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HomeMy WebLinkAbout008-1016-60-000 0 cn o ~ -V 0 C7 r_ 0 -0 7! i v c v d fD A O o 0 ° 00 a) 0 CD S, m d. t9 n N m ID Z O ° n d N CD W n N) 0 A O z W ° 0) 6 ° c cn (p (D N M O. 01 C O A~ x H N W Cn G G c n 0 G a ti 3 rn o > o \Na < E ix I x ~ (D z 5D j~ Q O co w -0 M -0 cn 0 0 z ~ H ~'x z ooo • H n rt± Zf = m Z (D Cn t < n c fn fn fn ~ < o D ~f t~ p C;, N~ v v v ° a) V (DD = CD (a d rt O co DY N (D d ON 3 _ _ <D co n CD 4, o N o Z W tin p o D D o O N t - Q j 4-- N G O n ~yl • 00 J 0 Z7 N W FY N L~7 N C?' w N b7 _ Oo CD -4 cn z Z) CD (D .JC G7 AO n A Z O r- W F- +n N ,a N ON cn 0 O)Q (D :3 co n Vu co (D m N A CL z -di zt Z a 0 3 `U o Z m m< (D A W ~ C (D < 3 N W Q (D 0 0: v c n oz a f m d N C rl I ~ ( (D (D b W O• w m m d N N O N (D H A 0 A i O CD DAQ a O O 0 ~ yv 0 CD ° L i ti Parcel 008-1016-60-000 12/21/2005 04:11 PM PAGE 1 OF 1 Alt. Parcel 6.28.16.84B 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 ROBERT S & PATRICIA M READ O - READ, ROBERT S & PATRICIA M 2166 55TH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 2166 55TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC i i Legal Description: Acres: 4.000 Plat: N/A-NOT AVAILABLE SEC 6 T28N R1 6W 4AC IN SE NE LOT 1 CSM V Block/Condo Bldg: 4/1194 EZ-U-1164/240 (ADD-L HISTORY QC-1229/489) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 06-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1118/210 QC 07/23/1997 1095/310 WD 07/23/1997 968/599 07/23/1997 742/694 2005 SUMMARY Bill Fair Market Value: Assessed with: 138288 134,900 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 22,500 71,000 93,500 NO UNDEVELOPED G5 2.000 1,400 0 1,400 NO Totals for 2005: General Property 4.000 23,900 71,000 94,900 Woodland 0.000 0 0 Totals for 2004: General Property 4.000 23,900 71,000 94,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch 513 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 138.00 Special Assessments Special Charges Delinquent Charges Total 138.00 0.00 0.00 .w Parcel 008-1016-50-000 12/21/2005 04:11 PM PAGE 1 OF 1 Alt. Parcel 6.28.16.84A 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 - HIELKEMA, HARVEY N & SUE HARVEY N & SUE HIELKEMA 540 SUMMIT CIR BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 36.000 Plat: N/A-NOT AVAILABLE SEC 6 T28N R16W 36A SE NE EXC CSM V Block/Condo Bldg: 4/1194 NKA 106-2033-50 (939) AX-535608 (EZ-U-1113/025) (EZ-U-1110/027) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 06-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 835/211 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 01/10/1996 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 C E1t`1`IYIED SURVEY' MAP HkftVE'Y HIELK11,1A Part of the Southeast 1/4 of the Northeast 1/4 of Section 6, Township 28 North, Range 16 West, Town of Eau Ga.lle, St. Croix County, Wisconsin. o Indicates 1" x 24" iron pipe weighing 1.13 lbs./l.in. ft. set UNPLATTED LANDS S 88. 00' 38"E 454. Z m 0 \ 93' to < <-0 90. 00, W W o X. 001, 'O m0z 0 CD 0 J Cr OD 0 J M 00 a z g _T~~ W N Z W p I 0 0 0) O z 0 to F- ~ W Z ao a LL 0 0 J I en 0 NI' -0 ~ O LOT 1 - 4.000 ACRES M 4 I O 1 7 4 z u w o O 238 SQ. FT. 4 Z u N W lrl _ J1 W rl W N ET. 3.514 ACRES - W Jjr in 153,084 SQ, FT. O of o O JI N M OD `3 WI 0 a M1 N W S O V) Ir ° 01 I a O J _ al 0 W Z O W Z z (n = J 00 ARM STEAD Wr N 00 v~ U) 0 u ° O 0 to O 9 90° a O S 87° _37_5 0, X LL 454.94 00" O W u 0 m LX oi Cq O jr W 0 O jr a V - r 'M 0 a Q0 M 4 457. 78' N 88° 00' 38"W - NITER SEC.6,T28N, S LINE NE 1/4 EI/4 COR. SEC.6,T28N, 6W,(2"IRON PIPE UNPLATTED LANDS RI6W,(2"IRON PIPE I TH AL. CAP ) - 7 WITH AL. CAP) DESCRIPTION: 66' TOWN ROAD That certain parcel of land located in the ,outheast 1/4 of the Northeast 1/4 o,':3ection 6, Township 118 North, Range 16 West, '.Town of Eau Galle, St. Croix County, Wisconsin, more fully described as follows; CO1',ff1hNCING at -the East 1/4 corner of said. Section 6; thence N 881 00' 581, W (recorded bearing; on the South line of the Northc,a:3t 1/4 of.' said section 6) a distance of 1+':)7.78' to the POINT OF BEGINNING of the parcel to be herein described; thence continue on said line N 88° 00' 38" W 454.93'; thence N 01° ~y' 22" E 38.3.00'; thence S 880 00' 38" t. 451+.93' ; thence S 010 59' 22" W 383.00' to the POINT OF BEGINNING, containing; 4.000 acres, more o.r less, beinxr subject to easement over Southerly portions of said parcel for `town road purposes more fully described as follows; EAST, vvE- VT DESCRIPTION: COPED-± ICING at the East 1/4 corner of said Section 6; thence N r)8° 00' 38" W (recorded bearing on the South line of the Northeast 1/4 of said Section 6) a distance of 457.78' to the POINT OF BEGINNING of said easement; thenc" continue on said line N 88° 00' 38" W 151+.931;thence N 01° 59' 22" E; 48.001; thence S 87° 37' 58" E 454.941. thence S 01 ° 59' 22" W 45.00' to the POINT OF BEGIN;d11NG State of Wisconsin) County of Pierce) I, James L. Murphy, Registered Land Surveyor, do thereby certify hai. by direction of -the Owner, Harvey .Hielkema, I have surveyed ind divided the lands shown; hereon .in ~~N j#IN (FI4lR>~ jpc e with official records, Chapter 236 of Wisconsin Statutes and the Ordinaric~ County; and that the above map and description are a true and correct .`~~r JAMES N", U F. f H Y 0 4 2 Vol. Page Jam< s L,, Murphy Certified Survey Maps t~ C ttt°gr stF,rE,d Ladd :~urwe-yor St. Croix County, Wisconsin CF 6 State of Wisconsin ` Department of Industry, Labor and Human Relations } }"s 3;'SAFETY & BUILDINGS DIVISION 201 East ryashi ngton MV, _ L;(F P."1. Box . lpy~iy 49 ,ir-. frank, t runike l &A-4616' •.,W b F-rani: Trunk} -l - i'ropi~r,, , IOvid CJ Eau Gdile, ~St. ..r inank you for your interest in securing a aunu syster,. Your app,.-I ca iom is ~ u , e i n c j returned to jou with this letter. A l l new appi icat oafs fur moun stets to serve new construction are to be submitted throug i the c *unt,+ ;R{wry:it issuing egent. Please contact }+E?ur C{}i; nt,y lc ror assist:incz: 1 skj,Ii?t.#:1F±'"_ .,or l..'Y..u-w si rcere i u i ie H. Peterson t'1: Examiner y ~t- 44,,ulu L. gar:.per, Zlonin!? ~1t,~ miistratur St. Crc lx Luunt DILHR-SBD-6423 (N. 04/81) State of Wisconsin ` Department of Industry, Labor and Human Relations 8 SAFETY & BUILDINGS DIVISION CEjV ~o 201 East Wasningt o . JU( E~ P. O. Box 79 Ipy,NC 1983 - z V Private Sewa9t System -o i suDiect Petition for Madif%dtivn of sect iw - .;~ir}istrative Cod, .gas considereti un June 26, It t of ova `;c:za;s ! tydss . ~~D~3t°Ui~~..tE. !'w, rile requires that a soft tuffs rptlot) System slhelI tt" lixated no 1<'SS $t E:„ feet tro,;i ark lot line. road All of trie o Considered. U i s appr'uvil is spec i ' CC: Y Ffr , Heroic C. Barber, ZA St. Cnuix Count,, DILHR-SBD-6423 (N. 04/81) SBD 6678 (9/81) (Plb 100a) Detach And Return Upper STATE OF WISCONSIN DILHR DIVISION OF SAFETY & BUILDINGS Portion Of This Form With BUREAU OF PLUMBING Any Return Correspondence 201 E. WASHINGTON AVE. RM 178 P.O. BOX 7969 6 9 MADISON, WI 53707 41 608-266-3815 DATE: co RECEIVE0 PROJECT: JUL 5 1983 >o ZONING DffICF ~i ~E,27,32,1 it s z ti PLAN I D. # DETACH HERE PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ ❑ Underpayment - Please submit the additional fee. ❑ Overpayment - Refund forthcoming. ❑ Plan accepted for review. ❑ Plans being returned. ❑ No fee has been remitted. Plans submitted with no fees will be ❑ Additional information required. SEE BELOW. held in abeyance. 1. Plan Submission ❑ Complete data relative to anticipated use of bldg. ❑ Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required (1 copy). ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. (1 copy) ❑ All information submitted shall be signed, dated and sealed or stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. ❑ Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent, manhole alarm and II. Pressurize Distribution Systems (Mound or In Ground Pressure) manufacturer if precast. Complete construction details if site constructed. ❑ Application for use of an alternative system signed by owner and notarized. (1 copy) El Holding tank agreement signed by owner and local unit of government (sample enclosed). ❑ County onsite required (1 copy). ❑ Design calculations ❑ Reason for installing holding tank. Soil test or statement for pressurize distribution. ❑ Soil boring & percolation test data. from county (1 copy). ❑ Plot plan showing location of holding tank with lateral dist- ❑ Cross section of system. ❑ Pipe lateral layout. ances to any building, wells, water service i in water El Plan view of system. ❑ Plot plan. p p 9, El Verification of Exception Status Form by County. (1 copy) course, lot lines, swimming pools, all weather service road, Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp tion system extending 25' on all sides. ❑ Calculations for total lift pump discharge, head and gallons pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Location of area suitable for replacement system -provide ❑ Size, length & depth of force main. soil data. ❑ Detail & model of pump or automatic siphons including ❑ Plot plan showing lot size and all lateral distances from size, pump curves, drawdown and average flow rate GPM. sewage disposal system to buildings, lot lines, well, water ❑ Cross section of lift pump tank showing pump(s) or siphon(s). course, swimming pools, water service piping, Etc. ❑ Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precast. VI. Systems In Fill (Fill must be placed prior to plan submission) ❑ Construction detail and cross-section of soil absorption ❑ Total area filled (fill to extend 20' beyond edge of trench system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill. tified soil tester (1 Copy). ❑ Copy of onsite report by county or district staff. CkPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &'HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 IT ❑CONVENTIONAL ®ALTERNATIVE IS,,,, Plan LD Number assigned) ❑ Holding Tank ❑ In-Ground Pressure X Mound 1. 621W_ I NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE Harvey Hielkema 990 Hillcrest St., Baldwin, WI 54 02 BENCH MARK (Permanent reference Pomt) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. P ELEV.. SE NE, Sec. 6, T28N-R16W, Town of Eau Galle Narne of Plumber. MP/MPRSW No.. Cou my Sanitary Permit Number: 3215 St. Croix 38456 Bennie Helgeson i 1 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAP ACITV. TANK INLET ELE V.. TANK OUTLET ELEV.: WARNING LABEL LOCKING OV R PROVIDED: PROVD YES ENO ❑'iE ENO BEDDING: VENT CIA VENT AT L_ JHIGH WATER G.~ NUMBER OF ROAD P 0PERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FROM LINE J ANO DYES ENO NEAREST4 ~~^:x_ DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACI iY PUMP MODEL PUMP/SIPHON MFNUFACTURER WARNING LABEL JLOCKING COVER PROVIDED PROVIDED: EYES Z ~ YES ENO YES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTV WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE / s AIR 1 PUMP ON AND OFF) EYES ENO NEAREST iiii, SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I ENG TR IDIAMITIR JMATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE ~`-~ry - a the soil is dry enough to continue.) MAIN /1 C1 CONVENTIONAL SYSTEM: WIDTH. LENGTH f; NO_ F PIPE SPACING COVER INSIUE DIA -PITS. LIQUID DIMBED/TRENSIONSENCH i TR E8'! MATERIAL: PIT DEPTH. GRAVEL DFPTFI FI LI.. DEPTH OISTH PIPE DI TR IPE ISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INL EL V END. PIPES N UMB ROM , LINE. AIR INLET. FEET F NEAREST-so- 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- O meets the criteria for medium sand. TIONS MEASURED. YES ENO SOIL COVER ExTURE JPERMANENT MARKERS OBSERVATION WELLS YES ❑ NO ES ❑ NO DEPTH OVER TRENCHBED DEPTH OVER TRENCH; BED DEPTH OF TOPS 01L. SODDED SEEDED MULCHED CENTER V5 EDGES. ( ` /F DYES NO DYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH N& OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH OV~OVER. BED/TRENCH TRENCHES DIMENSIONS C MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL. NO. DISTR. JD~STRPIPJ- DISTRIBUTION PIP MATERIAL & MARKIN ELEVATION AND GEL VC DIAEL V PIPES DA I r G ~ rJ DISTRIBUTION X 9 INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORR~SPON S T® A O PLANS Q~)t~ YES ENO DYES' NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING. FEET FROM LINIi V YES 1:1 NO YES ❑ NO NEAREST Yu rL°~. 14 IT L Sketch System on -Retain in county file for audit. -ce Side. :g ,2i a`l .1 i) P~ (,✓7 SIGNATURE TITLE: I~ l . J L a .JV' HIV IY'" 3 SBD 6710 (R. 01/82),} a DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTPY, DIVISION BOX HUMAN REDLATIONS PERCOLATION TESTS (iiV) MADISON W 53707 LOCATION: SECTION: TOWNSHIP/M LOT NO.:BLK. NO.: SUBDIVISION NAME: 1 S I/a /T~~3N/R16~) W cou G4 e COUNTY: OWN R'S BUYER'S Z E: MAILING ADDRESS: Sq101W, WA~ ear- ~ S ~ USE DATES OBSERVATIONS MADE NO. BEDR COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLAT ON TESTS: LZKlidence ❑ New I~Heplace 4? / Y \ 7 154 RATING: S= Site suitable for system U= Site unsuitable for system gla. j a e CONIL: MOUND: EU IN-GROUND-PR ME If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL V. If any portion of the lot is in the under s.H63.09(5)(b), indicate: I ` Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) b 9 ! S / ' s q Bil Srr,fLy ''6' SC 1- - o r, , Gy B/ 7 hfl~ e / a3•' J4K S C L. v titn 3& I M tom/ ®r~ 10'l,07 5,.'/ s /0" 8.t .9, (L /U "8-% SC L FiGA p}'3,M 5!f" 9 B tf /'1 S, I( m /6,r' 16-1 S C L ~A o SC 4- 4,44 4 B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PRIOR PERI002 PERIOD PER INCH P- get P- r . - v P- P- PLAN VIEW: 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 slop. SYSTEM EL NATION C)(- l/ B.~(}v.R.~~ ~ _ soon ,axis _5 100.0 Ste,+cbii _q ~a ~a~~~ P3 i _ e tN 8t 7 , . q er leo I, the undersigned, hereby certify that the soil te5fs reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME 'nt ) TESTS WERE COMPLETED ON: e cam 7 k D AD ESS: r ' CERTIFICATION NUMBER: PHONE NUMBER optional): CST SI ATU E: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. ILHR-SBD-6395 (N. 03/81) AS BUILT SANITARY SYSTEM REPORT 00 OWNER" ,7~"~Z i fs `COWNSHI:P ~ Ac SEC. ~~,F/f~7• • jo ~ Allll1tLSS S'1'_ CROIX COUN'T'Y, WISCONSIN. O ~j~s l9~~ - i Ike SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to :Meet requirements of H63 SHOW E'VERYTHINC WITHIN 100 FEET OF SYSTEM 0 ~l i l r Ii di at N r h rrc w BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: iG.C1U Slope at site: ,5910- SEPTIC TANK: Manufacturer: Liquid Capacity: kcv) Number of rings on cover lank manhole cover elevation: 'l'ank Inlet Elevation. Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycleA-6 gallons; Total capacity of distribution lines--61Q-75_- gallon: size of pump /1 head; gallon per minute . horsepower brand name of pump and model number- _,l o cyl~- 7P ; Type of warning HOLDING TANK: Manufacturer- Number of gallons Elevation of manhole cover- Type of warning device _ SEEPAGE PIT SIZE; Number of pits feet diameter feet liquid depth- seepage pit inlet pipe-elevation bottom of seepage pit elevation _ fvt. SEEPAGE BED SIZE: number of lines width length. the depth art SPADE 'T'RENCH: width- _ length PERCOLATION RA'Z'E AREA REQUIREll ,,5- -1 - OC) 12 AREA AS BUILT O.,P,4i INS11ECT0R - „ rDATED PLUMBER ON JOB - _ LICENSE NUMBER- DEt?AR'r :VIENT OF APPLICATION SAFETY & BUILDINGS ku'Nis~►.„ FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HU4AN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property, Owner: Mailing Address: r t' t2 - UJj(A o~ S; A00,P Prope y Location: City, Village or Township: County: '/a '/aS T.Q N R X=f ar 16 W - Q ` Lot Number: Blk No:: Subdivision Name: Nearest Roa Lake or Landmark: ate Plan I.D. Number: C y~~ X (lfs©ned) 7 TYPE OF BUILDING Number of ❑ /Public* ❑ Variance* ❑ Other (specify)* Bedrooms: ©~l or 2 Family *State Approval Required. <71 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER V MANUFACTURER: L-V Z--e s EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New 24 Replacement ❑ Experimental [Seepage Bed ❑ Seepage Pit ~Alternative (specify) 1m /1t1 A 4 ❑ Seepage Trench Lt 9 Water Supply: Owner's ame as Listed on Soil Test Report (If other than present owner): I PSuPrivate ❑ Joint ❑ Public a e iJ . I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N e of Plumber: Signature: MP/MPRSW No.: Phone Number: 15 1 "o ` Plumb 's Address 4 Name of Dasigner: COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: n Date: _ APPROVED Sanitary Permit Number: 6~" ❑ DISAPPROVED /•.S_ Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) Form - S T C 100 Owner of Property 1 i d ~ T Location of Property F. 1 T'r. Section T N R __.W. Township G~1. E Mailing Address Subdivision Name C i C T- ti'0 y Lot Number c' A-1 Previous Owner of Property Total Size of Parcel 4-l y C r S Date Parcel Was Created %1 Are all corners identifiable? Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other I:egal Document which describes the property 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..3 9 / 2 7 ; 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. -3 v SIGNATURE OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED CERTIFIED SURVEY MAP HARVEY HIELKEMA Part of the Southeast 1/4 of the Northeast 1/4 of Section 6, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin. o Indicates 1" x 24" iron pipe weighing 1.13 lbs./lin. ft. set a UNPLATTED LANDS N~3 Q _S 88.00',318"E 454.93' zF M - N Y 9- ~ 4X-0 ii • Q w o 00, W X • O mom o 001, 00 \ J cc M o J O 2 Z M O Q O Z W Q to O al O S ° °I 0 _ f-~W z - o a o ° d~ CD 0 cI K 0 J! rn ° W 0 0 LOT I s 4.000 ACRES m QI y Z 0 N ° 0 174,238 SQ, FT. J W J~ W o N ET : 3.514 ACRES I D f W ri o _ - o al a M 153,084 SQ. FT. 0 3 W U) 3 O J N M (p = HI =>(O aI M N 0 - z. ( n M_ Q I W (A O - O ° • ow; In ILI W • Z W T N Q Z 00 FARMSTEAD u v) ' (n 0 F- 0 to O a. L ~ n O 90• 9 000 0 > W ~j S 87137' S8"E 454.94 0" (L ~ W 8 V) o in MW O O U. 0 U. Q 0 M 45___4 g~T - M 457. 7A' N J8.00' 3W M =LATER SEC.6,T28N, S LINE NE I/4 EI/4 COR. SEC.6,T28N, 16W,(2"IRON PIPE LNPLATTE0 LANDS R16W,12"IRON PIPE 11TH AL. CAP) WITH AL. CAP) DESCRIPTION : 6 6 ' TOWN R O A D That certain parcel of land located in the Southeast 1/4 of the Northeast 1/4 of Section 6, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin, more fully described as follows; COMMENCING at the East 1/4 corner of said Section 6; thence N 88° 00' 38" W (recorded bearing on the South line of the Northeast 1/4 of said Section 6) a distance of 457.78' to the POINT OF BEGINNING of the parcel to be herein described; thence continue on said line N 88° 00' 38" w 454.93'; thence N 01° 59' 22" E 383.00'; thence S 88° 00' 38" E 454.93'; thence S 01° 59' 22" W 383.00' to the POINT OF BEGINNING, containing 4.000 acres, more or less, being subject to easement over Southerly portions of said parcel for Town Road purposes more fully described as follows; EASIJ-10T DESCRIPTION: COMIAIENCING at the East 1/4 corner of said Section 6; thence N 88° 00' 38" W (recorded bearing on the South line of the-Northeast 1/4 of said Section 6) a distance of 457.78' to the POINT OF BEGINNING of.said easement; thence continue on said line N 88° 00' 38" W 454.93';thence N 01° 59' 22" E 48.00'; thence S 87° 37' 58" E 454.94'; thence 3 010 59' 22" W 45.00' to the POINT OF BEGINNING, State of Wisconsin) County of Pierce) James L Murphy, Neg18;;e, ?u La;ia :7ur' ; eyoc , u~. uul w~ c. ✓ _ 04iner, '.larvey Hielkema, I have surveyeu and divided the l,iias shown hereon :L%,,,j*gmo"#)pce with official records, Chapter 236 of Wisconsin Statutes and the Ordinanc\€ ti County; and that the above map and description are a true and correct W-Cli jb'rr, JAMES L. r MURPH I' ry L, C i 70 S 1 U 4 2 r v = RIVER FALLS, ;O Vol. Page Jamea L. Murphy WISC. A Certified Survey Maps Registered Land Surveyor C~~~iD St. Croix Colx:*:y, Wisconsin State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 ~cj f Madison, WI 53707 ro a Z Plan Identification Number J Re: PRIVATE SEW= SYSTEM ONLY- The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above-mentioned location. The pla s and specifications were prepared by 12 and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of The proposed system is for a Wastes from the building will discharge to gallon capacity septic tank which will discharge to a n gallon capacity pump chamber from which a pump having a capacity of gallons per minute against a total dynamic head of-Z 7 feet will discharge through a 3 inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS County By Other Enclosures DILHR-SBD-6159 (R. 7/81) mes Sargent, B (rector State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION i . ~i{kY. add a ~^y. •~ii any rs It.tshinaton Avv2vu- _ f i _ ;O 8" 1 J.Pprou. rjw W,, L,..~. ar•,., s+ 'r iT.~ i - :~;1. "i:.~ iJ oi l F v #gra car, usawater as iwicatej I;y soi i rcottl i=ic#. , 2 ti'::#i~tr .,iGL r'. tt.it:4j 'f ,i _1 F. )E ii yL it . y~ f ys ( Y g ~.4i•jn I inc'r~F3s of ri at i.: r1.1 stlf f #!"AW_a h4 t'•## . ?••(3} .K 4^Cr f,.t~i f.#3 i`E`.AC _0-r1 is.Di ! DILHR-SBD-6423 (N. 04/81) 4 } I ..fia 'tom ti 'ct. ~ ~ e 1 r gr i~°, r t7: too, 0 y j~ t +S ro Y .a r. ~ J ^'...ry,.yYO.. _..N •i~M~4~'„~F`7"` ~I'~'. "G/~ ar~ .Y' M1'~ h.., a9 S 'MM tit 4fP Fffii ¢fT .I'.: .yi. h ^'I 4; 4's lZ 3 .°C t g 4 0. 4i . 3 X . Straw, Marsh Hay, Synthet;; Covering a, ~~istrit;: Medium Sand . Topsoil E 0 Ij 1, !r I j Jed 0f 2 -2 Force M c i n Plowed ayer A MounC System Using E A Bed For The Absorption Arec F G __j (D Ft, ined. Jim _ [i Ft. Number: ~ r: , ,t-ss.. K~.~F" ate Position -2 ~_L.2 //1} of _ r f F,-)rce Main W DFt. Observation Pipe K _ . 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