HomeMy WebLinkAbout030-1022-10-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Divisioq
INSPECTION REPORT Sanitary Permit No:
430495 0
ATTACH TO PERMIT)
GENERAL INFORMATION ( state Plan ID
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)i. / p;
Permit Holder's Name: City Village X Township ar I Tax No: 140
Stahl, Justin St. Joseph Townshi (�1 030 - 1022 -10 -999
CST B Elev Insp. BM Elev: IBM Description: Section/Town /Range /Map No:
9.9b C'Ut 9 ( U4 06.29.19.94A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
I
Septic Be h 'f14
Dosing t. BM
Aeration �._. - Bldg. Sewer
Holding St/Ht Inlet 5-� q0 • r
St/Ht Outlet
TANK SETBACK INFORMATION g0 .4Q
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic , r I / Dt Bottom
Dosing Header /Man. `S
Aeration - - - Dist. Pipe
�� _ • S2
Holding Bot. System 1 rJ• Za 3 •1�')
;-
Sqn
Final Grade
PUMP /SIPHON INFORMATION .00.
Manufacturer ---- - - - - -- Pefluak St Cove r
GPM Z,1 5fv� S 9 .2,2
Model Numbe
TDH Friction Loss_- System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTE 3 0,
BEDITRENCH Width ^ / C% p� No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ` t at ?
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufact
INFORMATION CHAMBER OR �0dL SRS
Type Of System: 2S + 3 i UNIT Model Number• 1
.�. � I.
DI TRIBU N Y
Head / w , Distri ution x Hole Size x Hole Spacing Vent to Air Intake
` wy� N pik's)c�
Length. ` Length Dia Spacing
SOI COQ , - x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bedrrrench Center Bed/Trench Edges Topsoil [
Yes F] No Yes 1 No
COMMEN l : Include c dg disc�e per ons preseftt, etc.) �Insnection #1: 66 L Inspection #2:
Location: -1+76 McKinley W - 54016 (N 11/44 NNW 11/4 6 T29N R19W NA Lot /� Parcel No: 09.29.19.94A
1.) Alt BM Description ,, ,, n
2.) Bldg sewer length = - gD ` , " /aaJZ � t (-74 r-"
- amount of cover = +2 �,, A � k QL X41 �res� °� C e�udl C t�
Plan revision Required? ! ] Yes No 0 y �� l
Use other side for additional information. 6�' . l _ — T
SBD -6710 (R.3/97) ate Insepctor's Signature Cart. No.
75 x504
VOL 18 PAGE 4717
KAT9EM H. WALSH
REGISTER OF DEEDS
O
ST. CROIX CO. YI
v z m (n x RECEIVED FOR ftfiEbRD
o p C '- c 03/24/2004 11 :40AM
BEARINGS ARE REFERENCED TO THE S z `' K. z L S
ST. CROIX COUNTY GPS NETWORK cn x C7 2 CERTIFIED SURVEY MAP
z m REC FEE: 13.00
N r m COPY FEE: 3.00
� c � PAGES: 2
,4
z
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WEST LINE OF THE N00°03'35"W 667.19'
NFI/4 OF THE NW1/4 200.43' 466.76'
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SHEET 7 OF 2 SHEETS
Vol 18 Page 4717
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
1* isconsin See reverse side for instructions for completing this application PO Box 7302
Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County \ State Sanitary Permit Number ❑ Chec c if rev ication State Plan I. D. Number
l sYo �++��•• --��
I. Application Information - Please Print all Information Location: I 'j (- Me M IeK
Property Owper Na e ZUUJ Property Location 9�/
1 /
14 ,1 1 A41 4 , S ji T I (o l
Property Owners ailing Address _ ZONIN G OFFICE L t Number Block Number
,. _
City, State Zip Code Phone Number Subdivision Name or CSM Number
W lype - 6f Building: check one ❑City
1 or 2 Family Dwelling -No. of Bedrooms: U eo ❑ Village
❑ Public /Commerglal (d cribe use): �� gown of
�
❑ State -Owned VYIY(716 D /l� Ali✓ 1 -10n7L
Nearest Road
3 DrsT., 3 Yj 5 Parcel TaxNumber(s) a
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable)
A) New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic T iJ ' ❑Recirculating ❑ r:
V. Dispersal/Treatment Area Inf oration:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elev tin 7. Final Grdoe
Required Proposed ( (S I Rate (Gals. /day /sq. ft.) (Min. /inch)- Elevation
VII. Tank Capacity in Total # of Mdnufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber' ignature (no stamps): MP/MPRS No. Bu Phone Number
Plu is Address (Street, City, State, Zip Cod
IX. C unty/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ) sued Issuing ent Sig atu ps�
Approved ❑Owner Given Initial Adverse Surcharge Fee) � n� Ua (� j I o `� �i�� Lv
Determination A of
X. Conditions of Approval /Reasons for Disapproval: 4-14 " ��
SYSTEM OWNER: � - l,G .ems( a4vz 9
1 Septic tank, effluent filter and C /J YY1 6 67 • �3, S7i I� (/
dispersal cell must all be serviced /maintained 1 41 Q h +0p o l�O` 100 D /
as per management plan provided b lu Try YMy c
2. All d Vl C{/S/L '
as per applicable code /ordinances maintained
G G}� 9 03
vv a � L J 0 '
SBD -6398 (R. 07/00) r(]��� ����a �� �Cr�� GL � •
ter.__ hQt�
PLOT PLAN
PROJECT Justin Stahl ADDRESS 1176 McKinley Dr. Hudson Wi. 54016
NE 1/4 NW 1 /4s 6 /T 29 N/R 19 w TOWN St. Joseph COUNTY ST. CROIX
10 -28 - 3
MPR5 Byron Bird Jr. 2205 �. DATE BEDROOM
CONVENTIONAL XXXX -Grade C NVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE .4 ABSORPTION AREA 1125 # of chambers 37
BENCHMARK V.R.P. TO of well
Top ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H,R,P Same as BM
LVent SYSTEM ELEVATION _
T 1 =87.8 T -287.4 T -3 =87.0
f
CC dard Leaching
mber with 31.1
Cov per chamber
ung 34
rade at System
600' PL
150'
100
�I PL
Pro 3 bed
house
J
Well BM 35'
Al BM st
30
I�
70 45'
B2
1.3 80 ' sl
91
d B 1 veway
S I bi 40'
I 1 75'
90'
B3 40'
600 30' PL
S _
Soil Test Plot Plan 3
Project Name Justin Stahl Byron Bird Jr.
Address 1176 McKinley Dr. Hudson Wi. 54016
M #220527
Lot Subdivision Date 10 /28/2003 County CROIX
N E 1 /4 1/4S T 29 N /R W Townshi St. Jose
Boring Q Well PL Property Line
Alt. BM Base of Well 100.9 �-ldut rc
,BM or VRP Assume Elevation 100 ft Top of Well
System Ely. T- 1 =87.8T-2=87.4 H.R.P. T -3 =87.0 Same as BM 11
600' PL
CX
150'
100'
PL
Pro 3 bed
house
Well B 35'
Alt BM
B2 7
80'
91 B 1 Drivew
40'
90'
B3 40 '
600' 30' PL
' PLOT PLAN
PROJECT Justin Stahl ADDRESS 1176 McKinlev Dr. Hudson Wi_ 54016
NE 1/4 NW 1/4S 6 /T 29 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
10 -28 -03 BEDROOM 3
MPRS Byron Bird Jr. 2205 DATE
CONVENTIONAL XXXX At. ade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE .4 ABSORPTION AREA 1125 # of chambers 37
BENCHMARK V.R.P. Top of well ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL •H.R.P. Same as SM
Vent SYSTEM ELEVATION T -1 =87.8 T -287.4 T -3 =87.0
f Standard Leaching
C Chamber with 31.1
Cov ft ^2 per chamber
6"
lon 34"
600' PL
150'
100'
PL
Pro 3 bed
house
Well BM 35'
Alt BM 30'
st
70 45'
B2
80' 81'
91 BI veway
a'
a'
40'
75'
Sol
mil/ B3
600 30' PL
�—
Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 , 3
Division of Safety and Buildings
in accordance with Comm 5, WS�f,�M
Attach complete site plan on paper not less than 8 1/2 x 11 inches i size. Plan must
G re
include, but not limited to: vertical and horizontal reference point (B ), dir r I.D.
percent slope, scale or dimensions, north arrow, and location and stanc�tdn�art$oa@00 0�^ /0
G e 6 �a —� — �3�6Please print all information. Revi by Date
�r. cRoj '` �,� ry 3/ 03
Personal information you provide may be used for secondary purposes (Pri i
Property Owner ApMr�ope- s/�Gt V *� 114AV14 S T � N R � E (o Property Owner's Mailing Address Block # I Subd. Name or CSM#
city State Zip Code Phone umber ❑ City ❑ Village aTo Nearest Road
% New Construction Use:542esidential /Number of bedrooms _� Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material �1� � _ f OG �- cl s Li Flood Plain elevation if applicable ft.
General comments
and recommendations: ri^ $ 7 8
�7-
❑ Boring # JR Boring
❑ Pit Ground surface elev. O ft. Depth to liming factor :2 3 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
zo Ll
L � [
1
2 - Boring # Boring s
cam ❑ pit Ground surface elev. / �' � ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please gnature CST Number
Address ate Evaluation Conducted Telephone Number
l — ,
i
Property Owner V C 6, r y ,S Parcel ID # Page 2, of
[ Boring # Boring ❑ Pit Ground surface elev. / s ft. Depth to limiting factor %� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff#1 •Eff#2
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
1:1 Pit
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
' Effluent #1 = SOD, > 30:5 220 mg/L and TSS >30 150 mg/L • Effluent #2 = BOD _< 30 mg/L and TSS 1 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
SBD -8330 (R.07 /00)
1
Soil Test Plot Plan
Project Name Justin Stah Byr n Bird Jr.
Address 1176 McKinley Dr. Hudson Wi. 54016 `
TM #22052
Lot Subdivision Date 10/28/2003 Count ST. CROIX
N E 1 /4 NW 1/4S T 29 N /R W Townshi St. Josep
Boring Q Well PL Property Line# Alt. BM Base of Well 100.9
,BM or VRP Assume Elevation 100 ft Top of Well
System Elv. T- 1= 87.8T -2 =87.4 H.R.P. T-3 =87.0 Same as BM
600' PL
150'
100'
PL
Pro 3 bed
house
Well BM 35'
Alt BM
7 '
B2 130,
91 B 1 Drivew
40'
90'
B3 409
30' PL
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer z a f .�
Mailing Address 11 7,6 - /,�� ,��� �� ✓
Property Address
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number el to 9,9
�D
LEGAL DESCRIPTION o 9 7 A
Property Location V. %., Sec. T, Town of
Subdivision , Lot #
Certified Survey Map # . Volume . .Page #
GW D �� / �v Volume Z Z Page #
2 3 �! 3o Zvaa
/117 -7L/ (a � 2� /l
Spec ho� yls no Lot lines identifiable SKyes 0 no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restricted plumber or a li cense d p verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration to
�'�z
SIGNA7E1OF APPLIC DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property cribed above, A a of a warranty deed recorded in Register of Deeds Office.
SIGNJ1WRE OF APPLICANT DATE
« « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. "" "
«« Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 4 of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity 7, Z a l ❑ NA
� `
Permit # /L2„ q'F" Septic Tank Manufacturer �t,�h 13 NA
DESIGN PARAMETERS -'V / Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) B� al /day Pump Manufacturer ❑ NA
Soil Application Rate
g al/day/ft' Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly verage* Pretreatment Unit A
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 6150 mg1L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly avers a Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L 1 (� n - Ground (gravity) ❑ In Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L XN A ❑ At -Grade ❑Mound
Fecal Coliform (geometric mean) 510 cfu /100 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
Z year(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) 5��� least once every: � year( 1(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA lz�year(s)
Ins Inspect um um controls & alarm At least once eve ❑ month(s) ❑ NA
P pump, pump every: ❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
Page t &
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the um tank removed b a Se tae Servicing Op erator p rior to restorin
P P Y P 9 9 P P 9
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWT
he si a not be ev uated to ' nti a suitab�r�� U n failu OWTS a it and site
valua i m st be erform to I ate a sui ble re replacement area is available a ho ding tank
may b instal s a last res replace the fai
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING > >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name h ;, �, Name - < f
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name �v-i Name _ ( a
Phone '�� Phone c716 V"r-'
This document was drafted in compliance with chapter Comm 83.22(2)Ib)(1)(d) &If) and 83.540►, (2) & (3), Wisconsin Administrative Code.
i
U 2423P 427
74 1 866 y
STATE BAR OF WISCONSIN FORM 5 - 2000 KATHLEEN H. NALSH
PERSONAL REPRESENTATIVE'S DEED REGISTER OF DEEDS
Document Number ST. CROIX CO.. NI
Neil A. Langager RECEIVED FOR RECORD
09/30/2003 10:50AN
as Personal Representative of the estate of Bennie Langager, a single person PERSONAL REPRESENTATIV
EXBPT #
REC FEE: 11.00
( "Decedent "), for valuable consideration conveys, without warranty, to Justin A. TRANS FEE: 839.70
COPY FEE: 2.00
Stahl, CC FEE:
PAGES: 1
Grantee, the following described real estate in St. Croix County,
State of Wisconsin (the "Property") (if more space is needed, please attach addendum):
The Northeast 1/4 of the Northwest 1 /4, except a 2 Rod right of way on Recording Area
the East side and except rights of Wisconsin - Minnesota Light and Power Name and Return Address
Company in 83 foot strip on the North side, all in Section 6, Township 29 Edina Realty Title, Inc.
North, Range 19 West, Town of St. Joseph; 400 S. 2nd Street, Suite 115
And except parcel in Volume 381, page 298 as Document No. 267136, Hudson, WI 54016
And except parcel in Volume 491, page 99 as Document No. 313131, Oq
And except parcel in Volume 565, page 448 as Document No. 345141,
And also except parcel in Volume 637, page 600 as Document No. 374362,
all in St. Croix County, Wisconsin. 30- 1022 -10 -000
Parcel Identification Number (PIN)
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had
immediately prior tto Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired.
Dated this a /V'OL day of S�Q , 2003
' * Neil A. Langager
Personal Representative Personal Representative
A RON ACKNOWLEDGMENT
Notary 1'tiblic STATE OF (/y t y,8915
Signature(s) State i
...,.,,,•....». /� County ) )
�� N� � � ss. // ,,��,
authenticated this day of Personally came before me this 2 0 0 L day of
Grri , 2003 the above named
* Neil A. Langager, as Personal Representative of the estate of
TITLE: MEMBER STATE BAR OF WISCONSIN Bennie Langager
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) instrument and acknowlg4ed the san
l
THIS INSTRUMENT WAS DRAFTED BY
Brent R. Johnson Notary Public, State of Aj 15 =5 , /I
400 S. 2nd Street, Suite 210, Hudson, Wisconsin 54016 My Commission is permanent. (If not, state ex ira . on date:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN
PERSONAL REPRESENTATIVE'S DEED FORM No. 5 - 2000 INFO -PRO (800)655.2021 www.infoprofbrms.com
2't 2'3 P 4 2 8 741867
KATHLEEN H. WALSH
MORTGAGE SREGISTER
. CRO
IX CO.. .. DE EDS
DOCUMENT NUMBER RECEIVED FOR RECORD
LOAN NO. 203 - 811216 09/30/2003 10:50AN
MORTGAGE
NAME & RETURN ADDRESS EXEMPT i
;ERI MORTGAGE NETWORK, I C. REC FEE: 41.00
BOX 85463 TRANS FEE:
�d� �� COPY FEE:
DIEGO, CALIFORNIA 92186 CC FEE:
�&T* q 0 q -75-1 PAGES. 16
PARCEL IDENTIFIER NUMBER
30- 1022 -10 -000
[Space Above This Line For Recording Data]
MIN 1001310 - 2030811216 -6
DEFINITIONS
Words used in multiple sections of this document are defined below and other words are defined in
Sections 3, 11, 13, 18, 20 and 21. Certain rules regarding the usage of words used in this document are
also provided in Section 16.
(A) "Security Instrument" means this document, which is dated SEPTEMBER 26, 2003 ,
together with all Riders to this document.
(B) 'Borrower" is
JUSTIN A. STAHL, A SINGLE PERSON
Borrower is the mortgagor under this Security Instrument.
(C) "MFRS" is Mortgage Electronic Registration Systems, Inc. MERS is a separate corporation that is
acting solely as a nominee for Lender and Lender's successors and assigns. MFRS is the mortgagee
under this Security Instrument. MERS is organized and existing under the laws of Delaware, and has an
address and telephone number of P.O. Box 2026, Flint, MI 48501 -2026, tel. (888) 679 -MERS.
WISCONSIN - Single Family -Fannpe/Fr*d Mac UNIFORM INSTRUMENT WITH MERS Form 3060 1/01
(P® liA(WI) t000el
Papo 1 of 16 VMP MORTOAOE fORM3 • (300)6
r 9
199WI
41 a
2423P 443
//
ADDENDUM
TO
WISCONSIN REAL ESTATE TRANSFER RETURN //JJ
PIN 30- 1022 -10 -000 11 - 7 (o�l� -/n
Social Security No.
GRANTORS: NEIL A. LANGAGER L} - 1 - 1 1 �' �l� t
Lam" I "g&s_� s
GRANTEES: JUSTIN A. STAHL
PROPERTY DESCRIPTION
A parcel of property described as follows:
The Northwest 1/4 of the Northwest 1/4, except a 2 Rod right of way on the East side and except
rights of Wisconsin - Minnesota Light and Power Company in 83 foot strip on the North side, all
in Section 6, Township 29 North, Range 19 West, Town of St. Joseph;
And except parcel in Volume 381, page 298, as Document No. 267136,
And except parcel on Volume 491, page 99, as Document No. 313131,
And except parcel in Volume 565, page 448, as Document No. 345141,
And also, except parcel in Volume 637, page 600, as Document No. 374362, all in St. Croix
County, Wisconsin.
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030 - 1022 -10 -000 Parcel Number 06.29.19.94A
OWNER NAME: First BEN Last LANGAGER —
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type eS SD A AAp�rtm�
1176 MCKINLEY DR d
�S-� �kS ���9
SECTION 6 WN 29N RANGE 19W 1 /4160 %40
Line Description Line Description
TOTAL ACREAGE 13.550 PLAT LOT BLK
01 SEC 6 T29N R19W S 1/2 FRL 15
02 NE NW EXC P94B & EXC THAT 16
03 PART TO P94E AS DESC IN 17
04 637/600
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
. MW a 29 _ 3OmN R_20_19 —W
�� � %' See Page 112 For Additional Names.
19
150th AVE 400
h
w HERON
Gloria c
LN awe
Basel Ema ' Ernest Meye rs _
0,_ 114 Fade M ed Ernest -
Klued -
40 t �
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37 AVE 1181 120 tr
N 5 '�"' N 0,10 u �'c DA 8 [�
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tr M & Joyce r &s w &B s
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155 ' ° Carr
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a 17 Edward &Carol & U N ° 14 20 40 a
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SOMERSET'S' PAGE See Page 112 For Additional Names;
R20W R19
)ERSEN SCOUT CAM RD 20000 23rd ST 3D0 150th AVE 400 ,
— —� 3 Kevin &I `lo T s tr u M HERON $
us Rolke Linda ' Gloria WC$8e ' LN James
0 40 Hinz Basel Erna x v oelter Robert 80IM Wegge �, Frjn &Ernest Meyers F- Ernest
& 53 '� tr O° MsM, 1Anikr- 145th 114 Family 1 nued la "40 co R
7g Q � ARBOR
V Y } R HILLS son Trust 160 p
Plourde .8 40 DR ' 37 AVE 118' 120 Ln
33
1 35 Paakk a N 5 1r g N y 14 u .. ¢ P DA 8 a
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q $ 77 tr y z4 & L ynn Dilts � 9 t
RIVER EST u 10 sacs z2 v B Trust
30 N RD _ 4-� w n T Best a: IQ a 14 40 _ _ 66 1&s B la g s o ,N
291V i `�ia Px t s&G Stanley JM T 18 1 tr N Donald
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rn 11dhd r " to ad �
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RIVER HEIGHTS TRL F�TY 35 GOLDEN TROUT LE ALLS
HUDSON'W PAGE 26 OAKS LN BROOK RD LAKE
IRST We're right here - in this local area -
to help you, your neighbors and our local
*NAL communities.
And because we're here, your deposits
rANK w ith us are invested in loans to benefit
the local economy and local people.
Prescott
_MINOR SUBDIVISION APPLICATION
ST. CROIX COUNTY
The submittal deadline for certified survey maps is the 4' Tuesday of the month two months prior the
irvg� &Pation r approval
by the Planning, Zoning & Parks Committee.
FEB 2 4 2004
Property owner �,ST /ti1 ��Qt -1 L- Agent (if not owner)
Mailing address / _ Yr" .i �_ ` r � Mailing address S ZONIONIX COUNTY
>h
Daytime phone/ ? 2 Daytime phone
AddresslKL' SU>:vF `llu�� �b 1�OU 14
Surveyor QDIlZ l
Phone �"l " $ ` FAX `74� — 1-- l SQOZ 3
rt
Property location N16 1/4 1/4 Section e. T l _N -R J_ t — Town of
No. of lots _ Total acreage of lots 77 Size of original parcel
Parcel Identification no(s). Zoning District of parcel
MAKE A SKETCH IN THE BOX SHOWING HOW THE NEW LOT(S) FIT WITHIN THE ORIGINAL PARCEL
LOT - PPROVED
t
T. CROIX COUNTY
LOT I Plannl Z mNle
on1nQ and Parks Come
' , -,k AR 2 4 2004
d within of
(ziJE gyp. approval date approval sW be
I certify by my signature that all information presented herein is true and correct to the best of my knowledge. I hvala kdeegidest the St. Croix
County Zoning Departme t to process th'51 application according to Chapter 18 of the St. Croix Zoning Ordinance.
Date
Signature
DOwner uthonzed Agent
CIE CIE �iE �iE �iE �iE �iE �iE CIE �iE CIE CIE CIE CIE CIE CIE �iE �iE CIE CIE CIE SIC CIE � � CIE CIE alE 31E �iE �iE CIE CIE CIE CIE CIE CIE CIE CIE CIE �iE CIE CIE CIE
Eight (8) copies of a "concept " map are to be submitted for staff review. The applicant/agent will be notified of any required revisions.
Once the "concept" corrections are made, an official minor subdivision application may be submitted.
NOTE: ONLY COMPLETE SUBMITTALS WILL BE ACCEPTED.
Submittal deadline is the 4-Tuesday of the month
SUBMITTALS MUST INCLUDE THE FOLLOWING:
certified survey map `
•
I
7 5 7 5 0 4
VOL 18 PAGE 4717
XATffEM H. WALSH
REGISTER OF DEEDS
ST. CROIX CO. YI
v z m () RECEIVED FOR RECORD
o O gg q ci 03/2412004 I1:40AN
BEARINGS ARE REFERENCED TO THE Z 3 C z CERTIFIED SURVEY MAP
ST. CROIX COUNTY GPS NETWORK n
O � $ m PAGES ° �2 3.00
oPi �
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_
j� WEST LINE OF THE
— iZ5' NOO*OW35rW 667.1 Sr I ® O 0
NF114 OF THE NWJ/4 200.43' 466.76'
APPROV IED '
ST CROIX COUNTY $ v O v x m
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m MAR 2 4 2004 g� g r. z
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SHEET 7 OF 2 SHEETS
Vol 18 Page 4717
E '7
U 2599P 120 76 CS. ae+1
STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH
Document Number
WARRANTY DEED ST. CROI O
CROIX , W1
RECEIVED FOR RECORD
This Deed, made between JUSTIN A STAHL A SINGLE MAN 06/18/2004 02:10PH
Grantor, and MICHAEL A NORDMAN A SINGLE MAN AND JODI L
WRIGHT A SINGLE WOMAN Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT #
described real estate in ST CROIX County, State of Wisconsin (the "Property") REC FEE: 13.00
(if more space is needed, please attach addendum): TRANS FEE: 444.00
PLEASE SEE ATTACHED EXHIBIT A COPY FEE:
CC FEE:
PAGES: 2
V 1S���
Recording Area
Name and Return Address
V JOHN LINDELL
NORTHWEST TITLE AND ESCROW CORP
744 RYAN DRIVE, STE.101
HUDSON, WI 54016
Together with all appurtenant rights, title and interests. 30- 1022 -10 -000 0 /"� ^-
I Q
Parcel Identification Number (PIN)
This IS homestead property
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasi fee simple and free and clear of encumbrances except
NONE
'1
Dated this day of j
* S INAST
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WI "Unue L D. MOONEY
N Public
ST CROIX Count 4t Of �>SCOCI8�1
authenticated this day of
Personally came before me this 1 N day of
V\ Q -1 , 20 the above named
JUSTINA STAHL A SINGLE MAN
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me knovol to be the person(s) who executed the foregoing
authorized by ¢706.06, Wis. Stats.) instrum t d acknowledged th same.
THIS INSTRUMENT WAS DRAFTED BY
Northwest Title and Escrow Cora
744 Ryan Drive, ste. 101, Hudson, WI 54016 Notary Public, State of C Aj I S LC.v►S t `^
My Co issio is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) 77 �� )
• Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO (800)655 -2021 www.infopmfonns.com4TATE BAR OF WISCO
WARRANTY DEED FORM No. t - 2000
P 121
Deed #1 Notes For: 10- 00521415 U 2599
Lot 1 of CSM filed 3/24/04 in volume # 18 page 4717 as Document No. 757504 St Croix
County, Wisconsin.L'I
Page 1 of 1
f
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030-1022 -10 -000 Parcel Number 06.29.19.94A
OWNER NAM rst JUSTIN A L
PRO
PE SS --
. Hse # 1/2 PD Street Name -- a SD Apartment
1176 p
I NLEY D
6 MCK R
SECTIO 6 TOWN 29N RANGE 19W 1 /4160 1 /440
Line escription Line Description
TOTAL ACREAGE 13. LOT BLK 1
01 SEC 6 T29N R1 9W S 1/2 FRL 15 i
02 NE NW EXC P94B & EXC THAT 16
03 PART TO P94E AS DESC IN 17
04 637/600 18
05 19
06 20 � r
07 21 u
08 22 ` \
09 23 T ��
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
I
VALUATIONS ST. CROIX COUNTY, WISCONSIN OLD TXSCR03
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030 - 1022 -10 -000 Parcel Number 06.29.19.94A
OWNER NAME: First JUSTIN A Last STAHL
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
1176 MCKINLEY DR
Lottery Card Printed? Y Claimed: 1 Batch: 213 Pass /Fail:
TOTAL ACREAGE 13.550 Values Last Changed on 07/07/2004
Reason Codes:
Classification Code _Acreage Land Improve TOTAL
Residential G1 3.000 70300 78000 148300
Productive Forest Land G6 10.550 110600 110600
TOTALS: 13.550 180900 78000 258900
PRIOR YEAR TOTAL:
GENERAL PROPERTY: 13.550 108800 62200 171000
PRIVATE FOREST CROP: 0.000 0
F1- General, F4 -Prev. Parcel, 175 -Next Parcel, F6 -Legal Desc., F10 -Exit
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030 - 1022 -30 -001 Parcel Number 06.29.19.94D
OWNER NAME: First LAWRENCE W & DIANE Last STAHL
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
1188 MCKINLEY DR
SECTION 6 TOWN 29N RANGE 19W %160 '/440
Line Description Line Description
TOTAL ACREAGE 1.930 PLAT LOT BLK
01 SEC 6 T29N R19W N 1/2 OF E 15
02 1 /2OFW 1/2 OF N 660 FT OF 16
03 NE NW & COM N 1/4 COR, TH W 17
04 656.76 FT, S 330 FT, W 30 FT 18
05 TO POB: S 30 FT, W 90 FT, N 19
06 30 FT TH E 90 FT TO POB EXC 20
07 N 83 FT 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030 - 1022 -40 -000 Parcel Number 06.29.19.94E
OWNER NAME: First JAMES L & JILLAINE Last STAHL
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
1184 MCKINLEY DR
SECTION 6 TOWN 29N RANGE 19W '/4160 1 /440
Line Description Line Description
TOTAL ACREAGE 2.440 PLAT LOT BILK
01 SEC 6 T29N R19W S 1/2 OF E 15
02 1/2 OF W 1/2 OF N 660 FT OF 16
03 NE NW EXC PARCEL 30 FT X 90 17
04 FT IN NE COR. COM N 1/4 TH 18
05 S 384.68' TH N 89 DEG W 33' 19
06 TO POB, TH N 89 DEG W 20
07 1274.77' TH N 38.71' TH S 89 21
08 DEG E 1273.81' TH S 54.26' 22
09 ALG R/W OF EXISTING TOWN 23
10 ROAD -POB 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
I
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030 - 1022 -30 -000 Parcel Number 06.29.19.94C
OWNER NAME: First LAWRENCE W & JAMES L Last STAHL
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
SECTION 6 TOWN 29N RANGE 19W 1 /4160 '/.40
Line Description Line Description
TOTAL ACREAGE 13.120 PLAT LOT BLK
01 SEC 6 T29N R19W NE NW E1/2 15
02 OF N 660 FT OF NE NW & W 1/4 16
03 OF N 660 FT OF NE NW EXC N 17
04 83 FT 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
Jessie Nye
Subject: Byron, 430495
Location: St. Joe
Start: Tue 9/28/2004 12:30 PM
End: Tue 9/28/2004 1:30 PM
Recurrence: (none)
030 - 1022 -10 -200 0 1� 1 107
06.29.19.94A20
1 182 McKinley Drive
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