HomeMy WebLinkAbout036-1000-60-075 1
D,ocuiiient Number Document Title 8 2 4 9 9 9 4
Tx:4204321
State of Wisconsin DRIVEWAY AND SEPTIC DRAIN 1000056
Department of Natural Resources FIELD EASEMENT BETH PABST
P.O.Box 7921 REGISTER OF DEEDS
Madison,WI 53707-7921 Section 23.09(1),Wis.Stats.
►=onn 2200-017 ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DRIVEWAY AND SEPTIC DRAIN FIELD EASEMENT 08/13/2014 12:10 PM
is entered into by and between the State of Wisconsin Department of EXEMPT #:
Natural Resources (hereinafter referred to as "Grantor") and James S. REC FEE: 30.00
and Mary A. Johnson, husband and wife, as their interest may appear
PAGES: 6
(hereinafter collectively referred to as"Grantee").
RECITALS
WHEREAS, Grantee is owner of the following described real
property located in the St. Croix County, Wisconsin, described as Re e Area
Return: Department of Natural Resources
follows: Bureau of Facilities and Lands—LF/6
P.O. Box 7921
Township 31 North Range 17 West Stanton Township Madison,WI 53707-7921
)
Section 1: Part of the W'/2 of the NWt/4, more particularly Attn: Sharene Smith(CE-01357x'
described as follows: Parcel Identification Number(PIN):
Benefits: 036-1000-60-075
BEGINNING at the NW corner of said Section Burdens:036-1000-70-100
1; thence N89 057'29"E, 847.98 feet along the
North line of said NW'/a; thence S00°14'55"E,
892.45 feet;thence S89°51'55"E, 470.97 feet to the East line of the W'/2 of the NW'/4;
thence S00 021'31"E, 582.79 feet along said East line; thence N89°51'55"W, 1320.09
feet to the West line of said NW'/4; thence N00 014'55"W, 1472.62 feet along said
West line to the Point of Beginning, more accurately depicted.as Parcel "A" on the
attached Exhibit"A";
WHEREAS,Grantor is owner of the following described real property,for Western Prairie Habitat Area, located in
the St. Croix County, Wisconsin, described as follows:
Township 31 North, Range 17 West, Stanton Township
Section 1: Part of the NW'/4, more particularly described as follows:
Commencing at the NW corner of said Section 1; thence N89°57'29"E, 847.98 feet
along the North line of said NW'/4 to the POINT OF BEGINNING; thence continuing
along the North line, N89°57'29"E, 1786.48 feet to the N'/4 corner of said Section 1;
thence S00°28'04 11E, 2736.46 feet along the East line of said NW'/4 to the SE corner
of said NW'/4; thence N89 041'21"W, 2645.05 feet along South line of said NW'/4 to
the SW corner thereof; thence N00°14'55"W, 1247.49 feet along the West line of said
NW'/4; thence S89°51'55"E, 1320.09 feet to the East line of the W'/2 of the NW'/4;
thence along said East line N00 021'31"W, 582.79 feet; thence N89°51'55"W, 470.97
feet; thence N00°14'55"W, 892.45 feet to the Point of Beginning, more accurately
1
St.Croix County 1000056 Page 1 of 6
depicted as Parcel `B" on the attached Exhibit"A";
WHEREAS, Grantee desires a pennanent easement for ingress and egress and a septic drain field for the benefit of
Parcel "A"over and across Parcel"B"described as follows:
Township 31 North, Range 17 West, Stanton Township
Section 1: Part of the SW'/4 of the NW'/4, more particularly described as follows:
Commencing at the W'/4 corner of said NW'/4; thence S89°41'21"E, 1113.39 feet to
the POINT OF BEGINNING; thence N000 15'5 8"W, 990.93 feet; thence
N89 051'55"W, 77.00 feet; thence N00°26'57"W, 260.00 feet; thence S89°51'55"E,
143.83 feet; thence S00°15'58"E, 1251.12 feet; thence N89°41'21"W, 66.00 feet to
the Point of Beginning;
WHEREAS, Grantor originally acquired Parcel`B"from the Grantee and at the time of said acquisition the parties
g t
intended for Grantee to retain an ingress and egress easement across the land sol d o the Grantor,
but somehow the
parties inadvertently omitted the reservation of an access easement from Grantee's conveyance to the Grantor;
WHEREAS, Grantor now desires to convey to Grantee said easement for ingress and egress as well as a septic
drain field over and across Parcel"B";
NOW, THEREFORE, the Grantor, for good and valuable consideration, hereby grants to the Grantee a non-
exclusive or the purpose of obtaining ingress
and
ravel driveway f
exclusive driveway access easement over an existing g y p rn g �'
egress over Grantor's Parcel E to Grantee's Parcel A along with a septic drain field system easement.
It is understood by the Grantor and the Grantee that this non-exclusive easement is subject to the following
conditions:
1. The parties hereto confirm and agree that the recitals set forth above are true and correct and incorporate
the same herein for all purposes.
2. The access and septic drain field easements are for the benefit of the Grantee's present ownership as a
single residential parcel identified as Parcel "A". Said access and septic drain field easement areas may
not be further subdivided, transferred separately from or severed from title to the entire Parcel "A." Said
easements cannot be used for more than one residence. The benefits granted by this access and septic
drain field easements shall not be extended to provide access to any subdivisions (including a
condominium), lots or parcels created off the Grantee's present ownership of the entire parcel. Any
purported subdivision of this easement shall constitute a material breach of this easement and said
easements shall be automatically considered null and void.
3. No cutting or trimming of trees shall be done without the prior written approval of the Grantor, except that
dead and downed trees that obstruct passage on the easement areas may be removed without such written
approval. Any trees removed from the easement areas remain the property of the Grantor. All stumps,
slash, waste materials and other debris resulting from construction or maintenance of the easement areas
shall be disposed of by the Grantee as directed by the Grantor.
z
St.Croix County 1000056 Page 2 of 6
4. The Grantee shall maintain the area under this easement in a safe condition at all times such that the Grantee
shall cause no obstruction to free and uninhibited use of the access and septic drain field easement areas by
the general public.
5. The Grantee agrees to fully restore or reimburse the Grantor for any property damage to the easement areas
that is caused by Grantee's maintenance or use of the easement areas.
6. The Grantee does not have the right to make any improvements to the easement areas. Any desired new
construction or improvement on the easement areas shall be submitted to the Grantor for written approval
prior to beginning any work. This does not include general maintenance of the easement areas.
7. This access easement is solely for the purpose of ingress and egress to the Grantee's property and
maintenance and replacement of existing septic drain field system.
8. The Grantor reserves the right to convey further easements or permit other access on the easement area,
including utility easements consistent with the rights granted hereunder.
9. The Grantee agrees to protect, indemnify, and save harmless the Grantor, its agents and employees, from
and against any and all claims, demands, suits, liability, costs and expense, by reason of loss or damage to
any property (state or other) or bodily injury to or death of any person whatsoever, that may arise from the
Grantee's maintenance or use of the easement areas and the Grantee shall defend the Grantor in any such
action or claim upon request of the Grantor.
10. The access easement may be used by the Grantee, his guests and invitees. This easement shall bind and
inure to the respective benefit of the Grantee, his heirs, successors and assigns. The term Grantee when
used herein shall mean either singular or plural, masculine or feminine, as the case may be and shall
include the present and future owner or owners and mortgagees, heirs, personal representatives,
successors and assigns of the Grantee's property. Said easement shall be for the benefit of a single
residential site only.
11. This easement sets forth the entire understanding of the Grantor and the Grantee and may not be modified or
amended except by a written document executed and acknowledged by all parties to this easement and duly
recorded in the office of the Register of Deeds of St. Croix County, Wisconsin.
12. If any term or condition of this easement shall be deemed invalid or unenforceable, the remainder of this
easement, or the application of the term or condition to persons or circumstances other than those to which it
is held invalid or unenforceable, shall not be affected thereby, and each term and condition shall be valid and
enforceable to the fullest extent permitted by law.
13. It is intended that this easement shall be construed as being an adequate and legally enforceable
agreement. Enforcement of this easement may be by proceedings at law or in equity against any person or
persons violating or attempting or threatening to violate any term or condition in this easement, either to
restrain or prevent the violation or to obtain any other relief. If a suit is brought to enforce this easement,the
costs including reasonable attorney fees from the
party all e entitled to recover its Y
prevailing ys b g
nonprevailing party.
14. This easement shall be construed and enforced in accordance with the laws of the State of Wisconsin.
END OF CONDITIONS
3
St. Croix County 1000056 Page 3 of 6
IN WITNESS WHEREOF, the Grantor grants this easement and has caused this instrument to be executed on its
behalf this Ek day of , 2014.
State of Wisconsin
Department of Natural Resources
For the Secretary Q
By: D-�•-�°�— (SEAL)
Douglas J. Haag
Deputy Bureau Director Facilities and Land
State of Wisconsin )
ss.
County of Dane ) !
Personally came before me this O day of , 2014, the above named Douglas J. Haag, Deputy
Bureau Director Facilities and Land, State of Wisconsin Department of Natural Resources,to me known to be the
person who executed the foregoing instrument and acknowledged that he executed and delivered the same as for
the act and deed of said Department of Natural Resources.
J. cSM
Notary Public, State of Wisconsin
My Commission (expires)(is) 8 I �`1I2o1�
C,, W• ~
r//, .••Jl, r
"/rlr•.
4
St.Croix County 1000056 Page 4 of 6
IN WITNESS WHEREOF, the Grantee hereby accepts and consents to the terms and conditions of this easement
and has caused this instrument to be executed on their behalf this day of ,2014.
(SEAL)
es S. ohnson
L, (SEAL)
x M y i6h76n
State of Wisconsin )
�r ss.
County of v� )
Personally came before me this day of , 2014, the above named James S. Johnson
and Mary A. Johnson, to me known to be the persons who exec ted the foregoing instrument and acknowledged
that he executed and delivered the same.
E. S p.
Notary Public, State of Wisconsin
NOTARY My Commission(expires)(is)
PUBLIC
of:W 1�GO.�y
i * Please print name. An
This instrument drafted by:
Attorney Kristin A.Hess
State Bar# 1001214
State of Wisconsin
Department of Natural Resources
5
St.Croix County 1000056 Page 5 of 6
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FORM - STC - 04
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP
SECTIONT 31 N-R_ /7 W
ADDRESS
Je-
Cj ZZ59v ST. CROIX COUNTY, WISCONSIN
SUBDIVISION_ LOT_,& LOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
112e L(
\ C
a 3-5
~ I
INDICATE ORTH ARROW
BENCHMARK: Elevation and description:_ O.J~.c,~ ,q«•
V
Alternate benchmark
SEPTIC TANK: 1•1anufacturer: /?,6kis 0.60. Liquid Cap. I
Rings used:~Manhole cover elev:/()o?~s Final grade elev:- /p a ~O. °
Tank inlet elev.: fC -j Tank outlet elev.:
i
No. of feet from nearest road:Frontl' 74 Side , Rear Ft.
From nearest prop. line:Front/d7G, i Side , Rear Ft.
No. of feet from: Well /0C'I' , Building: $I
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
a
PUMP CHAMBER
Manufacturer:
u~C KS Q Liquid capacity: BOO
Pump Model:/,o Pump/Siphon Manufact.: Pump Size ,
Elevation of inlet:Bottom of tank elevation y'a
Pump on elev.:&&fo_Pump off elev.:-Gallons/cycle: ZJ O
Alarm: Man.:_Switch Type: Location
Distance from nearest prop. line: FrontY1~r Side_, Rear Ft.
Distance from: Well Building- / `f S
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage Pit:
Width:,S Length 6 Number of Lines: 'Z Area Built -od 4
_
Exist. Grade Elev. Proposed Final Grade Elev.142
S
Fill depth to top of pipe: Z 7
No. feet from nearest prop. line:Front/ Side Rear Ft.
No. feet from well:Zedy- No. feet from building-
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: E evation of bottom tank:
Elevation of inlet:
No. feet from ne est prop. line:Front , Side , Rear Ft.
No. feet fro . Well , building , nearest road
Ala m Ma facturer:
INSPECTOR:
DATE: PLUMBER ON JOB: &&je,01
LICENSE NUMB R : ~j~/,Y~~/
6/90:cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MA ISON 153 07
SW Ste Plan I.D.
,1Vfinj , ,Spec , 1,T31-R17 (Itass'gned) Number:
ONVENTIONAL El ALTERATIVE
Town of Stanton C
9
h St . ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
James S. Johnson 1922 235th Ave. Deer Park, WI
BENCH MARK (Permanent reference point) DESCRIBE tF DIFFERENT FROM PLAN: REF. . ELEV CST REF. PT. E
/ v.9d `
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
lGary Steel 3254 St oix 128828
SEPTIC TANK/HOLDING TAN ~ oCw(,_ka(e Cwe4- _ '
MANUFACTURER: LIQUID CAPACITY: TANK II TA V.: WARNING LABEL LOCKING COVER
i PROVIDED: PROVIDED:
GJV 9 I 9B . GB YES ❑ NO ❑ YES NO `
BEDDING: ~tEP}~DIA.: Y .W~MATL.: HIGH WATER 44NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T RESH
U. ALARM: FEET FROM LINE: / f AIR IN ET:
2rYES F-1 NO F-1 Y NO NEAREST
DOSING CHAMBER: O / o 0, 17 _ .
MANUFACTURER: BEDDIN . LIQUID CAPACI P MODEL: PUMP/SFWW61J MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED:
j PZ ~ y J ( 70 o 1 3 YES ❑ NO YES ❑ NO
LJ¢1-f~ YES E:1 NO ~ , GJc- 0.3 Y
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF 120 YES ❑ NO NEAREST SAS
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN 3C3
the soil is dry enough to continue.)
CONVENTIONAL SYSTE 3p` d-& ,C e r ~S =
WIDTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: PITS: LIQUID
BED/TRENCH TRENCHES: / MATERIAL: PIT DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV./INLET: ELEV. ENDi y~Q r F^ :St 40 PIPES: FEET FROM LINE: AIR INLET:
~O -.3Z 79 7 SC ~ CC. w ~tlCi ~ NEAREST ~ ~/ClD ~/GZJ 3(z
1/0 - > 3S~'
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PL NS
❑ YES ❑ NO YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROP TY WELL: BUILDING:
COMMENTS: FEET FROM LINE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST---*
~ y~~ ~.,~.~,¢~~z.ct,~,~~•-e.r c~-~~--~ ~.~d ~-cee.~e_s~/ ~.,~c.~.~G~~a le~~.
Sketch System on in in county file for audit.
TITLE: /
Reverse Side. SIGNA URE:
t~,
SBD-6710 (R. 06/88)
DILHR SANITARY PERMIT APPLICATION COUNTY Act6no 3
In accord with ILHR 83.05, Wis. Adm. Code St. Croix
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than El Q~~
8% X 11 inches in size. Check if -vision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
James S. Johnson SW % NW S 1 T31 , N, R 17 Ffor) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
1922 235th.Ave. n/a n/a
CITY, STATE ZIP CODE PHONE NUM ER SUBDI ISION NAME OR CSM NUMBER
Deer Park, Wi. 54007 715 2~9-5198 n~a
1:1 CITY
VILLAGE NEAREST ROAD
111. TYPE OF BUILDING: (Check one) El State Owned ❑
.Stanton 235th. Ave.
AM =W Q
❑ Public D 1 or 2 Fam. Dwelling- # of bedrooms 3 PARCEL AX NU ER() 03~ `
L000-70-aa
111. BUILDING USE: (If building type is public, check all that apply) 9r
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.0 New 2. @1 Replacement 3. ❑ Replacement of 4.E1 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 Z5cseepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
450 900 900 .50 34 96.63 Feet 100.48 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
Septic Tank or Holdin Tank X 1000 1 Weeks C . P.
Lift Pump Tank/Si hon Chamber X 800 1 Weeks C . P. 1:1 El D I F1
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's gnature: (No tam M/MPRSW No.: Business Phone Number:
Gary L. Steel 3254 715 246-6200
Plumber's Address (Street, City, State, Zip
1554 200th. Ave., New Richmond, Wi. 54017
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination qS X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/86) 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 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 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 & 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.
II. 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 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-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
APPLICATION FOR SANITARY PERMIT
8TC-100
This application form is to be completed 1n full and signed by the owner(a) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. -Should this development be intended for zesale by
owner/contcactor,(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 James S. Johnson
Location of property __2j-1/4 f /4, Section - T 31 1-=
Township Stanton
Mailing address 1922 235th. Ave.
Deer Park, Wi. 54007
Address of alto same -
subdivision name n/a
Lot number n/a
Previous owner of property Albert Linder
Total also of parcel 240 acres
Date parcel was created 8-21-79
x
Are all corners and lot lines Identifiable? on o
X
Is this property being developed for resale (spec house)? as __No
Volume as recorded with the Register of Deeds.
59=and Page Number 58
INCLUDE
WITH THIS APPLICATION THE FOLLOWINCt
A WARRANTY DECD which Includes a DOCUMENT NUMBER, VOLUME AND PACE NUNBRR, and
the ORAL OF THE RBOISTER OF DRRDB. In addition, a certified survey, it
available, would be helpful so as to avoid delays of the reviewing process. it
the deed description references to a Ceitifled Survey Map, the Cettlfled Survey
Map shall also be required.
PROPERTY OWNER CERTIFICATION
t(we) certify that all statements on this form are true to the best of my tout)
knowledge; that t twe) am (ate) the owner(s) of the property described In
this Information form, by virtue of a warraf~d d recorded in the office of
the County Register of Deeds as Document No. 3593V ; and that I (we)
presently own the proposed site for the sewage disposal system (or t (we) have
obtained an easement, .to run with the above described pcopecty, tot the
construction of said system, and the same has been duly recorded in the office
of the Count =R9 Deeds, as Document No. 1.
lgnatuce of wnec signature of co-owner (II Applicable)
Data of signature Date of Signature
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SEPTIC TANK MAINTENANCE AGREEPIENT
St. Croix County
o~
James Johnson f''
OWNER
O
Fire Number p
ROUTE/BOX NUMBER 1922235th. Ave. V
0+
CITY/STATE Beer park Wi. ZIP 54007 ct
PROPERTY LOCATION NW Section, T 31 ► R1-7 W•
Town of Stanton St. Croix County,
'Subdivision n/a Lot number n/
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed, 's'ept'ic tank pumper. What you put into
the system can a ect t e unct-ion ot t e -septic .tank as a treat-
ment-stage in the waste disposal system.
St. Croix County residents m be eligible to recieve a grant for
.gZ a maximum of 607. 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 's't'ems agree to keep their system properly
maintained.
The property owner agrees to. submit to St.. Croix County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or..a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and •(2)•after inspection and pumping (if nec-
essary), the septic-.tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year'expiration.
H
I/WE, the undersigned have read the above requirements and agree 0
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, asset by the Wisconsin Depart- W
went of Natural Resources, Certification form must be completed •,d
and returned to the St. Croix County Zoning Offic within 30 days
of the three year expiration.date. 4
SIGNED O
DATE 10-23-90
St. Croix County Zoning Office
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069
HUMAN RELATIONS
(ILHR 83.090) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/MOMMOOGUM)k LOT NO.: BLK. NO.: SUBDIVISION NAME:
1/4 NW 1/4 1 /T31 N/PtAtor► W Stanton n/a n/a n/a
NTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix James S. Johnson 1922 235th. Ave., Deer Park, Wi. 54007
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
esidence 3 n/a ❑New ]KgNeplace 10-29-89 110-30-89
RATING: S= Site suitable for system U= Site unsuitable for system
r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTEM-IN-FILLHOLDINGTAN RECOMMEND ED SYSTEM: (optional)
❑U ®S ❑U [BS ❑U S DUI ❑ S EUK: conventional
If Percolation Tests are NOT required D ESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation:
decimal' PROFILE DESCRIPTIONS page 5 SAB
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPT ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-1 7.10 99,33 none >7.10 .83bl.1. 1.33bn.sil. 1.00bn.s.sil. 3.92bn.l.s.&gr.
2 7.17 100.48 none >7.17 .92bl.1. 1.25bn.sil. 5.00bn.s.1.
B-
B3 7.17 99.96 none >7.17 .67bl.1. 6.50bn.s.l.
-
B-
B-
B-
decimal' PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER IZX3MX AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD 2 PERIOD 3 PER INCH
P_ 1 2.70 none 30 1 //Z5 -54
p- 2 3.85 none 30 z 4 24
3- 2 2 15
none
30
h
P_ 3.3
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. 0 05;,
SYSTEM ELEVATION 96.63
E
3 ern
1
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t
_k
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3
E
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E F
v
- t~ 102
3 3
1, 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:
Gary L. Steel 10-23-90
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
1554 200th. AVe., New Richmond, wi. 54017 2298 171A-246-6200
CST SIGNA .
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
l
THE
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This
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1
STEEL'S SOIL SERVICE 1554 ZOOM. Me.
Gary L. Steel ive
C.S.T. 2298 New Richmond, WI 54017
MPRSW-3254 (715) 246-6200
James S. Johnson
SW-14 NW-14 S1-T31N-R17W
Stanton, township
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PAGE CF
PUMP CHAMBER CROSS SECTIOU AAIG SPECIFICATIMS
VEMT CAP
Y"C. Z. VENT PIPE APPROVED LOCKING
WEATHER PROOF
JUNCTION BOX MANHOLE COVER 1
25' FROM DOOR, \0\ 0.5 ~
WINDOW OR FRESH 12"MIU.
AIR INTAKE
I
GRADE G I
( Y" MIIJ. „~j
COIJDUIT
PROVIDE I -
IiJLET AIRTIGHT SEAL
I v
APPROVED JOINT A ( I APPROVED JOIWTS
WlC.I. PIPE I I (I W/C.I. PIPE
EXTENDING 3' I II ALARM EXTENDING 3'
ONTO SOLID SOIL I I ONTO SOLID SOIL
6 I I
I I oN
63 C .I t
ELJ:V. ~j AFT. PUMP _'j
OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED OIJLS IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPECIFI•CATIOAIS
DOSE.
TANKS MANUFACTURICK: WMBER OF DOSES:-PER DAS
TANK SIZE: ~(t)o GALLONS DOSE VOLUME '
ALARM MANUFACTUKER: 4/&~' INCLUDING BACKFLOW: GALLONS
MODEL AlUMSER: 4214 CAPACITIES: A= UCHES OR 00 GALLOWS
SWITCH TYPE: B= INCHES OR GALLONS
PUMP MANUFACTURER: l D u'l C~ C INCHES OR / 2 O CALLOUS
MODEL NUMBER: 112&2.~L D- I INCHES OR S GALLONS
SWITCH Tun: ey n-«-4 NOTE: PUMP AMD ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEKEMCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURT~,E//.. . . . . . . . E FEET
♦ FEET OF FORCE MAIN X , F/ooFtFRICTIOU FACTOR..) t FEET
TOTAL DtIMMIC. HEAD = FEET
ILITERNAL DIMEMStoMs; OF TANK.: LEM&TH 8_;WIDTH ;LIQUID DEPTH "
51GhIED: LICENSE MUMBER: 3a5L~fYlp6o) DATE: `a3 "fv
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TOTAL HEAD ; ;TOTAL HEAD O
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• 11/27/2006 11:41 AM
Parcel 036-1000-60-075 PAGE 1 OF 1
Alt. Parcel 01.31.17.6A-10 036 - TOWN OF STANTON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
O - JOHNSON, JAMES S & MARY A
JAMES S & MARY A JOHNSON
1922 235TH AVE
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 1922 235TH AVE
SC 0119 AMERY
SP 1700 WITC
Legal Description: Acres: 35.000 Plat: N/A-NOT AVAILABLE
SEC 1 T31 N R1 7W NW NW SW NW FKA Block/Condo Bldg:
036-1000-60 (6) EXC PT DESC IN
WD-1730/585 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
01-31N-17W NW NW
Notes: Parcel History:
Date Doc # Vol/Page Type
10/02/2001 658103 1730/585 WD
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/04/2004
Description Class Acres Land Improve Total State Reason
UNDEVELOPED G5 5.000 3,000 0 3,000 NO
OTHER G7 4.000 20,000 97,700 117,700 NO
ENTERED BEFORE'05 CLOSE W8 23.000 38,000 0 38,000 NO
Totals for 2006:
General Property 9.000 23,000 97,700 120,700
Woodland 23.000 38,000 38,000
Totals for 2005:
General Property 9.000 23,000 97,700 120,700
Woodland 23.000 38,000 38,000
Lottery Credit: Claim Count: 0 Certification Date, Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00