HomeMy WebLinkAbout042-1020-10-115Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division INSPECTION REPORT
GENERAL INFORMATIO (ATTACH TO PERMIT)
Personal information you provide may e used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's, Name: City Village Township
Jeffrey Olson
CST BM Elev: jIns4, BM Elev: IBM Description:
T,&Mt< IMI=ORMATION
TYPE
MANUFA
CTURER
CAPACITY
Septic
Dosing
Pd)
Aeration
Holding
----------
10#9�ANK SETBACK INFOR ATION
Vent to Air Intake
�Aeration
0 now
MOM"-
41MC001 9. "_
Holding
oiir-.,mD1Q10Wr)M 11INIFORMITION
Manufacturer
Demand
GPM I
Model Number
TDH
ILift
Frictio oss
Syste
TDH Ft
Forcemain
Length
Di
Dist. to Well
SOIL ABSORPTION bYb
I hM
BENCH 'W
�
th
Length A-1
No. Of Trenches
DIMENSIONS
SETBACK SYSTEM TO
PIL
BLDG
WELL
INFORMATION Type of System:
ki
(,OV% tj §4 §4
DISTRIBUTION SYSTE40.&I
Header/Manifold
Dis ti
ibution
I I
Pip E
(s)
1=1 F-VATiom nATA
County: St. Croix
Sanitary Permit No: 648465
State Plan ID No:
Parcel Tax No:
Section/Town/Range/Map No:
STATION BS
Benchmark
8 ZZ
HI
r
FS
I
ELEV.
I I
Alt. BM
Bldg. Sewer
St./Ht Inlet
1.f4 S
)7_
St./Ht Outlet
Dt Inlet
Dt Bottom
Header/Man.
Cf
Dist. Pipe
Bot. System
�'
1
Final Grade
�A0.0
St Q'over
101 1 3
Liquid Depth
PIT DIMENSIONS No. Of F!1-ts Inside Dia. Liquid
LAKE/STREAM ING Manufacture
4HAMBE R
IT 5 Model
L4
x Hole Size Ix Hole Spacing (Vent to Air Intake
Length___ O!V Dia 'I— Lenuth pacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Yes No
To it
Bed/Trench Center Bed/Trench Edges > i F'j Yes No 'j
b *dic
COMMENTS: (include co lbrepenci es, persons present, etc.) Inspection #1: Inspection #2:
Location:
1.) Alt BM Description
2.) Bldg sewer length C
- amount of cover
Plan revision Required? � es, LJ No
Use other side for additional inf rmation.
Date
SBD-671 0 (R.3/97)
Insepctor's Signature
Cert. No.
smiccs Division County
4M Ma&son Yards Way
Madison, W1 53705 Sanituy Permit Mmnbir- (to be filled in by Co.)
IP MAY 0 2 2023 P.O. Box 7162
7 W1 53707-7162
unitary P nit Application state Truanction Nunibu
In acwrdancc with SPS 383. 1(2), Wis. Adfn. Cx;dk, submission or this fetm to the appropriate govenummtal unit
is required pnOr to Obtaining a sanitary Pcrmll, t4otc- Applicafion fotrm fear suu>.owrjcd POWTS am submitted to Project Addrew (if diffe"mt than mailing addn:ss)
1the Dqmft=l of Safety WX PTOfMiOwl Scrvices. PC130nal infMMIllon you Provide may be used forsecondary
purposes in accordance with Privacy Law, s. 15.04(l)(tri). Stat&
1. A l Inrorma a - PkaSe Print All Informatics
Property S Name
Parcel #
-Az
Propwy Owner's Maifing A 3d -
citry, S --- zip Phow Number1
Govt. Lot V4, Section
7
ELT of Building (cb4ck all that app�ly) T. 7 t4 IL
MI or 2 Family DwvIlinip, - Number ofBetiroomas SubdivWos Nffft
Uj aublirJ'�zcial - i)"-ribc tise Hko—ck # �2
tMe Owned -- Describe One or
CSM -42 q0) i -L11agc of
�of 0'%V
7
Ill. Type of POWTS Permit: (Check dth" upkWnor "Replacement" and other applicable on line A. Check ose box on line B. Complett line C i
I%PPlinable.
ew systr-M cplaocnwnt Sytfttn Eld*r Modificat on it) L'Aisfing Sys:Lcm (cxpLalln) Additional PrefTeatment Unit (explain)
[jWdingT=k In-GrOUnd ommw Individual Sitc Design Othcr Type (explain)
conventiomill-)
c. El R...w mm- EIRevision of Plumber aramtftc &D t*W Previous Permit Number wW Date Imacd
pmphvion
y,
TV. PU"LlTres— Aires and Task Information: L
Dcsiga Flow (Vd) Dcs gn Soil Appikation Raw(gpdtsf) I Arca Required (so Daoi3W Asks 3 11r.-
- I I q G
t1J 6�ki W,
Capacity in TOW # 'of ujaeftmw
6
Tank Gatkm3s Gatk3as Units B)
111�� Ta� 40 U
Tomb
/7n
7/;
U Gn tn kz 0 4L.
Septic or IRAchft Tw&
Dming QwT&, E3
V. RespongbUfty Sts t- 1, the us ---Ibfty -Itadesa of the POTS shown cm the attached plaw.
-4
Pkinriba's Sip MPIMPRS Nun3bcr Ekisimm Phonc Numbcr
zol 2 7
P I U V V46 *8 Cirty, St"e. Zip CO&) 791
VI. County Use Only
� �
PerinFeeit FDate hmuW Ismung AgogW
Sic
ved 4I S
n for Den S2- �/ZD2-3
Conditions of A
W
ER.
'
er adispersal SYSTEM
1 Septic tank, efflffl7uent fill er and dispersal cell
must be serviced intained as per
management plan pr ided by Plumber. -C>/2�/2-o23.
2. All setback requiremen s must be maintained
as per applicable e / ordinances.
Attach to c*EWWe plans for tkw syvtrm wW sobmit to the County **ty an paper not Ir" than 8 in i I! Anchn in rite
SBA}-6398 (R. 03/21)
� CQo IX COUNTY
�L"l ��11 -71 111111111111111111111111111111 �� iiiii P_
hkk� k' TATE SAN R P
IT j
! V FRMIT
/V7_0 TSL
OWNER \ 6 DLSOA)
W_ - V6
J 1
PLUlVIBER 1�� DGaaN�w
�—a
PREVIOUS NO.
LIC*# 22 q2_6 S
TOWN OF wf}RR�
SEC ,T 2? Nq Ri /8 MID*
AND/OR LOT BLOCK
(�SOA132.#-72Lfo Wt%
SUBDIVISION
AUTHORIZED
THIS PERMIT EXPIRES 5/23 / o2s
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Nate: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
ISSUIVG OFFICER —DATE 'r113Z2ea.?_
UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R11 /20)
4
. �* ►+�;��, industry SeMces Division county
# 4822 Madison Yards Way -'
Madison, WI 53705 Sanitaty Permit Rumber (to be filled in by Co.)
s
° �' a P.O. Box 7162
: ---- ti Madison, WI 53707-7I62
. Staatc Tr�i+on Number
SanitaryPermit ippl�caion
in accordance with SPS 383.21 )6 Wis. Adm.. Code, submission of this farm to the appr OMC govcrMnen al unit
is rrquircd prior to obtaining a itwy perm t. Mate: Application f+v m for state-owncd POWIS arc subr+ittcd to Pic jcct Adds s (ifdifferCnt than mailing address)
the Dot of Safety and fecal Services. Perms infrxmatiorx you provide may be used for s''
Wpom in accordance with privacy Law, s. 15.04(lXzn) Stats. T
L Apolkation Tnfermatio -- Maw Priest A0 tafor=atien c
Property
s Name Parcel #
ply �r's • ing �Y Location
City,State Zip Cade Phone Number
V-- --V4, Sectice 0�?
-N Aw-
II. Type of.B d t (Chet A that apply) Lot # T� N R E o
bdiviar+an Tlarsnc
MI or 2 Family Dwelling — Nt Mber ofBedmOms
B
E�ublicCommeircial — DewdIe Use
0
Elstate- Owned -- Describe U Number
own o
Of POW" P It (Cbe& �er'"I' W or "fit " aed r applies on li A. Eck one boat ea B. Complete lice C
M.
'rYP�
a irabie.
A. cw iasring System explain) dditional t Unit (explain)
SFIlowing Tank t]k-Cr+atutd t 0mou individu ite Design Type (explain)
(conventional) I --
ist Permit Number =A Date lssuel
C. []RmewalBefore Revision of tuber "nuasfer e°w
Expiration Mumma f
'
TV. (lisp atf Croat em# rea sad Tana form ost I -
El
ign Flow (gpd) lei Soil n At�a Dish (sf) Systcan
7—
7�in T h M r 6
Ga
C" c7
Tank Information -� jt-
New sees Ti �
U Wn w t7 a
Septic or Holding Tank
Dosing caber �,....---+
1:3
V. fb# ty Sin # I, the Pow!► t� of tse P VWM" shown on the attached pens.
s Sr-- I 1 MPIWRS Numbff BusiDcss Phow Number
Ale
P 's A d (shier, 0, s zip code
VL Ceuatyaxrtmcnt I ise Oaty
_ Pet Fee Date Lid Issuing Agent Signature
� �
�] Apptoved 'sap S
0 Own Reason for DeaW
Conditions of J�V—prov"4zsons for Disapproval
to +rite phm for the sywtew auk mbmit to the County oldy oil pxW not Iris (ban ti in x II ides in dace
SBD-6398 (It. 03/2 i )
DroierA lqame,--
owrwes wwne:
CMnWs Addy
LegW De=*Wm
Towmhfp--
C.ounW--
SubdWision NaMe:
Lot NuMber-
Pamd 10 Number-
CONVENTtONAI- COMPONENT DESIGN
RedderMAmocaoon
MSE AM TITLE PAGE
page
index and We
Page 2
Plot Plan -
3
%%ft & emwZecfion
page 4
--7= FEW
pen" 5
mandL-�� In n
page 6
pm
R39e 7
St Ctubc Chl SsPlic Tank N—Wnftnance Foun
Page 8
Pzqe.q
CSMorPlat
AffachinwIS: � Test & Hmise Pis
cense Nkunber-
-17
Phomfhmmbef
Ll
A U — 6 j &ftntmi *W poVVTS van 2-0 SBD-10706-P 04MWI)-
pasu lb 4 %pawe I
2F2 21 it
System
lit
IL
IHI �I(IIIIIII�IIIllI11�I►IIIIii(�Illillfl(�li�llllllll�
- 1-
T AM,
-4-w FA
Ulz-lffs.,fo-� lily a -
of
"iZaWG' loc. PL-52Effluent Filter
Innotions inPfcc"I'Drarage [& lVas le -water Pr*&Xfs A WOW of Pa" hV.
11L-5.2.5 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16 " filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball
installed with every fi Iter. When the filter is removed for cleaning, the ball will float up and temporanily shut off
the system so the effl ent won't leave the tank.
Features:
• Rated for 10,000 GP
(gallons per day).
• 525 linear feet of 1/
6" filtration.
iCHD
• Accepts 4"" and 6"
40 pipe.
• Built in gas deflecto
• Automatic shut-off
all when filter is removed.
• Alarm accessibility.
• Accepts PVC extension
handle.
PL-525 Installation:
Ideal for residential
d commercial waste flows up to
10,000 gallons per da
(GPD).
1. Locate the outlet of
the septic tank.
2, Remove the tank cc
ver and pump tank if necessary.
3. Glue the filter hour-
ing to the 4" or 6" outlet pipe. If
the filter is not center
id under the access opening use a
Polylok Extend & Lo
or piece of pipe to center filter.
4. Insert the PL-525 filter
into its housing.
5. Replace and secur
the septic tank coven
PL-5525 Maintenancei
The PL-525 Effluent
"filters will operate efficiently for
several years under n
orural conditions before requirincr
cleaninor. It is reco
ended that the filter be cleaned
every time the tank1pumped,
or at least every three
years. If the installe
filter contains an optional alarm,
n
the owner will be n
Tied by an alarm when the filter
j
needs servicing. Sery
cing should be done by a certified
septic tank pumper c
r fi-istaller.
1. Locate the outlet o,the
septic tank.
2. Remove tank cove
- and pump tank if necessary.
3. Do not use plumb
X
g when filter is removed.
4. Pull PL-525 card
ge out of the housing.
5. Hose off filter ov6z-r
the septic tank. Make sure all
solids fall back into
septic tank.
6. Insert the filter cart
-idge back into the housing making
sure the filter is prof
erly aligned and completely kLserted.
7. Replace and secuiV
septic tank cover.
1/16" Filtration Slots
[10,000 GPD) ,
Accepts 4" & e' C_
SCHD 40 pipe
Outdoor SmartFilterO,_ Alarni
Polylok, Zabel & Best filters accept
the SrnarffilterO switch and alarm.
Alarm Switch
(Optional)
Accepts 1" PVC
Extension Handle
Rated for
10,000 GPD
525 Linear Ft.
of 1116'j
Filtration Slots
Certified to
NSF/ANSI Standard 46
Gas Deflector
Automatic
Shut -Off Ball
I'Mend & Lok.-"
Easily installs
into existing tanks.
PolylokId Blvd. Wallingford, CT 06492
, Inc. 3 Fairfi 'Toll Free: 877,765.9565 Fax: 203.284.8514 vmw.polylok.com
I
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
Page �Of
FILE INFORMATION
DESIGN PARAMETERS
Number of Bedrooms 1
4-
0 NA
Number of Public Facility Unds
ki NA
Estimated flow (average)
7
n
gal/day
l
Design flow (peak), (EstimatEd x 1.5)
gal/day
Soil Application Rate
'7
gal/day/ft2
Standard Influent/Effluent QLality
Monthly average*
Fats, Oil & Grmase
(FOG)
:!�30 mg/L
Biochemical Oxygen Demand
(BOD.)
�220 mg/L
0 NA
Total Suspended r--olids
(TSS)
<1 50 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand
(BODE)
<_30 mg/L
Total Suspended ',r-. olids
(TSS)
1530 mg/L
0 NA
Fecal Coliform (geo etric
mean)
:510' cfu/ 1 00m I
Maximum Effluent Particle Sze
Y in dia.
0 NA
Other:
11 NA
*Values typical for domestic wi I istewater and septic tank effluent.
MAINTENANCE SCHEDULE I
SYSTEM SPECIFICATIONS
Septic Tank Capacity
gal 0 NA
Septic Tank Manufacturer
11 NA
Effluent Filter Manufacturer
0 NA
Effluent Filter Model
0 NA
Pump Tank Capacity
gal E( NA
Pump Tank Manufacturer
ET NA
Pump Manufacturer
NA
Pump Model
19'NA
Pretreatment Unit
JA NA
0 Sand/Gravel Filter
0 Peat Filter
0 Mechanical Aeration
El Wetland
0 Disinfection
11 Other:
Dispersal Cell(s)
0 NA
E9 In -Ground (gravity)
0 In -Ground (pressurized)
0 At -Grade
0 Mound
0 Drip -Line
El Other:
Other:
0 NA
Other:
0 NA
Other:
0 NA
Service Eve t
Service Frequency
Inspect condition of tank(s)
At least once every:
❑0 month(s) [9 Year(s) (Maximum 3 years)
0 NAI
Pump out contents of tank()
When combined sludge and scum equals one-third (Y3) of tank volume
0 NA
Inspect dispersal cell(s)
At least once every:
0 month(s) (Maximum 3 years)
JR) year(s)
0 NA
Clean effluent filter
At least once every:
0 month(s)
year(s)
0 NA
Inspect pump, pump contro & alarm
Ist
At least once every:
0 month(s)
0 year(s)
E) NA
Flush laterals and pressure
At least once every:
0 month(s)
0 year(s)
14 NA
Other:
At least once every:
0 month(s)
0 year(s)
0 NA
Other:
0 NA
MAINTENANCE INSTRUCT[ NS
Inspections of tanks and 1 ispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Pumber 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 he visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground rface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification oftqe 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 (lode.
All other services, includil but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at pritervals of :512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be pr� vided to the local regulatory authority within 10 days of completion of any service event.
GMW (4101)
Page 6 of
START UP AND OPERATION
For new construction, prior I ,o use of the POWTS check treatment tank(s) for the presence of painting products or otherchemicals
that may impede the treatm nt process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by ateptage servicing operator prior to use.
System start up shall not oc�ur 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 -.ell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situ ion have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pum or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within he pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or other -wise disturb or compact, the area
within 15 feet down slope c f 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:
0 All piping to tanks knd pits shall be disconnected and the abandoned pipe openings sealed.
0 The contents of alli tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all antis and pits shall be excavated and removed or their covers removed and the void space filled with
soil, pravel or anot er 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 replaceent area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The repla -ement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks rom existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need or a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the ri les in effect at that time.
® A suitable rep lac ment area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holdil-ig tank may be installed as a last resort to replace the failed POWTS.
[3 The site has not een evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed a a last resort to replace the failed POWTS.
Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biornat at the
infiltrative surface Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> > DiOR INSUFFICIENT OXYGEN. DO NOT
SEPTIC, PUMP AND OTH R TREATMENT TANKS MAY CONTAIN LETHAL GASSES AN
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 INSTALFJ/ POWTS MAINTAINER
I
NF: Na I
Nance Name
A 114-11 Z
Phone Phone
SEPTAGE SERVICING OPE ATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone hone
This document was drafted in ompliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3),, Wisconsin Administrative Code.
S-r: C R 0 t1v 7, JN-FY SANITARY SYSTEM File #:
Office Use Only
��` �µ F� OWNERSHIP/ADDRESS FORM Created 212021
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be Provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be seit to you by email.
OWNER/BUYER INFORMATION
Owner/Buyer Jeff 01 on
Mailing Address 108 11 Oth Street
City/State/Zip Roberts, W1 54023
Phone Number (requirEd)952-334-7573
Email Address (require jolsonl984@yahoo.com
Parcel Identification umber
(found on the property tax bill)
III
NEW SYSTEM: LEGAL DESCRIPTION
Property Location 1/4 1 NE /4 , Sec. _8, T 19 N R 18 W, Town of Warren
Subdivision Plat.
-
Lot # 6
Certified Survey Mai # I Volume , Page #
Warranty Deed #
Number of bedrooms 4
(before 2006)Volume Page #
Spec house 0 yes 0 no Lot lines identifiable 0 yes 0 no
OFFICE USE ONLY
New Property Address 1D.7S //0 l fit 511622
(Verification of new address required from Community Development Department for new construction.)
23ZZ
(Staff Initials) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if references made in the warranty deed
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
'� I "") 1101 Carmichael Road, Hudson, Wl 54016
Y WwW.SccWi._(7oV
TERMINATIO OF DECEDENT'S INTEREST
DECEDENT'S NAME DATE OF DEATH
��.
JaQ�1 dre, 1112 6
DECEDENT'S ADDRESS AT DATE OF DEATH CITY STATE ZIP
1oyy !10-11 5�- RobQrfi WL j yo�3
THE INTEREST OF THE DECEDEN'"IN THE PROPERTY LEGALLY DESCRIBED HEREIN IS TERMINATED
PURSUANT TO THE FOLLOWING WISCONSIN STATUTE AND TRANSFERRED AS PROVIDED BY
STATUTES:
El 867.045 - real propert in which the decedent was a joint tenant, had a vendor's or
mortgagee's interest, or ha a life estate.
867.046 - property of a lecedent specified in a marital property agreement, survivorship
marital property; a third pa confirmation; or a nonprobate transfer on death as described
in 705.10(1) or 705.15.
DOCUMENT UNDER WHICH DE CEDENT'S INTEREST IN THE PROPERTY IS NOW TERMINATED -
Copy(ies) of which is/are attac d-
Recorded Document No. � �Tr2_�- - Volume- 151 Page
P6Deed OTransfer i . )n Deat"11 El Land Contract [I Mortgage
El Other
Unrecorded Document:
El Marital Property dgreement [I Other
I',i lllIIIId:III�IIIIIII!II11
Tx: 5119035
1158107
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
08/30/2022 12:32 PM
EXEMPT#: 8M
REC FEE 30.00
PAGES: 3
Recording Area
Nome /and Return Address:
�o �l ��° i�0
Sr 1-1-1 %..- &p.- 3
Parcel Identification Number,
SEND TAX STATEMENT TO:
DESCRIPTION OF THE PROPE TY TRANSFERRED (check all that apply):
N REAL PROPERTY - legal de ription as set forth in the attached/referenced and previously recorded document
El REAL PROPERTY - current I gal description if different than the foregoing document
r
[I NON -REAL PROPERTY - p1perty identified in the attached document, inc. digital property, bank accounts and securities
Name(s) and address of own r(s) of the property immediately after the
decedent's death; attach add tional names & addresses, if more than one
owner.
0
interest of the signer of this document in the property:
EJ joint tenant 17 remainder person if a life estate
El mortgagee L1 land contract vendor
JZ decedent's spouse [I beneficiary of a marital property agreement
EJ beneficiary of a transfer under 705.10(1) or 70S.15
El other:
DECLARATION: To the bestof undersigned's knowledge and belief, the undersigned declares that this document is true, accurate, complete and in
conformity with the provi ions and limitations of the Wisconsin Statutes.
DATE: 0
ECL AIGNATURE ACKNOWLEDGMENT
STATE OF
COUNTY OF I
PRINT NAME: Signed an to (or affirmed) before me on
Fgr n
by A aS
Yf N, R y
N I
THIS DOCUMENT WAS DRAF ED BY:
- --4- ;10e\
Print Name:
�.
Notary Public, State of "CZ
My Commission (is permanent) (expires ',,) ��v
_I
-z-
400
TE 0;
THIS IS A STANDARD FORM. AN I MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. "Ifillitilk%
TERMINATION OF DECEDENT'S IqTEREST - Wisconsin Reg. of Deeds Association form HT-110 and TOD-110. Version 6.21.18
St. C ro'vx County 1158101 Page 1
DOCUMENT NCI.
ISTATE 13AR OF WISCONSIN FORM I — 1982
-WARRANTY DEED
TO WL
This D43 made between John A. Kurkowskl aka
John KurkowsK and Anne T ---------------------
----------------- -----------------------------------------------------------------------------------
Kurkowskl hu band and wife
------------
f -----------------------------------------------------------------------------------
------------------- --------------- I --------------------------------------..'..Grantor,
and_.___ ----- Jeff?7_qy._ A._ Olson.. and-- Jeane_tt_e._ M.-, Ols-on
---- ----------
swrv1varshIp r1tal propexty
--------------- ----------------------------------------------------------------------------------
4
----------------------------- ---------------------------- -------------- ----------------------------
---------------------------- --------------------------------------------------------------------
. Grantee,
Witriesse hq That the said Grantor, for a valuable consideration_--___
----------------------------------------------------------------------------------
conveys to Grantee t e following described real estate in - - - rOI-X
1 7 C- - - - - - - - - - - - - - - - - - -
courity, State of Wiconaln:
TMG !SFACE "ESERvED rOR FIECORD1140 DATA
REGISTER'S OFFICE
ST. CROIX CO... Wi
AL Reed fcx Record
J U1_ 0 6 1992
at 8:30 A. M
CP crrt-��
Regivef of Deeds
RL-TURN TO
MW Off' NEW RICEMC)ND
Tax 1"arcel No: -----------------------------------
Part f Northeast Quarter of Northeast Quarter of Section 8-29-18 described
as fol ows: Lot 2 of Certified Survey Map filed July 24, 1991 ire, Volume "8",
1
page 82, Document No. 471816 and right of ingress and egress as shown on
said ertified Survey Map.
Whig ... :Ls rot
homestead property.
(i : a not)
Together -witi. all and singular the hereditarnenta and appurtenances thereunto belonging;
And_ ----- ---- ---------------------------------------------------------------------------------------
Warrants that the title is good,, indefeasible in fee simple and free and clear of encumbrances. except
and will warrant a7ld defend the sarne.
Dated this ----------- day of ------- .19 ---------
---------------------------------------- (SEAL) Y-- •- --- ---- i-------------- (SEAL)
------
jKkk!
------------------------- ----------------------------------o- 9 - --------- urows----------------------
-------------------------- ---------------------------------------- (SEAL) -- ------- - I ----- ------------ _-.777- ...................... (SEALY
4 ........ ; --------------- i ----------------------------------------
AUIVHENTICATION
0 Anne T. Ktirkowsk:L
--- ------------
AC1KN_0W14EDQMEXT
Signature (a) ------------------------------------- -----------------
STATE OF WISCONSTN
.0s.
------------------------------------------------------------------------------- St. Cro:Lx County
--------------------------------- Y-County.
authenticated this _-_--_day of -------------------------- Personally came before me this ----QJ --------- day of
'alay ------------------------------- 19--9.2.-- the above named
John_ -------
------------------------------------------------------------------------------ AnDle- - Z, - - - AkaL - Anne - JKurkQwaki., ------
TITLE: MEMBER STATE BAR OF WISCONSIN husband __ anc5
(If not,
----------------------------------------------------------
authorized by 706.06. Wis. Stets.]
dm
to me known to be the person ---------- &'Wei_'Ute raoe
:Foregoing 1 ent and knowleth
AkL
T" Is I Ns-rRij 1EN_r WAS ]DRAFTE0 BY
W
and knowle
Bakke Norma S. C.
------------------------ -- ----------------------------------------------------
t� L. Zap-
enneth L. Za
Baldwin, W1 6ons ±n
I
-------------------------- ----------------------------------------------------- Notary Public
(Sig -natures may, b authenticated or acknowledged. Both 'NLTy Commission is permanent. (Xfqw-�,
are not necessary.) 5/9/93
date-- ---------- --------------------- --- -
'k1q1MMt-_ft of personas slarn Sr in any capacity Bhould be typed or vrinted below their mignnture-s.
WARRANTY DEED STA*rE BAR OF WISCONSIN Wisconsin I-Pairal Blank Co- Inc -
FORM 7qb. 1.-1382 Milwaukee, Wis.
St. Croix County 1158101 Page 2 of 3
Parcel #.
42-1020-10-120
Valid as of 11/06/2022 12:16 PM
Alt. Parcel
: 08.29.18.113A-20
TOWN OF WARREN
ST. CROIX COUNTY, WISCONSIN
Owner and
Mailing Address:
Co-Owner(s):
JEFFREY A O
SON
1084 110TH
ST
Physical Property Address(es):
ROBERTS WI 54023
* 10$4 110TH ST
Districts:
Parcel History:
Dist# Des
ription
Date Doc # Vol/Page Type
2422 SC
D ST CROIX CENTRAL
08/30/2022 1 1e 107 / TERMJT
1700 NO
THWOOD TECH
07/23/1997 958/157
Abbreviate Acres: 6.820
Descriptio
:
SEC 8 T29N
118W PT NE NE BEING LOT 2 OF
CSM 8/2382
6.82 ACRES EZ-U-1201/243
Plat
Tract (S-T-R 401/4 160'L/4 GL) Block/Condo Bldg
* N/A -NOT
VAILABLE 08-29N-18W
2022 Valu
ions:
Values Last Changed on 09/04/2018
Class and D
cription Acres
Land Improvement Total
G1-RESIDE
TIAL 6.820 95,100.00
225,100.00 320,200.00
Totals for 2022
General
Property 6.820 95,100.00
225,100.00 320,200.00
Woodland 0.00
0.00 0.00 0.00
Totals for 2
1
G
neral Property 6.820 95,100.00
225,100.00 320,200.00
Woodland 0.000
0.00 0.00 0.00
2022 Taxes
Taxes have
iot yet been calculated.
Key
* - Primary
2021 Real state Tax Summary 07/01/2022 02:27 PM
Paue 1 Of 1
Parcel #:
042-1020-10-120
TOWN OF WARREN
Alt, Parcel #:
08.29,18.113A-20
ST. CROIX COUNTY, WISCONSIN
Tax Address:
Owner(s): 0 = Current Owner, C = Current Co -Owner
JEFFREY A & JEANETTE
M OLSON
0 - OLSON, JEFFREY A & JEANETTE M
1084 11 OTH ST
ROBERTS WI 54023
Districts:
SC = School, SP = Special
Property Address(es): Primary
Type Dist #
Description
1084 11 OTH ST
SC 2422 113CH
D ST CROIX CENTRAL
SP 1700
NORTHWOOD TECH
Legal Descriptior: Acres:
6.820
Parcel History:
SEC 8 - T29N R18VJ
PT NE NE BEING LOT 2 OF
Date . - Doc #. Vol/Page Type
C8M 8/2-3-82" 6.82"
ORES EZ-U-1 201/243
07/23/1997 958/157
Plat: Primary
Tract: (S-T-R 401/4 160'/AGL) BlockJCondo Bldg:
N/A -NOT AVAILABLE
08-29 N- 1 8W
Tax Bill #: 43804
Net Mill Rate
0.015710101
Installments
Gross Tax
5,596.06
End Date Total
School Credit
565.69
Land Value
95,100
Total
5,030.37
1 01/31/2022 21244.54
Improve Value
225)100
First Dollar Credit
76,49
2 07/31/2022 2,476.94
Total Value
320,200
Lottery Credit
I Claim
271.30
Ratio
0.8975
Net Tax
4$682.58
Fair Mrkt Value
356,800
Amt Due
Arnt Paid
Balance
Bal. Codes
Net Tax
4,682.58
4,682.58
0.00
N
Special Assmnt
0.00
0.00
0.00
N
Special Chrg
39.00
39.00
0.00
Delinquent Chrg
0.00
0.00
0.00
Private Forest-
0.00
0.00
Woodland Tax
0.00
0.00
0.00
Managed Forest
0.00
0.00
0.00
Prop. Tax Interest
0.00
0.00
Spec. Tax Interett
0.00
0.00
Prop. Tax Penalty
0.00
0.00
Spec. Tax Penally
0.00
0.00
Other Charges
0.00
0.00
0.00
TOTAL
4,721.58
4,721.58
0.00
Cover -Payment
0.00
Notes:
Payment History: (Posted Payments)
Date Re i -.ei pt # Source Type
11/01/2021 C L
01/03/2022 376 M T
Amount GPT SA
271.30 D N
4,721-58 N N
Int. Pen. Total
0,00 0.00 271.30
0.00 0.00 4,721.58
Key: Balance 'ode: D - Delinquent, P - Postponed, N - No Balance
Payment Source: C - County, M - Municipality
Payment Type: A -Adjustment, B-Write Off Bankrupt, D-Write Off Deeded, Q-Quit Claim, R-Redemption, T-Tax
St Croix-Coi iribi I E,8JDJ Page 3 -of -3--
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Wisconsin Departm!nt of fety and *71 JZUes Page of
Division of Industry Serrll �zls•
ounl0bul VALUA I IUN REPORT
OPM 'I
el) ,� m e ni�
cojnl _0 t)l rice with SPS385,Wis. Adm. Code nty
Attach complete site plan on p per not less than 8 1/2 x 11 inches in size. Plan must include,
but not limited to: vertical and orizontal reference point (BM), direction and percent slope, Parcel I.D:
scale or dimensions, north aa. and location and distance to nearest road.
Please print all information. Re
rm7,,e/
Personal infoation you provide -nay be used for secondary purposes (Privacy Law, s. 15.04(l)(m)). VA
Property Owner
ff - - �;/ -
Property Location 0
-Sc 'A ,
Govt. Lot 114 j�Z 1/4 S T N R E (or) W
Property Owners Pfailing Addre,
I
s
Lot #
Block #
Subd. Name or CSMW?f4"
-V
city
Fzz
S
Zip Code Phone Number
city ❑Village To Nearest Road
A.
New Construction
Use:
Residential / Numberof bedrooms
Code derived design flow rate GPD
EIReplacement
Parent material,
El
:Iublic or commercial — Describe:
z
Flood Plan elevation if applicable ft.'2D"�
a
99neral commentsrecornmer
idations:
El Boring
Boring 4
Pit
Ground surface elev. /ft Depth to limiting factor% in.
I Qr%;1
Horizon
Depth
In.
Dominant Color
Mu i isell
Redox Description
Qu. Az. Co .. nL Color
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Structure
Gr. Sz- Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
*Eff#2
Al
Cj
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Boring # El Boring
Pit Ground surface elev. ft. Depth to limiting factor in
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Depth
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Redox Description
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CERTIFIED SURVEY MAP
Located in the NE 1/4 of the NE 1/4 of Section 8, T29N, R18W,
Town of Warren, t. Croix County, Wisconsin, being Lot 2 of
n;
the Certified Su y Map recorded in Volume 8, Page 2382, •
ry
Document NumbS 471816.
L of ly C.S.M., Vol. 3
R. 865, Doc.— Unplatted Land
P lo. 359930
Legend
County Section Corner
monument, found (Aluminum
North line of the NE 714 &
NE Corner i Cap, unless otherwise noted).
Section 8
T29N, R18W 0 1 1/4" (o.d.) Iron Pipe, found.
C, (1 1/4" o.d.
Iron Pipe)
Unplatted Land 1 1 1/4" (o.d.) x 18" Iron
\Vo — — — — — — — — — 0 Pipe weighing 1.68 lbs./
linear foot, set.
co
Previously recorded
a al Bench Marks (200.00) dimension.
(Top of _rron Pipe)
Septic
OCObservatior
C) C
Qj 1 0 BM1=10.16.64
Pipe Soil boring.
V. \. ,c o \ S %,
BM2=1026.77
o 3 .- l%
H.W.E. High Water Elevation.
up
LOCO i
Low Building Opening
6n x
Elevation.
d \
3.783 Acres LP kP #0 �r; Proposed Driveway.
164 779 S.F. CP, y 9 t- �'
Inc ding Road 0-
CO 04
ool Right -Of -Way 33, \� oe—I \ 3` tp
3.1(3 Acres Cn I ° j „ as
CO
Lr)
CS E
Ln .. 0 =
C V) Ln
Excluding Road C
N
M
Q) Right -Of -Way N IC - *§ NU - 0
j (L) 0
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cz RT r
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EE
Z
W.E.=1002.
`tiL.B.O.=1004.8
Daniel P. Kugel S-2684
Lot 6 19,
0 Professional Land Surveyor
09
I Ogden Engineering Company
3.031 Acres gyp? 1234 South Wasson Lane
0 in LO
132,047 S.F. River Falls, W1 54022
Including Road
co N Z�; Job No. 22-3687
Right -Of -Way N C"s
Q� N Date: February 17, 2023
H. W Acres : a
: * LU N
2.895 AContour..j %
S.F.
126,083 (See N to I c C) I
Excluding Road
on Pa 3) L0
`% COAI
Right -Of -Way 0
C)
Sj
(33.039 Ln 2$*F
396.91'(39700) 33.041— 2 :0
-,k
N 88"051061w W 4294-90-85 —1 4 DANIEL P.
(N 168000'41" W) BMI KUGEL
" 4--
-0 a).S�
Owner & Subdivider 0
(D S-2684
Jeffrey Olson N 88"05'06" W 12. 73' 1
0 RIVER FALLS,
1084 11 Oth Street
(N 88 o0q,14 p, W 12.62)
v(0Roberts, Wl 54023 Lot 3, C. S.M., Volume 12,0 U) WI
— — — — — — — — — — — — — — — CD 0
0 a) D 0
S� 3:
Fla 3344, Document No. 564787 -0 %
e
9 U)
--— — — — — — — — — — — — — — — — S U
E 1/4 Corner uj
This instrument drafted See Note 2cv Section 8 I 0.(n
by Daniel P. Kugel on Page 3 T29N, R18W - Page 1 of 3
Wis=sin Department Safety "d Prof M4* Page Of
Division of Industry Se
S 1, C C SOIL EVALUATION REPORT
rn
OL
with SPP' 385, Wm Adm. Code County
Attach complete site plan or paper not less than 8 112 x I I" i �e. Plan must Inc",
but not limited to: vertical a horizontal reference point (SM), &rec*wiand percent slope, Parcel I.D.
scale or dimenslom, north FW5 and location and distance to newest road.
Please print aft information. Reviewed by Date
Personal Inforrnafion y2y pro may be used for R292LWM p2rposes (Fid UW. S. Is.(x(l)(MD. L
Properly Owner Property La M&Dn 0
Govt. Lot Y. 1% S T22 N R jr6 E (or) W
Property owners kfailkQ A Lot # 01 Bkx* # Subd. Name or CSkV
t
j4' V
city,/ sla Zip Code Phone Number y Village Nearest Road
cit
New Construcfion use: Residence I Nwnberof bedrooms Code derived design flaw fate(1�4L GPD
Replacement Pubic or commercial - Describe:
Parent material . x,, �5 d Flood Plan elevation if applicable ft.
General cornments and recorru iendatkxis:
4el/. 9V. 311
Boring #
0 Boring
Pit Ground surface elev.2nv_ ft. Depth to limiting factor In.
Anrdii-afieum
Redox
Qu.Az.Cont
!�l/1.f!�M��1G'�l/Id�7l�l�.�l.IA»■f��.J�i
M
Boring # D Boring
Pit Ground surface elev. ft.
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AL
CER DIED SURVEY MAP
Located in the NE -1/4 of the NF, 1/4 of Section 8, T29N, Rt(SW,
Town of Warren, St. Croix County, Wisconsin, being 1-,ot 2 of
the Certified Su ey Map recorded in Volume 8, Page 2382,
Document Numb r 471816.
Surveyor's C2kjificate
1, Daniel P. KugE I , Professional Land Surveyor, hereby certify that I have surveyed, divided,
and mapped this C =.lrtified Survey Map located in the N E 1/4 of the N E 1/4 of Section 8, T29N, R 1 8VV,
Town of Warren, St. Croix County, Wisconsin, and is described as follows-.
Lot 2 of the Certiried Survey Map recorded in Volume 8, Page 2382, Document Number 471816.
This parcel cont ins 6.814 acres, more or less, being 296,826 square feet, more or less,
including road righ of -way, and 5.998 acres, more or less, being 261,266 square feet, more or
less, excluding roa-1 right-of-way. Subject to the Joint Driveway Easement as shown on said
Certified Survey M p. Subject to all other easements, restrictions, covenants and
conditions of record.
I certify that I haye made such survey, land division and Certified Survey Map by the direction
of the owner of sai land, that such map is a correct representation of all the exterior boundaries
of the land surveyed and the subdivision thereof made, and that I have fully complied with the
provisions of Chap-er 236.34 of the Wisconsin Statutes and the subdivision rules and regulations
of the Town of VVaqren and St. Croix County in surveying, dividing and mapping the same_
Date: February 17, 2023
Revised: March 20, 2023
Revised- April 5, 2023
01 '10%11111111 flit,
C
NX Opt's %
af DANIEL P.
KUG
S-268
RIVER F LLS
Curve Table
Daniel P. Kugel S-2684 Job No. 22-3687
Professional Land Surveyor
Ogden Engineering Company
1234 South Wasson Lane
River Falls, Wisconsin 54022
Owner & Subdivider
Jeffrey Olson
1084 11 Oth Street
Roberts, VVI 54023
CURVE RADIUS CENTRAL
ARC CHORD
CHORD
TANGENT TANGENT
NO.
ANGLE LENGTH LENGTH
BEARING
IN OUT
C1 315.16' 2
*38' 23 152.03' 150.56'
S 48019'36.5" E
S 62008'48" E S 34030'25" E
(?7-39'72'9 (152.71) (75D.649
(S 4 8 014'55 " E)
(S 34 -25'19 " E)
C2 592.330 32,036'
04" 347.37# 342.42'
S 17042'23.0" E
S 34030' 25" E S 00'054' 21 " E
(5 77 03 77 7 " E)
(5 34 -2579" E) (S 00-4 975" F)
C3 282.16' 2,-1058,
151, 118.05, 117.19'
S 46029t 32.5" E
S 58028'40" E S 34'030' 25" E
(?3'-59'10')
(118.12) (717.269
(5 46 -2454 " E)
(S 34 02579" E)
C4 559.33F 3 .2,
* 3 6' 0 4 328.021 323.34'
S 1704223.0" E
S 34030'25" E S 00054'21" E
(5.92.33)
(5 77-3 777- E)
(S 34 -2579 " E) (S 00 '74 9 75 " E)
St. Croix Coun!y
Note
Each parcel show
on this map is subject to State,
County and Township laws, rules and regulations
(i.e., wetlands, mi
imum lot size, access to parcel,
1
etc.)_ Before purchasing or developing any parcel
contact the St. Cr
ix County Community Development Department and the Town of Warren.
Page 2 of 4
3.-;t - -7,,? L4- C>
St. Croix County 116617,1 Page 2 of 4
CER IFIED SURVEY MAP
L' 1/4 of Section S., T29N, R18W,
Located in the NE 1/4 of the N
Town of Warren, t. Croix County, Wisconsin, being J,ot 2 of
the Certified Survey Map recorded in Volume 8, Pacwe 2382,
2n
Document Number 4711816.
Town of arren Approval
This map ha been approved by the Town of Warren.
Da W -�5�-o Han'so/
Town Chairperson
Countv Tr6asurevs Certificate
State of Wisc nsin )
SS
St. Croix Coutty )
APR 2 8 2023
St. Croix County
Community Development
1, Denise Anderson, being the duly elected, qualified and acting treasurer
of the County of St. Croix, do hereby certify that the records in my office
show no unredeemed tax sales and no unpaid taxes or special assessments
as of 20aS affecting
the lands included on this Certified Survey Map.
'D
e) a
Date Denise Anderson
County Treasurer
1. The High Water Elevation and contour are based on current conditions/current topography
2. In order to meet the driveway standard of 200' separation distance between driveways, the
proposed driveway would be built over the top of an existing 30" diameter culvert which carries
water from thn- East side of 1 10th Street to the West side. Since that is not 'Ideal, a variation
to the drivew y location was approved by the Town Board of the Town of Warren at their
December 1 , 2022 meeting (See Detail on Page 4).
Date- Februa 17, 2023
Revised: Marc 20, 2023
Revised, April 2023
I fill 1111111111.011,f
0 /V
DA141EL P.
K GEL
2684
RIV R FALLS,
W11
S
(rl
Daniel P. Kugel S-2684 Job No. 22-3687
Professional Land Surveyor
Ogden Engineering Company
1234 South Wasson Lane
River Falls, Wisconsin 54022
Owner & Subdivider
Jeffrey Olson
1084 11 Oth Street
Roberts, WI 54023
Page 3 of 4
St. Croix County 1166174 Page 3 of 4
CE IFIED SURVEY MAP
Located in the NH 1/4 of the NE 1/4 of Section 8, T29N, I218W,
Town of Warren St. Croix County, Wisconsin, being Lot 2 of
the Certified Sur Warren, St.
Map recorded in Volume 8, Page 2382,
N Document umb r 471816.
Proposed
Driveway Detail
a) Wo
Q
L.
p t 7
-0 jj -
0 cc E
4-- M
in
CD
co CD
T- Z
4T
Ln
330
M I"
CM
Cn
33'
z
Ngo
(D 0 Uj N 0
CO 'W Z I--
z
I }
Scale In Feet
�,
501
1
0
30 60
124
C%4
L-) U') ,
Lot F3
Lr"C�4
I
CD _
CY% z,-x
Lrl
r14
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cr)
0
C:Z� C=
ZZ) CD
Uj
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CD
LO
00
Co
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co
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Cn
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CD I
C) I
--j I
CD
Driveway
1
1
�I
(3.9700)
C/i
Q I
396.911
(33 ' 03)
33.040
N 88,005,06
" W 429.95y
(/V 8,9-00,47"
W)
N 88-05'06" W 12.73-1---
Date- Februa 171 2023
Revised: March 201 2023
Revised: April 5, 2023
0 IV
DANIEL P.
PqUGEL
$-2684
RIVER FALLS, �z
W1
%% 40 `,1
Daniel P. Kugel S-2684 Job No. 22-3687
Professional Land Surveyor
Ogden Engineering Company
1234 South Wasson Lane
River Falls, Wisconsin 54022
Owner & Subdivider
Jeffrey Olson
1084 11 Oth Street
Roberts, WI 54023
Page 4 of 4
St. Croix County 116617,1 Page 4 of 4
U
1166174
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
CERTIFIED SURVEY MAP RECEIVED FOR RECORD
Located in the NE 1/4 of the NE 1/4 of Section 8T29NR18W, 04/28/2023 12:24 PM
, ,
CERTIFIED SURVEY MAP
Town of Warren, St. Croix County, Wisconsin, being Lot 2 of VOLUME: 32
the Certified Sure y Map recorded in Volume 8, Page 2382, PAGE:7240
Document Number 471816. REC FEE: 30.00
L at 1, C. S. M., Vol. 3 --- PAGES: 4
Unplatted Land
Ao. 359930 Legend
--- North line of the NE 114 County Section Corner
z
0
ta
C3
t3
Qj
ou
45-
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"N
C C'-
7
co 0%
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co 0
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25' Incl
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3.10
co 135,
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cn
2 -5'
E ��
25
HW
Can
(See N
on Pag
Owner & Subdivid
Jeffrey Olson
1084 11 Oth Street
Roberts, Wl 54023
This instrument dr
by Daniel P. Kugel
Current Zoning=
R-2 (Residential)
Unplatted Land
Building Setback
Line, typical
iii moo monument, found (Aluminum
NE Corner i Cap, unless otherwise noted).
Section 8
T29N., R18W
(1 1/4" o.d.
Iron Pipe)
9
Bench Marks I (200.009
(Top of lraa Pipe)
EL
BMI=1016.64
HM2=1026.77 H. W. E.
kln� LP U)
L. B. D.
t 7\
1 1/4" (o.d.) Iron Pipe, found.
1 1/4" (o.d.) x 18"' Iron
Pipe weighing 1.68 lbs./
linear foot, set.
Previously recorded
dimension.
Soil boring.
High Water Elevation.
Low Building Opening
Elevation.
cp— __moo*
Acres CIP-71. \ ,,, ->� U-) —W-41b Proposed Driveway.
CN
ding RoadLC
t-of-way
cc
'1�1
cc
3 Acres
183 S.F.
uding Road
C
�t-Of-Way
Septic
Q
E
Manhole
o Covers j.
0' as ,
0
r�,�. � a I
A/1 C's
C1
Well
-919,
4P �4 0,
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L W E. 1002.8 ---r \
-.B.O.=1004.8 Aze ci
Cn
C/
Lot 6 19
3.031. Acres
to
132-�047 S.F.
Includincy Road
L-0 CIR
Right -Of -Way 50,
04
WA C%4
2.895 Acres :::T LU
LU
C'N
C'N
)Ur 1261,083 S.F.
�t3�1 Cy
C) lr�
6VxcludingRoad
Co
Right o
-Of-Way
T- -Kr
in
-71 396.9-11 (397L7og (33-039 Ln
(D
CD
— 33.041
Cn
N 8800so6" W 429.95" Bm-1 T
88000'41" W)
N 88'005 "06 " W 12.73
(At 88 000'4 1 " W 72- 62)
Lot 3Y C. S.M., Volume 12,
Qz� Ca e3344, Document No. 564 787
Red see Note 2 on Page 3 E 1/4 Corner
and Detail on Page 4 Section 8
T29N.) IZ18W
- j c.,� � s_
cc E c
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1- 0 Cc CD
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in LU 0 1z
r- gD V. -
= V. Z
40 0 LAJ 0
Z
Scale In Feet
0 60 120 240
Daniel P. Kugel S-2684
Professional Land Surveyor
Ogden Engineering Company
1234 South Wasson Lane
River Falls,WI54022
Job No- 22-3687
Date: February 17, 2023
Revised: March 20, 2023
Revised: April 5, 2023
0
i `,���;�11�ilI�tI�IJ�N11�eI�`�rr
0 ks/VIC
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DANIEL P.
a� KUGEL
X S-2684
RIVER FALLS, Q7
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C) Page I of 4
3D-
St. Croix County 116617,1 Page 1 of 4