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Parcel 042-1016-10-100 09/13/2012 03:21 PM
PAGE 1 OF 1
Alt. Parcel M 07.29.18.97B 042 - TOWN OF WARREN
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - MCKENNA, THOMAS M & DANA M
THOMAS M & DANA M MCKENNA
1080 100TH ST
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 1080 100TH ST
SC 2422 SCH D ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 2.890 Plat: 3653-CSM 13-3653 042-99
SEC 7 T29N R1 8W PT NE NE BEING LOT 1 CSM Block/Condo Bldg: LOT 1
13/3653 2.890AC
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
07-29N-18W NE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
10/29/2004 778434 2685/415 WD
10/08/2001 658493 1733/205 EZ-U
07/03/2000 625748 1523/459 WD
07/23/1997 1058/341 WD
2012 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/0612010
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.890 41,400 210,100 251,500 NO
Totals for 2012:
General Property 2.890 41,400 210,100 251,500
Woodland 0.000 0 0
Totals for 2011:
General Property 2.890 41,400 210,100 251,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 12/04/1998 Batch M 554
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM CountSt. Croix
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) ` Sanita g27No.:
Personal information you provice may be used for secondary purposes (Privacy Law, 5(.,1,,5.044 (1)(m)).
,p~r H t~ ne: ❑ City 11 MTTbWfiShip State Plan ID No.:
nCST BM Elev.: Insp. B ev.: BM D scri on: Parcel x1N9-016_10_100
/00-0 d 0 ~13
TANK INFORMATION ELEVATION DATA le, 9- /8F/ ?7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_
Septic Benchmark Z2.
AIL. LJITI
Dosing - - o All Z)
/
Aeration Bldg. Sewer 1Z,5Z) D
Holding St/ Ht Inlet ) . 3t,' (D 7. D
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO / L WELL BLDG_ vent to ROAD Dt Inlet `e
Air Intake /17 -1
Septic ' 3 YJ 1' N NA Dt Bottom
Dosing NA Header / Man. (*T
Aeration NA Dist. Pipe
Holding Bot. System rf< S" /o y `l3
PUMP/.SIPHON INFORMATION Final Z . 5 S 07.5
LrJ
Manufacturer Demand over ~S f I
Model Number GPM R/ N
TDH Lift Lrictio System TDH Ft Q'lj~p/ S
oss Ff
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ► Length 1 '1 No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
TEACHING Ma• ur.
SETBACK SYSTEM TO P /L BLDG WELL LAKE/STREAM,,' CHAMBER 4tv-
INFORMATION Type O Lfs / / 20 r i Model Numbe
System:
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe s) r x Hole Size x Hole Spacing Vent T Air Intake
Length Dia. Length Dia. Spacing
1/k ~'vr. ~-90
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
DepOver / k Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Berenc h Center Bed /Trench Edges Topsoil [I Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.Inspection #1: OB / 1 ° / ° f Inspection #2: /e 3l Z
Location. 00th Street, Roberts, WI 54023 (NE 1/4 NE 1/4 7 T29N R18W) - 07291897B -Lot 1 f~
= ~C
Alt BM Description
2.) Bldg sewer length -
-amount of cover = > 57.6 :5 l Z ~e% No ~j
Plan revision required? ❑ Yes No C
Use other side for additional information.
Date Inspector's Signature Cert No.
SBD-6710 (R.3/97)
- -
- -
JiQ
1(~
7
r
/oo ,
411
Z2 ? (tp S Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this, application PO Box 7302
Wisconsin Personal information you provide may be used for secondary purposes Madison, WI 53707-7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8-1/2 x 11 inches in size.
County State anitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number
I. Application Information - Please Print all Information Location:
Property Owne Name Property Location
G = Vii`" 114 - 1/4, S ,N> (o
Property Owner's Mailing Address L Lot Number Block Number
A59 15;0 Je' f
City, S Zip Code Phone 'N umbr~ + j Subdivision Name or CSM Number
II. Type of Building: (check one) ❑ City
0 1 or 2 Family Dwelling - No. of Bedrooms : ~ ❑ Village
Town of
❑ Public/Commercial (describe use):_
❑ State-Owned
Nearest Road -44
Parcel Tax Num er(s)O `0 O o
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 07- Alf , IF, q 7
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
XNon-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information: X 1375 -M'('VC'k
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil App ication 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation
VI . Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Stat en ,
I, the u dersigned, assume responsibility for installation e POWTS own on the attached plans.
Plumber's ame rint Plumber's Si nature MP/MPRS No. Business Phone Number
r _ '
er's Address trees, City, State, Zi Code)
IdT
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
AApproved ❑ Owner Given Initial Adverse S harge Fee) dV
Determination 22S, r z ?VD t
X. Conditions of Approval /Reasons for D,isapproval: «~A
S+f s4~- e., n s-~ Ion s ~ .t.^ dot. '~s 3` ~ s k e
0w'*~ t5 ~l,c (tSi d'~ S?if tc. ~dwK~ 1S
SBD-6398 (R. 07/00)
'4,1e;4p, --791111084
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION 2
LFA -sand Human Relations Page / of v
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attt.ch cdmt~ete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and S~ ' ~'iPoi
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel I.D. R
APPLICANT INFORMATION - Please print all Information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner / HRH l3tM9 L AA-1 j Property Location
pAUt- /'//o A J C CO P, Govt. Lot /VE 1/4 /Vjr1%4,S 7 . T N,R toD E (or)N
Property Owner'` Mailing Address ~4~ 1311f 3 ~ ~Lot A Blocklr Subd. Name or CSMtY
7/l 7 ~T / i PewPI,V G- CSM C¢ /of
City State Zip Coe Phone Number Nearest Road
5~• ~i1uL /f'~N• 55/0/ ((P/Z) zzz- 555 El city ❑ Village P3Town
lo-7 f~ ,¢v
I 5 A1
U New Construction Use: MResidential / Number of h-drooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived dally flow _&o0 gpd Recommended design loading rate 7 bed, gpd/f12 fa trench, gpd/tt'
Absorption area required _ bed, ft2 trench, ft2 Maximum design loading rate --!__-7 bed, d/f12
gp trench, gpd/ft2
Recommended infiltration surface elevations s~ 3
4Q- it (as referred to site plan benchmark) Q n
Additional design/site considerations Sl TE '~E~•Ni°tE~l~/I}T~O c1 - 7t+-' cl S o.J 5/a~sQ Ltd/ R,,5- rQ/ST ,
Parent material 3765 51 5y6w5 .FS S,I Flood plain 019vstion, if epptieablA p
S Suitable for lsysteln Conventional Mauna In=Groun ressure ~A~T~-Gr rye 6plem FIIi Holding Tank
uUnsuitable for system p~p u C s~tj U Cp 1 u [D's El u p S p u u El
S
SOIL DESCRIPTION REPORT At ZAnM
_ ( [ 1 -
goring # Holizon Depth Dominant Color Mottles Texture' Structure GPD/ft2 1Z
In. Munsell Qv. Sz. Cont. Color Consistence Boundary Roots
Gr. Sz. Sh. Bed ,Trench
/ 0-/0 2-,w She ~s e -5 1 -f- s
Z -~7 /'0 Ground
elev. 7- ;k /a ~L/
X03 , ~o_n. 'v /oaf
Deplh to e - eye
O
limiting -
lactor
qll _in. -
Remarks:
Boring #
J 2- 31il
~J , /0 f S4A
Ground
elev.
102,3-0
_rt. -
Depth to - -
limiting
factor
%~in. t'lemarks:
CST Name (Please Print) Signature
Telephone No.
39 8/8S`
Address
Date CST Number
_ ..-t?►brt ~4ssociata>! y/, C 5 Tiv 2-ti 82
private S9wage Consultants
855 O'Neil Rd.
Huds-Irl, Wls. 54018 I
1
Z 3 4 ORIGINAL
s
s
Pf~E*W®
x
6
~~Mg I k ~ L/w~ PROPERTY OIL DESCRIPTION REPORT
OWNER S 3
( (~'~Nt~►~~-- C$~ Page of
PARCEL 1.131
Boring # Horizon Depth Dominant Color Mottles Structure
in. Munsell Clu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots D/ft2
Bed Trench
~ •S
Z g-3,1 fsh,r /IM fie Ground 3 lig p 21s/
elev. _ f S~/~ i1v~ f C~ , S , • i~
//3 10 -ft. -7
/f Os
Q
Depth to
limiting i
factor
Remarks:
Boring If
,931
z io 3 - s6 -F cs 4 S -j
- ~o 4M S C,5' 7 S'
Ground
elev.
,
Depth to
limiting
factor
q in.
/ Remarks:
Horizon Depth Dominant Color Mottles Structure
in. Munsell Clu. Sz. Cont. Color Texture Consistence Boundary Roots GPD/it2
Gr. Sz. Sh.
Boring # ( _!3 /e 31.1- Bed Trench
ifsb~ /k,-r2 cs 3f
_YZ &Y *A d5 -
o io , 01,
S. DS
Ground
elev. -
//O • /.f ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft• ,
Depth to
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION `FORM
Owner/Buyer c
Mailing Address, ~/g
Property Address ~1,~,5'0 7/
(Verification required from Planning Department for new construction)_
City/State Jr- Parcel Identification Number
LEGAL DESCRIPTION
Property Location,AL-'/4, %s, Sec. '7 Tz ~N-R.L5L_W, Town of 1
Subdivision Ss~ , Lot #
Certified Survey Map # Volume 43 ...Page #
Warranty Deed # ('op-s- `(8 , Volume 15'2-3 , Page # Spec house ❑ yes ,3 no Lot lines identifiable Jai yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days year expiration date.
~7
SIGNATURE F APP DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the p rty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
t~1?/ 3/ /o/
SIGNATURE OF APPLIC S DATE
Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
r
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In-Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number oZ
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd) Q'a
Septic Tank Capacity (gal)
Soil Absorption Component Size (ftz) i- tV
Type of Wastewater Dom tic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Abso tion Component
Design Flow - Peak (gpd) t1UW - as
Maximum Influent Particle Size (in) 1/8
Maximum BODS (mg/L) 220
Maximum TSS (mg/L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se and outlet filter shall be assessed at least
once every 3 years by inspection. Th utlet sh II hP r~PanPri ac cncarc
prroppeer oiler ' n. The filter cartridge should not be removed unless provisions are made to
re a- in solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
F Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep-rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
yr~
1523nu 459
STATE BAR OF WISCONSIN FORM 2 • 1998 16255745
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROI)t CO., WI
This Deed, made between Humbird Land Corporation, a RECEIVED FOR RECORD
Minnesota Corporation
07-03-2000 9:30 AM
YARRANTY DEED
Grantor, and Patrick L Kerns and Kelly IL Kerns,busband EXEMPT N
and wife CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 118.50
RECORDING FEE: 10.00
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to
Grantee the following described real estate in St. Croix
County, State of Wisconsin:
Reeccordin Area
~ erne and Return dyes
Lot 1 edified Stuvev MaD 60390 corded in Volume 13,Pag N a 3653, St.
x County, Wisconsin
os~a -/oiG -io
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Subject to easements,restrictions,covenants and rights of way of record, if any.
The warranties of this deed, either expressed or implied are limited by the grantor to the
grantee, or anyone in the chain of title, to the consideration expressed herin, that being the sum of thirty nine thousand five
hundred dollars 39,500.00).
Dated this 19th day of June 2000
Humbird Land Corporation
* by f~ President
* * Austin J. Baillon
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
) ss.
Signature(s) Ramsey County. )
Personally came before me this 19th day of
authenticated this - day of June 2000 the above named
Austin J. Baillon
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, inst ent and ackn ledge the ■
authorized by § 706.06, Wis. Slats.) j( PAULA. BAILLON
`
taMRe sNESOTA
THIS INSTRUMENT WAS DRAFTED BY r,. MV CO MMi$SgN E%a
ES 1.31•
* Paul A. Baillon
Notary Public, State of Wisconsin PWRV9QVVVVV~ V.
(Signatures may be authenticated or acknowledged. Bo[h are not My Commission is permanent. (If not, state expiration date:
necessary.) January 31 2005 )
*Names of persons signing in any capacity should be typed or printed below their signatures
STATE BAH OF W19CONSIN
WARRANTY DEED FORM No. 2 - 1991
INFORMATION PROFESSIONALS COMPANY PONT) DU LAC. WI 800.655-2021
1rr1LED
01 mhj 2 7 1999 ► .
G0,3909 ~GobCA VA ,
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