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Parcel 042-1013-60-000 10/19/2006 09:07 AM
PAGE 1 OF 1
Alt. Parcel 05.29.18.80D 042 - TOWN OF WARREN
Current X_j 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 - HANSEN, CLIFFORD R & PAMELA J
CLIFFORD R & PAMELA J HANSEN
1082 110TH AVE
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 1082 110TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 4.910 Plat: N/A-NOT AVAILABLE
SEC 5 T29N R1 8W IN SE SE LOT 2 OF CSM Block/Condo Bldg:
VOL 3/865 ORD ALSO W 177 FT OF LOT 1 CSM
VOL 3/865 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
05-29N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 952/154
07/23/1997 706/246
07/23/1997 602/290
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/19/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.910 36,400 126,700 163,100 NO
Totals for 2006:
General Property 4.910 36,400 126,700 163,100
Woodland 0.000 0 0
Totals for 2005:
General Property 4.910 36,400 126,700 163,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 127
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
jj ~ L5 lV s u e~
4iri',''!' ~J l7
ST. CROIX COUNTY
RVEYOR'S RECORD
CERTIFIED SURVEY MAP
GEORGE SCHWALEN
Part of the Southeast 1/4 of the Southeast 1/4 of Section 5, Township 29 North,
Range 18 West, Town of Warren, St. Croix County, Wisconsin.
9 ~ 91
o Indicates 1" x 24" iron pipe stake weighing 1.13 lbs/ft. set, n
• Indicates 1" iron pipe found. ~1`ED ~f W
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APPROVED s s 0
o m0
Q Q;I~ 00`oa~aaGnOiuuni
N r I 0 ~5...". N
SEP 19 1979 "
S1. C~OIX COUNTY .'JAMES L.
COMP.&HENSIVE PARKS PLANNING `V ' ~I'/ (L pJ = MURPHY
AND ZONING COMMITTEE O.
OQ ~ 0 S 1 0 4 2
RIVER FALLS, rAa
APPROVAL OF THIS MINOR SUBDIVISIOIO N per . wlsc.
1641 .
DOES NOT MEAN APPROVAL FOIb~ ' ~l
1~ '0
BUILDING SITE OR SEPTIC SYSTEM; Ol m 1 q LAND
P~``
1 I 4uW uai uu►u~~
REFER TO H62.20.
z 0 ✓ 1
Vol.__I_Page 865 v 4110-
Certified Survey Maps ;I James L. Murphy
St. Croix County, Wisconsin I Registered Land Surveyor 00
1J (Description on reverse)
AS BUILT SANITARY SYSTEM REPORT
s
4NR TOWNSHIP SEC .S T "N R W
ADDRESS d 1 ? zz, ST. CROI COUNTY WISCONSIN . ___L
SUBDIVISION LOT Z__ LOT SIZE ,
PLAN VIEW
Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
,e- e-
I di a e o th Arrow ' j
S L - i
SEPTIC TANK(S) / MFGR. CONCRETE STEEL
NO. of rings on cover / Depth ,[a-
PUMPING CHAMBER SIZE PUMP MFGR. MIL NO.
GALLONS Per Cycle
TRENCHES NO. of wic t-H length area
BED NO. of lines width z , length _sz area ,-,Z V-&/
dept to top o pipe
NUMBER OF SEEPAGE PITS Outsi a diameter total pit area
AGGREGATE /y'
PERK RATE ,S AREA REQUIRED ~ !J' AREA AS BUILT _j;:
Disclaimer: The inspection of this system by St. Croix County does not imply
,complete compliance with State Administrative Codes. There are other areas that
it is not possible to inspect at this point of construction. St. Croix County
assumes no liability for system operation. However, if failure is noted the
County will make every effort to determine cause of failure.
GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH
e
INSP
DATED .mod, 41 & PLUMBER ON JOB
LICENSE NUMBER-
C' f
S'
C i a ,
Z .i
REPORT-OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
San.itaAy Penm.it_
State SQpt.i.e /
NAME- ,p
Towneh.c St, CAaix County
. Location Section
SEPTIC TANK J--
S.ize- yzr - gattone. Numbers oS CompaAtmentb
ViAtanee Fnom: Wet it. 12$ oa gneatet 4tope it
~ .
Bu.itd ing-7 j- it. Wettand.6
H.ighwaten
DISPOSAL SYSTEM
D.catanee Fnom: Wett Lvj -7/ it. 121 on gAeateA a.tope -----ix.
Bu.itd.ing 12 d it. W ettandb Ft.
• H.ighwateA it.
FIELD DIMENSIONS: _
Width o6 tAen eh -2 it. Depth o6 Ao ck b et ow t.ite 1 Z in.
2- Length o6 each tine li it. Depth o6 Aoek oven t.ite .in.
Numbe&. o6 tin e.6 Z Depth of t.ite below gnade
Totat .length o6 .Lined Z it. Slope o6 tneneh in pen 100 it.
DiAtance between .Linea G t. Depth to bedAock St.
Total abe onbtion area 6t2 Depth to gAOUndwateA ~z.
Requited anea 4o1 ~t2 Type o6 Coven: apeh on StAaw
PIT DIMENSIONS:
HumbeA o6 p.itb - Gnavet around p.ita ye.a no
f ,
Outa.ide d.iam" tz Depth below .inlet it.
2
Totat ab.6 Abt.ion anea St Z
A
Area kequi.ked _ it2 m
INSPECTED BY - TITLE
APPR®- P DATA ? 19
REJECTED ,DATE 197
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
> P.O. BOX 309
MADISON, WISCONSIN 53701
REPORT ON SOIL BORINGS AND PERCOLATION TESTS
LOCATION:' Section _51, TaL~N, R L E (or) W, Township or Municipality
Lot No. , Block No. County )e
ubdi ision Na
Owner's Name: /
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW J ADDITION REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS 7- PERCOLATION TESTS - 2-2 L/ ^2f'
SOIL MAP SHEET S[ SOIL TYPE It/
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P-1
P - 3,i 1
P-3 136, N1 o~ 6'
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
B of e_ b Lq ~i/ y3 g
B 7 7 = Sid %D`-5
yb.,s
`--51
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square feet of suitable re s. Indicate number of ware feet of absor n a a
needed for building type and occupancy. r deeLl n ate e
or distances. Give horizontal and vertical reference po ts. Indicate slope.
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PLff 67 State and County State Permit #
Permit Application County Per i #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address:
/ GI '091 L /`3 9 f / e L/ . G 252
1 1 / ry G r ~er ~~5 LGwi
B. LOCATION: Se Sec io T;? 7 N, R / E (or) W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
Township L~/gr/' c •L
~v
C. TYPE Or OCCUPANCY: *Commercial *Industrial *Other (specify) Variance
Single family Duplex No. of Bedrooms No. of Persons
D• SEPTIC TANK CAPACITY Total gallons No. of tanks e-g-e -
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify)
New Installation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT__L)ISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft.
New - Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed: -Length- Width 42 Depth 3 Z" Tile depth (top) No. of Lines
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land- Distance from critical slope
WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner: ZGr.
I, the undersigned, do hereby certify that the information have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME/ G C.S.T. # y 3 and other information
obtained from (owner/builder).
Plumber's Signature ZC~ MP/MPRSW# a S`9 Phone #2 0"e
Plumber's Address,
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Dave Fogerty Plumbing
• SEWER SYSTEMS & PERK TESTING
FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 1~i1 rE zivSTAtti~O
(715) 749-3656,~~/,? 03
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sa~~o a~,v. Tom- rl.~ o~
79E PA*Xz ~t t1~ eu1L! G rS~ zL~r /C yowl-
c.3v,4 tfE ooyT 6J'/ - yol - •2!0` ,C'cC~i'~ drd~
NXS <o 41dR)
~EI/ /V - Tarr ss 7'y~ L Lr fT~i~
/ ~ T S.EtirT T v GG IFf ~ ~Sn.! ! -
L 77
CofS~'~77, s"yei7 .
y
PlAs
W,
Dave Fogerty Plumbing
♦ r SEWER SYSTEMS & PERK TESTING
FOGERTY HEIGHTS ROAD ROBERTS. WISCONSIN 54023 RECEIVED
(715) 749-3656
' a tooz
UIiUIRICOUNT'r
ZONING OFFICE
CGtFF~ .
sr-- f OX4*
k,4914tXW-4 A5 ,WF A'6,,
COw 4ocAl
R/Arz..oc'' .41407jaeorb 711' w 4w row, .Pa ~
~►A~iE~ 7 ZrC- XAt 77V,,-- fEcdFc 4r'WE. 7//07` .t1 .rte-'
E c.~tL Af4e ltT 6S/ - y®1- .?!O` ,~►c~is+,~dr~~
/7
7
Syr oj-
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Gt,cF, qA& Oj
0
ADDRESS
2,0
2 fT , r,. a Sow t
SUBDIVISION / CSM# tl&l -mss r3a LOT # 2
SECTION _T Z`r N-R1y W, Town of
10,
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
,
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- _ _ - -T - - - ---rte-- Ir
i
, !?y
/14
d = rOP or' ta,t~~,p,t ~L~~
SCOZ C7 Lea
y dog sysr~.+~
C~
Xoar
INDICATE NORTH ARROW
Provide setback and elevat on information on reverse of this form.
Provide 2 dimensions tenter of septic tank manhole cover.
a y BENCHMARK : Y o W i2 N ►L E /dd,
el a
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
/7 4ta -rLrE14
Manufacturer: Liquid Capacity:
Setback from: Well > ioD ' House 09 Other
Pump: Manufacturer Model# Size
Float seperation Gal e:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: S Length /Oo Number of trenches 2
Distance & Direction to nearest prop. line: > yo - w%s i
Setback from: well: House 72v t Other
.rr. , /.2 ' /
ELEVATIONS
Building Sewer ST Inlet: 31V ST outlet: /.T/, cy
PC inlet - PC bottom Pump Off
Nor
Header/Manifold * 2 9/.B' Bottom of system,.y z Po&o l
Existing Grade Atz iho Final grade*~_,?%&
t
DATE OF INSTALLATION: l ~ llx
PLUMBER ON JOB:
vl
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
-Labor aad Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit NO.:
GENERAL INFORMATION 284203
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
HANSEN, CLIFF WARREN
CST BM Elev [Insp. B Elev.: S BM Description: Parcel Tax No.:
AQAnnAA7
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic iY p/ ~cnQ, Benchmark /Oo,0o
Dosing
Aeration Bldg. Sewer
H9kg` St/Ht Inlet ' "1.21" ~
TANK SETBACK INFORMATION St / Ht Outlet
TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing - NA Header / Man.
Aeration DA Dist. Pipe Y7'
Holdin Bot. System
i
PUMP/ SIPHON INFORMATION Final Grade 9.x(07
Manufac Demand
Model Number GPM
TDH Lift Lriction System TDH Ft
Force in Length Dia. ti Dist. To well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. O~enches PI EN I No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Manufacturer:
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHI
SETBACK CH R Moe Number:
INFORMATION Type O A./z, o UNIT
System:c. e,,
DISTRIBUTION SYSTEM GD
Header 1 a Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length __L~- Dia- Length ! Dia. ~ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or rade System
Depth Over < ,f Depth Over xx Depth Of,-' xx Seeded/ Sodded Tx
/ v « Yes ❑ No ❑ Yes ❑ No
Bed /Trench Center , `f - Y& Bed/ Trench Edges p?~ - 0 Topsoil E] COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: WARREN.8.29.18W, NE, NE, 11,0/TH AVEn5~ -
_A,*4 ( ZC
Plan revision required? ❑ Yes [2/No op
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
k
Safety and Buildings Division
v■~■~ir• SANITARY PERMIT APPLICATION Bureau of Building Water systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size.
• See reverse side for instructions for completing this application state sanitary Per it Number
~t o?
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
(Privacy Law, s. 15.04(1)(m)]-
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
1ia 1/4, S 8 T , N, R E (or)(0
lq,* Al
Property Owner's Mailingpddress Lot Number Block Number
l® y-z //p .4vE
City, State Zip Code Phone Number Subdtwmop or CSM Number
O gn 13 w 1223 (7 ) 386.3 L -3. P S9 3D
II. TYPE OF 'BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road
❑ ge
Public 21 1 or 2 Family Dwelling - No. of bedrooms Town OF
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
o y2 - ie e - 4o //0 Fresco A04 L
1 ❑ Apartment/Condo D Z /o/3-6D eft.
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. jWNew 2. m Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
______System System Tank Only______________ Existing System _________Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S stem Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 0 0.0 ~ ~ I va$ion
dD#
r 2 90,p Feet Feet
VII. TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per-
New Existing Gallons Tanks Concrete Con- Steel glass Plastic App
structed
Tanks Tanks
Septic Tank or Holding Tank / WEE S ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ~ ❑ ❑ ❑
VIII. RESPONSIBILITY STATE-MENT
1, the undersigned, assume responsibility for installation oft a onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Sta ps) M44MPRSW No.: Business Phone Number:
T ~z~ 7 - GrG
Plumber's Address (Street, City, State, ip Code): ,
o /3v r r, Wr 0 .13
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signature (No Stamps) -
X Approved E] C,Dd Surcharge Fee)
Owner Given Initial ~ /
0/ A
Adverse Determination
X. CONDITIONS OF APPROVAL / REASON FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety 8 Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed-
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7,
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or. with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
DAVE FOOOM PLUMBING
Licensed6Po Test Plumber
89
w. aT ROBEWjMSONCN5540
Phone 749.3656
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Dave Fogerty Plumbing
SEWER SYSTEMS & PERK TESTING
FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023
(715) 749-3656
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations
Division of Safety and Buildings in accordance with s. ILHR 83.Og, WIS. Page / of
Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan most County
include, but not limited to: vertical and horizontal reference point (BM), direction
percent slope, scale or dimensions, north arrow, and location and distance to r- S GRO%
a road. parcel LD. #
APPLICANT INFORMATION - Please print all information. ) 1/ 2-16 ZG /6 //a
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (i) (m)).
Property Own_er A
Property Location
Thy ~~~+0~. /~/M 14f yEA
Property Owner's Mailing Address Govt. Lot NE i14 1V,6' 1/4,S 8 T 21 N,R /B E (or)~
~a 90 ~~~1 ~~fe • 11W # 414'99F ock# Subd. Name or CSM#
City State Zip Code Phone Number O ~4clS PEED/~ C'S~
Ro13ERTS 5yoZ3 M _ )7fe _ 3706, ❑ city Village 0-Town Nearest Road
[B New Construction Use: Residential /Number of bedrooms 3 w
❑ Replacement Addition to existing building
❑ Public or commerbial - Describe: _ NO r
Code derived daily flow
gpd 0 Recommended design loading rate
Absorption area required Al bed, ft2 d0 bed, gpd/ft2 trench, gpd/t~
trench, ft 2 Maximum design loading rate /V
Recommended infiltration surface elevation(s) .Sle.~ p 4 , 3 bed, gpd/fl2 • .~P trench, gpd/ft2
ft (as referred to site plan benchmark)
Additional design/site cons bons ZrSE" LO,v(,~- ,Uj¢ieiClpec) -~-.t~~lS ~
P rent material S,4TrAr- ' /?v,P,rlii9,~oT- D,Po ~oX p/ST,~°i~vTo
N lo1/0 plain a evation, If applicable ft
j0d
S = Suitable for system Conventional Mound •In-Ground Press
ure AT-Grade
U = Unsuitable for system El U P's El U ~S~yst~em in F(II Holding Tank
CIS ❑U CIS ❑U &'S System
❑S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles
' in. Munsell Ou. Sz. Cont. Color Texture Structure Gr. Sz. Consistence Boundary Roots
Sh. GPQ/tt2
0-/o low 3/2- Bed , Trench
y 1-0qy .7Ay sbk a°sti es 3f s
Ground -7 elev.
2 'e
s. CIS
Depth to
limiting
factor
y f2-ln. 1
Remarks:
Boring #
o- /oYrP 3/i.
Z L 2
S
C ~'F
C-/3: /o fR 31o a®ti S -
2
U C_17 S
Ground 3 3~ O L 1" L .
elev.
Depth to
limiting
factor
? in. Remarks:
CST Name (Please Print)
Signature y~-
4O~~IpT =N_
Address 7/!J '
/0 Date
CST Number
14 PROPERTY OWNER SOIL DESCRIPTION REPORT Z .
Page of,
PARCEL I.D.# Ate T etc7 /eq 44cz-S
Boring # Horizon Depth Dominant Color Mottles Texture
a In. Munsell Qu. Sz. Cont. Color Grt Sz. Sh. Consistence Boundary Roots 2
Bed . Trench
~ 3 o- io ye 3/z MR Z d CS 3f
Z -/P /o o~M CS z-~ • . Y ' • S
Ground 3 -27
elev. ✓ ~
yy att. 7-3 75 . s. o s ,e 7:-9
Depth to S 0 7 , g
limiting
factor
In.
Remarks:
Boring #
•S /o y~e 3/2, oAM 2,Av 5je 6fS4 CS 3f /0 3l ~y / sh,~ sti cs . y ;.5
Ground
elev.
bn. S . ,s O S . 7 ' • $
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles im exture Structure Consistence Boundary Roots G'
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # d Ne /oYiR 312- fl M 21M AS'ti eS 3 f . S ~
5- z -/G /o Yoe 312 - A Y rid 4 a f • `f ;
3 3 2 /0
Ground l~
5 ;Y16 4,e / , s- . fop
. 5.
elev.
y att. /o S p S 7:-8
Depth to
limiting
factor
In.
Remarks:
Boring #
Ground
elev.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER GGCF~ ffi¢SE.t~
MAILING ADDRESS 10,f .1 Ile A,,.
PROPERTY ADDRESS Sf4~'
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE if Rco & .t S-/oz-7
PROPERTY LOCATION 1/4, elE_ 1/4, Section r T 2- 9' N-R / W
TOWN OF &IVAIZ ,e AX-) ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP (17181(- , VOLUME PAGE .423,12-, LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
.
County Zoning Officer within 30 days of the three year e p atjgn e
/
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of property_/v,- 114 ,vl= 1/4, Section k T~ _N-R IF W
Township Mailing address
Address of site S,4/yfF_
Subdivision name Lot no.
Other homes on property? Yes_~No
Previous owner of property ,sr ,¢4ao2
Total size of property
Total size of parcel ^-,tov ar.imo
Date parcel was created Iffo6
Are all corners and lot lines identifiable? ✓ Yes No
Is this property being developed for (spec house)? Yes ✓ No
Volume /2,9/ and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the _
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. : s-e 2. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County. Register of Deeds as Document No.
l ~
a~nature of pplicant Co-Applicant
113
0LC%
47.816 CEP T I E .I ED SUP V E Y MCI
Located in the NE1 /4 of the NE1 /4 of Section 8, T29N, R 18W , Town
of Warren, St. Croix County, Wisconsin.
Surveyed for: Anne Kurkowski
1020 99th St.
Roberts, Wi.54023
(715) 749-3772 HARVEY G. 1"l '1
_G.S. M . C.S. M. = JOHNSON
• S-1899
VOL VOL. 3 HUDSON
• North line of the
N1/4 Corner _PG_. _694_ PG. 865 WtS 0~,~• NE1/4
Section 8 (S89°17'30"W) I 2590.50
N 88' 45' 27"E (S89017'30"w) of f$ fi 08'40"E 897._29'
~~•fi _ - - NE Corner
_I LOTH_A_YE i- 33.00 ( - \ Sect ion 8
N 884527"E
301.16' T29N,R18W
co 4 East line of the
@° NE1/4
1- "1
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perc'd areas
CSI
m
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442 , 610 Sq. Ft. i°n: ° (D I O
3 zo (10?, 16 Ac.) a X~oO Q w CL Ji
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cn 427, 367 Sq. Ft. a \ \ - I
~l (9. 81 Ac.) m rn: \ \
F- ; Excluding right -of -way • \ o J
C) 0:
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Z 25 L07 2 \1\
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n-{ 296,930 SqA. \ \ I -
tali
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::D( Inc. right -of -way w 6 w
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(6.00 Ac.) l JmU I
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W 'T885.21'
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UNPLATTED LANDS t
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CERTIFIED SURVEY MAP
GEORGE SCHWALEN
Part of the Southeast 1/4 of the Southeast 1/4 of Section 5, Township 29 North,
Range 18 West, Town of Warren, St. Croix County, Wisconsin.
8 91.:1 d~ .
o Indicates 1" x 24" iron pipe stake weighing 1.13 lbs/ft. set.
• Indicates 1" iron pipe found. F1`ED ~f
co SEp 21099
0. C
DES
of Desd5
/ SCALE / " = ZOO S? RS~sGotx ~punty. A%,
~ll+ca"MI \ 0
E 2 0
AGG ,E3 E~q R//V S ~4E.~' 7-O T~'E EA 5 T m
G ?"/SAE' :e5,/6 --S7, Z 4-=) N V)
S 00° 00" 00k 85 8-7 ' z5~ I\ Vi
0
o ~ W •r ~ ~ I
Im
0 ~1 ~ Q Q ~ m •m ~z : o ~ . m
W m
r ~ m 0 ONQ o `o
1
0 /V 00 D O 00 E S'7Z. (515
CD ~I '0 N N . ~ o
0 00 ~i m
g7" N 600.00"
_ /1 0 O°00'00",E- /-!5 /O. e7 "
10b O`~S8~ H T Q
N/0 6" _ C 0
/(0 C /10° Sz'OO'
I~ O d /50 --3 O"
APPROVED' s I N
0 h ` V ~I \\p1111iiiliifi(11q///// ~W
S E P 19 1971
n I 0 °°~,~~5•G N
y
DESCRIPTION:
That certain parcel of land located in the Southeast 1/4 of the Southeast 1/4 of
Section 5, Township 29 North, Range 18 West, Town of Warren, St. Croix County,
Wisconsin, more fully described as follows;
Commencing at the Southeast corner of said Section 5, thence S 89° 17' 30" W
349.60' to the POINT OF BEGINNING of the parcel to be herein described;
thence S 89° 17' 30" W 331.99';
thence N 000 00' 00" E 1310.87';
thence N 890 17' 30" E 681.59'
thence S 000 00' 00" W 1185.$7'along the East line of the Southeast 1/4;
thence S 69° 08' 00" w 374.13' to the POINT OF BEGINNING of the above described
parcel containing 20.01 acres, more or less, together with an easement for
ingress and egress over and across that certain parcel described as follows;
Beginning at the Southwest corner of the above described parcel, thence go
N 89° 17' 30" E 331.99'; thence S 44° 43' W 82.90' to the centerline of a town
road; thence Northwesterly along the centerline of said Town Road on a curve
concave Southwesterly whose chord bears N 780 40' 25" W a distance of 279.06'
to the POINT OF BEGINNING; said parcel being subject to easement over the fol-
lowing described area for ingress and egress;
EASEMENT DESCRIPTION:
Commencing at the Southeast corner of said Section 5, thence s 89° 17' 30" W
349.60' to the POINT OF BEGINNING of the following described easement;
thence S 89° 17' 30" w 331.991;
thence N 79° 00' 00" E 302-801;
thence N 25-023,'311 E 91.95';
thence S 780 42' 02" E 66.00';
thence S 11° 17' 58" W 107.46';
thence S 69° 08' 00" W 51.75' to the POINT OF BEGINNING.
(For purposes of this description all bearings are referenced to the East line
of the Southeast 1/4 of Section 5, T 29 N, R 18 W, assumed N 00° 00' 00" E)
State of Wisconsin)
Pierce County)
I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction
of the Owner, George Schwalen, I have surveyed and divided the lands shown hereon
in accordance with official records, Chapter 236 of Wisconsin Statutes and the
Ordinances of St. Croix County; and that the above map and description are a true
and correct representation thereof.
` NG nOz
Dated: 4 September 1979 S.•• •-NS
JAMES 1.
MURPHY '
Vol. 3 Page 865 S- 1 0 4 2
r YOL1;7{~ PatE4:3 ~~C~l~~'At
530271 F-: tir P&A
OCT 2 1996
at 10:00 4 P:i
D / l CI Pe d t56eds
{/fJ~~wT" r/~ - l O 20 s-
Return to: GRANT OFEASEME=NT
Heywood & Cari, S.C.
204 Locust St., Hudson vu 54016
WHEREAS, John J. Agger and Kimberly F. Agger, husband and wife, hereinafter referred
to as "Grantors", own a certain parcel of real estate located in St. Croix County, Wisconsin
described as Lot 1 of a Certified Survey Map recorded July 24, 1991 in Volume 8 of CSNI's, Page
2382, Document 471816, being part of the NU 1/4 of the NE 1/4 of Section 8, Township 29 North,
Range 18 West., which property is hereinafter referred to as "Grantor's Property and
WHEREAS, the Clifford R. Hansen and Pamela J. Hansen, own certain real estate in St.
Croix County, Wisconsin which lies North of Grantor's Property and which is described as Lot
Two 2 ertified Survey Map, recorded September 21, 1979, in Volume 3, Page 865,
Document No. 359930, being a part of Southeast Quarter of Southeast Quarter (SEIi4 of SE 1/4)
of Section 5, Township 29 North, Range 18 West, Town of Warren, St. Croix County,
Wisconsin, which property is hereinafter referred to as "Grantee's Property", and
WHEREAS, the Grantees are in the process of replacing their septic system which
services their property and in order to do so a new drain field must be installed, which would be
located on Grantor's Property and Grantors are agreeable to the location of the drain field on their
property, and by this instrument are hereby granting to the Grantees, an easement for the
placement of a drain field and septic system line on and across Grantors Property as hereafter
provided
1. Grantors hereby grant to Grantees a perpetual easement for the installation, future
maintenance, repair and replacement of a drain field and septic line leading to said drain field on
and across Grantor's Property, the approximate location of which, shall be within the North 135
feet of the West 162 feet of Grantors Property.
2. In addition to installation of the drain field appurtenant lines, Grantee's shall have the
right to maintain, repair and replace the drain field and lines aind Grantor fur'e, giants th4~,, right
of ingress and egress across Grantor's Property for the purposes of maintciiance, repair and
replacement.
1, PAc `?T4
VDL .
3. This easement shall run with the land and inure to the benefit of the Grantees, their
heirs and assigns
Dated this day of September, 1996.
Cli±~1` rd R. Hansen Pamela 1 flansen
Aw J- AI K1mbc0y F Ag-cr
ACKN0" LF.DGM 1v NT
STATE: OF WISCONSIN )
)Ss
ST. CROI X COUNT Y )
Personally came before me this 3-4 day of September, 1996, Clifford R- Hansen,
Pamela J. EFansen, John J. Agger and Kimberly E. Agger to me known to be the persons who
executed the foregoing instrument and acknowledge the sainc.
RUTH LUNDELL
NO" Y 913LK MINNESOTA
S 1 4
MY COM.>r11SSION EXPIRES - TT
JANUARY 31, 2000 Notary Public
St- Croix County, Nksconsin
my commission expires _ J- -dogo-_-
This instrument drafted by.
Heywood & Cari, S C. by Samuei R. Carl
204 Locust Street, P.O. Box 125
Hudson, Wisconsin 54016
(715) 386-5551
.
♦ ' DOCUMENT NO. STATE BAR OF WISCON-SI\ FOR*4t1 --1983 TN_* SPACE RESERVED FOR RECORDING DATA
Y
_.yvARRArir EI)
S
li This Deed, made hetwf-n -_John.-A KUrkowsk-1 --ak. Rf01STFQ°S OFFICE
JO-hp .KUTkQWs.R. ---and_A,.,Ze T. Kurkow-sU ._ak..a.Anne- ST. CROIX CO., Wi
Kurk.owski.,._husband_ and wife,. Reed for Record
. - Grantor,
AUG2 61991
1 and .John .J...Ag er.. and .Kimberly Agger, .
husband and wife, as survivorship-marital
proerty.._.. - . . 11:90 A.~Mn
C
~I • - -----Grantee, oiDegds
Witnesseth, That the said Grantor, for a valuable consideration
of Twenty Thousand-_($20,.000.-0-0) .Dollars
conveys to Grantee the following described real estate in $_t . _ CTO X R[7 R,1 TO
County, State of Wisconsin:
Tax Parcel No:
Part of the NE1/4 of the NE1/4 of Section 8, Township 29 North, Range
18 West, St. Croix County, Wisconsin, described as follows: Lot 1 of
Certified Survey Map filed July 24, 1991 in Volume "8", Page 2382,
Document No. 471816.
This -._l.S_-IIOt homestead property.
(is) (is not)
a Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Gran_ for
° warrants thbt the title is good, indefeasible in fee simple and free and clear of encumbrances except
{ and will warrant and defend the same.
Dated this ...-.23rd _ =~•Ugi1
`y - - - day of S t 19.91
i~1..✓..' - (SEAL) ----(SEAL)
. John A. Kurkowski
1 ak - --J ro~w~k I - - -
- _ - - ---..(SEAL)
. Anne T. Ku_rkowski
aka Anne Kurkowski
AUTHENTICATION ACBNOWLUDGMENT
Signature (a) - - STATE OF WISCONSIN
as.
- - - -•------•-_.County.
authenticated this ..day of-..-------- 19 Personally came before me this ____23 d----day of
--------------19-------- the above named
- . -
TITLE: MEMBER. STATE BAIL OF W1 S;'1)ti:3n;
(If not-
authorized b - -
y $ 705.06, Wis. Stats.) to me known to be the person - who executed the
C ~ rM:S 8F0.Ci RLSEAYL~ FOR RECJ~+'iG DA'A
DOCUMErNT No. STATE BAR OF WISCONSIN FuI )1 3- 1432
CLAM DEF-D
4838%: 5 VOL 9'_ 2?A,X154 REGIS ERIS 1 c
VALERIE J. BALL and STEVEN J. BALL,. r
Wow V I'
i.
husband and wire -
- MAY 2 S 1992
quit-Clain:. to _'.CLIFFOp-R,. HANSFNand-PA,'IELA J. HANSEN.---_-.-_--
Of 2:00 P. M
a d wife.
----•-husban . n.....-
-
Rey t W Dw&
,
the following described rea: estate in ___.Sta_CXS~. X._.-...--•------------ - y • RETURN To
State of Wisconsin:
t µy~z - =
Tax Parcel No'
Lots 2 and 3, Certified Survey Map Vol. "3", page 865, St. Croix County,
Wisconsin. Being a part of the SE 1/4 of the SE 1/4 of Section 5-29-18,
Town of Warren, St. Croix County, Wisconsin,, said Certified Surveypaap
is Document No. 359930 and recorded September Deed l~ 19ted79. SeptAND that rcel
ember 21, 1979,
of land described in that certain Warranty
authenticated September 21, 1979, recorded October 9, 1979 in Vol. "602"
page 290, Document No. 360314.
F~
~:XE►_~1Pr~
This is__nOt......... homestead property. {
(is) (is not)
Dated this 40.T.k.--- day of I is 9Z
-
'7 -----(SEAL)
..................(SEAL) ._~_(~-~.t-+~-~`•'~
Valerie J. Ba 1
~Ll+~lti _ (SEAL)
(SEAL)
` Steven J._ Ball. -
- r+
AUTHRNTICATION ACS.NOWLEDIDUPNT ti
STATE OF WISCONSIN 1 :i
Signat~ire(s)
St. Croix County. s~
Pe Y
authenticated this day of---- 19 `1 came before me this IS 92-_. the above namm
_ ValeriQ J, Ball and ~$teven ,1. ~aII
.
TITLE: MEMBER STATE BAR OF WISCONSIN -
(If -
(If not, - 1
authorized by $ 706.^6, WIS. Stats-) to ;c ts,;., pa to be the person I . . who O[eCnted the
foregobig izi:%trz sent and acknoa::3 tN. sack-
: ~
THIS INSTRUMENT WAS DRAFTED SY