HomeMy WebLinkAbout030-2070-30-120
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER_ ,~G 2 r aC
ADDRESS 2 7 S~,
SUBDIVISION / CSM# 'P 2 -~t LOT # 2-
SECTION T _ o N-R ~y W, Town of1~
ST. CROIX COUNTY, WISCONSIN
II
P VIEW
SHOW EVERYTHING WITHIN 100 FEET F SYSTEM
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7 y I ~ovv
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> s^-v INDICATE NORTH ARROW
Provide setback and eleva ioi~ info ation on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
# ~i ~C 1i7 a G a ~rr'~f' /OO;O
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: zyr-eAr Liquid Capacity:
Setback from: Well y ~o House z~ Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
~I
SOIL ABSORPTION SYSTEM
Width: S~ Length 1~'7 Number of trenches 2
Distance & Direction to nearest prop. line: 7 -s5
Setback from: well: >/Od House Other
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ELEVATIONS
Building Sewer ST Inlet ;mot y 66 ST outlet S!
PC inlet PC bottom Pump Off
Header/Manifold 2-y~i,s Z Bottom of system z ~e,3 ~P .6y
Existing Grade Final grade 9.2,e
N
DATE OF INSTALLATION:
PLUMBER ON JOB: Jg-tti c f0,/j w, G~v~
LICENSE NUMBER: i~ TT rs,s~
INSPECTOR: i✓f/ W f o'~/ - f~~y~G~G
3/ 9 3: j t LJ~ow/ -vt SP
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Numan Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit i
GENERIIAL INFORMATION
PerMCKEAIE,eJERRY/TAMARA ❑ City ❑ village R Town of: State Plan o.: St Joseph
CST BMElev.:Insp. BM Elev.: BM Description: Parcel Tax li
/D
/ 10 P/0 Z"') A9401i
TANK INFORMATION ELEVATION DATA /6 aS 9
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 0 Benchmark C d
Aeration Bldg. Sewer
Holding St/ Inlet ?v
TA TBACK INFORMATION St/ ii outlet
Ventto
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
Septic )Spy NA Dt Bottom
Dosing NA Header] 9 0 9~9~•
Aeration Dist. Pipe ~7 , 9/a
/o, ~9 0, a7
o.s~~ .9• y56
Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Mana a r Demand
Model Number GPM
TDH Lift Fri He Ft
Forcg Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Li Depth
DIMENSION 5 8/ X77 C_~ DIM
Manuf rer:
CMNG-
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA
SETBACK CHAMBER
INFORMATION TypeOf 114w Cv-k / odelNumber:
System: -1i cS sv 9 OR U
DISTRIBUTION SYSTEM
Header HOWWO „ Distribution Pipe(s) 7 i x ~le Size x Hole Spacin en it Intake
Length )4/a Dia_ Length ~7(l Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S my
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
/Trench Center 46221-/Trench Edges y - y TopST_~ ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: St JopepP.36.30.20WSW NE Lot/-2 -.4
~ P
G,w
Plan revision required? ❑ Yes Q_No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No
= SANITARY PERMIT APPLICATION
r~'~Lr■■'\ In accord with ILHR 83.05, Wis. Adm. Code COUS.
. CleD tX
STATE SANITARY PER IT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1 n
8% x 11 inches in size. 1:1 Check if revision to revious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
P ERTY OWNER PROPERTY LOCATION
•4 a?.4144jt GrJ'/a /4, S 36 T I , N, R E (or
OPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, TAT ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
YZ) Y/IF
0 If CITY NEAREST ROAD
III. TYPE BUILDING: (Check one
) ❑ State Owned ❑ VILLAGE :
c~Kf OF: ❑ Public 1 or 2 Fam. Dwelling-~# of bedrooms AR ELTAX N UMBER c (s) h
Ill. BUILDING USE: (if building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4-E] Reconnection of 5.E] Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 M Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 Seepage Pit Pressure 43 ❑ Vault Privy
140 System-In-Fill QfD -j9141 - la- d4 f- - v !I'
VI. ABSORPTION SYSTEM INFORMA ION: 4er s
"(NEV. 7. FINAL GRADE
1. GALLONS PER DAY 12.ABSORP.AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RAE 6. SY~'~~
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Ya• ELEVATION
0 2 .Feet $?•O'* Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber 1~~ F-1 F-I 11 1 El 1 0
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sews ystem shown on the attached plans.
Plu b is Name (Print): lumber' ignature: (No ItI1PfMPRSW No.: Business Phone Number:
v ~f 7X/Z-
sAddress (Street, Ci fate, Zip de):
0 0' rv~ O 2
. COUNTY/DE AR MENT USE ONLY
Groundwater a e Issued Issuing Agent Signature (No Stamps)
❑ Disapproved Sanitary Permit Fee (Includes Surcharge Fee)
Approved F-1 Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL:
SBD-6398(R.08193) DISTRIBUTION: Original to County, One Copy To: Safety & 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 the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Saniiary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county. prior to installation.
5. Onsite sewage systems must tie 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 codo'administrator" or the
State of Wisconsin, Safety. & 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 instslled.
II. Type of building being served Check ohlyone 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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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, ground-
wfiter contamination investigations and establishment of standards'.
SBD-6398 (R.11/88)
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SEWER SYSTEMS & PERK TESTING -:A
FOGERTY HEIGHTS ROAD , ROBERTS, WISCONSIN 54023
(715) 749-3656
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DEPARTMENT OF
INDUSTRY, REPORT ON SOIL BORINGS A
LABOR AND PERCOLATION TESTS (115)
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: OWNSHI UNICIPALITY: nNO.:IBLK. NO.: SU
sw%/,~ 1/ 36 /T 3oN/RzoE(or sT. s~S~H
COUNTY: WNER' YER'SNAME: MAILING ADDRESS: ~T- 2 $pk lZ
ST.C~2.ut \~vUSU~ w syo
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER
Residence 3 NJ • t\- New ❑Replace $ ` ) 0- S O-
RATING: S= Site suitable for system U= Site unsuitable for system C7
CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
[gS ❑U YS ❑U ®S ❑U ❑ S 120 ❑ S 9U z ` s- ~RcN s'x-) S' L
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the A
under s. ILHR 83.09(5)(b), indicate: L° L-/~Cg 5 2 Floodplain, indicate Floodplain elevation: • s A .
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-fte" s CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH W. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
q3 1 ' Nox,~ 7 S o --I' bk3>7 S l Ts; G►-:
B S.(3' o`...)' 11 . S VV 1't51 ~PoA
B- S. o' 46. b + ? 5.0, - 0.61 'r U.4' Cue4Y AA,mt,
0.6 c~►sl.~ 1.-2, F3.4 C.
B- (c•2' °t t. _ 6.z~ << o•S' ,C 3-o'IS )4=s•2_0'VS, s
RZ.N I.3' it
j3.3'$h 'FS _
t~" Is • 3.4' -e%'% s
B--q S.o' Cl « > S•o' y.3' C3h sj l CUtVWy VrmtQ~
B
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH
P-
P
P-
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. C{Q.S' G~ y f C ~V~.j f-"
SYSTEM ELEVATION ® B9 S'
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
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ADDRESS: OvT-~ 4 Zwc Zz~ CERTIFICATION NUMBER: PHONE NUMBER (optional):
E L-L.S W O V D 1 S_) 71S- (4 Z S- a 16
CST SIGNATUR :
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DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
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ABBREVIATIONS FOR CER . L T~
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TO THE OWNER:
This soil test report is the first step ii sanitary permit. Th r r nt may request
verification of this soil test in the field 1~cior to permit issuance.., c „ ns for the private
selvage system and a permit application rnrA b jbrnitted to authority in order to
obtain a permit, The sanitary permit must: he ~,ined arid post_ any construction.
%Et Ada "~9ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINI-S
r l 1 RY. DIVISION
E ~j' P.O BOX 7969
r 0~ iD P RC~OVA 1 ION TESTS (115) MADISON WI 53707
,IjIAN RELATIONS
(IUAR 83.09(1) & Chapter 145)
ILO-ATION TSECTION: C)_.1'f °HIP UNICIPALITY LOT NO.:BI_K. NO.
/T N/R : SUBDIVLSION NAME
'/al 36 3ozo E I ~ rt _Z:1~ H L-
- -
_
I•'OUNTY: INNER'S/ YER'S NAME: M4 LING ADDRESS: 7~- gpx 1ZS
~~T•CR~i1yc Loot-tom ~NN~ wI -SVQ L -
USE DATES OBSERVATIONS MADE
IN BEDRMMERCIAL DESCRIPTi NPROFILE DE RIPTIONS: ERCZATION TESTS
XRes,dence L dNew _ Replace ~ _ t O _ 8 ,
s N.)
RATING S= Site suitable for system U= Site unsuitable for system
ULHEISGXU.RECOMMENDED SYS-,hhcNall
J L s'k~S~L
IN-G~J P,URETYEIS I2N-FIL-OLDI TANK
DESIGN RATE:
If Percolation Tests are NOT regwred If any portion of the tested area is in the
riders. I LHR 83.09(5)(b), Floodplain, indicate Floodplain elevation ' t 1 .
PROFILE DESCRIPTIONS
BORING! TOTAL DEPTH TO GROUNDWATER-Ifs CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
INUrv18ER IDEPTP IEN,1ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
IJOtyE_ 7 -7'5 t)hC 1y $11 TSv UyL s) at G 6'O iziih YS
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B - S ~'I q►.I 7 5.0' 3 S' ~tZ•s3 6 o.-)' 't 't L~rt61.Is ;3.zBr5-)s
B- ii:4 S -Z- ' -46 o.6~ _ _ U•y, .r Cu&V-y ~t~zn
v,,o'T 4.2' or) ' 't 2. D' ,o•6~S.~: !.z'B.,S;o.6'Gy C-
Oil - A/ Io. Z' o• S' " 3- d' t3h l~s ; Z-o Z3n s
B _$~6.t3' " > 6.8 o-E>' 6't3h)sns
l gTS.o` 4e•3 > S o' p•7' ~/.3' 3v,sjl ~vL-t yq~
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
,NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIODI PERIOD2 PERI PER INCH
P-
P-
LD_
P-
_P A-
PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings ~an~d-tthe direction and percent
ol and slooe. `y !r).'~' ~11 J~ L/ ttC lcr. 'U~Jt~t1'~T~}11
SYSTEIM ELEVATION
g9.S' 1 SIE _To @E. tNT t~~ST ZS'
lDo.o olv SP)r, W' L, iU gC` A,T LL"gST S0 ,
g.Z I ~ / ltv ~2.'' orth FZ.ux-~ \~;.K,1ltl..lt=► Z~S.,
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1, the uncle clgr:ed, hereby certify that the soil a is !eported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Adininisti ative Code, and that the data record: d and the location of the tests are correct to the best of my knowledge and belief.
-
r\:.,"dlE (p:int): (TESTS WERE COMPLETED ON
M P, r,tR: PHONE NUMBERt<p,;, al)
NJ SS l~ou~~ 4 i~~f~X Z 2b CERTIFICATION
~1S (4 ?_S_ (316
CSI ~If NATURE:
f Rl'.,~ ' )N: w,a ind one copy to Local .Authority, P,eperty Owner and Sot, Tester.
Sr. tR 10`83) -OVER -
fir,-_-"''►
CERTIFIED--SURVEY MAP
LOCATED IN THE SW 1/4 OF THE NE 1/4 OF SECTION 36, T30N, R20W, TOWN OF ST.
,JOSEPH, ST. CROIX CO., WI.
OWNED BY: LLOYD DAHLKE
RT. 2 HWY. 35
a HUDSON, WI 54016
W T BEARINGS ARE REFERENCED TO
TH E - W QUARTER SECTION LINE.
IRECORDID BEARING).
UNRECORDED SURVEY
IOWNEd BY OTHERS) ,SEE CURVE DATA ON
UNPLATTED •LANDS, SHEET2 OF2.
1
33
. 1331
N89007'55"E 505.89' 3 I a
412.6 _
31.21' O
~W
2 t a ~g
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WSE o LOT goy
M 3.94 ACRES
M (171,885 SO. FT.) NI V) t`~
3.89AC.EXC. R.O.W. a W i = c7hV
1180,771 S0. FT.1 I~ N ~ to~
I k oit ¢
0 -9-
N; It Z N. pox
cl. G+ 109.07'58"W 533.11' p• o•
• IV 50..0.45 33.06)' NuWi'
cs 4• in mm
J• W nl m I. W J• w
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a Wo LOT 2 c•w 0% a
W• w _ 3.74 ACRES o~
1162.955 SQ.FT.) N ti
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00 1153.047 SQ. T.) ( N I v
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41 z I-. a
4• S09.07'S0"W 551.24' ( W N•' &
Z•' 518.22 33,02 '
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00 i I is
cm 4.24 ACRES °o
a? p (184,446 50.FT.) N 4:
C ml 3.39AC.EXC. R.O.W.
n y,}_
VI- N (147,857 S0.FT.I I :
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N09.04'24"E M _ ■aa aim _ 2 6 Se 91314.45'
3 3 3 6. 6 4-*- i~ S89-34 Z 4 W 567.99
Mi
-•W QUARTER LINE 25 TH• AVE. 0IN
UNPLA•TTED LA•MOS• S
0 • SET 1"X 24" IRON PIPE WEIGHING 1.13 LB S. PER LINEAL FOOT. JAM A
K • 1', IRON PIPE FOUND. ;i wm ~s
• • 3/1"RE BAR fOUN 8-1804
SMIN13 VVAUAY
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SUR
SHEET I OF 2 w
JAMES iV~EBER S-~~
90- 34 rf THIS INSTRUMENT DRAFTED BY OATEYO. :_w~o
CURVE DATA
Curve No. Radius Cent. Angle Arc Chord Ch.Brng.
1-2 1150.00' 2051104" 57.23' 57.22' S5°51'11"E
3-4 1117.00' 3°02'28" 59.29' 59.28' S5056143"E
5-6 47.00' 91°21'56" 74.95' 67.26' S42°53'40"W
7-8 113.00' 15°58'22" 31.50' 31.40' S50°07'33"W
TANGENT BEARINGS
Atl=S7°16'43"E At2=S4025'29"E At3=S7027157"E At4=940251290E
At5=S2°47'18"E At6=S88034138"E At7=S42°08132"W At8=S58006154"W
DESCRIPTION-
A' parcel o and loeatea -in the SW 1/4 of the NE* 1/4 of Section 36, T30N,
R20W, Town of St.Joseph, St.Croix County, Wisconsin, more fully described
as follows:
Commencing at the E 1/4 corner of said Section 36: Thence S89°04'24"W along
the East-West Quarter Section Line a.distance of 1314.45' to the point
of beginning:
Thence continuing S89°04124"W along said line a distance of 567.991;
Thence-NO°07'10"E 960.291;
Thence N89°07155"E 505.89' to a point on the centerline of 27th Street;
I
Thence southerly 97.23' along said centerline, also being the arc of a
1150.00' radius curve concave westerly whose long chord-bears S5051111"E
57.22'; ,
Thence S4°25'29"E along said centerline 361.18'; j
Thence S2°47118"along said centerline.and it's extension a diatance of
542.39' to the,._ point of beginning.
Contains 11.92 acres subject to 27th Street-right-of-way over the easterly
and 125th Avenue-right-of-way over the southerly portions as shown.
Also subject to any and all additional right-of-ways,•easements or
conveyances of record.
SURVEYOR iS CERTIFICATE
1, James M. Weber, registered land surveyor, hereby certify:. That in
full compliance with the provisions of Chapter 236.34 of the Wisconsin
Statutes and the provisons of the St.Croix County Subdivision ordinance
and under the direction of Lloyd Dahlke, owner of said lands, I have
surveyed, divided and mapped the above described parcel of land and that
such plat is,a correct representation thereof. ` o p
Dated this 5"` ' day of Tr.p.y ___11990. G NSA
4
A►M~ M z wza,~.~.._ .IAMI~ M.
James M. Weber S-1804 8 a
WEBER LAND SURVEYING $PA8- 1ALLEY
RIVER FALLS, WI ` WUL a
(715)-425-0164 0,
This Certified Survey.Map is hereby approved by the Township of
St.Joseph.
Dated •
t:
SHEET 2 OF 2
This instrument drafted by .l
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S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS c2 ? T FIRE NUMBER
CITY/STATE T/~~e T c~~ No/,6 ZIP f 6
PROPERTY LOCATION : 1/4 1/4, SECTIOM9 , T-2
D_N-R_=4__W
TOWN OF St. Croix County,
SUBDIVISION y , LOT NUMBER Z
Improper use and maintenance of your septic system could
result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three
years or sooner, if needed by a licensed septic tank pumper. What
you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix county residents may be eligible to receive a grant
for a maximum of 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 Co. Zoning officer within
30 days of the three year expiration date.
SIGNED:
DATE: 10
St. Croix co. Zoning Office.
911 4th St.
Hudson, WI 54016
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), thenla 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 ~err%i / i55 :Z,^
Location of propertyg~) 1/4 6v1/4, Section T 3o N-R.;to W
Township
Mailing address jVh",1.14 ~Nf
Lam![ l~ i ` a ee y0 3
Address of site
Subdivision name Lot no. Z-
other homes on property? yes No
Previous owner of property
Total size of parcel :9.7y
Date parcel was created
Are all corners and lot lines identifiable. Yes No
Is this property being developed for (spec house)? Yes 4o No
Volumej/0.1yi/and Page Number 15-3 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 & 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. J'Y7/ y/ , 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 County Register of deeds as Document
No. -b I
Si na re of applicant Co-applicant
fir
Date of Signature Date of Signature
A(y _ i DOCUMENT No. WARRANTY DEED THIS $FACE RESERVED ►OR RECORD1110 DATA
r STATE BAR OF WISCONSIN FORM 2-1989
tot 0
REGISTERS OFFICE
atawcom
Llo..d H. Dahlke a sin le person
OCT 1 21993
conveys and warrants to Jerry L. McKenzie and Tamara OR 9' 15 A. M
-
J. McRenzie.•_..husband..arid..W1 e...AA
survivorshin marital..property-........................................
o
. ONd~
r~
.
RETURN TO
r 81can4AiJnT!lfE II+~Q
239NaathMalnBl:+9et0 pQBaat]a3
the following described real estate in At._ Croix County, -
State of Wisconsin:
Q
. Tax Parcel No:
1
Lot Two (2) of Certified Survey Map in Volume 8 of Certified Survey
Maps, Page 2224, as Document Number 459724, filed in St. Croix County
Register of Deeds Office on June 20, 1990, being located in.the
Southwest Quarter of the Nori:heast Quarter (SW 1/4 of NB 1/4) of
Section Thirty Six (36), Township Thirty (30) North, Range Twenty (20) r
West, Town of St. Joseph.
r?
A.S.C.S. Corn Base stays totally with seller. $
1
J
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
a a x n r u r r■ - Nino
d ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
- _ - Hudson, WI 54016-7710
(715) 386-4680
October 11, 1994
Firstar Bank
213 East Chestnut
Stillwater, Minnesota 55082
ATTN: Peter Boyle
RE: Septic Inspection
Dear Mr. Boyle:
An inspection of the septic system serving the Jerry and Tamara
McKenzie property was conducted on October 5, 1994. This property
is located in the SW; of the NE; of Section 36, T30N-R20W, Lot 2,
Town of St. Joseph, St. Croix County, Wisconsin. At the time of
the inspection, this septic system was found to be code compliant
for a three (3) bedroom home. Should you have any questions,
please feel free to contact this office.
ince~ely,
i
mes K. Thompson
I
Assistant Zoning Administrator
St. Croix County, Wisconsin
mz
i
j
I
I
II'~
y%J.~~ q- ---s'_U~f::~ _ FILED
Ali' JUN 2 019900
q JAMES O'CONNELL
a 7- g
- = - Register of Deeds
SL Croix Co., WI
4-59724 d 3c) - v~TI 7 3c'?_- ~..~_s~ ~ ~_.1~.:~r? .__`~~-=7~a ~.3 ~~~t+5t~? ~l ~ _ /
CERTIFIED SURVEY MAP
LOCATED IN THE SW 1/4 OF THE NE 1/4 OF SECTION 36, T30N, R20W, TOWN OF ST.
JOSEPH, ST. CROIX CO.,WI.
OWNED (3Y: LLOYD DAHLKE
}t~L'- H
H U D ST'f N , _W T__5.4 016
NOTE: BEARINGS ARE REFERENCED TO
THE E-W QUARTER SECTION LINE.
I RECORDED BEARING).
UNRECORDED SURVEY
(OWNED BY OTHERS) SEE CURVE DATA ON
SHEET 2 OF 2.
UNPLATTED LANDS,
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h _ S88.34'38 "W 484. 9' (2„24. SQ. FT.)
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:11 QUARTER LINE .12.5. TH. •AVE.. ,`t, SG~NS`Iy~4
UNPLATTED LANDS,
0 =SET I"X 24 IRON PIPE WEIGHING 1,13 LBS. PER LINEAL FOOT. JAMES Y.
I"IRON PIPE FOUND, ff ~f +a wEBIEA
(d'~ 0 : 3/4 "RE • BAR FOUND. $ - 1804
SPRING VALLEY
SCALE 1" 150 ' . , MS. Ap•
J U Cr f ~9 ll.i ~e~q p a►
0 75' 150 300 KSt"Ji~tiH{~~i7VE PARICS PI ANNII"G ~~''~sQ S U
PAQ70 rvrcc~r~r;if +ee~~~~0°°d~m°
SHEET I OFr.bw . »oe
JAMES M. WEBER S-1804
DATED
90- 34 TH I S INSTRUMENT DRAFTED BY _ ~.a. ;,G V.-ty•.~a
VOLUME 8 PAGE 2224