recommendations: 5T Cf�y - IMG CUFFICE ' Boring # Boring F il [ pit Ground surface elev.'? i� . Sy ft. D- 11 it foptor '/ 3 in. Soil Application Rate Horizon 1 Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 l8 --3i -- r a S 0 s � r t - Z zy -ti'� � o�r r `7�(to YS - f3a /6. r `t`t(a _ S G 5 YYt 3� F -FP - 01 o 83. Borin g # Boring a ® pit Ground surface elev. C1 ft. Depth to limiting factor 13 in. [ Soil Application Rate Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 c a�l 3l t OS CS — •� /.Z G s -f t t - m 5 s ✓n l — _ �- i• Z i Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD _ 30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Ad W" SU a�-cdc - ex 3 3a9 Address Date Evaluation Conducted Telephone Number /D - - O/ 71S /Ja Property Owner 0 ew t. iAt Parcel ID # Page __, Of a Boring # ❑ Boring [� pit Ground surface elev. 1 7,0 9 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I •Eff#2 Z ZS o 6a, OUE ❑ Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 ` Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. SOD4330 (R.07/00) 4- 3 too. o } o ` eowe r 6,MZ •y U i "C of P s+ z s33o9 e) i • p re gMz• -�v 1p /45 c �� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address RA Property Address Ael (Verification required from Planning Department for new construction) 4 0'X& - I tom'$ '`rq - o OU City/State ,W eAJ /�.' � 1 x�= Parcel Identification Number / b lo - LEGAL DESCRIPTION Property Location --` i /4, i /4, Sec. A, , T 3d N -R Town Subdivision . �' +�� , Lot # Certified Survey Map # . Volume _ . . Page # Warranty Deed # _ ?SS_ 5� , Volume _�`1 . Page # 3 Spec house ❑ yes 0 no Lot lines identifiable ❑ yes Y no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mas pl journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification sta ' tt your septic stem been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of e a exp' h date 7 . , ` G� , �99ATURE APPLICANT i DATE OWNER CERTIFICATION ;A; I (we) certi that all stat ments on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of es abov , irtue�of� warranty deed recorded in Register of Deeds Office. O APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed rr 357554 :`VOL 59 , N-;1311 CONTRACT FOR DEED THIS AGREEMENT, made and entered into this / Y� day of May, 1979, by and between Frank P. Casey, a single of the County of St. Croix, State of Wisconsin, party of the first part, and Cemstone Ready -Mix, Inc. a Wisconsin Corporation party of the second part. WITNESSETH, That said party of the first part in consid- eration of the covenants and agreements of said party of the second part, hereinafter contained, hereby sells and agrees to convey unto said party of the second part, its heirs and assigns, by a Limited Warranty Deed, accompanied by an abstract of title evidencing good title in party of the first part at the date hereof, upon the prompt and full performance of said party of the second part, of its part of this agreement, the tract of land, lying and being in the County of St. Croix, State of Wisconsin, described as follows, to -wit: REGISTERS OFFICE Parcel A ST. CROIX Co., WIS. The South one -half (S]�) of the Southeast Recd. for Rewril Ws 14th One - quarter of the Southeast one - quarter day of Jung A6979 _ (SE4 of SEj) of Section 16, Township 30N, at_ . Range 18W, County of St. Croix, State of M. Wisconsin, James 0 Pa rcel B Commencing at a point on the East line of / the Southeast one - quarter (SEk) of Section 16, Township 30N, Range 18W, County of St. Croix, State of Wisconsin which point is Oil rods North of the Southeast corner of said Section 16, which point is also the Northeast corner of the South One -half (Sh) of the Southeast One - quarter of the Southeast One - quarter (SEk of SE's) of said Section 16, thence West 80 rods, thence North 16 rods, thence East 80 rods, thence South 16 rods to the point of beginning. And said party of the second part, in consideration of the premises, hereby agrees to pay said party of the first part, at a place designated by him, as and for the purchase price of said premises, the sum of FORT"-TWO THOUSAND AND NO /100---------------------- --- - -- ($ 42,000.00 ) Dollars, in the manner and at the times following to -wit: TEN THOUSAND FIVE HUNDRED AND NO/l00ths-- ($10,500.,00)-- - - - - -- Dollars in cash on the date hereof, the receipt of which is hereby acknowledged, and the balance of THIRTY -ONE THOUSAND FIVE#HUNDRED AND no /100($31,500.00 ) Dollars plus interest at the rate of Nine percent (91) per annum to be paid in annual installments of THREE THOUSAND NINE HUNDRED THIRTY - SEVEN and 50 /l00ths------------- - - - - -- ($ 3,937.50 ) Dollars or,more, together with accrued interest from the date of this contract, the first installment plus accrued interest to be paid on the first day of August, 1980, and a like payment of THREE THOUSAND NINE HUNDRED THIRTY -SEVEN and 50 /100ths --------- - - - -($ 3,937.50 ) Dollars plus accrued interest to be paid on the first day of August of each year there- after until the first day of August, 1987, at which time the second party agrees to pay the remaining balance of the contract for deed in full. First party and second party agree that second party shall have the option of prepaying the outstanding balance of this contract for deed without incurring any prepayment penalty, except that it is understood and agreed that payments to the principal in the year 1979 shall not exceed 29% of the total purchase price of subject premises. Each payment shall be applied first to the accrued interest then due and the balance of each payment applied to the principal balance. •+ VCL 595 I The first party shall be responsible for real estate taxes due and payable in the year 1979 and any special assessments levied or pending as of the date of this contract. The second party shall be responsible for and shall pay be- fore penalty attaches thereto real estate taxes due and pay- able in the year 1980 and real estate taxes payable there- after. It is agreed and understood that second party has in- spected the real estate, the premises and the structures located thereon and is purchasing the same in an "as is" condition. Any buildings and improvements now on subject real estate, or which shall hereafter be erected, placed, or made thereon, shall not be removed Therefrom, but shall be and re- main the property of the first party until this contract for deed shall be fully performed by the second party unless the first party in writing expressly authorizes said removal. The second party agrees and covenants at its own expense to keep any buildings on said real estate at all times insured in some reliable company or companies, to be approved by the first party against loss by fire, extended household coverage and against loss by windstorm for at least full insurable value payable to the first party, its successors or assigns, and in the case of loss, should there be any surplus over and above the amount then owing to the first party, his successors or assigns, the balance shall be paid over to the second party as its interest shall appear, and to deposit with first party the policies of said insurance. But should the second party fail to pay any item to be paid by second party under the terms hereof, the same may be paid by the first party and shall be forthwith payable, with interest thereon, as an additional amount due to first parties under this contract for deed. It is understood and agreed between first party and second party that the time of payment shall be an essential part of this contract for deed; and that all the covenants and agreements contained in said contract shall extend, run with the land, and bind the heirs, executors, administrators, and assigns, of the respective parties hereto. It is further agreed that each payment shall be applied first to the accrued interest then due, and the balance of the payment applied to the principal. The second party shall not assign, sell, lease, donate or otherwise transfer this contract for deed without the prior written consent of the first party and if the second party does assign, sell, lease, donate or otherwise transfer his interest in this contract for deed, the first party may immediately declare the unpaid balance of this contract for deed due and payable. No improvements, repairs, renovations, modifications or additions costing more than TWENTY -FIVE THOUSAND AND NO /100ths ($ 25,000.00 ) Dollars and no placement or erection of any building shall be made by the second party with respect to the aforedescribed real estate, premises and structures thereon, unless second party obtains in writing the first party's consent. With respect to any improvements, repairs, renovations, modifications and additions and with respect to the placement and election of any buildings on or relating to the above described real estate, premises and structures thereon, it is expressly agreed and understood that the same shall be solely at the second party's expense and that the second party shall promptly make payment to all persons, corp,.ations or companies von 595 PACE T23 that have furnished labor and materials for the same before any liens thereof shall accrue or be filed according to the law; and the second party shall pay and discharge or record all such materialmen's liens and laborer's liens commonly known as mechanic's liens which may accrue and be filed, and shall pay all costs, expenses, damages and attorney's fees which the first party may incur with respect to any such liens; the second party shall and does hereby indemnify and hold harmless the first party against all liability by reason of such liens. Within sixty (60) days after labor and material has been furnished as aforesaid, second party shall at first party's request, provide lien waivers properly executed by all materialmen and laborers. It is understood and agreed between first party and second party that second party is purchasing subject real estate for the purpose of mining, processing, utilizing and selling the sand and gravel located on subject real estate and adjoining real estate and that second shall not commit waste or permit waste: of the premises but shall have the right to mine, pro- cess, utilize and sell said sand and gravel. Should default be made in the payment of principal or interest due hereunder, or if any part thereof, to be paid by second party or should it fail to pay the taxes or assessments upon said real estate, premiums upon said insurance, or to perform any or either of the covenants, agreements, terms or conditions herein contained, to be by said second party kept or performed, the said first party may at his option, by written notice, declare this contract cancelled and terminated, and all rights, title and interest acquired thereunder by said second party shall thereupon cease and terminate, and all improvements made upon the premises, and all payments made hereunder shall belong to said first party as liquidated damages for breach of this contract by said second party, said notice to be in accord- ance with the statute in such case made and provided. Neither the extension of the time of payment of any sum or sums or money to be paid, however, nor any waiver by the parties of the first breach thereof, shall in any manner affect the right of the first party to cancel this contract because of de- faults subsequently maturing, and no extension of time shall be valid unless evidenced by duly signed instrument. Further, after service of notice and failure to remove, within the period allowed by law, the default therein specified, said second party hereby specifically agrees, upon demand of said first party, quietly and peaceably to surrender to first party possession of said premises, and every part thereof, it being understood that until such default, said second party is to have possession of said premises. Or in the alternative, the first party may, at their option, enforce specific performance of this contract for deed. IN TESTIMONY WHEREOF The rties have hereunto pa ve her nto set their hands the day and year first above written. Wi7sses- Cemstone Ready -Mix, Inc. jj 'o two B % H. T. Bec en, President Li Witn sses: 1 • ' ran c P. ase I hereby attest to the signature of H. T. Becken, President of Cemstone Ready -Mix, Inc., a Wisconsin corporation. 1" Secretary of Cemstone Ready, Inc. 'r' ^l r:�t1a rA�E3 4 i� STATE OF WISCONSIN ) COUNTY OF ) The foregoing instrument was acknowledged before me this y - day of A , 1979. By: Frank P. Casey, a single person STATE OF WISCONSON ) } COUNTY OF ) The foreoing instrument was acknowledged before me this day of 1 1 1979, by H. T. Becken, President of Cemstone Ready -Mix, Inc.. a Wisconsin corporation. STATZ OF Vtii3=._ - !N ST. Mix CGU:•i i Y NOTARY PUPL.' DLUZ M. 6JQS IQ COMMSION EXPMS ZQ : l BU This instrument was drafted by: i t r Paul H. Anderson ` LeVander, Gillen, Miller & Magnuson E 402 Drovers Bank B;ailding South St. Paul, Minnesota 55075 (612) 451 -1831 l THE FOLLOWING LIST MUST BE COMPLETED PRIOR TO THE SUBMITTAL OF ALL SANITARY PERMIT APPLICATIONS. A COMPLETED SANITARY PERMIT (COMPLETENESS IS ESSENTIALHU) • MUST HAVE LICENSED PLUMBER'S SIGNATURE ^--- • ATTACH STATE APPROVED PLANS (IF DESIGNED AS A MOUND SYSTEM, AT - -~ GRADE SYSTEM, IN- GROUND PRESSURE SYSTEM, HOLDING TANKS AND EXPERIMENTAL SYSTEMS) 0 DETAILED PL fA • ABSORPT LOCATI AI NORTH • � �n ,TV U • LOCATE A • IDENTIFY BUILDING! • LOCATE D' / • IDENTIFY MANAGEMENT '' l ORIGINAL SOD COMPLETED Ar COMPLETED I -,„u» I CNANU AND OWNERSHIP AGREEMENT F 1� SIGNED BY THE OWNERS, ORIGINAL SIGNATURES ONLY, F PIECA BE A CEPTED) RECEIVED \ 6 COPY OF THE WARRANTY DEED (REGISTER OF DEEDS) D E C 2001 ST cFiGv ❑ COPY OF THE CERTIFIED SURVEYOR MAP (CSM) OR COPY ~ -t[HE L@T;M TH RECORDED SUBDIVISION PLAT (REGISTER OF DEEDS) za'ui H�cFF�c� �, I E COMPLETE SET OF H U PLANS NOT RE UIRE4 FOR REPLAC LAIP ❑ ( f a,M. �,,..•�l,oli � re vim( 7) ur'APPLICABLE FEES 10 --p Incomplete applications will be laced in a "hold" file until they are completed. p PP P The workload and number of permits we receive necessitate that we handle only complete applications and that we obtain cooperation from the plumbers regarding the submittal of COMPLETE permits! REMEMBER: WE REVIEW ALL SANITARY PERMITS ON MONDAYS. YOUR COOPERATION WILL IMPROVE THE SERVICE WE PROVIDE. ARCH. DESIGN GROUP Fax =715- 235 -4898 Dec 4 '01 15 :13 P.02 w Safety and Buildings 2331 SAN LUIS PL STE 150 GREEN 9AY WI 34304 TDD tl: ( 264.8777 Visconsin www,00mmetc .was on s in.gov WwW.wiscottsin.taov Departmdrit of Commerce Seett McCallum, Governor Brands J. Blanchard, Secretary Au 27, toot CU-ST ID No.263106 AT?'N Bu[ldi�Structure� lncpector TIMOTHY K PETERSON ARCHITECTURAL DESIGN GROUP, INC. NEW RICHMOND INSPECTION 393 RED CEDAR ST STE 3 156 E FIRST ST MENOMONIE WI 54751 NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/27/2003 Identification Numbers Transaction ID No. 669772 SITE: Site 1D No. 60872 CEMSTONE REDI MIX CORP Please refer to both identification nurnbers, 1190 CTH G above, in all correspondence with the agency. CITY OF NEW RICHMOND, 54017 -1119 ST CROIX COUNTY; FIRE DEPT ID: 5502 FOR: DESCRIPTION: 56'X I I V VEHICLE REPAIR GARAGE BUILDING OBJECT TYPE: BUILDING REGULATED OBJECT ID NO.: 808226 CLASS OF CONSTRUCTION: 6 METAL FRAME UNPROTECTED; NEW PLAN; 6,160 PROJECT SQ FT; 1 STORY BLDG; UNSPRINKLMED; OCCUPANCY: HAZARDOUS The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin! Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in c0: chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: API DEPAK VIVISIO N C • COMM 50.12(4)(x) l,c. Snowdrift loadings were not included in the structural calculations. Submit with metal building plans the calculations indicating consideration for drift loadings, and, if necessary revised plans, SEE C • COMM 52.58(1) From the information provided; ircannot be verified that the material specified for toilet room ceiling is srnooth & nonabsorbenf, as required by this code section. Verify acoustic tile to building inspector. • COMM 63.16 When demonstrating building envelope compliance using COMcheck -EZ, the data used for computational purposes must be shown as a detail on the plans, be part of the building specifications, or included as s •product cut sheet. Plans do not show the R =1 insulation for the V above grade concrete wall and do not clearly show roof & wall insulation to match the calculations as received, verify amounts to inspector. • COMM 50.12 This review does not include heating, ventilating or air conditioning, The owner should be reminded that HVAC plans, calculations, a eon Meted SBD -11 S application form and appropriate fees are required to be submitted for review and approval prior to installation. • COMM 50.12 Submit, prior to installation, one (1) set of properly signed and. sealed metal building plans, a completed SB -1 I8 application form includwg this transaction number and signed by the building designer, and $ 100 submittal fee to Safety & Buildings. P.O. Box 7162, Madison WI 53107 -7162. Also one copy shall be provided at the job site. When the total building volume exceeds 50,000 cubic feet. each set of plans shall bear an indication of review which has been signed or initialed by the building designer of record. • COMM 63.01 Prior to installation, lighting plans and calculations shall be prepared in compliance with the cock and properly signed and sealed. The plans shall be available at the job site as requested by the Department representative or local official. • As of today's date, our records indicate that a refund in the amount listed in the FEE portion of this letter has been initiated and forwarded to a manager for review. The rchmd will be trade under sepatate cover. Please expect a 6 -8 week time for fiscal processing. Refunds will be made to the payer. ARCH. DESIGN GROUP Fax:715- 235 -4898 Dec 4 '01 15:13 P.03 TIMOTHY K PETERSON Page 2 8/27/01 A copy of the approved plaits, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Departrnent, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction linstallation/operatiois. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stars 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to the at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED S 580.00 FEE RECEIVED $ 650.00 REFUND AMT $ 70.00 JACK A MILLER PLAN REVIEWER, INTEGRATED SERVICES WiSMART code: 7648 (608)785-9348, M - F 7:45 AM - 4:30 PM JAMILLER@COMMERCE. STATE. W I.US cc: JOHN J DAHL , BUILDING INSPECTOR, (715) 232-6600, THURSDAY, 7:45 A.M. - 4:30 P.M. TOM BECKEN - CEMSTONE READY MIX ARCH. DESIGN GROUP Fax:715- 235 -4898 Dec 4 '01 15:12 P.01 A&gW= DESIGN GROUP INC. FACSIMILE Date: J V .Pl lp, To: r �� FAX # It s - From: �d r Re: _ STonXZ TOTAL NUMBER OF PAGES (INCLUDING THIS COVER SHfiET): PLEASE CALL (715) 2354849 IF YOU HAVE ANY PROBLEMS WITH THIS TRANShUSSION. MESSAGEISPECIAL HANDLING INSTRUCTIONS: Signed: 393 Red Cedar Street, Suite 3, Menomonie, WI 54751 Phone: 715.235.4848 Fax: 715.235,4898 St. Croix County Zoning Activity Property Activity Detail Property Number 026 - 1048 -90 -000 Acres 28 lv- 0 Parcel Number 16.30.18 246B Owner Name CEMSTONE READY MIX, INC., Municipality TOWN OF RICHMOND Activity REZONING Request 09/14/1989 Past Zoning AGRICULTURE/RESIDENTIAL Current Zoning INDUSTRIAL Ordinance ZONING ORD. Citation Variance NOT APPLICABLE Other Variance Overlay NONE Decision APPROVED Date 12/12/1989 Condition Objection Support Hardship Link to Zoning ❑ ❑ ❑ ❑ ❑ Conditions Expiration Date Wednesday, December 26, 2001 Page I of I AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC . T N R ADDWF ST. CROI W C UNTY WISCON�. !� SUBDIVISION LOT LOT SIZE PLAN VIEW Distances ,& dimensions to meet requirements of H6 2.20 - SHOW EVERYTHING '00 FEET OF SYSTEM G` I di a e 4o th Arrow SCAL : SEPTIC TANK(S) GR. ,�,�5 ) ;� , C ONCRETE STEEL NO. oT rings on cover ! Depth -- PUMPING CHAMBER SIZE PUMP MFGR. D E L NO. GALLONS Per Cycle TRENCHES NO. of width length area BED NO. of lines width _ length y area dept to top o pipe NUMBER OF SF�.EPAGE P �'S Outsi`�e�aiameter total pit area AGGREGATE Y" �- PERK RATE �� AREA REQUIRED AREA AS BUILT s� y' , j Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the Y Count will make every f County e y of ort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR DATED 6 o PLUMBER ON JOB dAZjjAj „ LICENSE NUMBER / old Wisconsin Department of Industry. PRIVATE SEWAGE SYSTEM County: -Labor and and Human Relations INSPECTION REPORT St . Croix Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Se, SE, Sec. 16,T30— R18,Co. Rd. G 149246 Permit Holder's Name. ❑ City ❑ Village W Town of: State Plan ID No.: Cemstone Ready Mix, Inc. I Rich CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 026- 1048 -90 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss H ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING manufacturer: SETBACK CHAMBER INFORMATION Type Of model Number: System: OR UNIT DISTRIBUTION SYSTEM Header J Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed ITrench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? ❑ Yes [ Use other side for additional information. SBD- 6710(R 05/91) Date Inspector's Signature Cert.No_ ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: x t t SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY DILHR St. Croix STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than Q f � y �� 8% x 11 inches in size. 1:1 C /eck if revlsloTrto previou s application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION Cemstone Ready -Mix Inc. SE '/a SE '/a, S 16 T 30, N, R18 &(or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1190 Ct . Rd. #G nia n/a CITY, STATE I ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER New Richomond Wi. 154017 1 (715 246 -4238 n/a 11. TYPE OF BUILDING (Check one) NEAREST ROAD .CC�� 11 El Owned CITY VILLAGE Richmond Co. Rd. #G H Public ❑ 1 or 2 Fam. Dwelling -�# of bedrooms — A 111. BUILDING USE: (If building type is public, check all that apply) C� ?, �10 1 ❑ Apt/Condo C� 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 U Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) ��11 A) 1. E1 New 2. El Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 9 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) � , Gv ELEVATION .Cl? JO / 3 J'6 O 9 / � — Feet �O� Feet VII. TANK CAPACITY Site in callons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdina Tank X 1000 1 Powers Lift Pump Tank/Siphon Chamber - - -- -- VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for InstallatjA of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's ature: (No S mp MPRSW No.: Business Phone Number: Gary L. Steel 3254 715 46 -6200 Plumber's Address (Street, City, State, Zip o 1554 200th. Ave., New.Ri ond, W . 54017 IX. COUNTY /DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature o Stamps) Surcharge Fee) Ir Approved ❑ Owner Given Initial An&� A v rse D ermin i n X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DI Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Y6ur sanitary, permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DIIHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) �_. � ►T� � I DN ;��P- �T, Gam+ X GD. � � 1 ND SCpl) L.r✓ �A \CP G �> GoN IGTDIz To G00E-t71r-^7 G ITE I Pf INhtiE it GIW^PIH41 Q o"e uI I Mr;Nrs W / OW NGIZ- f7POP To E*c#PIVPj•TIoN . NOTE = Ei�F,IiT�IG>'°�L.TO GAS- PIrI�T� 1 nD01� -• v{� o� T��I� G�-P,� To ® NEW �UII�DING1 yo HMO' ✓C i✓ . PUP�if�' r1v�J� =,E - ��"�' P�a1� - chl� >71N -� �-- -__��_ I �� z y �',�J✓ o ` ::;� , ��� y -� ��,p� �� 00 ' � GONSTR�iJC�T14N - BEN. � �`� � �• • �o��Trz- �c, -To I�Mvv� �' J � �- �'tr - NEW 1 I V �hh P Y v t5. r E . Di E;�EI� fit, i✓l K-+� 5h PUMP. .3 ! ��fz-/ I 4-fl TO E • _ ( ` GIF^V L)Pp:A,GE - �I v f�Ll.. r'Ii�UND �; aV u LIrl- _ ff- a i i ! r�orE = G�P��,T� New Et,EGTf21G�,L.. TO bVI1..DIN41 . • j� �- E�G�TE L'�i I�iTlr -IG� T f✓L.E�f 1 / S��/IG� "T N�VJ CSVILDIt -IG� , EXIh � � ROAD G ' EH• 115 A. .9ns ' _' REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: X— SE -'4, Section _J6 TJf_N,Rj it (or) W, Town or Municipality Lot No• , Block No. , County • �T, _lox _ Subdivision ame Owner's/Buyers Name: Mailing Address TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS _ PERCOLATION TESTS S -� SOIL MAP SHEET _ NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE RATE NUM INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIO�D / 1 PERIOD 2 PERIOD 3 P— / / P P— P_ P_ SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- ( > t B- ( G r - g- / B— ( - � x - v sin _ C C B_ C PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan ttte Nation and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy S�faD Indicate scale or distances. Give horizontal and vertical reference points Indicate slope. �� s k ' 4 {.. _ E � E N IF i it t 0 s i fit!� 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in aconrd 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 .Name of installer if known CST Signature ".opy A —Local Authority II SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BU'Y`S& ADDRESS: {, / J FIRE NO: LOCATION: 1/4 SL 1/4, SEC. 1(e2 T ) N -R 1 8 W, TOWN OF: `-- ST. CROIX COUNTY SUBDIVISION: ' LOT NO. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I /WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. 'W ern Mal SIGNED: -G t I. DATE: St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ----------------------------------------------------------------- Owner of property Location of erty �� 1/4 � 1/4 , Section (, T -R W Township Mailing address L o L Address of site C-1 Subdivision name Lot no. Other homes on property? yes -- L No Previous owner of property S Total size of parcel . :h S Date parcel was created dS Are all corners and lot lines identifiable? x Yes No T Is this property being developed for (spec house)? Yes No Volume and Page Number .37 as recorded with the Register of Deeds. --------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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. 'Ls , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. j Corm 5'tvt YF lylf Signature of ap�licant Co- applicant Date of Signature Date of Signature IMF a r lam, <� k 357554 �. CONTRACT FOR DEED into this /I' day of , THIS AGREEMENT, made and entered a singp� May, 1979, by and between Frank P. Casey of St. Croix, State of Niscansis� of the county Mix, In the first a►o a party n of C he t sec onda p art. corpora t in cow - ` , " rt of the first par WITNESSETH, That said pa Y of tom_ t of oration of the covenants f contained, her sel z and second part, her the part, its heitf ` arty of te second pa to convey assign , by a Limited Warra unto said p accompanied by an abaB+Adt , s nty Deed, of t h e f 'rot l py g title in party k.; Of title evidencing g f perfox ! n prompt and a at the date hereof , upo e pro art, of its part of this F, said party of the second Pa► being in the County of the tract of land. lying and as follows, to -wit: tiY State of Nisconsin, described Parcel A SL r. Southeast Of The South one -half toys) east quarter d� � one- quarter of the Suthe ship 30N, (SE% of SEk) of Section 16, Tote < R 18M, County of St. Croix, State of Wisconsin. parcel g the East line of Comisencing at a poiz' arter tSE�t) the Southeast ons qu k 34N, Range 18M, COUP of 16, Township. State of Wisconsin w St. Croix, hi . n` F is ' rods 16 which Po of the Southe�stc sda° 1# Of said Section , of the South One -1r the Northeast corner rter of theS (Sh) of the Southeast ono-quarter wk t ) of said t Southeast.one-9u t Section 16, thence West 80 rods. North 16 rods• thence East 80 rods, is South 16 tads to the point of beginIkIX4• , M y a in onside�cAtioe " And said party of the second part, c t ; f irst ees to pay said Par y o f tw h the Pr him as and fovc' herSbY t. i a plow designat ted y , is P as al �'Plld ` pr ies of said pr the s ($ 4x,000.48 ) Dolhazs• h " - .�........ it! NO /100 at the following times to-'M in the manner and R� AID NO /iooths -- ($10, 500,88 THOUSAND FIVE HUND x H e 1 the receipt o� Dollars in cash on the date bbalance of THIRTY -ow " her acknowledged, Dollars plot lstst r FIVE HUNDRED AND no /1o0t$31, r annum to b paid im at the rate of Nine percent t98) PINE HUNDREn _ c, IL annual installments of THREE "OUSAND t$ 3,937.50 ) hollers �` SEVEN and 50 /looths '"' - - - -- date of or more, together with accrued interes f rom interest to this contract, the first ofsAu ltnt1980• and a like paYnt be paid on the first day interest THREE THOED THIRTY SEVEN a cr i t USAND NINE HUNDR r of ($ 3,937.50 ) Dollar P accrued ear thee- -'"'�"-- - -� of August of each y to be paid on the first day August, 1987, at which time the of Augu after until the first day the remaining balance of the second party agrees to pay contract for deed in full. party agree that second party shall 7. First party and second heyou nal tstanding balance of this have the option of prepaying any prepayment pety, contracthatriteed understood and agreed that payments to the except ar 1979 shall not exceed 298 of the total principal in tt►e Ye Each payment shall be purchase price of subject premises• first to the accrued interest then d and the balance plied lied to the principal ba of each payment app VOL 59 � r . ��'� ••;!!^axa ;ail. 5 t, The first party shall be responsible for r(-al rstat taxes due and payable in the year 1979 and any shec•i,,l assessments levied or pending as of the date of this cwlt ray: t. ' The second party shall be responsible for and shall pay be- fore penalty attaches thereto real estate able in the year 1980 and real estate taxes I)ay,:1> tc t ht after. It is agreed and understood that second party LA. i n- spected the real estate, the premises and the str,,-t„zcr. located thereon and is purchasing the same in an "t,ry condition. F*. Any buildings and improvements now on subject rear estate, or which shall hereafter be erected, placed, or made thereon, shall not be removed therefrom, but shall be and re- kx main the property of the first party until this contract for deed shall be fully performed by the second party unless the first party in writing expressly authorizes said removal. 1 The second party agrees and covenants at its own expense to keep any buildings on said real estate at all times insured in some reliable company or companies, to be approved by the first party against loss by fire, extended household coverage and against loss by windstorm for at least the full insurable value payable to the first party, its successors or assigns, and in the case of loss, should there be any surplus over and above the amount then owing to the first party, his sucr_ssors or assigns, the balance shall be paid over to the second party as its interest shall appear, and to deposit with first party the policies of said insurance. But should the second party fail to pay any item to be paid by second party under the terms hereof, the same may be paid by the first party and shall be forthwith payable, with interest thereon, as an additional amount due to first parties under this contract for deed. It is understood and agreed between first party and second party that the time of payment shall be an essential ' part of this contract for deed; and that all the covenants and agreements contained in said contract shall extend, run with the land, and bind the heirs, executors, administrators, and assigns, of the respective parties hereto. It is further agreed that each payment shall be applied first to the accrued interest then due, and the balance of the payment applied to the principal. The seed party shall not assign, sell, lease, donate or t otherwise transfer this contract for deed without the prior written consent of the first party and if the second party does assign, sell, lease, donate or otherwise transfer his interest in this contract for deed, the first party may immediately declare the unpaid balance of this contract for deed due and ` payable. {. No improvements, repairs, renovations, modifications or additions costing more than TWENTY - FIVE THOUSAND AND NO /100ths (g 25,000.00 ) Dollars and no placement or erection of any building shall be made by the second party with respect to the q " aforedescribed real estate, premises and structures thereon, w unless second party obtains in writing the first party's consent. With respect to any improvements, repairs, renovations, modif ications and additions and with respect to the placement d and erection of any buildings on or relating to the above described real estate, premises and structures thereon, it is expressly agreed and understood that the same shall be solely at the second party's expense and that the second party shall promptly make payment to all persons, corporations or companies VOL %."V PALES that have furnished labor and materials for the same before any liens thereof shall accrue or be filed according to the r law; and the second party shall pay and discharge or record all such materialmen's liens and laborer's liens commonly known as mechanic's liens which may accrue and be filed, and shall pay all costs, expenses, damages and attorney's fees which the first party may incur with respect to any such lions; the second party shall and does hereby indemnify and hold harmless the first party against all liability by reason of such liens. Within sixty (60) days after labor and Material F has been furnished as aforesaid, second party shall at first party's request, provide lien waivers properly executed by all materialmen and laborers. It is understood and agreed between first party and second party that second party is purchasing subject real estate for ' the purpose of mining, processing, utilizing and selling the sand and gravel located on subject real estate and adjoining real estate and that second shall not commit waste or permit waste: of the premises but shall have the right to mine, pro- cons, utilize and sell said sand and gravel. Should default be made in the payment of principal or interest due hereunder, or if any part thereof, to be paid- second party or should it fail to pay the taxes or assessments upon said real estate, premiums upon said insurance, or to perform any or either of the covenants, agreements, terms or conditions herein contained, to be by said second party kept or performed, the said first party may at his option, by written notice, declare this contract cancelled and terminated, and all rights, title and interest acquired thereunder by said second �. party shall thereupon cease and terminate, and all improvements '. made upon the premises, and all payments made hereunder shall belong to said first party as liquidated damages for breach of this contract by said second party, said notice to be in accord - ance with the statute in such case made and provided. Neither the extension of the time of payment of any sum or sums or money to be paid, however, nor any waiver by the parties of the first breach thereof, shall in any manner affect the right of the first party to cancel this contract because of do- faults subsequently maturing, and no extension of time shall be valid unless evidenced by duly signed instrument. Further, V * after service of notice and failure to remove, within the period allowed by law, the default therein specified, said second party hereby specifically agrees, upon demand of said. first party, quietly and peaceably to surrender to first party possession of said premises, and every part thereof, it being understood that until such default, said second party is to have possession of said premises. Or in the alternative, the first party may, ' at their option, enforce specific performance of this contract for deed. IN TESTIMONY WHEREOF, The parties have hereunto set their hands the day and year first above written. wises: Cemstone Ready -Mix, Inc. . / r ' H. T. Bec en, es ant • 6 Witnesses: 1 ran P. ase ` y f , f` 0.4 - aA I hereby attest to the signature of H. T. Becken, President of Cemstone Ready -Mix, Inc., a Wisconsin corporation. acre ry o erns ne a y- x. �. t 1 vii 59 : << �. STATE OF WISCONSIN ) COUNTY OF ) The foregoing instrument was acknowledged t)(•fM TTW this Z - day of .n /A 1979. By: Frank P. Case;, a single person „ STATE OF WISCONSIN ) COUNTY OF ) The foreoing instrument was acknowledged before me this rC day of /A i , 1979, by H. T. Becken, President F of Cemstone Ready -Mix, Inc. a Wisconsin corporation. STATE OF ST. CROM CC:! " i Y NOTARY PU °'1:: DIANE 111. OAKE S got s�wo�oK $x�es iQ-- /�-8t� This instrument was drafted by: i }} Paul H. Anderson '! LeVander, Gillen, Miller & Magnuson 402 Drovers Bank Building South St. Paul, Minnesota 55075 (612) 451 -1831 s t 7. r AS BUILT SANITARY SYSTEM REPORT R OWNER - . 11. TOWNSHIP SEC . T N R ADDRES ST. CROIX UNTY WISCONSIN. 1 W C SUBDIVISION LOT LOT SIZE PLAN VIEW Distances & dimensions t meet requirements of H 62.20 SH0 EVERYTHING WITHIN 100 FEET OF SYSTEM A F � Ft� Ir di ate qo��thj Arrow SC L SEPTIC TANKS) �� MFGR. �- -�l ONCRETE STEEL NO. of rings on cover ) Depth -- PUMPING CHAMBER SIZE PUMP MFGR. M DL NO. GALLONS Per Cycle TRENCHES NO. of width length area NO D B lines E of 1 nes length a II en t g � area 1<44 dept to top of pipe NUMBER OF SF�EPAGE P �S Outside - diameter total pit area A PERK RATE r AREA REQUIRED 46 AREA AS BUILT Disclaimer: The inspection of this system by St. Croix does not imply complete compliance with State Administrative Codes. There are other areas that- it is not possible to inspect at this point of construction. St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYTEM. INSPECTOR DATED 6o PLUMBER ON JOB LICENSE NUMBE J _ . •- ,. 1� .--- REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM San.it Penm.it cc nn State Septic NAME � cST��f - I�G�,(J ml,Y Townbh.ip �",717i 0,0 St. Cno.ix County Location Secxion_Z�_Lo:t # Sub'dcvis ion SEPTIC TANK Size ga.2ton.6 Numbeh o6 compaatmtnt6 Distance Anom: We.2f, � _ Buitd.Lng .....12% btape H.ighwaten PUMPING CHAMBER Size ga. -tons. _ Pump Manu jaC ;..;' Modet Numbea HOLDING TANK Si ze, gaf-ton Numbe& o6 Compa&tmen.tb Pumper Atanm System Distance 6nom: Wet.2 Bu.itding - 12% b.Q.ope_ Highwaten ABSORPTION SITE Bed Trench D.i Lance nom: WeE.E 1�9 Bu.i.Ed.ing 2% btope � . H.ighwaten ABSORPTION SITE DIMENSIONS Width o6 tneneh it Requited arcelat Le.ng�h o6 each .Lane it Depth oj nbak below tite ,�, in Number 0 5 .e a -.e.6 Depth o 40¢h oV ti e in Totat Eeng th o6 tines 6t Depth o ,,,U e,':.betow ; Shade 3 2- in Distance between tines 40 it Stope o4 '''tk nah in. pet 100 t A Totat abboxptaon aAea_ .5 it Type 0 C0ve Pap of bthaw R, ' PIT DIMENSIONS Numb ex 0 6 pats Gnave.2 atalund p ita�yeb no Outside diame,tet � � ��. it Depth: be'Zow' inlet 6x Totat abe onpt.ion area it Area &equ.ined it INSPECTED r✓t .w� ,-" ,/�_., TITLE APPROVED DATE ���� 19 8 REJECTED DATE 198 REASON FOR REJECTION II 4�94. REPORT ON INSPECTION OF SANITARY PERMIT # / (1 ) Name and Address of Permit Holder Person /Persons at Site (2 )Date of Inspection -- Fame, res , Ucense No. ot instaiiing Plumber Time of Inspection &z� 2 ( 3 )INSTALLATION CONSISTS OF: ❑ Septic Tank ❑ Seepage Trench [] Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank [:]Fill System ermanen re erence oin Describe: 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 (7)DOSING TANK: Manufacturer: # of gallons: i # 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 of 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. i (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 H: Total length of seepage trench ft; width ft; j tile depth ft; ft to well; ft to ordinary high water mark of I lake or stream; ft to edge of slopes greater than 20% failing away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. i I (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 -SBO -6095 N.0 8 Signature of Inspector I State and County State Permit # �� P Permit �r aApplication ti• n County Permit # �f � `'O i for Private Domestic Sewage Systems County X *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY fr11 Mailing Address: n 18 off(. --c > B. LOCATION: Ya '/4, S ion ' T.-10 N, i7E ® (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 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 -X Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top No. of Trenches Seepage Bed: Length - !V Width. Z.2 Depth Tile depth (top No. of Line Seepage Pit: Inside diaer Liquid Depth No. of Seepage Pits Percent slope of land _ -3 Distance from critical slope WATER SUPPLY: Private ❑ Joint ❑ Community El Municipal ❑ Owners name as listed on EH 115 if o ther than p owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, that I have sized the effluent disposal system from the EH -115 prepared by the Certified oil Tester, NAME C.S.T. # and other information obtained from (owner /builder). Plumber's Signature MP /MPRSW# f S 3 Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include rection 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. a 3 Mr E I , 9 9 i 7 3 i y S s t a I a _.... 3 � t 3 _. s a i e E t � Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY to Date of Application �- �� Fees Paid: Stat .� County ,S Date Permit Issued /Rejected (date) `1 Issuing Agent Name �}�• Inspection Yes_� No State Valid# Date Ree'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 0 b., 60 i +1178 r SHEET PROJECT DETAIL DATA NAME OF BUSINESS LEGAL DESCRIPTION 1- -�- a AILING ADDRESS OWNER M `,�. ZIP Sy�� 7 ARCHITECT, ENGINEER, ADDRESS PLUMBER OR DESIGNER S c ZIP Zf 1 61 TELEPHONE NUMBER 21 (0 S 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed. Please consult Section H 62.20. New building Existing building e 9 Addition ( ) Apartments and condominiums . . . . Number of bedrooms V 00 ( ) Assembly hall . . . . . . . . . . . Seating capacity Bar . . Seating capacity # of meals served ( ) . . . . . . . . 9 ( } Bowling alley . . . . . . . . . . . Number of lanes ( ) With bar ( ) Campground and camping resorts . . . Number of sewered sites Number of unsewered sites Total number of sites ( ) Camps • • • • • • • • • ( ) Day use only Number of persons ( ) Day and night Number of persons ( ) Catchbasin . . . . . . . . . . . . . Number ( ) Church . . . • • • • • • • • . . • . ( ) No kitchen Number of persons { ) With kitchen Number of persons ( ) Dance hall Number of persons ( } Dining hall Number of meals served daily ( ) Dog kennels Number of enclosures ( ) Drive -in restaurant . . . . . . . . Inside seating capacity Car- service -- Number of car spaces ( ) Dump station . . . . Number of dump stations ( Employees ( total of all shifts) Number of employees Hotel ( ) Motel { ) Cottages . Number of units with 2 persons per unit Number of units with 4 persons per unit (A } Medical and dental office bldgs. Number of doctors, nurses, medical staff Number of office personnel Number of patients ( } Mobile home parks . . . . . . . . . Number of sites ( ) Nursing homes . . . . . . . . . . . Number of beds persons Toilets ( ) Showers r o f ( ) ( } Parks Number p ( ) Restaurant . . . . . . . . . . . Seating capacity ( ) Dishwasher and /or disposal? { ) 24 -Hour service ( ) Retail store. . . . . . . . . . . . Total number of customers _ ( ) Schools . . . . . . . . . . . . . Number of classrooms T7 Meals ( ) Showers ( ) Self service laundry . . . . . . . . Total number of machines ( ) Service station . . . . . . . . . . Number of cars served daily ( ) Swimming pool bathhouse . . . . . . Number of persons ( ) OTHER . . (Specify . . . . . . . COMPLETE OTHER SIDE } 2. Indicate whether the following facilities are present. Floor drain yes no Number -of drains / Food waste grinder yes no _ c Dishwasher yes no x Automatic clothes washer yes no / Number of clothes washers 3. Septic tank capacity . _ / 0 0 0 Holding tank capacity p Septic or holding tank manufacturer a �s 4. SEEPAGE TRENCHES: total square feet width of trenches length of trenches depth number of trenches SEEPAGE BEDS: total square feet S/ width I length of bed 17 depth SEEPAGE PITS: total square feet outside diameter depth below inlet total depth from top to bottom of pit Signature of erson completing form: FOR DEPARTMENTAL USE ONLY Address f K - 3 A1,,: Q Zip S If o I i i Telephone Number Date P y • 't10NS ` pR AND NUM N RE1.p+ h O'0 pEPAR E OF INhUSTRi' D8 iLA 5 pN1SION OF SAF �6 SEE CO PE ONDE r rcvic 07 / 5 16, T30 Al Ae Wmoad 7ow4, *P, Sr. C?O c, kj-r 1 (,Aow Ao 1 6 , 6 3 NO / Sc OA 80 02236 t AL ESN � �Q NG 'r 1 7 ss , z1 u p � \� 7 6Z /OT a � _ O rd 'C„ T3OA/ e/ 8 �✓ nn ass T iRd 3 f/l /, Ayi of itlJl�ERrl`!1 Bv, l jo4".'e wtsazo 7e0a P ✓� t�,chs;,c - la �1�s ��x 8 0 0 2 2 8 .E-��',Cu�,v� QzspQS,4i s�SsFrh 6 75-0 5A l m„ vrarc.N, ,L. 6yvtQiv '(SU �nf�lo A 17 , 1 7 pcPtf/ o Il�u % lz wrW .3� — .2 .4 ,nrk5 �.�pg�, {� /000 9 R 1 %��Ik ro a e us' 4 SS �Rc• + e>Prr,c,fA Scope Pka m G'o.)ceEr'c P. G' . 1� loon l kl. Cz.nkNt P1Scld4c �s _ /�l — S'(, ,�,,� „SAW? A "f a ro rc -f /” Cam. } PLUMBING i//J / o'v' JA _ kv / (foittoha ED /YI t�5f 3 BOB AN HUMAN RELATIONS ART NT OF 4NOUSTRY I NGS DIVISION OF SA Y A SEE C RESPONDENCE EH 115 9 /78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS r WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION — '/ _ ' /., Section ,,// _ , _LSa._ T- ..�N,R.�,1t` (or) W, Township or Municipality Lot No. , Block No. County ame u ivlslon . Owner's %Buyers Name: rud Mailing Address: t TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW ___Q REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS _S- • Y7 PERCOLATION TESTS SOIL MAP SHEET _ �x f^ NAME OF SOIL MAP UNIT 6k T PER COLATION TESTS TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES NUM - DEPTH CHARACTER OF SOIL RATE INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- , 1 P_ / � ' I P- SOIL SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES e– �j , z- C B– k:# ' _Ad - �, t - 9/ c. 19Z r. PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan t Nation and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy D Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. _^ 1 i J ' 1 , F i _ N u r 1 t. _ _ eQ { � r 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 Name of installer if known Copy A — Local Authority CST Signature State Of WiSMnSin ` Department of Industry, Labor and Human Relations Please Reply to: Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protection P.O. Box 7969 Madison, WI 53707 Telephone 608- 266 -3815 f IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAM OF PROJECT r TYPE OF APPROVAL S TREET AND NO. CITY OR TOWN COUNTY ' STATE ZIP O WNE R Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes, and Wisconsin Adminstrative Code, the plumbing plans and specifications are approved contingent upon compliance 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 Safety & Buildings Division does not hold itself liable for any defects in plans or specifications, plan ommissions, examination and reserves the right to 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 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. Sincerely, PLANS REVIEWED BY: DATE ., f James Sargent /Bureau Director cc: D 6WS' Owner DILHR /Locai_'ffl Plumber H &R (2) County Mfg. Rep Bur. of Health Fac. & Serv. Rec. & Env. Services DILHR -SBD -6099 (N. 06/80) �'+ 8 A . �� ? ..�,( jyy� ,rxe ;:`1,� G v:Xii �'s[ �r �� 4 h� �'� � �. j: DATE. PROJECT:' , 50wa e Di s.. osai z SO4 S w. _3611 U 3 t ? p sue- s � ,�� "q � F is ,Ric d 'i t 54 , DE f ACH HERE � ��F � � I - -- -- —,.— — -- — — — -- — , � _ d r. �. ; Getz is a i y In , : , : e`` il k # is #+ elcn+l3 ±ee$�s ►i" o r tl' f wfor the v+e4"�*.", - el tmtt�+ary r81Hew'dndtfAtei plan• review a reht�r1'AS R r ) t Plan acc eow for roview, t o received is ..� , .•:�•" Of �'� r t3lerit.'ent. w �. �U. Fee ai b>fIng returned because � Pay � rpayn� , tt # .> rti Providing one of the two catagortes abo is checked remit Corr t fee in ona p t. = •.�' �;�� � c� i �'. [I i ` No-fee -has been remitted. ans submit es>�i with no,' * wiH be,, eld fn. al eyancis. t Plans bung returned. V A; . a ; El Additional lotormletion, requlred: SCE E ©w. _ " L 'Plan Submission ❑'Additional infa+'�xtation.thaltbe su fitted in triplicate specifically ndted. CI Plans not clear. or permanent D Ali informatidWsubmitted shall, be s' , isalO or stem in, accor4 witt oection H 62,261 ❑ Affidavit 6ndiised,'' ` t {¢ va tl Alternate sewage'Disposal Systems (M u Systems) E3'PLB 108 (Application for use of an t m ate, systafrrr). :, $ ❑ County onsite required (1 copy }. Q ,sign caHeuiat{ons for ressurized die tbution ❑Cross section of mound. M Pipe la ral layout. ❑ Pla view of Iternske. a Ill. Private Sewage Disposal Systems E Ground slope with 2' contours in an a area of toil absarpti system °exte 25' on all sides ❑ Elevation of permanent reference poi t (benchmark). ED Location of area, suitable for replace ant syttem - Provide s test date. [❑ Plot plan showing tot sire and all late distances from sew disposal syste , or, holding tattle: W, coursoi -atc, ' © Construction detail .of septic, holding r lift pump tank if sit'. constructed or ank manufacturer if'. recast ❑ Construction detail and crass section' f soil absorption syste s El Soil boring and percolation' Ast on E 115 completed'by ce 'f'sedsoil testers 1 a py�'l. [❑Complete data relative to anticipated of bldg. Q3 eopi of PL ¢0 encC C3 Deed restriction required (1 copy). F .ry g a ry Au,'. Holding Tanks 1Profrle of holding tank. ,..� f rn t' sam 1 enclo lased i 'C�d~Ftaldsng tank agreement signed by o and �local,urnt o g men tf � ) ( llesso wE for installing,holding tank soil eft or_statement from unty:(1 copy # I V. Lift Pump 0Calculations for tote[ lift pump.discha. , head and gallons p ped per cycle: 0 Size, length &-'depth of:force main. E]. petaiF dt model of .pump or< stomatic ghons ineiudino'size, mp;curves, dr down and. avera e rafap :gam F € { E Cross :section of lift -pump tankshowi pumps) or',siphonls), 019. x Vfi . ust be ta.plan submission) r E Total area ilted (611 -- xtefid 20' beyondcado a# tleitCh bef a side sly n). , tj Depth and type of fill. -" r E Copy'ol omite j*port, by- county or district plumbing-supe f E_I L.e%th of time fill has been in place. qrW Ot A 4 , 4 .. `2;. '� P 1 b : f s5 € .F'` ♦ ay b T i• �`%+i A s ' - C &' .' F t " j1 $ ^' i s v t f , y _ a 71 •° f }/ • �k_1_ 16 :ti��`. a,Pi 6. �, +'� - # <.. .�fi •��"' �+ sa,. xt }�„ �„+�' �./ ��'A � r ,'. .,• .. .� .� .. .,ctt ..l ,- - ,.'f.. .. ., u :. +raven =._ { . . ar r , s � y, R # R r _ t { x ..