Loading...
HomeMy WebLinkAbout008-1035-90-100St. Croix County Planning and Zonin Detail Sanitary Information Tuesday, July 12, 2005 at 4:28:03 PM Page 1 of 1 Computer #: 008-1035-90-100 Sub/Plat: NA Section: 12 Parcel #: 12.28.16.1828 Lot: 1 TN/RNG: T28N R16W Municipality: Eau Galle, Town of CSM: Vol. 11 Pg. 3007 1/41/4: NW 1/4 SE 1/4 Owner: Benck, David A. 441 270th Street Woodville, WI 54028 State Permit: 353385 Issued: 04/10/2000 POWTS Dispersal: Mound Permit: Reconnection County Permit: 0 Installed: 04/10/2000 POWTS Detail: NA Bedrooms: 5 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed None Yes Timm, Roger Typically not inspected unless changes proposed $0.00 Signed Off: No or concerns exist regarding POWTS. Original house burned and now connecting a new house to existing tanks and mound. Otd Foundation to be filled Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 4/10/2003 __ Owner. Nelson, James 441 270th Street Woodville, WI 54028 State Permit: County Permit: 268667 Issued: 09/30/1996 POWTS Dispersal: Mound 0 Installed: 10103/1996 POWTS Detail: NA Permit: Replaceme Bedrooms: 5 WI Fund: No ~} POWTS Pretreatment: NA ~j Notes Inspector As Built Plumber Other Requirements Additi otes Monev Owed Jim Thompson Yes Helgeson, Bennie 1450 gal. Midwest septic to 1000 gal. Dose $0.00 Signed Off: Yes chamber to mound for 750 gpd Maintenance Scheduled Puma Date Pumped 1st Notification 2nd Notification 3rd Notification 10/3/1999 12/10/1999 04/01/2005 12/10/2002 04/01 /2005 Wisconsin Department of Commerce Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Count~rt Croix Sanitaru~4rglit No.: State JJPIJJan331 DbbJJNo.: ParcebT~ ~~135-90-000 'ersonal information you provice may oe usea ror secondary purposes (Privacy Law s.15.04 (1)(m)] ermit Holder's Name: ^ City ^ ~Ilag~ [7, WNn o nck, David A. au a e 1 ownship ST BM Elev.; insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t, Dosing ~, r~ ~~°~ Aeration ~ i <' Holding ~ '~ TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Lriction System TDH Ft Forcemain Length Dia. Fi Dist. To Well FtLtVAIIUN UAIA STATION BS HI FS ELEV. / B chmark Bldg. Sewer St1Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade St cover SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 N DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Num er: System: OR UNIT DISTRIBUTION SYSTEM Header /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 1 Trench Center Bed 1 Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present etc.) Ins ectlon #1: / /____ Inspection ;'t~: / i Location: 441 270th Street, Woodville, WI 54028 (NW lj4 SE 1/4 12 T28N R16W) - 12.28.16.182A 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 3.) contour = Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT N 201 W. Washington Avenue isconsin Ina r wi h ILH ~ I . P O Box 7302 Department of Commerce cco d t R 83.,p~,1(V j~ Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the t m, on~~q$ les~~, ` Bounty ~ ~ ~ than 8 v2 x 11 inches in size. rr, , -~° • See reverse side for instructions for completing this ap Irc~tioR~ ~='~'~ ~. ~' ~ ~ooo ' to anitary Permit Number :- ~ 3 s3 ass Personal information you provide may be used for secondary purposes ~; . S7 C?4OlX ~- . tio n Check if revision to previou ap plic a (Privacy Law, s. 15.04 (1) (m)]. -~~ Z~~~ ~ ate Plan LD. Number e~ s ~ ~ ~ ~J I. APPLI ATI NINFORMATI N-PLEASE PRINT AL RMA `~ ~~~5-~""'` 9 - y-IZO~~ 0-01- 94~ Propert Owner Name on t 4 1/4, S/ Z T ZS , N, R `(~ ~(or)~ Propert Owner's Mailing Addres~ ~Yr a ~o ~-k Lot Number ~(/~ Block N tuber City, State ., ~ Zip C de Phone Number ) ( Subdivision Na a or CSM Number c~ ~ / I1. PE F B ILDIN (check one) ^ State Owned ^ Icy Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ~ ^ Village Town OF ~~~76~ III. BUILDING USE: (tfbuildingtypeispublic,checkallthatapply) Parcel Tax Number(s) ~ Q~ I ~ 1 ¢~//L . i z- !/8 l u rT 1 ^ Apartment/Condo ~~' w35'r ~O 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Salesl Repairs 11 ^ Restaurant/Bar/ Dining 4 ^ Church /School 8 ^ Mobile Home Park i 2 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 Q Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable A) 1. ^ New 2_ ^ Replacement 3. ^ Replacement of 4. Reconnection of 5. ^: Repair of an ______System____-___System_____________TankOnly--________ Existing System ___,_-_ ExtstingS~stem B) A Sanitary Permit was previously issued. Permit Number o`2(~ ~(a ~-] Date Issued 9 ~p -~ rf V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distributron 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-ln-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 7 ~I~ (~ a5 a . 9% U Feet /O/r 3 Feet VII. TANK INFORMATION Ca acct in gallo s Total # of Manufacturer s Name Prefab. Site Con- l Fiber- Plastic Ex er. p N i E i Gallons Tanks Concrete Stee glass A p ew n x st struded Tanks Tanks Septic Tank or Holding Tank ~ p L ~~ ~ ' ~e/K ~. ® ^ ^ ^ ^ ^ Lift Pump Tank /Siphon Chamber ~Da~ / r +eSr~in ~~ ~ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbe 's5ignature: ( Stamps) MP/MPRSW No.: Business Phone Number: 4 ~, r ~-2 2 5~ 7/~i . ~ 7 L- 32~y Plumber's ddress (Street, Cit State, Zip Code): (2 ao th X}- ~~ L~ ~~ ~~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (I"dudes Groundwater ate ssue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) ~ 25 ~ '' \ Adverse Determination ° • -/0 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: ~~ P~,~ _ ~a,,t,.~ ~- SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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 property 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; 608-266-3151. ~ - To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to 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 8112 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 contamination investigations and establishment of standards. - TIMM EXCAVATING Route 1 Box 192 WILSON, WISCONSIN 54027 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN JOB d1G-~/ ~ ~~-P K G ~([ J SHEET NO. / OF r CALCULATED BY DATE CNECKED BY DATE SCALE PRODUCT 205-1 ~s Inc., Groton, Mass.01471. To Oidei PHONE TOLL FREE tA00-225E380 . , ,. .~ J ~,-' S , t' ~ j ' ` f w ~+ ~ r; .~ ,~ ,;,~ rlt ~ *~. io~i~~4..~'~A"''~.>~~ T$* wr~ .:1'~'~c':c~. .. ~ 1~26~AcE1~6 ,,.~ Qa- s~ • (~ cr,-rF 8AR OF WISCONSIN FORM Z - 1982 i~ I~ DOCUMENT NO. WARRANTY DEED James D. Nelson an8 Elinor A. Nelson, htlsban an w fe as sure vors p mar to property conveys and warrants to 3V enC the following described real estate in ~tY State of Wisconsin: See Exhfbit A attached hereto and made a part hereof. .~~.,.,.~-~-.r_.. REGiSj~A'3 G~~:~ ST. CROIX CTY., V'.1 ~~l~aol~ MAR 5 1991 ~ 10:45 A. M win.. a a.~~ _ _____J THIS SPACE RESERVED FOR RECORtNNO DATA NAME ANO RETURN ADDRESS Thomas A. McCormack Attorney at Law 990 Hiiicrest St. Baldwin, WI 54002 008-1035-90 PARCEL. IDENTIFICATION NUMBER TRANSFER ~ 500 0 .~ i s ~ l~rty (~~ ~c Exception to warranties: Easements and restrictions of record. Dated this ~~ day of ~~P(!rr A.D., 19 97 Signature(s) _ authea::cated this _ day of , 19_ • _ State of Wisconsin, ss. St. Croix Coon . e came before the this _ day of 19 i ttamed Jame D. Nelson an ` Nelson ~ 1. ~' TCfLE: MEMBER STATE BAR OF WISCONSIN (If not, ~ authorized by 9706.06, Wts. Stats.) to me known to tl ,~ instruntettt attdl TH13 INSTRUMENT WA3 DRAFTED BY °~~`~ Thomas A. McC~rTaack Krson s etlCtir a th~~ot~egjj}nj f.. .dam ~ , *~ ~ ^ J ,,' # Baldwin, 1MfI 54002 ~~~ ~~" Notary Fui,iic, '~t~° ~~~'~~~~~` `J (Sig. atl.n:s may be authenticated or acknowkdgrd. Bah arc not My commission is prrt^anent. (If not, sate .~ +~ Ttecessar~!) I~ • Names of ,xr.~ns sgning in mr ~pa:iry should by typca o- primed txlow their sigemurr,. ~~ WARRANTY DEED STA7~oB~AR o 219»an51N AUTHENTICATION (SEAL) (SEAL) • ames D. Ne sQn _ (SEAL) _ --- (SEAL) linor A. Nelson ACKNOWLEDGMENT ration dur 19_ _.) VVfsoanein tayeil t~a'k Ca. Vie. Mlhrarkaa, W4 ~c 1~'6~cf1?~ gXHS82T 1- Part of NW~S of Sf~Certifi d Survey Map tiled Nov mber1611199g Lot 1 and11at1page13007 (No. 20)• _ in Vol. thane ~ Part of NW~t of SEA uari.ert corner of isaid uSection a12; 01 awst Commencing at the South Q th~nca N2°36'04"W 1319.6? feet to the South lino of the said ~~joint of along said South line S89°44'23°E •192.13. last to the p thence beginning, uaid point lying at the centerline of River Road; continuing 389°44'23"E 832.4 s id East line N2°23 34"w11320.65Wi?!~ the SEA; thence North along thence N89 47 to the Northeast corner of said NWT of the SE~% of the SE~i to the 332.91 feet along the North line thencie along said centerlic• centerline of said River Road; S21°12'21"i9 415.27 feet to the,~No ahe 30071 thence S69°36t35eEt67i09 Survey as recorded in Vol. 'll ~ p g thence S48°16'36"L 270.32 lest; thence S2Q°53'40"w 136.62 feet: thence S37°54'20"W 192.83 feet; thence S15°28'33"W 137.30 feet; feet; thence N78°59'58"W 265.99 feet to the centerline of saidthenca Road; thence along said centerline S19°05`01"w the6arc o' a curve S15°31'12"w 243.66 feet; thence 129.15 feet along central concave Soo l4 42't a d~a chordg which bearsoSll°23 51"We129.40 feet t° angle of 8 ~ the point of beginning. ~ art of the Nwh of SEA of Section 12-28-16 des Y ibed isn Alsa, that g follawsaCommencing at t thenc..co815°34f'26"~W i 110 feet] thincs Vol. 11 Page 3007; thanc• 378°59'58"E 98•n4 the centerline of e270th Str~aetOto the South lies K15°34'26"E alo g thence N78°59'58"1~ along the South of said Certified Survey Map; line of said Certified Survey Map to the Point of Boginninq J STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~~ ~ ~21.~ p ~ ADDRESS ;~~{/ ~ ~d ~~ S r SUBDIVISION / CSM# -- ~T`~/# ""' SECTION~T c~~ N-R ~.~ W, Town of ~~w ~~l/-E.._ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~ ~~~ S ~~ S~ ~ ~~: R .~ >> o kov s S' 'L !` ~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r • .. BENCHMARK• ~ ~ y / 7 A a~~ ~ ~ ~ c~S L S~c~F' r~ S (.1.~~ C Or.~ p~ ~, ALT~RNATE ,~M: '; ., A ..~ r ~`~' ''~ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION -~,.. Manufacturer: ~ ~S'~~,-~. cc~S~ Liquid Capacity: (~SZ~ 1 ~ ~ Setback from: Well `j O House a/ Other Pump: Manu~facturer~.~ -~_ ~~~ ~ Model# aS~ Size ~„ ,~/JL' Float seperation ~'" Gallons/cycle: 010 ,cif( Alarm Location ~~.se., ~~~~~,~ ~t/~pu,~~ SOIL ABSORPTION SYSTEM Width : ~ Co ~ ~ $ Length ~ ,~ Number of trenches ~ k 7q 1~,~~ ~pS Distance & Direction to nearest prop. line: ~~' ~' ~°O,w. Setback from: well: ~~o ~ House ~/0~ Other ELEVATIONS Building Sewer /Dl ~ S~ ST Inlet: /O/ , 3,,~ ST outlet: /~ / , /S PC inlet ~~ ~ ,3(j PC bottom `~, S Pump Off 9'3, ~ Header/Manifold '~ Bottom of system G ~ Existing Grade , 6 Final grade jam/, 3 DATE OF INSTALLATION: -~ -~'/ ,PLUMBER ON JOB: ~ ~ o~ LICENSE NUMBER: ~~ f~ /~~S _~~( INSPECTOR' ~1~ ~ ~© t_r-v~ 3/93:jt • _~~Fr~_ ~~ `j~ J ----- I ;.~ c~~,c~ ~~ C~. j ,% i ~~ ,~ i ! i _ ~,,~~ i ~ '~'~ ~~~~ ~U~~ ,~ ~~ ``~ ~i i I .~, Inc ~> I ~JL-ti'~ I ~ CSC>t-- ® ~x ~ sf~~5 SEPt, ~ . - Q~ d, 7c~~ k C.~cQ er S.},z~S f-~u~~-~ I I (d,M ~O~l+~ti r r 3~ :~q ~ ~ . y~ sc% G ~L f Sc~t~c J 1 g ~ I + 1 ~~ I i~ i I' ~ a7o1 ~' S ~~ i I I ~~ 0~ ~ l ~ -2 Cc~ cty)~roy'C. i 11 ~i Ccb~,-i c~.~_~.. ~1~~ 9~.~, ~ t ~ WisEonsin Department of Industry, • PRIVATE SEWAGE SYSTEM 'i Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: NELSON, JAMES ^ City ^ Village Town o EAU GALLE CST BM Elev.~~:pp~~ , ~~r (iLJ Insp. B Elev.: ~~~. ~ ~ BM Description: ~ Q TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~S-~e~'r~ !~~ Dosing `~ '` Aeratiofi Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic ~~i yspl ~~ NA Dosing ,.. / ~~, ,fir >/Gds >/G~~ NA Aeration NA Holding PUMPINFORMATION Manufacturer ~ a/~Grn~,,~ Demand Model Number ~Sj~,33 ~Gt P TDH Lift ~~3~ Lrictio ~ Syste ~~~ TDH ~a,(a~Ft Forcemain Length //0~ Dia. o~ ~~ Dist. To Well ~/(,~~ SOIL ABSORPTION SYSTEM ELEVATION DATA County: ST. CROIX Sanitary Permit No.: 268667 State Plan ID No.: Parcel Tax No.: 0 AAF,nfl'37(1 //J'~~J~/9/_ STATION BS HI FS ELEV. Benchmark ~ ~05 a b ~ 9 SU ~ / , ~ U/~rm. ~ x.33' d9,/7~ Bldg. Sewer 7.10 ~ /~/ ~ ~ St/~ Inlet 8',~ dJ 3( ~ St / y'E Outlet ~ 3s' jp/, /S ~ Dt Inlet , 3S , 3d ~ Dt Bottom d~ ~ ~, (off/ ~ r/Man. 3~/S~ ~ ' Dist. Pipe ~` q~'~ •~• ~~ ~`~ ~ d Bot. System 3 ~0~ 3, g/ ~Q ~~ Final Grade BED /TRENCH Width ~ ~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM N I N 79 / DIMEN I SYSTEM TO P/ L BLDG WELL LAKE 1 STREAM LEAC anu acturer: SETBACK ~ CHA ER M N INFORMATION y p ~ ~.c /QE >/1 C5 >~ . ~ NIT um er: o a tem: S s y d l . S~told DISTRIBUTION SYSTEM ^~ tr .~ y,~ SOIL COVER vi . ~1 ~~ Header /Manifold ~~ Length ~ Dia. ~ Distribution Pippe(f) r „ ,~ Length ,~ 0 3 Dia. ~ Spacing ~~ x Hole Size ~~ yt~ x Hole Spac~~g c5 ~ Vent To Air intake ~ /~ ~ 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 /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALrLE.1,2J.28.16, /NW~gSE, 270'T~i STREET l IJ,aN~ a...~~,nn't ~c.-„c.k,~le^.o-~.~ ,cL~-~ c~ FG~~~/~l ~,G~-C.t`-"-d ~S,`c~, Ck~w1~~ ~'~~'.~u~'. i ~ f Plan revision required? ^ Yes to Use other side for additional information. lG G~ SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. N V'~L~f~1 ~ANITARY PERMIT APPLICATI~IJ In accord with ILHR 83.05, Wis. Adm. Code Safety and Buildings Division Bureau of Building Water Systems 201 E. Washington Ave. 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 8 1/2 x 11 inches in size. ST. CROIX • See reverse side for instructions for completing this application State Sanitary Permit Number ~ a~~~~~ The information you provide may be used by other government agency programs ^ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 596-41204 Property Owner Name Property Location JA1vfES NELSON nw 1/4 SE 1/4, S I2 T 28 , N, R 16 ~~r) W PropertyOwner's Mailing Address Lot NumberN/A Bloc N }tAmber 441 270TH ST / City, State Zip Code Phone Number Subdivision Na a or CSM Number WOODVILLE WI 54028 ply ) 698-2688 N~A il. TYPE OF BUILDING: (check one) ^ State Owned ~ ity Nearest Road ^ Public 1 or 2 Famil Dwellin - No. of bedrooms _~_ Town OF EAU. GALLE 270TH STREET III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) bob- 13.5- ~-/oD 1 ^ Apartment /Condo 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 online 8, if applicable) A) 1. ^ New 2. ~ Replacement 3. ^ Replacement of 4- ^ Reconnection of S- ^ Repair of an -___System -___-___System _____________ Tank Only- -_ Existing System ____-___-Exlsttng 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 1 1 ^ Seepage Bed 21 Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trench 22 ^ In-Ground Pressure 42 ^ Pit Privy ~ 43 ^ Vault Privy 13 ^ Seepage Pit 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 750 625 625 .4 N/A 99.0 Feet 101.3 Feet VII TANK Ca acit . INFORMATION in alto S g TOtal # Of Manufacturer's Name Prefab. Site con- l s Fiber- Plastic Ex er. - p N E i ti Gallons Tanks concrete tee glass A p ew x n s strutted Tanks Tanks Septic Tank or Holding Tank 1450 1450 1 MIDWESTERN PRECAS ~ ^ ^ ^ ^ ^ Cift Pump Tank /Siphon Chamber 1000 1000 I MIDWESTERN PRECAS ~ [] ^ ^ [] ^ 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 Sta s) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON RS 3215 715/772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (~ncludesGroundwater ate Issue Issuing Agent Signature Ip S mps) Approved ^ Owner Given Initial Surcharge Fee) ~ an ~ '~ rG ,930 !G ,,,,,~L.~ Adverse Determination X: CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: S8D-6398 (H. OS/y4) DISrRIBUTION: Original to County, One copy To: Safety & RuilJings Dive 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 priorto 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: I. Property owner`s name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to 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. Cheek 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, pumplsiphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from D1LHR. VIII. Responsibility staten^ent. Installing plumber isto 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. ,- ~~~ ~ .,:..nr ~ w' ~,~?cifica'+c,=;s not smaller than 8 1l2 x 1 1 inches must be submitted to the county- The plans must ~~_.;. ~ ,;' ~ ~;n~_~~ ~; pot urn, drawn to scale or with complete ci~~neraic~~s, location of holding tank(s), septic _ 'Zl i<;nh:; ~~...~I~!~ Se'NerS; ~ENells; wiJt<~- i'1<~IhS%!~~ l'2~ t-'~uIC~'" St'e~fTiS dr.<.i IakeS; pUI71p Or SIphO'1 i ..., ~~i' ~ , =~~rUrion systems, replaci.r +t-~i_ ~ys!~~m areas; and tkie !ovation fa~= the auilding served; .~~ c ~ i1 <-:re'~1~;' ?J~t'115, ~l CC?" J~~' ~ >?<, `, _ :Ilf?n5 for pumps a ~':-+trols;,dOSe VOlume; t - _, ." tit t. _, ~.:rrp r~-f~; ,,,anG° ~ r„ ,~,p tn~ ~ ~; anr.' pL:rop r?1~lntrfc~~.'lrer, ~} Cr~JSS `seCUOn _~. ,_ . .. .. ~te(71 If+E'gUii,_',i ~1' if;e CJUnty; ~:! S<i, ?E:st date .ire a I ~ ~~ i0(i~', cE~~..~ j ..!I Si21ng InformatlOn. GROUNDWATER SURCHARGE 1981 Wiscons+r; •.ct 410 in:iuded the creation of surcharges (-fees) for a number of regulated practices which can effevt groundwater. The monies coiievtUd tf~rf~~_rgh -these surcharges are used for mor;i _cring groundwater contamination investigations and establishment of standards- S~J6-41204 Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID # Owner's Name 596-41204 JAMES NELSON Legal Description NW4f SE4, S 12, T 28 N, R 16 W Address 441 270TH STREET' CitylVilla eJTown TOW~'SHIP OF EAU GALLE Co my SST CROIX Contents Page # Included Two copies needed for all plans I X Plot Plan 2 Plan View/Laterat 3 Cross Section 4 g Tank & Pump/ Siphon Information 5 System Sizing (Public) 6 7 I, the undersigned, hereby certify that the plans and specifications submitted herewith were prepared under my direction and control. Plumber/Designer License/Registration # BENNIE HELGESON MPRS 3215 Address City State W1229 770TH AVENUE SPRING VALLEY WI 54767 Signature Attachments: Application Soil & site evaluation Fee Needed for Holding Tank Submittal: One copy of notarized holding tank agreement. (Originals to County) Needed for At-Grade Submittal: Original signed and notarized Application for "Use of an At- Grade" County on-site One additional set of plans Comments/Special Instructions QX Return by Mail 0 Fax Letter to (County) (Submitter) Circle One and Provide Fax #: ( ) Call for Pick-Up: ( ) Q Other Seal (if applicable) (' cG / ~ ~e;•~iY Office ~y ~~ I~. ~ ~ ~,~~® S OR ~ ~~8~ 4~~5 _.~~~ ®F ~ ~d~ ~ ~p~~~~ ~~ °'~ ~ - SBD-10268 (N.O1/96) ~:-I I ~x ~ s+~~q Seri', C Tc~.1 k unJCQ ~r -. S 1-e ~ S ~- I ~,~c~cc~~c~. ~,M+U.R.P Io~,O Top a~ ~ ~ h -~ 1, ~~~~ ~ I j y, i ~C~rv~~') C`~~ktiv~'r I ~Pe.~; ~y 5 ~ ~, J ~ ~ I ~ J~ ~a I Cc-n-~ L•vr ~El~e~. 9g.~ ~ ~~~ Q~~ ~~ '- B~ ti•' ~Dc g rw~'a I t a7n1ti S . I G~~ r~~n~ •- r~~ _ iysU CT« ~ `~~Pt~c A /~ ~ t ~ •+2 l S ct,~Q/)r off`, ~ '~ Sou-.~~~( o~ g, l~, LJ LJ f ~~~~~~~ti ~~ ,~~ ~~r~~-~~ ~. `C~ ~ ~ ~ ~~~k~ ~ f s ~.``,~-~ L ~ '~~ ~'~ ~~ ic.~v ~' ~~~c/ j ..~~~~ ~ ~i~:~C~1 1 c~~L.~a- ~- ,~~ ~ ~- ~ 1 ' f ~~z~ ~~,y~e~ ~r~s ~o Lc~7i ~ ulz~ _SY~~ ~7rs) l ~ j` -~3yd • • SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations September 25, 1996 HELGESON EXCAVATING W1229 770 AVE SPRING VALLEY WI 54767 RE: PLAN 596-41204 NELSON, JAMES NW,SE,12,28,16W TOWN OF EAU GALLE MOUND SYSTEM 2226 Rose Street La Crosse WI 54603 FEE RECEIVED: COUNTY OF ST CROIX The Department has reviewed the above-referenced submittal. 180.00 Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, G rard M. Swi an Reviewer Section of Private Sewage (608) 785-9348 SBIIA-7987 (R. 10/94) 4_ En Permanent End Markers Holes Located on Bottom are Equally Spaced EN4 c a N -~' ~a~t r1ax~ to tno Gap Distribution Pipe Layout Signed: License Number: ./L/n~~°`,S' ~~/~ Date . C _~~L; -`i'l~ ~ 9~ P 3$. 3 R - S ~~ X ~5 ~ y 1{ , 5 Hole Diameter ~_ Inch Lateral !~ Inch (es) Manifold " 2, Inches force Main " ~_ Inches /V V /G V / C / /"-[.~~~C4/ Perforated Plpe Detoll .~~~~e~~~-~ T~T,~Cc~~ ~ Page _ Of Straw, Marsh Hay, Or Synthetic Covering ~rS i i~l ~ 3 3 Medium Sand ~ .,,,. Topsoil ___J I 3 Slope Bed Ot 2y- 2 %2 Aggregate istribution Pipe ~~ Tea, ~r~' ~1 ~. 9't. S F rv c - °I°!. U D . . Force Main From Pump Cross Section Of A Mound System Using A Bed For The Absorption Area A ~ Ft. v. Signed: g Z~ Ft. License Number: /7~i~S --~~~5- K ~0,3~ Ft. Date: ~-~~~-%~- - L 99.6 Ft. ~ ~-S Ft. ' T /0,~8 Ft. Force Main I W a~- ~~ Ft . Plowed Layer D J•D Ft. E ~ Ft . F , ~ ~ Ft . G (,C Ft. H ~ •S Ft. L ~ Observation Pipe-~ ~ g -- K r.-..-------- _`--------_ Imo'---'-------- A ! i ,~ ,~ Distribution Bed Of 2 - 2 z Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area PLJh1P CHA,M~,e.R C~i~55 ~EC"ICf.! AIJG ~PECIFIi:l.1lU"!`: WIFJOOW OR FR ESN AIR INTAKE .~.. $i 18"MIN. IAILET APPROVED JOINT W~C.Z. PIPE EXTENDIA1Cs 3' 41JT0 SOLID SOIL ELEV. ~'L~ FT. ,~-VENT CAP r WEATHERPROOF JuucTIOIJ gox 12"MIU. I GRADE I I COIJDUIT ~-- A 6 • C D V PROVIDE AIRTIGHT SEAL PUMP -~ C0IJCRETE BLOCK ~~~~.I 4PFROVED LOC.~~.:".; i. MA~JHOLE COVE F'. Y'~ MIIJ. I I I 'I I --~ ~ l 18" h1 I IJ . ~~~ ~!~ II~ I ~ I ALARM I~ I I b OIJ . I OFF \/ APPROVED JOtu75 W/C.I. PIPE EXTE1JDIUG 3' OIJTO SOLID SOIL ~" CJCCXG~.(~L RISER EX17 PERMITtED OIJLy IF TA-JK MAIJUFIc~TURER HAS SUCH APPROVAL. `~~~ ~ SPECIFI~GATIOIJS TIC f DOSE TAIJKS MAWUFACTURER: ~~C~/~-Jp~S~`~~''^ ~~'eC~~~ CUMBER OF DOSES:L,._PER OAy TAAJK SIZE: ~~`h~ G(~ALL01J5 DOSE VOLUME ALARM MAIJUFACTURE.R: •~• ~` Flecr~f"v-c~ INCL1JD11JG 6AGKFLOW: -~R~g~ GALLONS MODEL -JUMBER: 1 n l H W CAPACITIES: A=~IAICHES OR ~06•y~ALLOUs SWITCH TYPE: '~ g =~INGHES OR ~~GALLOLIS PUMP MAIJUFACTUR6R: •Y ~ ~ C, o~IAlLHES OR f ~ GALLO-JS MODEL 1JUMDER: ~ ~ D=INCHES oR ~30~~ALLO-JS SWITCH TYPE: ~~IJOTE: PUMP A1JD ALARM ARf 70 DE M1IJIMUM DISCHARGE RATE y~-1~ GPM INSTALLED OtJ SEPARATE CIRCUITS VERTICAL DIFFEREAICE ~ETWEEAI PUMP pFF A1J0 DISTRIBUTlOAI PIPE.. ~.5 FEET -}- MIAiIMUM NETWORK SUPPLY P~RE~S~S'URT,E/. s.2/.r5,~~ FEET -}- -~,~ FEET OF FORCE MAIN X ,.2s~`' F/oorr.FRICTIO-J FACYOR.._1_.!1- FEET ~ , 3j ~/~ ~ / PY La C,^ = TOTAL DYNAMIC HEAD = ~~ FEET 77/',,~ II ~~' / [~ if Q.t~ IAJTERNAL DIMEIJSIONL OF TAA1K: ^i'LE'.~C~TH 1~L~L~;WIGTH ~;LICdUID DEPTH v SIGIJED:y_ L.ICE.IJ~F -.!U/'IBER:%"~~~ ~~~~-~ pATE:_( 3~-~~ ' ~ ` ~ ° - SECTION 100 ., ~4~DR'O'~ThC a ENSIONAL DRAWINGS ~ -'u ~-----, ~ ~& PERFORMANCE DATA MODEL: OSP33 SUBMERSIBLE SUMP PUMP -MAX. SOLIDS 5/s" SPHERE -1750 RPM TOTAL Lit. No. 113.5 348 HEAD 3ho HP MOTOR ~-. I N FT. 24 22 20 18 16 14 12 10 8 6 a 2 0 FULL LOAD ~ AMPS AT 115 V. 10 20 30 ~'~ 40 ~ 50 60 U.S. GALLO S PER MINUTE MODEL: OSP33 9'/a ~s 319 NOTE: CASTING DIM. MAY VARY ±'/a VYisconsinDepartrnentoflndustry, OIL AND SITE EVALUATION FORT La',or and Human Relations Divis'an of Safety 8 BuikSngs ,•,•,,.,a ...:u. t~ uo ea nr ur... w ~ - Page 1 of _3 . ' 9 j, couNTY . ^ ~~ ; C~~X Attach complete site plan on paper not less than 81/2 x 11 inches in size. ind e but not limited to vertical and horizontal reference point (BM}, direction and ~ ~ , ~1~~ EL I.D. ~ . ~r`' dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT S `~ _ ~ .~~~~ ~ D BY DATE PROPERTY OWNER: ~'QCY"L `~ ~ ~.- S Oiv ROPERT~~Q~ipfV 1!4 S 4 ~Z- T ~ . ,N,R t 6 E (a~ PROPE NER'. RESS N G AD OR CSM ~ ~ ~ ~ Z~ ~ D S r` ,\ CITY, STATE ZIP CODE PH~VE NUMBER NEA A 1~Q~~V1L~,~ iv) S~OZB (~~S} 69$-Z~$8 ~ ~ MLLE Z~~ •T~} S7'. [ j New Construction Use [5(] Residential / Number of bedrooms ~ [ ] Addition to existing bttikfirtg ~. Replacement [ J Public or commeraat desaibe - Code derived dally flow `1 S ~ gpd Recanmended design loading rate o • y bed, gpolft2 ~ - trerx;h, gpdJft2 Absorption area required 6Z S bed, tt2 6Z S trench, tt2 Ma~mum design boding rate ~ •_S tied, gpd/ft2 ~' ~ trench, gpd/ft2 Recommended infit7ation surface elevations} °l q • O ~ it (as referred to site plan benchmark) Additional design 1 sr~e corsi~rations Y''~o~~ W/ 8' X ~ °! ~ ~ pD . W17Iv. } { or SPr1vD ~) t_L , Parent ma#erial SLI,~') oU~iZ: S - S C~ ~l l,~ Rood plain elevatan, if applicable ~l ~ - ft S = Suitable for System U =Unsuitable for stem CONVENTIONAL ^ S ~ U MOUND . ~ S L7 U IN-GROUND PRESSURE ^ S (~ U AT-GRADE ^ S [$U SYSTEM W FlLL D S ®U HCi-~ NG~MNC ^ S SOIL DESCRIPTION REPORT Boring # Vin. _-.x ~; ~' ~ _=: L+i. Ground elev. g-~.o ~. ~~ limiting factor 36" Boring # Z ~~ Ground le~-. ~" L ~. Depth fo limit~tg factor 3S~ Horizon Depth Dominant Color Mottles Texture Structure Consistience Barxiary -Roots GPD/ft in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. B~ Ttench ~ o-lZ LD`1.2~1Z - Sly 3msbh dl.s 0..S - •S .6 Z 1Z- l~ `~t2 y/ s ~ 1 2w- Sbk ~. s c.s - . S . ~ 3 ZZ~b t0 `t fZ 3l~ - S ~ 1 tin 5 b1-c ~ s1, C -- , `~ . S 6-s y ~~S `7 2 3!y i-s ~iZ s~ti s l -s c.l c~,-,., ~, ~ - - - L L. ~1b"~ Sl', Remarks: Z 9 ~ l0 `1.2 yl ~ S'} ~ Z `F-S~k ~ ~ C.S - . S . ~ 3 Zo~S ~O`t~- 3!6 - Sl ~ 2`~sdh ~.`~H ~ - . S ~ -~~ ~, y as.s~ ~,S ~2 31:x ~- era s 1~ sl-sal t,~ w-.~ ~._ .. - - - w ~. e~t~ 3s "~ sU5 srvy Y r)z r dT4.: is, T Remarks: PROPERTY OWNER 'ti~I.S~N OIL DESCRIPTION REPORT PARCEL LD. #~ Page Z bf 3 . Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 0-8 tio~~Z z~Z _ s' } Z 0.,bk s a.s _ • s 3 Zz-3~ l0`-t 2 ~ l(, _ s ~ ~. ~ Sb12 ln'~'~. CS - ~ ~ ,S y 3~-~~ ~ -S ~ R 31y 'F l~s y2 s s~ -sc~ D~-, vim;. `~1~ - - w `cz~. ~ _ `i~~ 3oy- 6 0 i i , Remarks: Remarks: Remarks: Remarks: SBD-8330(8.05/92) ~ PLOT ~ PLAN ~ SCALE 1"= ~~' Ap ~' --- `~ivs~ ~ ~^'~..1., "PS1~~ ~XI shl~ C S`ZS~fL~1 'Pti2.~T >.LOO' ~~. Ot- SL`1~ a~,! ~, SiD~- Ot` Z`l0'ft# sT• Z~w1J SYw1. P t'I'P P 1ZA V prt., w~ c.~ ~E ~, ~ u L R.C D _ ~ aF y' ~t s h , ~.~~ ~- ~pae~ ~~ ~ F~ ~ ~sT I o ~ ~ ~' IoM ~t~-cZ- oR ' r r i r ~~ 2s s -Z'' -- tom. 96 ? !1 2 O ~Q, o / a. ~ zS- j` ~~ ~ ~' J .~ ~ ~` ~ e ~~ ~ o r d i, o~ o- ~~ b N ~ ~O $.3 t~9`1 ~ fo ~` CN ~ F r? ~ ~ ~ ~ ~ O/ ~ 8-~~°l~ --- (715 ) 4 ~- ~ I~QQ576 CST Si~jnature Date Signed Telephone No. CST # Page 3 of 3 . ~ ~ ~ ,~ ~ • ~. s ~, ~ F~~.~~ 5 ~ ~,~ NOV ~ 6 w~.sH id ~~:~8~~ ~ ~~~ ~oioeed~ SLC10~C0"~ !, 666 ~ I6I6D ~6~V6Y M6~P L^CATED IN PART ^F THE NW1/4 ^(- THE SE1/4 ^F SECTION 12, T28N, R16W, T^WN ^E EAU GALLS, ST.CROIX C^UNTY, WISC^NSIN N89° 47'J7"W 36]0.25' N89° 47'17"W ]695.66' W1/4 i_.^RNER ~--------- - - 3 - `---------- SECTION 12: E-W I~UARTER SECTI^N L]NE n, E1/4 C^RNER T28N, R16W ~o~ SECTI^N 12, 3/4" IR^N BAR P^UND ~o. ~v / T28N, R16W ~, S?w ~ 1~9°~~, ~~ STEEL AXLE F^UND JAMES NELSON Q' 2/ ~l' W ~ F- `" a 441 270TH STREET ~ ~" ~// :? 3"x•0 - ~l JI ~ ° z P4 W^^DVILLE, WISCONSIN 54028 QJ~~v ~/ ~~ ,ti 3 ~ I ~oo LEGEND ~~~' ~j~/ ,02, ~ ~, 2/ ~ ql w~~ / ~ ~ ~~o ~L ~~ W I z N w Q- 1 1/2" IRON PIPE, WE]GHING ~ / '~' ~' ~ lQ ~ I-~ W ~ AT LEAST 1.502 LBS./LIN.FT„ ' / ~l ° M ~ Q~ WwN SET ~'~Oj / ~ "`' ~ --1 ~ w ~ a nv / ~ , 33 ~ ~ ~/ Z ~ w ~ ni 3 THJ$ JNSTRl1MFNT PRAFTEjI ~,// t~,, ~ ~I p.d'-' BY B. CANADAY ~ / ti~ 0?~ ~/~ ~ d F- o i. SCALE IN FEET +~//~~" ~/ I ~ 3 ~ v I W o 0 50 100 ~ / ~, ~ / / `rte, W a w / ,~ / ~ oawoz ~ ~ o- n' ~~~~,- BARN I •r'.~~ ~J! C/- ~, ~ SILO 1 ~ / ~ v- / `-~ tLl f- ~` ~ O M ~,~ <C] ~ rn p / HUT (,.~ C'') n f ~ ~ ~ O~ WELL // /~ - ~j ~-/~ HOU~E % Z%/ //~, LC1T 1 ~_/ ~ /,? r°/ / ~ '' Z/ / / ~~ GAR. /~j GAR. / / ~~ I ~ ~ ,, 6S,Q4, ~ 33~ 33, / ~ 6666, /~ ,o /~ J ~~' or ~, c3~, 6, Sa:,E 6 _ ~, -~ ~ it NN~L A T TE 6 -~ b ; PARCEL C^NTAINS D ~AND~ 2.58 ACRES EAST ^F ROAD R/W _ 112267 SQ.FT. 0.76 ACP.ES `W'EST ^F RDAD R/W 33046 SOFT. 4,24 ACRES INCLUDING R^AD R/W 184857 SQ.FT. M ti o Z ~ ~~~ I ~6 ~ ~ NOTE: ^UTL^T 1 IS INTENDED T^ BE S^LD WITH L^T • 1 VOL. 11 PAGE 3007 I, Bradley J. Canaday, registered wisconain Land surveyor, hereby certify that by the direction of James Nelson, I have stnveyed, mapped and described the land parcel which is represented by this Ceatified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in the Northwest Quarter of the Southeast Quarter of Section 12, Township 28 North, Range 16 West, Town of Eau Galls, St. Cro~c County, Wisconsin being further descm'bed as follows: Cannmencing at the East Quarter canner of said Section 12; thence slang the east- west quarter section line North 89 degrees 47 minutes 17 seconds West 1695.66 feet; thence South 21 degrees 12 minutes 21 seconds West 403.08 feet to the point of beginning; thence South 69 degrees 36 minutes 35 seconds East 100.09 feet; thence South 20 degrees 53 minutes 40 seconds West 136.62 feet; thence South 48 degrees 16 minutes 36 seconds East 270.32 feet; thence South 15 degrees 28 minutes 33 secx~nds West 137.30 feet; thence South 37 degrees 54 minutes 20 secxands West 192.83 feet; thence North 78 degrees 59 minutes 58 seconds West 364.36 feet; thence North 1 S degrees 34 minutes 26 seconds East 276.44 feet; thence along the meander line North 33 degrees 22 minutes 10 seconds East 348.52 few to the point of beginning, including all land between said meander line and the thread of the chantLel of the Eau Galls River. Subject to River Road right of way and any other easements and rastirictions of record. I, also certify that this Certified Survey Map is a cort~act representation to scale of the exterior boimdaty s~nvesred and described; that I have fully complied with the current provisions of Chaps 236.34 of the wiaconsin 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 regulatia®s (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. VOL. 11 PAGE 3007 1 • v sTC- ioo~ 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 ~~q,mes ,D q~ ~~-nor ~_ Ne(son Location of property A~1J 1/4 SE 1/4, Section 12 ,T ag N-R~_W Township ~uN ~allP Mailing address ~iy/-~~70t! Sf Address of site Sctrne Subdivision name ,4~Qpe Lot no. Other homes on property? Yes ~ No Previous owner of property ~e~er ~_ Ne~san Total size of property ag/ Qcres Total size of parcel 7,S'Fl acre{ Date parcel was created 11- ~ -qs Are all corners and lot lines identifiable? _~Yes No Is this property being developed for (spec house) ? Yes ~ No Volume ~l and Page Number 3 DO 7 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. 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. ~gnature of Applicant C Applicant `/ ~ ~~ Date of Signature q-16-9~ r~~3r.e of S i an;~t,ir~ • :~~ • ~ • ., - . STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _ ~~ rn e S ~- ~ e ~5 o n MAILING ADDRESS ~ y ~' ~ 7 (l '~ ,j ~ G~/ 0 4~/i~l~, lt) / 5 K ~ a8~ PROPERTY ADDRESS sa ~ e (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION ~~ 1/4, 5~ 1/4, Section /~ , T ~8' N-R~W TOWN OF ~au Ga C`l'e ST. CROIX COUNTY, WI SUBDTVLSION -~ ilI~ n ~ LOT NUMBER `- CERTIFIED SURVEY MAP s ~ s`~ ~ 1 ,VOLUME 1 / ,PAGE 3oa 7 ,LOT NUMBER 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. IlWe, 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. SIGNED: ~z2v DATE: ~ - /a ' q6 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 .. r~ 1 ' ~ pOCUMENT NO. _ 4'331 ~E BAROFIAf SOONSIN FORM 3-it~Z OU~TCL/UM DEED ~~1»es D_ J~(Cjsen ane( Q:wsr A. N~~ser~ Nwe~~ei,J anI w:F~ qW!-ciaNnq to Q e d ~ r i ~., e h.. tM lolbwing desaiged real estate in / ~ i< County, State of Wisconsin: ~.:_- 7/fc SF~i eF NN~~y, N4tf~y ~F SE~i ~z ~s~ y .E NF ~ .r n J N 33y Ff. of - N4i ,oF SW ~r -, Sec~io~ /2 -.28'-/6. ~_ ~- ~ - - a ,. =~ , l~ x. 4";:' s: 4Y ~'- P -d , ~~ ~~ ; --~- - a~ ~ - .. '" -_ Thi: / S' homestead a.aperyr. ~-:, (b) I/N not) ~~' patedthis B14ri'f~ lord {SERI.) .: c~itrres ~~ l~C fspH t~ _ - ff z >. AUTHENTICATION Signature(st ~ ,' _ x` ' ~~ authenttcatedthis day of +~ t. ~~ TITLE: MEMBEItSTATE BAA OF W iSCONSIN (N not ' authorized fly § 706.05, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BV James D_Nsison (Signatures may be authenticated or acfcnowtedgMrf_ t?loth era not necessary.) •Nsmes of penone s;pninp .n any capacity shoul0 be typsa ~. prnee0 toelow ene~r a~yratu~e~. QUtTClA/MDEEC ttI-7EaulAOf WISCONSIN NfT 19~. ISEAI) rsFA~) ACKNOWIEMiMENT STATE OF WISCONStN . ~ ss. $~ Clh31Z '. ~ County. P~rsonslly Came bNore me this Sth day of ~I1Rtl8t 19.~_the above named Janes D. Nelson and Elinor An Nelson t0 known tQ.~tAe pdjaoltT_. who executed the for inq ins('I~ImeACe wledAe ame. :u= Notary Public $~ ~f 7F~ County, Wis- My Commission b permanent '(It not, state expiration date: aDt'i123s t94~._) IITF 0023 talon Tax Farms, P.O. Boz 1020e, Gran Bay. tM 5~30~-o2De - TH~CE RESERVED fOR RECOROIN(i DATA REGISTEtYS OFF ST. CROIX ~., . Reed for Retord of goo II 1991 '~., ~ Mtr .M "~ rpbiKafDsidi RETURN TO Tax Parcel No• Parcel #: 008-1035-90-100 o7i~2i2oos 04:22 PM PAGE 1 OF 2 Alt. Parcel #: 12.28.16.1826 008 -TOWN OF EAU GALLE Current ', X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' =Current Owner "BENCK, DAVID A DAVID A BENCK 441 270TH ST WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 441 270TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 19.240 Plat: N/A-NOT AVAILABLE SEC 12 T28N R16W PT NW SE BEING LOT 1 Block/Condo Bldg: ' CSM 11/3007 ASSM T INC 008-1035-90-200 (1826) &INC PT E OF RIVER RD IN NW SE & Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ALSO PT DESC AS COM SW COR CSM 11/3007; 12-28N-16W TH S 15' W 110FT; TH S 78' E 98.04FT TO CTR LN 270TH ST; TH N 15' E ALNG CTR LN more... Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1226/126 WD 2005 SUMMARY Bill #: Fair Market value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 15.740 1,700 0 1,700 NO UNDEVELOPED G5 1.500 500 0 500 NO OTHER G7 2.000 6,000 131,600 137,600 NO Totals for 2005: General Property 19.240 8,200 131,600 139,800 Woodland 0.000 0 0 Totals for 2004: General Property 19.240 8,200 131,600 139,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00