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HomeMy WebLinkAbout008-1033-10-200 ~ I N a6 a) a a o y I cz N N N I I i ~ I ~ I 'Its I r 'Its o~ I O N z aD I 0 a z c U. c 0 E ¢ i W M V N > ~ y (>p Z 4j 0 z m d N Z a Co c O ozd' to FZ- N Z E o ~ m I wJ CD cr, N O Q Q O ~ Z Z Z I Cl) le E CD N N rn m LO LO a N O C O O ai L O G O a aa)i N N b o a = Z 0 o •N R Caaa a > r- co N J V 00 m O0) } v Z?s a p o o O In O O N N O p a Q) N L 'p ml p> N iq O 41 Q N ~ fO f6 C.' p N y 41 Co A~ N V ~ v O E It co 4) (D O cOO F- o ~ .C a 0 0 0 0 00 11 E IM c cca y N N l i.i f'7 r- a7 (n N c~ co ~R f0 Y O) C h r N 06 LU :3 o I y O r W LL N O Z N Z w U) v~ 10 € ti CL a a 4-, ~1 A c°~a~ ',lov~ci I e. 7 NOTICE: Please provide the following: • _ plan view sketch sho ing eve-. hing within 100 feet of the system. • o horizontal referent ro s t center of septic tank manhole cover. • ow alternate benchm k, 'f alicable. U PLAN VIEW I ~G65 0 57-1 410 t 4' ICATE NORTH ARROW t 1 ST. CROIX COUNTY ZONING DEPARTME (T' AS BUILT SANITARY REPORT ^ f` !S a Owner r a ,r Address City/State v`( "n ;~oF c~ j Legal Description: Lot Block - Subdivision/CSM # t/4 /tt- t/4 42E, Sec. 42, T:2LN-RAW, Town of PIN # - 103 3 '/c SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: JJ yy ~ Tank manufacturer rdr~ Size ST/PC/ Setback from: House `U Well P/L Pump manufacturer c Model Alarm location -F, (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width ~y Length Number of Trenches Setback from: House -70 r Well X75= P/L 75' Vent to fresh air intake /t/al-`- ELEVATIONS: Description of benchmark w e o rt4 Elevation ,~/'v Description of alternate benchmark Elevation ~2 -3 ST/HT Inlet ST Outlet O PC Inlet Building Sewer r PC Bottom.22. -71 Header/Manifold Top of ST/PC Manhole Cover ~1 Distribution Lines O % O ( ) Bottom of System O O ( ) Final Grade ( ) 0 3 ( ) ( ) Date of installation /4~ / 7APermit number a f / ( State plan number 1,73 s Plumber's signature /Z-,~.,License number Date -112-1-ff Inspector Complete plot plan Wiscgnsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Countv Z INSPECTION REPORT v C GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). C957,:7 /q Permit Holder's Name: J ❑ City ❑ Village ja Town of: State Plan ID No.: !kc,4 F, h K v Go-Ile CST BM Elev.: Insp. B Elev.: BM Description: Parcel Tax No.: ' ~tOfYlorSl 1 I~WGc+frle CT1~ C 008- TANK ~ Cif INFORMATION ~Ij ELEVATION DATA is 9700 (o TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. W ~~eta S tDOO Benchmark Rosin (B~p vin 6o - C,0 Aeration Bldg. Sewer ( .S' q7, 32r Holding <M~ IWlnlet 96,G3' TANK SETBACK INFORMATION (2>qt Outlet TANKTO P/L WELL BLDG. VAenttake ROAD Dt Inlet ° e is ~a" Ippt q54' NA Dt Bottom Iac?c/ ~c osln -70 1 Dom s NA Header / Man. Aeration NA Dist. Pipe 9 I ac~ r P" Holding Bot. System ' 2.(a 1o1.2 g PUMP/ SIPHON INFORMATION maX. m 3-2 Final Grade Manufacturer C 0,., Demand S c.tavtk q.37 R9.gq ` Model Number 3W-71 7'/VGPM TDH Liftxq Lrictionv.7q System2 TDHIq•2'/Ft Forcemain Length Cjp Dia. F L Dist. To Well SOIL ABSORPTION SYSTEM~,- RENCH Width Length No. Of Trenches PIT No. Of Pits I ide Dia. Liquid Depth DIMENSIONS - , C DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LE G an MBER INFORMATION Type O S-61 -7 CH ORU S ! S (1 Mode Num System: f11~ DISTRIBUTION SYSTEM Header / Mani old Distribution Pipe(s) ~ x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length C2_93! Dia. I' Spacing 3(Ap° 1 t q v ~&4 75 ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over it Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center 17- ~Bed /Trench Edges Topsoil Yes ❑ No ❑ Yes ~-fdo COMMENTS: (Include code discrepancies, persons present, etc.) qg7 ~_7,-vi 611ct Pe-1- Noy-,n4 q Fi mt 57/I*1q $ Plan revisionquired? ❑ Yes ® No Use other side for additional information. 15- 1 1 gj - 1-71 (5 7 SBD-6710 (R.3/97) Date nspector's Sig ture ert. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~wW^~ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Saannittaaryy Pe1rmi~t Number The information you provide may be used by other government agency programs ❑ Check if revision to pre-vious application (Privacy Law, s- 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION OMO 9720273 Pro pert Owner Name Property Location SC~OR P. FILIPIAK NE 1/4 NE 1/4, S 12 T 28 r N, R 16/F091W Property Owner's Mailing Address Lot Number Block Number 47 487 270TH ST 1 City, State Zip Code Phone Number Subdivision Name CSM N 3M $~7 WOODVILLE WI , 54028 ( > 7 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cityy Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Torag OF EAU GALLE 270TH STREET 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 !7"- to • 1 ❑ Apartment/ Condo 008-1033-10-%0 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 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2, EN Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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) Elevation 450 900 000/ 900 .5 N/A 101.3 Feet 103.6 Feet VII. TANK Ca in galloacits Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Ex's tin strutted Tanks Tanks Septic Tank or Holding Tank 1000 1000 1 MIDWESTERN PRECAST ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 650 650 1 MIDWESTERN PRECAST ® ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St ps) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON 20292 715/772-3278 Plumber's Address (Street, City, State, Zip Coe : W1229 7700 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater Date Issue Ilssuinct Agent Signature (No Stamps) IV/ 00 Surcharge Fee) Approved ❑ Owner Given Initial IR Z~o~ P 'd 4 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to Cnoni y, One copy To: Safety & Buildings Di--ion, Owner, Plumber INSTRUCTIONS ` 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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 and 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 isto be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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 DILHR. 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 1!2 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; wel s; 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 contamination investigations and establishment of standards. r SAFETY AND BUILDINGS DIVISION 2226 Rose Street NVisconsin La Crosse, WI 54603 Department of Commerce Tommy G. Thompson, Governor 29-Sep-97 William J. McCoshen, Secretary Ben Helgeson JAMES NELSON Helgeson Excavating N7649 Hwy 128 Spring Valley WI 54767 JAMES NELSON Plan ID 9720273 NE, NE,12,28,16W Municipality of SPRING LAKE Inspector: Dennis R. Sorenson County of Pierce (608) 785-9336 Private Sewage plans including the following element(s): MOUND 450 GPD 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(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan action is subject to the conditions listed on the following page(s). 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. All permits required by the state or local municipality shall be obtained prior to commencement of construction/installation/operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. Sincerely, r erard M. Swim POWTS Plan Reviewer (608) 785-9348 SAFETY AND BUILDINGS DIVISION 2226 Rose Street ' ~ LaCrosse, Wisconsin 54603 a ~scons~n Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary Page 2 - 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, prior to installation. - 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(d), Wis. Stats. SBD-5524-E (R.07/96) File Ref: 9 7 - 20 2 INDEX SHEET PROPERTY OWNER: JAMES NELSON RECEIVED 462 270TH S ~P 2 3 1997 WOODVILLE WI 54028 SAFL TY & BLDGS. DIV. PROJECT NAME: JAMES NELSON 97-20273 PROJECT LOCATION: NE 1/4, NE 1/4, S 12, T 28, N, R, 16 W MUNICIPALITY: TOWNSHIP OF EAU GALLE COUNTY: ST CROIX CONTENTS Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Pump Chamber Cross Section & Specifications Page 5: Pump Specifications Name: Bennie Helgeson Signe Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: September 19, 1997 Conditionally ROvr~ API ENT OF COMMERCE GS pEpARTM 1,DIN IS1QpOF SAFETY AN :~~CL DENCE gEE COF2RE F 4 ioo, ~vC[yre s i ~ 1 1 ~ ~r~rt i s 1 131 R _ s~:r v' . 470 )30T ~rew i _ UJ 8),70 -D - .N\, R-C j00. m 4g L?r J ~ Wp-y { Page Of _ Strow, Morsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand /03. i H'= ~G Topsoil F _J► E D /o Slope Bed Of 2 % Force Main Plowed Aggregate From Pump Loyer D / Ft' E~•3i Ft. Cross Section Of A Mound System Using A Bed For The Absorption Area F Ft. G / Ft. A 6.-?-S-Ft. H J•5 Ft. Signed: B 6 0 Ft. License Number: 9~ K /G, 31 Ft. Date. L Ft. J 7 Ft. T Ft. Force Main id Ft . r_ L 1 Observation Pipe---,,,, K A I i Distribution Bed Of 2 - 2 Pipe Aggregate i Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area i 1 I • ParfOra led Plpe Uololl End Vlew End Cop )POrtoroled y" PVC Pipe ~o~0`` , Permanent End Markers s Holes Located on Bottom are Equally Spaced ,a P Force Main * from Pwum mp _N4 /e PVC CA N Monlfold Pipe ..J% Oitlrlbullon... f Plp. Lott Hol• Should as Next To End Cop d Distribution Pipe Layout_ P R S X Y f Signed: Hole ..Diameter Y Inch License Number: Lateral " _r/ Inch (es) Date: Manifold " Inches Force Main " Inches 8 ~ld~e5 `P~~r ~0.~~✓u`( TOO Cr 5/eL-)• / Cl / - Q7,er.' let vyt ~_S lgoi Page_Of -COMBINATION SEPTIC TANK/PUMP CHAMBER 4" Cl Vent Pipe with (No Scale) Approved Cap, +2$' ,Approved Locking Manhole Cover From Buildings With Warning Label Attached Weatherproof Approved _ -Warning Label Junction Box Vent Cap 12" Minimum Final Grade 6" Minimum 4" Minimum 6" Maximum ' 4" C.I. Quick 18" Mi Insp. Pipe Disconnect M Insp. Pipe I 1/4" Weep Hole Baffles D ' i I Approved Joint , A w/C.I. Pipe t y Extending 3' Alarm 0 B Approved Joint Onto Solid Soil On 6; w/C.I. Pipe i C Extending 3' wl v Off Onto Solid Soi D Conc. Block 3" of Bedding Under Tank-/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ ofi Doses: //,.S Gallons Volume of Backflow:.......+7 j.~Gallons 3 1 a"Gal l ons Tank Manufacturer: g,-A4 ?_S ej, ~r~caS~ Total Dose Volume: Tank Size-Septic/Pump: Gallons 7 6-1 p,r r, 6. Alarm Manufacturer: Model Number: ,v Capacities: A/7- inches or 30 -gallons Switch Type: + B inches or 3 Y Gallons + C 1 nches or- Pump Manufacturer: T -2 Model Number: + D / inches or- L2 9 Minimum Discharge ate: Y 1-r Total _ i nches or ,:S~al l ons Vertical Difference Between Pump Off and Distribution Pipe: 7~Feet Minimum Required Supply Pressure:....... • Feet Feet of Force Main x I Friction Factor/100Feet: + ; Inch Diameter Force Main Total Dynamic Head:...= /3,0 Feet 1 Internal Tank Dimensions: Length 7y ;Width ,s ;Liquid Dept h Signature Date Number s a MODEL: 3871 Submersible SIZE: 3/4 SOLIDS PM: 1550 Effluent Putyq~ HP: 0.4 } . METERS FEET 8 25 7 _ _ 20 a 5 _ z 15. p 4 - 3 10 2 j i 5 p of f LO 30 J 50 GPM 10 12 ml/h 0 2 6 CAPACITY r(MGOULDS PLIKIS, INC. E l , . F S&eCA FALLS 1.: ,y NCAK 0148 r T.`. n'' a Raw V EI(oe ,e Octobor, 1988 PANTED IN U.S.A. Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Divisign of Safety and Buildings in acc A ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 inches i ize. s~rnu t County include, but not limited to: vertical and horizontal r ce poi ' ction nj C/\ 01-percent slope, scale or dimensions, north arrow, cation a to nea ,rdad. Parcel I. D. # to - G i . `r I~ i ~5 O ~S - !6 /d --/ae APPLICANT INFORMATION - Please t all in( ~~gr~'~ Rev' wed by Date Personal information you provide may be used for secon rposes (R~, s. 15.04 1.t-- y Property Owner p rly Location S O G~ c Lot ,E 1/4 A) 11/4,S T g N,R f E (or CW. Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# yip -7 o -f 4 S4- - - City State Zip Code Phone Number ❑ City ❑ Village D-Town Nearest Road v; (~l~e t J; ~~8 (7l )~8-zG 8~ a 70 4 sf ❑ New Construction Use: esidential / Number of bedrooms 3 Addition to existing building 0--teplacement ❑ Public or commercial - Describer Code derived daily flow YS-,Q gpd Recommended design loading rate 5- bed, gpd/ft2 ! f -trench, gpd/ft2 Absorption area required _!2[Zbed, ft2 0 trench, ft2 Maximum design II ding rate a bed, gpd/H2 t trench, gpd/ft2 Recommended infiltration surface elevation(s) 2CL/ 30 ft (as referred to site plan benchmark) Additional design/site considerations ~4fl Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ s Q-1- 9'9 ❑ U ❑ S 9-6 ❑ s C~3-t1 ❑ S [-u ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench v J -L) urs S' Ground 3 S- V 7- St- uL 'Si pelev. CG Depth to limiting factor ttin. Remarks: Boring # 1 o Y k y YVIQ uJ I , S- Ground S O C, 13- /Z U c 3 Yv`~ - e2 elev. /t:K.VA. Depth to limiting faator in. Remarks: CST Name (Please Pri t) Signature Telephone No. Address Date CST Number oa9~ 7'~9~ a. SOIL DESCRIPTION REPORT PROPERTY OWNER Page of ' PARCEL I.D.# OD~-1U~ /p /mod Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~ptft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground 1 S S ~K r cAi S, elev. Depth to limiting fact r ' Mn. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. tt. Depth to limiting factor in. Remarks: Boring # Ground elev. tt. ; Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) too.-43 ~q $o rAll ,r r :S LA1'6~ g~ ~a- M ov.%. dl Arc E w~ i ~ ~ ~ 3 ~oo.tev a~bA ~xiS1~~V.c~-f ~5410~1C ICiKk -Je I Fk, .1Z, P, i oc~.Qa L T3o~}"0 o f l~~se, S~ d~ ~,J" n/ ~V I~ 1 Lf =:q~g - ~77 ~t-we. W ay r 1~,~~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor arid,Human Relations Page of Divisiorrof Safety and Buildings Irt @ With s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less x 11 in esIan must County include, but not limited to: vertical and ho ' refers (BM), n and n oor percent slope, scale or dimensions, no , and Istance to earest road. parcel I.D. # APPLICANT INFORMATION - e prfnik~ ififatio Re iewed by Date Personal information you provide may be used I. rids ry p vary Law, 15 (1) (m)). Property Owner "Ki OFFcc Property Location 1 Jr O 1~ Govt. Lot 1/4 114,S / ~ T g N,R f E (or Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# ?o f 4t 4- City 11 State Zip Code Phone Number City [:1 Village ❑-fown Nearest Road f76G V ~ e LAX t~O 70 4 574; ❑ New Construction Use: esidential / Number of bedrooms 3 Addition to existing building M-A-eplacement ❑ Public or commercial - Describe: Code derived daily flow YT-0 gpd Recommended design loading rate bed, gpd/ft2 ~ trench, gpd/ft2 Absorption area required 9/>h bed, ft2 7S0 trench, ft2 Maximum design loading rate o s bed, gpd/fl2 f - trench, gpd/ft2 Recommended infiltration surface elevation(s) 10/. 30 ft (as referred to site plan benchmark) Additional design/site considerations .9.,95- Parent material _ • og e, - Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure TAT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S QT ©-9 ❑ U ❑ S e-I' ❑ S 9-tr ❑ S Q -U ❑ S 2-f SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Slh. Bed , Trench a- o , s Ground 3 ~6-'Ys I C) 'Y F, 7. 5' YX 12y sC Depth to limiting factor in. Remarks: Boring # v I~ . S- foYR y' YVI 3 - iJ y b r t 0 F w S- . Ground 5 O y ~2 C U O - _ elev. Depth to limiting ~f~!~ in. Remarks: CST Name (Please Pri t) Signature Telephone No. BP Vt Y\ 1 ~Q Address Date CST Number u;,~~9 77cf! ~~e ~H U r lam/', 57y76 7-ay- 9P a~00 9a S ~t~ Jotn SOIL DESCRIPTION REPORT of , PROPERTY OWNER c,w.- Page PARCEL I.D.# d ~V 3 -/0 /O d Borin # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots Gep/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench ' • 6 r Ground S r w elev. S 65~t. - 93 to ~t ' Cf S C C S b k t- I J 6 Depth to limiting fa r ; Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Boring # , Ground _ elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. . Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) 'Ploi `t l a~ i 57..fi ~_s u. awl 61 ~ l 5~e ~ Mou.~nd f4rtw E W' p~ai 99. o ' 1 ~ I ~ r~ t- I q 1 + Icv Y Tex-G S. 156 I ~ FCnct ~7blti ST t ~h U? ~K~Sllrt~ r sip Tc" k ~Hbrn,a.. - I: Z M 0. R.P. I oo.oo L Bo~to w. o f l~ruse. S ~ d~~5 I l L y0' 14V I~ y FILED =,w OCT 2 4 1997 ► KATHLEEN H. WALSH 1P ~ T~, i 4 1 G k 5 Register of Deeds St Croix Co, WI 567391 `ERTIFIED SURVEY NVI,.P LOCATED IN PART OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER AND PART OF THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER OF SECTION 12, TOWNSHIP 28 NORTH, RANGE 16 WEST, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN UNPLA_TTED LANDS Prepared for and at the request of. a S 890271541E 253.58 Owner: I 'amen and Eleanor Nelson - 33, 33' ~ 220.13' 441 274th Street 001-618 ~ r w r • Woodville, Wisconsin 54428 CV O ~00 ~T C OD 0) 7 0 1y) ABANDONED County Section Comer Z CV N I 0) N M , WELL ~p Monument of record It ~f a 001 _ I of CO r, - I P1 O Z I C4 J10: 0 1r' it midmil, I u , O 1. 5"x24" iron pipe weighing I n V I M N I a minimum of 1.13 pounds G o z per linear foot, set. 1 3 J ~ • 314" rebar found M 1 f~ I~ O 01 I F-1 e 1" iron pipe found 0) 1 HOUSE W I UJ I O Q TANGENT Cr1 13 I O J I TOTAL AREA BEARINGS F-I N i Z 4.32 ACRES w w w w CM w I M (A~ I M , I 188300 SO.FT. to N M ZI J 1 0~ Y, AREA EXCLUDING R/W v N v° JI w I N F-~ I z m, S8500VM 3.67 ACRES ao o w I Z OI w 87. 441 E 159662 SO. FT. z z Z z °w~ NI } , 0 0 Q; wELL' Q81N GRAPHIC SCALE Q I 43 I SHED 0 100 200 J~ -t 1 o Z BARN I I = SCALE IN FEET I INCH=IOOFEET SILO I i ao N , _w I N 1001 188.56 I a 1(o~ N8500913611 D - I-= (U 0) lr. 1 N 1 V6 (01 Z r~ ~M 1 4f Z 1 M Z 1 u 2'1- 1 ~ " i 3 JI IM ca NE CORNER V ' 1 O SECTION 12, 1" f I MrO IRON PIPE FOUND u 6 ► OO QI / O 1 ~1 o ' 0 J I Bearings are referenced to the Lesr. (p IM ~V r GO a line of the Northeast Quarter of ,ti' i U ! ,d I, Bradley J. Canaday, registered Wisconsin Land Surveyor, hereby certify that by the direction of James Nelson, I have surveyed, mapped and described the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the Northeast Quarter of the Northeast Quarter and part of the Southeast Quarter of the Northeast Quarter of Section 12, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin being fiirther described as follows: Commencing at the Northeast Corner of said Section 12; thence along the East line of said Northeast Quarter, South 2 degrees 19 minutes 54 seconds East 1545.71 feet; thence North 89 degrees 58 minutes 54 seconds West 939.80 feet to the point of beginning; thence continuing North 89 degrees 58 minutes 54 seconds West 149.00 feet to the centerline of 270th Street; thence along said centerline 496.06 feet on the arc of a curve concave northwesterly, having a radius of 1311.17 feet; a central angle of 21 degrees 40 minutes 38 seconds, and a chord which bears North 7 degrees 58 minutes 47 seconds East 493.11 feet; thence North 2 degrees 51 minutes 32 seconds West 189.93 feet; thence 182.18 feet along the arc of a curve concave easterly, having a radius of 825.00 feet, a central angle of 12 degrees 39 minutes 07 seconds, and a chord which bears North 3 degrees 28 minutes 01.5 seconds East 181.81 feet thence South 89 degrees 27 minutes 54 seconds East 253.58 feet; thence South 0 degrees 34 minutes 07 seconds West 370.66 feet; thence South 85 degrees 09 minutes 36 seconds East 87.44 feet; thence South 8 degrees 10 minutes 17 seconds West 145.82 feet; thence North 85 degrees 09 minutes 36 seconds West 188.56 feet, thence South 8 degrees 00 minutes 49 seconds West 354.20 feet to the point of beginning. Subject to 270th Street right of way over the westerly portion thereof and also subject any other easements or restrictions of record. L also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St Croix in surveying and mapping the same. Each parcel shown on this map (plat) is subject to state and county laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St Croix County Zoning Office for advice. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT /L St. Croix County OWNER/BUYER . _ ~JI~TT r', ri AD~ MAILING ADDRESS PROPERTY ADDRESS 487 270TH STREET, WOODVILLE, WI 54028 (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION NE 1/4, NE 1/4, Section 12 T 28 N-R 16 W TOWN OF EAU GALLE ST. CROIX COUNTY, WI II// SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP At A(o. , VOLUME 12, PAGE )~6y , LOT NUMBER 36739'1 42 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 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 for a maximum of 60% of the cost of 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 St. Croix Zoning a certification form, signed by the owner and by a mater 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. 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 stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. Y SIGNED: DATE: JQ - e2 - !7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11193 STC - loo 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 S oi-7' F. E. hlo.,~K Location of property NE 1/4 NE 1/4, Section 12 T 28 N-R___16_W Township EAU GALLE Mailing address Address of site 487 270TH STREET, WOODYTl,j,g WI 54028 Subdivision name M/1 Lot no. Other homes on property? Yes No Previous owner of property -JAm ES Total size of property y '3 Total size of parcel Date parcel was created oc-t. "RI Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume ia. and Page Number 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 AND 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. 5160 7qq , 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 the County Register of Deeds as Document No. ?7 q9 1111A ~'Jj L0,114 gnature of pplicant -Applicant na A o Sianature Date of Sianatiirp RIVER VALLEY ABSTRACT Fax:715-386-7664 Oct 31 '97 16:27 P.02 4% I I JJ STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO WL 1?74 %r f---- _ Laws n Melson anti Flin r n_ Neil Rtm. 1t hand and R7G R'S OFFICE wi Ce. SOIx CO., WI j for Record conveys and warrants to Sr+ni-~ D Fi 7laiak and 7g+,rin OCT 3 1 1997 A IIII 11 :15 AM Re rater of Desda t THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. CKQ x Count //~'f'' State of Wisconsin. County, /C"'~ I' Part of NE 1/4 of NE 1/4 and Part of 5E 1/4 of NE 1/4 of Section 12, Township 28 North, Range 16 jl West. St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map - __filed _ i October 24 _19-97_in Vol. 1+1211, Page 3369, ~Q8_tn'~~_7 lnn OC. NO. 567391. PARCEL IOENTIFIC TION NUMB 1E- I TR SFER I, I This is homestead pmpcrty. Exception to warranties: easements, restrictions and rights-of-way of record, if any. I' 3 I Dated this day of October , A.D., 19_27 • (SF-AL) (SEAL) I amea J D. Nelson • Elinor A. Nelson l~ (SEAL) (SEAL) i AUTHENTICATION ACKNOWLEDGMENT is Signature(s) State of Wisconsin, ss. • " / Couo authenticated this day of 19 Personally came before me this day of - October 19--q7-, the above named