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HomeMy WebLinkAbout032-2044-60-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479434 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Blanchard, Tim & Bobbie Jo I Somerset, Town of 032 - 2044 -60 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: rj 12.30.19.650A20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark 5 A -Ion Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet . 5 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r „ / 5 / 5 / Dt Bottom Dosing f i/ J Header /Man. ll� IS -7 Aeration Dist. Pipe /r • / rte' , t+'7 ,z .c3 cict •') Holding Bot. System 1 x - 15 e l .(., 7 PUMP /SIPHON INFORMATION Final Grade r • _ C �t 5 1 Manufacturer Demand St Cover ,� y G M IG • 73 '� Model Number TDH Li Friction Loss System He TDH Forcemain Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width j Length No. Of Tr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I r ` �. ` i '" ��•., SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. ^ M INFORMATION Ty Of S stem: ; r CHAMBER T OR t j , C CA . J' Yp Y Model Number: ��r a, n/ N DISTRIBUTION SYSTEM I }- / = Z Header /Manifold 4 IDistribution x Hole Size x Hole S acing Vent to Air ntaki Length � Dia Length Dia pacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over 1 xx Depth of xx Seeded /Sodded xx Mulch d Bed/Trench Center Bed/Trench Edges Topsoil Yes U No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1684 85th Street Somerset, WI 54025 (NE 1/ N S W 1/4 12 T30N R1 9W) NA Lot 1 r Parcel No: 12.30.19.650A20 1.) Alt BM Description = "� `.c»C. 6 Z 4 C' , C� 2.) Bldg sewer length = c- / - amount of cover = � `� 11 Plan revision Required? Yes X o - Use other side for additional informa - - — Date Insepctor's natur Cart. No. SBD -6710 (R.3/97) r Safety and Buildings Division County Nvi IN 201 W. Washington Ave., Sanitary Permit Number (to be P 7162 '5 C r ix S/�O �I� Madison, WI 53707 716 filled in by Co.) Department of Commerce (608)266 -31 1� — Sanitary Permit Applicati qU lan . Number In accord with Comm 83.21, Wis. Adm. Code, personal infonnati o 'de n' N may be used for secondary purposes Privacy Law, s15.04(1 ) 0ject A ress (if differ t than mailing address) I. Application Information - Please Print All Information O /6 04 Property Owner's Name # t # Block # 6,6 /'� �� �� / 032 �a'1y- -AX Property Owner's Mailing Address Property Location �/� o1A A i V4j /,, Section City, S to Zip ode Phone Number r ir r T� N; 1E cle II. Type of Building (check all that apply) Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms `� ❑ Public /Commercial - Describe Use ? -3 ❑ State Owned - Describe Use ❑City_ Village,�Kpwnship of III. Ty a of Permit: (Check only one box on line A. Complete line B if applicable) A. New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. El Permit Renewal El Permit Revision ❑Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) $ , A - N on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized n- round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching ber ❑ Drip Line ❑ Gravel -less Pipe r (explain) V. Dispersal/Treat ent Area I formation: TI> ((4 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ea Proposed (sf) S stem Elevation f� eye VI. ank Info Capacity in Total Number Manufacturer Prefab Site Steel ib Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Sep ' r Holding Tank O P P Aerobic Treatment Unit / Dosing Chamber ` VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum �` Name (Print) Plumb e ' ature MP/MPRS Number Business Phone Number Plum is Addre s (Street, City, State, Zip C 02V VIII. oun /De artment Use Onl pproved ❑ Disapproved Sanitary Permit F;�306. cludes Groundwater to ssued uing Age t Sign ture tamps) Surcharge Fee) El Owner Given Reason for Denial �- IX. Conditions of Approval/Reasons for Disapproval Y o T ,�d.BW"ER 1 Septic tank, effluent filter and dispersal cell must all be _ serviced/ malntained �O?itJ7 as per menace ant Ian er c 2. All setback requirements must be maintained as PArAppl cod Mc comp a plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size i SBD -6398 (R. 01/03) PLOT PLAN PROJECT Tim Blanchard ADDRESS 1485 Hollvwood Blvd New Richond Wi. 54017 NE 1/4 NW 1 /4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MFRS Byron Bird Jr. 220527 ! c DATE 8 - 25 - 05 BEDROOM 4 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. top of 1/2 pvc pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.p Same as BM Vent SYSTEM ELEVATION T -1 =99.4 T -2 =98.0 > 12" Of Bio Diffuser with Cov 3 1. 1 ft A2 per chamber 6' Long - Fle a T p %2'' Rg � — . l 0'2o $ 3 - fv B 1 , 45' , > 300' to L _/ crv, S r 7 °7v 10 � Q r - s p sY '409 rA /0 y B 1 9V' J B2 P L Garage 4 bed house 4 � vewa 85th st. PLOT PLAN PROJECT Tim Blanchard ADDRESS 1485 Hollvwood Blvd New Richond Wi. 54017 NE 1/4 NW 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MFRS Byron Bird Jr. 220527 DATE 8 -25 -05 BEDROOM 4 CONVENTIONAL XXX VZGrade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. top of 1/2' pvc pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.p. Same as BM Vent SYSTEM ELEVATION T -1 =99.4 T -2 =98.0 >12T Of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber 6' Grade at System 6" Long 34" Elevation B 1 45' B3 B3 > 300' to PL 87' 40' B 1 J B2 P L Garage 4 bed house 450' vewa 85th st. 4 Ws.; sin Department of Commerce SOIL EVALUATION REPORT Page ( of o3i`vision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code (/1 C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please tint r/1 �,M MTU � Date 76b Personal information you provide may be used es p Law, s 15.04(l) (m)). Property Owner perty Location Ou APR 0 1 2003 0, of j t, 2 141 tlal2l S T .� N R E (or ( Property Owner's Mailing dress ST. CROIX COUNTY t# Block# Subd. Name CSM# VD', (/ Z ZONING City State Zip Code one ❑ Village Town Nearest 21 c 7i� y 9 S" s New Construction U,e;K Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ,r7 ❑ Public o commercial - Describe: Parent material //L Flood Plain elevation if applicable i amid reoommendations +� 8�-t� Boring # ❑ Boring M Pit Ground surface eley(J / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure istence Boundary Roots GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 p - q - T— 6r. Zty i. ® Ong # Boring R Pit Ground surface eley�� ft. Depth to limiting factor r in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence // Boundary Roots GPD/ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. ��rl •Eff#1 'Eff#2 /� 0 -Sa " 99.4 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 • Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg& CST (Please _ S' re Number ZZ 16 IX Address Date Evaluation Conducted Telephone Number A. V, Property Owner Parcel ID # Page of Boring # ❑ ring © Pit / / l Ground surface elev ft. Depth to limiting factor d V in. ate y Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / •Eff#1 •E 3 elf. 5o F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 F Boring # ❑ Boring C1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Str Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 1220 mg1L and TSS >30 < 150 mg/L • Effluent #2 = BOD 130 mg/_ and TSS 130 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. S8D -6330 (1.6/00) Soil Test Plot Plan :,Project Name Doug Bell ShauY Address 1690 85th St. New Richmond Wi 54017 #226900 es ffi Lot Subdivision ------- Date 3/31/03 NE 1/4 NW 1/4S 12 T 30 N /13 W Township Somerset Boring Q Well PL Property Line County ST. CROIX I Assume Elevation 100 ft. T of 1/2 e Pi B VRP P P System Elevation 99.4/98.0 *HRPSame as Benchmark lt. BM Top of 1/2" Pipe @ 9 Alt. B.M. B.M. B -3 15% �- Slope 101' 30' 103' L5 40' B l 45' 45' 105' 50' 50' Pro 4 Bedroom House 85th St. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIF FORM Y Owner/Bu er 22� lc{ s - 7 C��t - &bz, l-- ✓o �whaAct'rl Mailin g Address Property Address'" (Verification required from Planning Department for new construction) Ci /State Parcel Identification Number e c�3a= —2vy� t!oo LEGAL DESCRIPTION Property Location V4, � V4, Sec. �sZ a T�N -R�W, Town of 0?•c.�lo � Subdivision . Lot # Certified Survey Map # e1 ©.S j� , Volume Page # � � — OUIT -10'1 � — eed # Z 3 Volume 2 7 2, , Page # to S Spec house ❑ yes Xno Lot lines identifiable A 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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. I/we, 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 of the year iration e. A PLICANT p DATE O CE ON 4 I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above by virtue of a warranty d5pd recorded in Register of Deeds Office. SIGITATURE OF AVI<ICANT 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 MORTGAGE Loan No: 3245107 (Continued) Page 3 Event of Default. The words "Event of Default" mean any of the events of default set forth in this Mortgage in the events of default section of this Mortgage. Grantor. The word "Grantor" means Timothy Blanchard and Bobbi Jo Blanchard. Guaranty. The word "Guaranty" means the guaranty from guarantor, endorser, surety, or accommodation party to Lender, Including without limitation a guaranty of all or part of the Note. Indebtedness. The word "Indebtedness" means all principal, interest, and other amounts, coats and expenses payable under the Note or Related Documents, together with all renewals of, extensions of, modifications of, consolidations of and substitutions for the Note or Related Documents and any amounts expended or advanced by Lender to discharge Grantor's obligations or expenses incurred by Lender to enforce Grantor's obligations under this Mortgage, together with interest on such amounts as provided in this Mortgage. Lender. The word "Lender" means S & C Bank, Its successors and assigns. The words "successors or assigns" mean any person or company that acquires any interest in the Note. Mortgage. The word "Mortgage" means this Mortgage between Grantor and Lender. Note. The word "Note" means the promissory note dated August 19, 2005, In the original principal amount of $175,000.00 from Grantor to Lender, together with all renewals of, extensions of, modifications of, refinancings of, consolidations of, and substitutions for the promissory note or agreement. Personal Property. The words "Personal Property" mean all equipment, fixtures, and other articles of personal property now or hereafter owned by Grantor, and now or hereafter attached or affixed to the Real Property; together with all accessions, parts, and additions to, all replacements of, and all substitutions for, any of such property; and together with all proceeds (including without limitation all Insurance proceeds and refunds of premiums) from any sale or other disposition of the Property. Property. The word "Property" means collectively the Real Property and the Personal Property. Real Property.. The words "Real Property" mean the real property, Interests and rights, as further described in this Mortgage. Rents. The word "Rents" means all present and future rents, revenues, income, issues, royalties, profits, and other benefits derived from the Property. EACH GRANTOR ACKNOWLEDGES HAVING READ ALL THE PROVISIONS OF THIS MORTGAGE. AND EACH GRANTOR AGREES TO ITS TERMS. GRANTOR: Timothy Blanchard X �C� >v Cw���C`�n�► Bobbi Jo Blanchard T This Mortgage prepared by: X Name of Signer: PATSY HANSEN. MTG LENDING ASST Complete either Authentication Section or Acknowledgment Section AUTHENTICATION Signature(s) of Timothy Blanchard and Bobbi Jo Blanchard authenticated this day of 20 Title: Member State Bar of Wisconsin or authorized under Section 706.06, Wis. State. Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s).. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the.cell(s) and may, result in the backup oCaurface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cott on swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; mast' scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 6b ,cS 3 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ..te slam t-e,S) f A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement Brea. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER ' . ' . POWTS MAINTAINER Name o t Name Phone o 26�'7 Phone G SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY c Name �� O — Name ! o Phone 6 �f$ Phone This document was drafted in compliance with chapter Comm 83.22(21(b)(1100) and 83:84(1): (2) & (31. 'Wisconsin Admb*VatWe Code. POWTS OWNER'S MANUAL &' MANAGEMENT PLAN. Page ( of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner G Septic Tank Capacity ® al ❑ NA Permit # Septid Tank Manufacturer ' P� f ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �� r ° e p NA Number of Bedrooms ❑ NA Effluent Filter Model 0--1 ❑ NA Number of Public Facility Units Pump Tank Capacity a l FYNA Estimated flow (average) Ol, al /da Pump Tank Manufacturer A l NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA Soil Application. Rat `1 gal/day/ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit A OG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg/L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cf 100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. E3 NA Other: ❑ NA Other: C3 NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume ,7 ❑ NA Inspect dispersal call(s) At least once every: ❑ month(s) (Maximum 3 yeah) ❑ NA jd year(s) Clean effluent filter s At least once every: ❑ month(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every:' ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by -an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Serviclng Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to .check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the bervicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any.service event. GMW (4/01) Parcel #: 032 - 2044 -60 -100 01/27/2005 12:35 PM PAGE 1 O 1 Alt. Parcel #: 12.30.19.650A -20 032 - TOWN OF SOMERSET Current XI, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " BLANCHARD, TIM & BOBBI TIM & BOBBI BLANCHARD 1485 HALLEWOOD BLVD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 1684 85TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 10.400 Plat: 1696 -CSM 17 -4515 032 -03 SEC 12 T30N R19W NE NW & NW NW LOT 1 CSM Block/Condo Bldg: LOT 01 17 -4515 (10.40AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 30N -19W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 06/12/2003 725434 2272/105 QC 05/08/2003 720533 17/4515 CSM 05/19/1997 1239/522 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 10958 100,200 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.400 85,000 0 85,000 NO Totals for 2004: General Property 10.400 85,000 0 85,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 202 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 it J 2 2 7 2 P 1 0 5 725434 �,? KATHLEEN H. MALSH STATE BAR OF WISCONSIN FORM 3 -1998 REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 06/12/2003 09:15AN Douglas J. Bell and Karen A. Bell, husband and wife, quit - claims to Tim Blanchard and Bobbi Blanchard, husband and wife as survivorship marital QUIT CLAIM DEED property, the following described real estate in St. Croix County, State of EXBPT ii 8 Wisconsin: REC FEE: 11.00 TRANS FEE: Lot 1 and Outlot 1 of Certified Survey Map filed May 8, 2003 in Vol. 17, Page COPY FEE: 2.00 CC FEE: 4515 as Document No. 720533. PAGES: 1 Grantor reserves an easement for ingress and shown on the above a eg ress, as s Name ame an n Area g d Return Address described Certified Survey Map. This easement shall run with the land. Ronald L. Slier VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 118 New Richmond, WI 54017 t l Identification Number ) not homestead pro p Dated this 54 day of , 2003. *Douglas J. Bell *Kar A. Bell AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. St. Croix County ) authenticated this _ day of , 2003. Personally came before me this day of 2003 the above named (/ to me Icdo� • rt�o TITLE: MEMBER STATE BAR OF WISCONSIN exec d the foregoing daac ss (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY * r L u w Ronald L. Siler Notary Public, State of Wi consin ► •�••'+ 0l, VAN DYK, O'BOYLE & SILER, S.C. My Commission is permanent. If note expi ti date: Post Office Box 118, New Richmond, WI 54017 Z - /(i ' 20 (Signatures may be authenticated or acknowledge. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM N0. 3 -1999 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800.8552021 Mode AM- 1531 SQ. FT. (OUTSIDE FLOOR) K 459 ��LL pp S M 8380 Ff 0 56' -0" 0 OPT. VAULT CEILING OPT, VAULT CEILING 0 12 0 12'_0" 18'_8" 13 d� 2440 2440 KCW446P ________ _____________..____________.__- (K ) (K) (2-K) i Modular Do BEDR BEDR¢OOM2 LIVING Code -H WwF wINT ROOKY! �H ` WALK -- 'x- rt ¢ GARAGE GA SITE BUILT BY CONTRACTOR rn C _ N _ J 4� HALF 1VALL W/ STAINED HARDWOOD CAP. AN BEDROOM 1 - (~ _ m DINING D ¢ wwF ROONl ------------------ _. _ OPT - W CHINA = 60 TUB ST NS-179) BLS _ 1632 1632 2440 3240 (M) i (M) (K) W \ (2 -G) 0 6 ,_ 8 " 0 5' ]0' - 8i 0 181 K, .... 14' - 8" O OPT, VAULT CEILING PT. VAULT CEILING P = STD BASEMENT PLUMBING VENT LOCATION oo f rF 7 7 r7 r DO 77 7FFF AM -452 WITH STD 4.39/12 ROOF PITCH, DOUBLE HUNG WINDOWS WINDOW GRIDS, MODULAR TYPE STORM DOOR, AND 140" BOX BAY GARAGE BUILT ON SITE BY OTHERS THE OVERALL DIMENSIONS OF HOMES SHOWN DO NOT INCLUDE A22" NOMINAL EAVE OVERHANG ALLAROUND THE HOME. DUE TO CONSISTENT PRODUCT IMPROVEMENTS FLOOR PLANS AND RENDERINGS ARE SUBJECT TO CHANGE WITHOUT NOTICE. EXTERIOR ELEVATIONS SHOWN MAY INCLUDE OPTIONS OR ADDITIONAL ON SITE WORK. jl TY FL SEP - 9 5 - 2� _ BODG 484 E~ R a W R 0 • 2 3 - a; -° 3 7� F l� Q)l t5 3 3 at :: CLEAR LAKE, t a +u m 4 - 2) - 03 ST. CRQIX COUNTY ••••'•.• WI •••' • Q' � e•�sra S - 0 3 VOL ] PAGE 451 5 - • __ -- SI.IR��i 4 RS RECORD �''rr, 4 Nb �� KATN'LEEN H. M ALSH "' '4J �im t�itv`v REGISTER OF DEEDS C E R T I F I E D SURVEY M A P RECEIVEDXFOR�RECORD Located in part of the Northeast Quarter of the Northwest Quarter and part of the 05/08/2003 09:00AK Northwest Quarter of the Northwest Quarter, all in Section 12, Township 30 North, CERTIFIED SURVEY MAP Range 19 West, Town of Somerset, St. Croix County, Wisconsin. REC F 13.00 ORDINARY HIGHWATER CC* of ed3wift 30 days of Prepared for and at the request of: MARK EL. 891.5 PA approval shall be OWNER: ESTABLISHED BY ST. nd void Doug do Karen Bell I �\ \� CORNER FALLS IN CROIX COUNTY 1690 85rd Street NAVIGABLE WATER. ZONING DEPT. New Richmond, N 54017 NO MONUMENT SET. 04/17/03 a�•� \2 \� Drafted by. Howard H. Herrild III I� I 0\ OD F O I • LrO� N Z �l 0� I� 6�a� z0 O {, O o e o� It��c o ��C o N v do - n j (n O N O 36 z Ir` I(j) ' 0. • (D E m �- ° o cnc o cD -m C Imo p .N •� 0) O O 9 n 0. :3 �'' ;0 0 m m P I �i ^� • ' n6 01 O � -� co o v' o, a o ' ° ° -1� a� I I P .° N z � ac �D 3 N N x 2.0 m D -(� I T S 1 Cn O n V1 O j N O� mCp 7 O O f I I� ='�1 O N N r�i m, x o N m C cn o ° ' ° -0 o m D O rn \ cD N W 114 -NW 1�4 rn 7 m W -n I� NE - 1/ -NW 1�4 te ��,I,Z I @ No D m j O rn Nn N o DO I y M° ., Iz- 0 . 0 p °`4W0 0 0 id co 0 N ti •O d 0 °3 on0F N I Sp°X0 C1 A a:3 OD ID C O -4 0O,p _ CA IO X 00° ? ��c.� N w OD `�C'n O ° �.�vi oa w I� m�caD c0 V 0 o O o IZ ^�4 p, m Ip � I O n o a �, oo 00 .'x,. I� 13 r n� � c `�T�.I I 6 � ' �1 � � _ O Z '0 0 m 0 fDQ I � *M : :� C7 S c o coa ' = m ' :3 o rt I� N � "c �'w �' W I� n 0 c _ -p► TIO OON" � I •'�� O N ° O O S >rn Z 3 cn I� �� nN nN :''�:.a?: V ( - M?� as mom �� a o 3 I� I� N' ;' am ao O mnn 0j0� I . ( v D o o0 (D m _a Z 0 O .. y d w Duo n� 0- �I :: w ;U .. I 00 p 3 ��o Cn'a cD 0 / / Iv, I tj c n Q) m r; S I ~ O '*1 D 0 N o to N Z O Z "J z Z M m C N O 3 M� I _ M - a m� N Cr m ie0c� IO I� �D�M 0 0 0 0 c: n m o r 0 cn ti c C. aZ I� I� o �p6 �0 C KpN� I� ��N� M�'d �/ LD ZD .�. c o �' '� I I to cn L� � ! 0 1 O I~ w L' '49 / z co 0 ° z IZ �'' 1 I J i•• 85th Street K m o \ 11 I 1 NORTH -SOUTH OUARTER _ • LINE OF SEC nON 12 MOW S 00 " W S 00_28'20" . 20 W JOB N WI057SU117 o; ' � 3977.87 cam _ 1251. Prepared by. S 00'28'20" W �_ 5294.92' ConsulSng Group, I nc. Phone No. (715) 246 - 4319 —� S I �'� �I BLUE STE Fax No. (715) 246 -3830 C S M 0 0• — —M '.0. Box 325 �L• �2 f? 6 2 8' m sw Richmond, WI 54017 _ — = 388 6 .0? 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