Loading...
HomeMy WebLinkAbout008-1018-10-200 7 � jj ; \ � 0 � C'I§=k � © §C % 7&R � o / .2 m�§ ) � §� § 2r q )§m E \%� 2 it {\\\\ # E $¥ a 06 M z cc 22E=am£ LL k � E cc J9 �© k /k® kc < ; .4< c « � $ � � 2 § � } � ' § . z - § 2 ! c § k a ■ � B z 2 . U) k 7 / / N ° 7 D / 4) . .� k 0) z \ 0 G " , 2 C-4 2 'a f k 2 k ) go Z kk k k ( z 0 0 0 -W*A § 2 co _ / / ° \ � c � 2 > � - � � \ � C S a (OD % . ) ) . - c, k LU § o ) 2 � EIL k \ \ L: CL 2 » E e E ; a § k J a 2 0 2 , ' Parcel #: 008-1018-10-200 12/02/2005 02:07 PM PAGE 1 OF 1 Alt. Parcel#: 6.28.16.90D 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): O=Current Owner, C=Current Co-Owner O-ANDERSON,WILLIAM R,&G J KEENLYNE WILLIAM R,&G J KEENLYNE ANDERSON 2127 55TH AVE BALDWIN WI 54002 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description '2127 55TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 2.290 Plat: N/A-NOT AVAILABLE SEC 6 T28N R1 6W 2.29 NW SE LOT 2 CSM Block/Condo Bldg: 7/2012 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-28N-16W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 864/399 07/23/1997 822/139 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/09/2000 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.290 25,400 136,000 161,400 NO Totals for 2005: General Property 2.290 25,400 136,000 161,400 Woodland 0.000 0 0 Totals for 2004: General Property 2.290 25,400 136,000 161,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 513 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 o.� G' G `I' Q-Cr. /✓W - 9cG l�0$-10 IS-lo – a re- 14 a, A 7 a-c- /VI –sa 440600 �a n , s , rn . y �-a �' 6796 CERTIFIED URV Y MAP Located in the NA of the SE4 of Section 6, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin; being Lot 3 of Certified Survey Map in Volume 4, Page 1123 . Lot_1-of-Certified Unplatted Lands Survey_Map–in–Vol. 4_ W} Corner of Center of ( Pg. 1123 Section 6 ------- Section 6 North line of the SE} of Section 6 L_ o , �� —5888 00 ' 381 793 .14 '- S 393.14' 200.001 200.001 55TH AVENUE 1368.171 — ---- ------ 393.141 200.02 200. 1 North line of the SW} o S87o5010311 793.181 of Section 6 __ la –Q N ` A L garage Hou a \�� d Ln LI '`. 171 1°n– _ o_ °- rn o �I o c m °o n'r 20 t .° W LOT = N LOT , d c-0 c W _ oo ° fr1 y 1 c 3 o u . M 1 �n Co u 0.1�� � ° ° N rol a E 41) co ro 41 3 d� rn.a.. t �I •i r 1 1 _ >1 H rn N88000138'IW 400.001 A c A-I o W •. 111 -v o "4 i ... O O .r - " ° 0 LOT 3 ° a m N I 3 Z 1 OI J 1 i SCALE IN FEET. 0 100 200 300 8 s �6� 49 \\ Sig ' 1�94�: m FILED zE AUG 18-lbbh 1NTERSTA LOT AREAS JAJM Of OC►Nld= Lot 1 Including Road R/W: bomw of Dow$ 99,958 Sq. Ft. Oats may' W 2.29 Acres 1S l�ooai EG END �8yZg4j �„•�@A so Lot 1 Excluding Road R/W: B County Section Monument ��,%,- C "� 'pis'. 97,078 Sq. Ft. 2.23 Acres • 3/411 Rebar found a% " 0 1" x 24" Iron Pipe Set is NYC ALLEN :� 1 Lot 2 Including Road R/W weighing 1.68 lbs. per linear foot ` y41 X 99,960.Sq. Ft. I y. 2.29 Acres Existing Fence–line I' n0 r V' Lot 2 Excluding Road R/W:, 41�'S' 96,952 Sq. Ft. 9 xrw. �yah +e 11/4 R� 2.23 Acres OWNER ���=?�'SLCL`�' "" y Lot 3 Including Road R/0 Howard Bengston 611,280 Sq. Ft. ' Route 1 AMROVED 14.03 Acres Baldwin, WI 54002 ' Lot 3 Excluding Road R/ VOLUME 7 PAGE 2012 1�b11� 8 9988 605,972 Sq. Ft. 13.91 Acres This instrument was drafted by Fran Bleskacek Job No. 8.8-31 � k PAWSU�NING I ~ l FORM N0.98S-A FILEDMG.M.I.iCbgYy® �- N0V51981 �* �r— S 3 !r�4 3`S e JAMES Of coxxELL 5 �\ Rsptstsr Of D',dv APPROVED CERTIFIED SURVEY MAP s 8 OCT S 01981 S�•e'O`x C;Zt-.'Y UNPLATTED LANDS OWNED BY OTHERS �t�h1P'Lffi?1i�t :VE A1►RYS �htrili�l!-i i►R�A ,Zm. trroG C(�AktlflT6E ,,,`�,,` �0rgs, S 8704724"E 638.36' 1 x a 17' 17' x o� LOT I EAST LINE SW I/4 NE 1/4 ♦ SiVR 837,022 SO. FT.ONCLUDING Ro trrrN�r 18.5 AC.' & 805,121 SO.FT. k (NOT INCLUDING ROAD) SCALE 1"2300' Ik V X M 0 100 200 300 400 -� UNPLATTED ,� REUBEN DOORNINK RT. I 0i N M WOODVILLE, WI (D w O-SET 3/4"X 30"ROUND IRON ROD x 3 -00 - M WEIGHING 1.502 LB./L.F. M (Lot 1 is not a o c` 0) buildable lot until Z UNPLATTED BRG. REF TO THE SOUTH LINE OF THE oo a suitable percula- NE 1/4 OF SEC.6,T28N,R16W. o tion test can be x ASSUMED BRG. S 88°00 38 E. 1 obtained) TOWN ROAD SOUTH LINE SW I/4 2"IRON PIPE BADGER TRAIL I x NE 1/4 WITH AL.CAP . • . • • • • • L • 51.06' 15.34 163D' 1 •75' 49.09' S 88°00 38"E _ _ S 88°00'38"E_ 131741' 1368.31 -S98 000'38"E 2"IRON PIPE 12.90' K '-680.35'-- 131741' WITH AL.CAP �( •637.06' D OUTLOT e 16.95' Eg—EXISTING UI DING 1 E IR CDR � d ! �� ((,A/ 2"IRON 17 GARDSK , �0 r _GU C PIPE WITF ` LOT 2 _ i AL. CAP LOT 1 3 0) ti � 435,600 SO. FT. _ x 811,133 SQ. FT.'(INCLUDING ROAD R.O.W.) (INCLUDING ROAD) p °O 18.36 ACRESt 87 9,934 S . FT. (NOT ' C� w UNPLATTED INCLUDING ROAD o.w) 9,81 AC.f & m°r-, ti 427,136 SOFT- a) (NOT INCLUDING 0 3 °' HOWARD E•N�8MN m ROAD) o 'rn R T. I 1.w z = BALDWIN, WI 0 EAST LINE NW I/4 SEI/4 0 m CRYSTAL FERN o (l�3 o RT. I z BALDWIN,Wt _ WEST LINE NW I/4 SE I/4 x 53Q•79 f LINE SCHEDULE � 13A0'25 80546 A-S88 000'38"E 64.00' N78o49'5�'E B- S00 019'51"W 148.25' C- N88 000'38"W 132.00' ' D- N00°19'51"E 148.65' E- S88000'38"E 328.31 "11111m 1-94 R.O.W. F- S88 000'38"E 132.00' 4 UNPLATTED Vol. 4 Page 1123 FORM NO.90A ,' � t�,�GIR1Rlmr . 26273 645468 << D v 2001 SURVEY R S RECORD 4084 CERTIFIED SURVEY MAP N0. VOLUME 1 s , PAGE 4084 LOT 29 CERTIFIED SURVEY MAP NO. 1123, VOLUME 4, PAGE 11239 LOCATED IN THE NORTHWEST NORTH, RANGE OF HE 1 SOUTHEAST 1/4t SECTION 6, TOWNSHIP 28 NOR , TOWN OF EAU GALLS, ST. CROIX COUNTY, WISCONSIN coy LEGEND .�,��' s�i�► PREPARED FOR GOVERNMENT CORNER (AS NOTED) DONALD M. ANDERSON EXCAVATING 120 USH 12 E MARK ,4 BALDWIN, WI 54002 • FOUND 3/4" STEEL REBAR 3"1590 2.1 O SET 3/4"X24" STEEL REBAR MEMO ONIE,,. �a� DRAFTED BY: WEIGHING 1.502 LBS. wt CLARK PER LINEAL FOOT. � ,g•.�h �..•' DONALD M. ...��IW�� ( ) RECORDED AS W 0�� q� ry ti UNPLATTED LANDS NORTH LINE OF NW-SE S T. OF BEG. _ S88.00�38 E _�55TH AVE'_ � n , NW COR. NE-SE N88.07'32"W - S88'07'32"E `r° m S8a-07'32"E 2634.82' 793.12 8 'S6 58"W 328.32' NW COR. OF SE 1/4 1132.00' ,0 1317.41 SEC.6, T28N, R16W , �/• $`� 64.00"- v 3 N 87 58'58' W EAST 1 4 CORNER FND. ALUM. CAP 00' SETBACK LINE 2 Nm SEC.6, T28N, R16W g r �/ FND. 3/4 REBAR N a S88'07 32 E Z 10 " ,� / �,� o OUTLOT 2 css6•oo'3e"�>Q N°v/// q, c at f � rn rn � � 196,z'c7 SQ. FT. 6 3 rn � C�2 �$ (4.50±ACRES) 2� r` co ° N W w 189,950 SQ. FT, LESS RW o 0 00 � 'o u (4,36±ACRES) LESS R1+// `� E Cft T g"5g 9j. O� = oil o {s 4� v� 2$ Z C'{ �Sn w N � rr3, S 804j56• W 3 7I ;a NC C( 0 53g" 183.37 N w w �►'I y SSA m W 3 3 ,* r 0000 �Yq NC SfP77C • ao 00 z � C-4 C4 Y �N y� cV NO U� Is on v7- d o� o o " LOT 4 p o cn � a78 zz �i ruin O o$ Em c 3 nj 239,324 SQ. FT. 04 v N o,o (5.49±ACRES) ® �/ 0 $ o \\ O N = 0 c o 5p' E W �- NCCESS ., o Co m NO g34.79 3 owl «^� _ �S 42 59"W�578'4951"� IIS c3 v A PR0YE4-- ' 1 94 (z 2 E o N o —ST.ORM COUNTY o ; ---Mannino Zoning and Parks Committee z w MAY 14 2001 SCALE: 1 "=200' aT c o:.a E z If not recorded within 30 days of 0' 100' 20V 400' , approval date approval shall be null and void S ' DOT NUMBER 55-94-3085-2000 CEDAR CORPORATION 604 WILSON AVENUE MENOMONIE, W 54751 SHEET 1 OF 2 (715) 235-9081 Vol.15 Page 4084 Form - S T C - 104 � _/AS BUILT SANITARY SYSTEM REPORT OWNERkI✓IIi'3 ���1/JOIyIL'C°Y TOWNSHIP ��1� �Q�j� SEC. T N-R�W ADDRESS Z ST. CROIX COUNTY, WISCONSIN 'Ba/O/W"'), &';"" 5Slmz_ SUBDIVISION AIX LOT 40#/ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I 2� I I Garay flause 7 /Z. efi U s���°y'c.r %G5� �z Ven ' I i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used--Q---- sed-o a')r i ,;I Te/i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon nufac Y'rer: Pump Size Elevation of inlet: ottont' 'f�tank e e tion: N Pump off switch elevation: ,Ga ons cle:-/V Alarm Manufacturer: Alarm witc Type: t Number of feet from nearest property''line: Front O Side, O Rear,0 Ft. Number of feet from well: 4 Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: yP S Trench: i Width: /Z Length: / Number of Lines: Area Built: . p � Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,0 Vt . � f� Number of feet from well: x Number of feet from building: (Include distances on plot plan). ,s SEEPAGE PIT Size: Number pi eter: Liquid depth: Bot of s epage levation: Area Built: Has either a drop box O or d tribut'on box Zwen used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: levation o bott f tank: Elevation of inlet: Number of feet from nearest op rj: ro , O Side, O Rear, OFt. Number o feet fl: Number of f et from g• Number of fee from nearest road: Alarm Manufacturer: ' Inspector: Dated: J / -?q Plumber on job: �2 License Number: 3/84:mj I EPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE!-4,SA-,S6,T2 8N—R 16W XkCONVENTIONAL ❑ALTERNATIVE State Plan l.D.Number: (If assigned) Town o6 Eau Ga.,?.2.e ❑Holding Tank ❑In-Ground Pressure ❑Mound NAME OF PERMIT HOLDER'. ADDRESS OF PERMIT HOLDER: I AT Melvin VandeAMeetc Rvu e 2 Baldwin W1 54002 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber MP/MPRSW No.: County Sanitary Permit Number. Date E. Hud6on I6621 St. Ctcoix 11 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED'. PROVIDED. LJEEIko `ct q $ ,`10 q?, Its, Cig. ONO ❑YES 9N0 IVENTOIA.. VENT MATL.'. HIGH WATER NUMBER OF ROAD: POPERTY WELL BUILDING. VENT TO FRESH BEDDING. AIR INLET NE' l (" ALARM' FEET FROM I h L (_O (a DYES O v� ❑YES `LINO NEAREST Q �v DOSING CHAMBER: MANUFACTURER BEDDING: LIOUID CAPACITY. PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. E YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL'. NUMBER OF PROPERTY WELL BUILDING VENT TEFRESH LINE AIR INLET (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENrrH DIAMETER MATERIAL AND MARKING excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF DISTR.PIPE SPACING jOR EETF INSIDE DIA #PITS LIQUID BED/TRENCH 1 TRENCHES L! DEPTH DIMENSIONS Z GRAVEL DEPTH FILL DEPTH DISTR PI F DISTR.PIPE DISTR.PIPE MATERIAL: F PR OPE RTV WELL BUILDING VENT TOF HE SH BEL(U PES ABOVE COVER. )V INLET ELE V.END �� LINE AIR INLET fl �, o l/�1 99 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. OYES 1:1 NO -- ]SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION IWE LLS OYES ONO : YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES'. O YE S ENO E YES ONO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELE V.'. ELEV DIA.. ELEV. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS CAL LIFT CORRESPONDS 70 APPROVED ❑YES ONO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE DYES ❑NO OYES ONO NEAREST r Sketch System on Retain in county file for audit. 8 Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710(R.01/82) Zog SANITARY PERMIT APPLICATION COUNTY TDIL HR In accord with ILHR 83.05,Wis.Adm.Code � . ' STATE SANITARY PERMIT# Po? 7,>' —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES XNO PROPERTY OWNER PROPERTY LOCATION e v/�, e,^ E % 5G j%, S S T Z�, N, R (or)W PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME AX/ CITY,STAT �) ZIP CODE PHONE NUMBER CITY NEAREST ROAD,L E OR LANDMARK �O� L/J/!'! L.�/� SyOD� /f ��'y3�D ❑ VILLAGE:4"UGI�Q /� II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): N� Ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if appli `00 0/� V 1. a.,X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE rOF SYSTEM: (Check only one in##1 and only one in##2) 1. a.1 �f Conventional b. ❑Alternative c. ❑ Experimental 2. a. 1:1 System- b. ❑ Holding c.❑ Pit Privy d.❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a.X Seepage Bed b. ❑Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): p Yj� 0 W&/) D Feet z Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank T DOD /O DO LJ Lift Pump Tank/Si hon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST## 271—D ale vlD CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 80 /irk �� S:7 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved I Sanitary Permit Fee Groundwater ate Issuing Agent Signature( o Sta s) Approved F-1 owner Given Initial QD t Ic- �� urcharge Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION t TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in #1. Complete#2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in #1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; Vlll. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground .88r included the creation of surcharges (fees) for a number of regulated practices which Wisco IrrS can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried retire a is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 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 -."qe / VI",2 er- 1%e" Location of property /Y&' 1/4 SA 1/4, Section �_, T N-R�W Township Qu so��� Mailing address A74. 'l Address of site &u 1'4 , Z01 Subdivision name Lot number 1 Previous owner of property h'ouJQlwl he�79S Total size of parcel Date parcel was created 9 7 -o'0 Are all corners and lot lines identifiable? _ \ Yes No Is this property being developed for resale (spec house)? Z Yes No Volume 92 2 and Page Number 13 % 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. ---------------------------------------------------------7--------------------- 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. 5Z5Zl U-? ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with 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. ) . Signature of Owner Signature of Co-Owner (If Applicable) Date of Signature Date of Signature p�umaw two. WAINJ MT DOD STATE BAR OF WISCONSIN FORM 2—SO" �R, VA 42 Co.,t fiar. yn..Bengtson. and Howard Bengtson.,,. _.. .. ...hey 884use. SEP 07............ y . .. .. _ of 8:30 A. M ....... � - - d Meer. . Vati..ai'.. . . . .. ` conveys and warrants to - M�l Y i n -�' Mir of a� � ........ .. ..... _... REIVRN TO St. Croix.... ...... ........County, the following described real estate in State of Wisconsin: Tax Parea No- --------------------........ }, of Southeast Quarter Part of Northwest Quarter (NW's of SE's) , of Section Six (ti) , Township Twenty-eight :North (T28N) , Range Sixteen West (R16W) , described as foll filed August One (1) and Two (2) of Certified Survey Map 18, 1988 in Volume "7", Page 2012, as Document No. 440600, Office of the Register of Deeds for St. Croix County, Wisconsin. f �2. This iS ....... .... .. homestead property. (is) ftn*) warranties: and restrictions of record. Exception to i, .{ sr , 1988 31 _. day of Dated this / -► t. (SEAL) Marilyn lBengtson.r+ _. (SEAL) f jC - Howard G. Bengtson �j� • •,� AU?HEN?ICATION ACSNOW LSDdltBt #4'jYi STATE OF WISCONSIN ��' •., gi�natnn(a) --•---•-- ----------------------- aa. F� 'f1 '• 3' ---- -----•--•-- -- -- ST. CROIX .. . .County. t authenticated this ........day of------------- •--••--•--• 19--•- Personally came before me this .- 3-ab .soon" 1�.U.g.G5k1` 19. 88 the sbora nsfss�d ► Y Mari(1yn Bengtson and Howard ............................... -- Bengtson ....... ... TITLE: MEMBER STATE BAR OF WISCONSIN (If not.-----•--•---•.. . . ........ snthorised by 4 706.06. Wis. Stats.) to me known to be the person S. who WACWWTMW foregoing instrument and acknowledge the same THIS INSTRUMENT WAS DRAFTED BY _ N A.��;� y _ C. Thomas_.A.-.McCormack Baldwin, WI 54002 Nota-. Punc� coon: " �, W . ............ ..................-•- Vlc ('ommission is permanent.(If nut. state.eiyttyaisoAa K (Signatures may be authenticated or acknowledged. Both � I � !*� � � {w, are not-necessary.) date: 0100010 i siga�IS @Ty b0<tity slu,ul.: be tpP�or printed below th.i� riRnuc.rr.. a�At=sA>R Ot wTtBCONSI�i �b-owrl4,1F1 § war R 'e � }_ �t IN.a�1yYa 7777 a.►yMw�. ,... It i STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /�e�Vli'I /JCl'e�^ /Vle�r ROUTE/BOX NUMBER Z 6 FIRE NO. CITY/STATE_ Q��ly�i� Gf/i ZIP S�zqey NW S- / All LOCATION: 1/4 1/4, Section Co , T Z C1 N, R All W, Town of Gall) 6?6711(f, , St. Croix County, Subdivision A11 1 , 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 for a MAXIMUM of $3000 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 systems properly maintained. The property owner agrees to submit to 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 form 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED l4 la�t�e 4,,01A DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&•BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) ;HUMAN RELATIONS 1 / MADISON,WI 53707. (1-163,090)&Chapter 145.045) LOCATION:S SECTION: TOWNSHIP/MUNGI�Cl/I�Y: LOT NO.:BL K. SUBDIVISI „ NAME: 1� 1/ %TZN/R/1®(o W �+/� (n7 / N•/4 /D, i/x COUNTY: OWNER'S BUYER'S NA E: MAILING ADDRESS: er IV 10 7 USE DATE OBSERVATIONS MADE COMMER A DESCRIPT I PROFILE DESCRIPTIONS:NO.BEDRMS. New Replace ,}} Residence — 6 7 STS: 09— RATING:S-Site suitable for system U=Site unsuitable for system CONVENTI NAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(o�pNS ❑U RS ❑U J2S ❑U OS �N EIS I Corr✓er��:��A/ If Percolation Tests are NOT required ]DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: lFloodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS f BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.H I GR-EST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- G•Z/Z /O/-5�Z ors �G.S`Z -' •� V. B- Z •�7 to/�?� /V n e ��-�7 , , n me B- �•�� /OD��y� JVOn t° ��'� /Z"' Ql ' • 2/""Bns)/' " S11 r -2'lo B- +tJ T PERCOLATION TESTS TEST DEPTH- WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 41 • ' AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D 2 P R PER INCH P- Z 33 r7 P- 3 0 `f Ado P . P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 98' YZ� TN 1,the undersigned,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 the location of the tests are correct to the best of my knowledge and belief. NAME print : TESTS WERE COMPLETED ON: ( Q n 7-Z9 -9 j ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional ): _?iVi3 CST SIGNATURE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— 1 ra N. -�'+w a...F, rorr ash '�t�,i ill.1!01 T7 .: .•0\ ,:�. �.:irl (�.✓t r311�..�.'-%R INSTRUCTIONS FOR COMPLETING:FORM 115- SBD -6395 { To.be.a complete and,accurate soil test,your report must include 1. Complete legal description - ­2.-vThe use section-'must clearly indicate whether this is a residence or commercial project; �7 -, 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plarhg aoi8•-2:001TIP 7 MAKE A'LEG'IBLE diagr nir cq,urateIyR locating lour test'Iocationip Drawing#o sclle, s pretixerred, A 1= „ i separate sheet may-be used if,desired; . fi c3 e`;_ `_' ` L� ._� ' __ � 8. Make sure your benchmark and vertical elevation reference.point are clearly shown,and are permanent 9. Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion; if appropriate; 10. If the information (sueh as flood t:Jlain,Oevation)does not apply, place N.A.in the appropriate box; 11. Sign the form and place your current address and your certification number; _ 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS !' Soil Separates and Textures Other Symbols ` P st - Stone (over 10") BR - Bedrock_ cob - Cobble {3 10") SS - Sandstone I junder.3") LS -.-Limestone ..�_. _ _ _ ._ .._.. �. gr .....Grave ,: =', - ,�`'.+41� ' t r£ rG I HGW - Hrgh rundwter _ ;I e%V_1A4 A-,cs Coars e Sand Perc - Percolation.Rate r.• med s - Medium Sand W - Well fs - Fine Sand Bldg - uildiny .• h Is - Loamy Sand > - Greater Than �. *sl - Sandy Loam - Less Than ! *1 - Loam Bn - Brown tt *sil - Silt Loam BI -- Black t-� S1 — Silt - Gy Gray rC:tlj av i , i *cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R --.Red sicl - Silty Clay Loam mot -Mottles se - Sandy Clay w/ - with sic - Silty Clay fff - few, fine,faint *c - Clay cc - common,coarse i pt - Peat mm - Many, medium m - Muck d - distinct p - prominent HWL - High water level, =`r * Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point I TO THE OWNER: This soil test report:is.the first step in securing a sanitary permit. The county or theDepartment may request verification of this soil test in the field prior to ;)ENT1 t issuance, A complete set of plans for the private sewage system-and a permit application must be submitted to the appropriate local authority in order to, obta (i a,per�rit. Tfte,'sanitary permit must be. Obtained ;end r�x)sted prior to the.start of arty coristructioflX , ,;� �C)w/?G Sec. !o M e/V�'n V.,,r e r m d Rf Z /0/40, No. SAC • 1-4 s/ yoo Z Lo 74 1B.M. - /o0. O' ---J S M - De-nof'eS Bend Mork 72 it C7 - Dernof'es Bore. Po/ex BZ /0/, � Pao - De n fe5 %erG //o�GS SysfeM ,eQ F 2)eno-as /Z'xeo" Bed !35 " 99'5y' X/he"note —penofes /2x86 Alferndd 3arl c ;s fop oT %Y" 0Ql, p in pence l'46 . Prop ' �ouSe. Np. �� n iaooGol, 'F,M�n. ; l Oe ti �.T O• h A ApproVyyt 0l `,' r'e 33� -01i yak ! /�'/Q/ev' '01 2y /�� QS� oI STD oA1 Vl ova eY -7„Ptrror4l C� • ,T F r,63E oA Z N I $a E 2 /s A b a5 2-7' 1I 5 ( ; I �rc►�n -3y : E— 3Z—�•.Gl BM s e, {�GG 33 l 3 /"= yo' SC-0/6 Ou,) Me /v,'n V Ole r rr�ee ✓ �` S;to .s'-VO Z �S Z.0 Lof Ale 13.M. - /00. 0" -�n B M -17enofes Benc� MAr ' A - Denof'eS l .re Bo o � eS' 13Z - /D1r r15' pa - Deno,"c.3 ;'erG /,lolls a 3 ' /O/• y� sysfcm yea DGno-'es /Z,X eo' Bed B y,- 100 18y 35 - 99'5y� Alternote —�enoles 12X86 Alfernde n in fence �,ne . prop 14ouSP- ,10 SeP Fal I �•. ,Jr,o M /� / /Q�C�/yl 33 1384 Gov,4 , 19Ss`ejafe . , •' a -S � / ^ op�7- v36 3 E E r/ z-7o ,5 v 3y : r ( � s e, � ss' n /y!P 66Z9 / `VOA Scak Csr 31}13