The URL can be used to link to this page

Home My WebLink About032-2177-05-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479393 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal inforr -.19 on you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Crott , Jason Somerset, Town of 032- 2177 -05 -000 CST BM Elev: Insp. BM Elev: t BM Description: Section/Town/Range/Map No: (70 • Qv C r 11.31.19.1509 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l (66( --4z_- p �.3p fo�i.�D t cw . r7 Dosing - - Alt. BM S � N �.�'9 p�•Sl Aeration Bldg. Sewer r Holding St/Ht Inlet I1. z I TANK SETBACK INFORMATION St/Ht Outlet 12 0 Sao 3 . 30 r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 4o' , (ova 5 i Dt Bottom Dosing _ -- - -- - _ Header /Man N 3 ! 3- 17- Aeration Dist. Pi a 13. S.6 T 13 •v?- . (o Holding Bot. Syste I'f • 9 y �'f ' Final Grade I � PUMP /SIPHON INFORMATION tg n i t Manufacturer _ GP and St Cover t �r� Oz • 3S r Model Number l TDH Lift 11 Plkion Loss System Head TDH Ft Forcemain ength Dist. to SOIL ORPTION SYSTEM Zg /TRENCH Width f Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 3 • �j pert • Z SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man acture INFORMATION CHAMBER OR Type Of System: 2—/ Q f SO i + UNIT Model Nur�l�er DISTRIBUTION SYSTEM U '�?j Header /Manifold �, Distribution -�._ x Hole Size x Hole Spacing Vent to Air Intake Length_ Dia � Len Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of i m Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes j No ?j Yes F7 No COMNv7 y �: (I I e code discrepencies, persons present, etc.) Inspection # 1: tO • << I� Inspection #2: -- -- % -�. 2N ll Location: 622 222nd Avenue Somerset,W1 54025 ( 1 SW 1/4 11 T31 R19W / HHidden Hills Lot 5 Par el o: 11.31.19.'1599 1. Alt BM Description = 5 T• W - J 4 L `-��` ` 5 &) T) 2.) Bldg sewer length = — 45 - 0 _ 5 Ac_ or 0M "'A y`�2 t"t>�� • S� S`� S�L�nti �lS '� (� J � qmount of cover ,, , p, / �s t/ "Z d f _ ct�cwa i - 4P of s et tCn 't t �JCdt Plan revision Required? ]Yes No �.,& Use other side for additional information. ------1 Date Insepctors Signature Cert. No. SBD -6710 (R.3/97) r A Safety and Buildings Division County r ` 201 W. Washington Ave., P.O. Box 7162 ,, sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)266 -3151 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83,2 1. Wis. Adm. Code, personal information you provide 1�1 may be used for secondary purposes Privacy Law, sl5.04(1 Xm) roject Address (if different than mailing address) 1. Application Information - PleasePrintAllInformation PKEIVED W n� Property Owner's Name P arcel # Lot # Block # AUG T, A/ IR ar- 7 VC0 #: $� c� ��z_ �d a.a 77 ds Property Owner's Mailing Address Z Property Location '::, CROIX COUNTY , t - Vg �' /., suV 'h, Section // �' City, State Zip Code circle o e) E C 0 50 II. Type of Building (check all that apply) v G K�e�� Subdivision Name CSM Number 1 or 2 Family Dw -Iling - Number of Bedrooms ❑ Public/Commercial - Describe Use Gl ❑ State Owned - Describe Use ❑City_ ❑Village Srownship of Q 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. El Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. T W m Type of POTS S ste: Check all that a l T Non - Pressurized In- Ground 11 At - Mound > 24 in. of suitable Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter i Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gl: s Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Coo ✓ s c 970, A r 76 ' 6) VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) is Signature M P umber Business Phone Number .4 1 7 - 7 �_7ztj . Plumber's Address (Street, City, State, Z ode) 7 VIII. un&De artme t Use Onl Sanitary Permit Fee (includes Groundwater D Issued suing Age Sign cure (N tips) Approved 11 Disapproved Surcharge Fee) 7%' �0 ❑Owner Given Reason for Denial / 3X z IX. Conditions of Approval /Reasons for Disapproval ��"G2 I SYSTEM OWNER: _ tank, effluent ilter and 73 Ste_ dispersal cell must all be serviced / maintained as per management plan providedaby plumber. 2. All setback requirements muse maintained n - �� yt p 2 as per applicable code /ordinances. ( I j � Q Attach complete plans (to the County only) for the system on paper not less than 81/2 X11 ir6hesinsize SBD -6398 (R. 01/03) vc VENT 11VTpecPa S' ysj�/ E �• iJ ! Aft lia e5 E /l fti 1 r � 7 � A F. Il i s ,� " 3 LP -_ LOT�t — � cwT44 U e, I r I SCAM J ` Vv- I I • cr L✓ ! j� Ay I / I j H I L L- CURVE TABLE ' PLAT) CURVE RADIUS DELTA ARC CHORD HOBO BEARIN TANGENT BEARINGS eset Quarter, port of the Northeast Quarter of ° Awrter of the Southwest Quarter, all In Section 3. 1 9' 7 IN e1 Somerset„ St Golx County, Wisconsin. C3 67 °1 ' 3. 7 ' 4 S ° 1 6e5 x1' LOT_ 1 _EO_T_ 2 CERTIFIED SURVEY MAP L _ S88 1158 20' VOL._11 �PgGE 3242 LOT 3 .o for Lots 9 10 88833 827.10' I N f I c 209, 519 sq. ft. M LOT 1n , : g s ¢ 4.81 acres + " � N� 289,195 sq. ft. oil 6.64 acres I 1 ® 1 — -627.p0' I 33' N89'29'10 "W 660.00' I — 988'24'11 "E 49 812' 237.43' N86'24 '11 "W I SONyy 260.70' I LOT 1 / /��•� °/j �,ts �(`r LOT 3 _C VO _3 �' 16 roue' C.S.(vl_ VOL. - 17 j PAGE 847 + L PAGE 4608 LBO = 9s1. o' 164,765 aq. ft• - - - 3.78 acres I Qil / I r' LBo = 950.0' g6� 58712'10 "E 660.57' .. 3103' 507.1 D' `120.44' LOT5 as M.`� lm 658 sq. ft. / , • v�,, J.07 acres 174157 sq. ft A04 acres ® L80 - 9555' i rn 1 6 .5 S S8874'11'E 615,88' 957.38 RXTH AVENUE LOT 7 43698 s 3.30 acres;' / LBO a 952 0'.• > I N M '9 NE THE PARCELS SHOWN ON THIS MAP ARE X SUBJECT TO STATE, COUNTY AND TOWNSHIP LAWS, RULES AND REOLJLA71ONS (( WETLANDS, MINIMUM LOT SIZE, AL:CESS TO PARCEL, ETC.). BEFORE PURCHASING OR DEVELOPING ANY PARCEL, CONTACT THE ST. A CROIX COUNTY ZONING OFFICE AND THE '� j� APPROPRIATE TOWN BOARD FOR ADVIGE. SIN N E ST AR LINE ED TO BEAR Sao / ��`$ �� -y /� r y ?h :' 950.7 M w' •� 9F8 .Fl J OF YH E APPROVED 2 � - - - 7t05I0N PLAN FOR smnl AYOilE — 11' TO BUILDING UPON. MAY a 7 2004 ��n Mp 1N0 OR PLANTING IN N y^ n SEC 11, T. 31 N., R.19 W. S SFFOINGSATER TOWN OF SOMERSET. ST. CROIX COUNTY, WI Z NI Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of J Division of Safety and Buildings - „ ' + $ Co 85, Wis. Adm. Code Attach complete site plan on pa er not less than 8 1/2 x 11 inch sin size. Plan must County include, but not limited to: verti I and t� Mnjl gfe point BM), direction and Parcel LD.Jo?3 / -7 � ' 0 - 6 � percent slope, scale or dimensi s, no a�'r�}0 d on an distance to nearest road. � Plea a prW 6RWQ"p1Qn. Re iewed by Date Personal information you provide avacy Law, s. 15.04 (1) (m)). Prop e Owner / /f Property Location / ee ,,— t° Govt. Lot � / 1/4 -S 1 1/4 S ! / T3/ N R 9 (or& Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 6 2- y .220 6 5 1 City State Zip Code Phone Number ❑ City ❑ Village [aTown Nearest Road SC"" e-r l 1 5 zr 1 ( 71 ) ;? ,,1 7 2 mP,.-fe f I 22Z a w e New Construction User Residential / Number of bedrooms Code derived design flow rate 6y GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 0 to - -G--- t f 6 Flood Plain elevation if applicable ft. General comments 5` yS t M ��.� D �� f'>Pi wry ✓ e4 `�� l Z and recommendations: — Z ❑ Boring # ❑ Boring �n pit Ground surface elev. �UU. ft. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 2 7-Z / 7, rye A �S /I? •= PE I d - 120 Ohs ps d- s6 Y a2 F21 Boring # ❑ Boring , 5 pit Ground surface elev. _(O 7 ft. Depth to limiting factor �� Z� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft < in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 2 cj-7- 2 757,X A NT S /Z- 7, 57X �" Gs �v l"z v „ 7 F � G 7 ,1 Z D A %? /�S �S r-2 3 Y w. • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) /nature CST Number Address Date Evaluation Conducted Telephone Number 3 1?j- ' Z � � e Sv r� �� r� w L L/-q' - � C/ 71 5-- T e7 SBD -8330 (R07 100) IL Property Owner ��G �'� Parcel ID # Page 2 of Boring # Boring F-71 U / pit Ground surface elev. �7. U ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 � IVA 1'G 2r4s�k l�- LS )3 -10 /c /'X O'3 A;4- vss ❑ Boring # Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ ❑ pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L 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. SBD -8330 (R.07 100) OWNER Page 3 of 3 Name C �04 lei ) Brian Parnell Addressr • by- 2 O Ck CST 231314 / G /-7 P�1 el- 4—;;r Date �l Benchmark 1 UC % e G L• �D U L�ite -T A Benchmark 2 ❑_ Soil Boring _ _� Suitable Area 1 " = 40' Scale i 1 i i 1 I I z I• � ! 1 � � —�� I I— I I 1 f i i r I I i i r L I U t� : eu I I 60A \ / D a I � - v I i c r I c� db s -. ., � �, �. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t7;q,Sy a Q��`� ' Mailing Address s ; Z 3-2 ny o A a g u/i ` S�D 2 5 Property Address a� (Verification required from Planning Department for new construction) City/State Sti L s,--� �!` Parcel Identification Number LEGAL DESCRIPTION L T Property Location )W2_ V4, 5j , & _ '/4, Sec. /� , T�_N -R W, o wn o Subdivision , /11,0 4 AW t- t • Lot Certified Survey Map # Volume , Page # Warranty Deed # 2 �K7_3-2 . Volume D , Page # ?/D Spec house ❑ yes ® no Lot lines identifiable 11 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 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. ? 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 yo septic has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of year on date. / /,go- ry; T ME OF APP OWNER CE R ICAT N I (we) certify that statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property descnbed , 008ve virtue of a warranty deed recorded in Register of Deeds Office. hy t - 7 /! � ® * * * ** Any informatio at is mis- represented ma 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 war ranty a copy of the certified survey map if reference is made m th e deed i i ` POWTS OWNER'S MANUAL St MANAGEMENT PLAN Page of Z FILE INFORMATION SYSTEM SPECISCATIONS Owner - i Septic Tank Capacity a l 13 NA Permit Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A ❑ NA Number of Public Facility Units E NA Pump Tank Capacity a l ® NA Estimated flow (average) g al/day Pump Tank Manufacturer E NA Design flow (peak), (Estimated x 1.5) (j g al/day Pump Manufacturer E NA Soil Application Rate al /da /ftl Pump Model E NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit E NA Fats, Oil & Grease (FOG) 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 E In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L A ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml / " ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA A � , 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ Nq 1 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 years) 13 NA every: ® year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once'every: M yea�( (Maximum 3 years) ❑ NA " --�� ,,--,��, Clean effluent filter ��;1�G� —� At least once every: ❑ year) 1 (s) ❑ NA pump, pump controls & alarm At least once eve ❑ month(s) Inspect p every: ®NA ❑ year(s) t ❑ month(s) E NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) ❑ NA 1 At least once every: ❑ year(s) t g . ( ` Other: ❑ NA` s' i z1 Pig } MAINTENANCE INSTRUCTIONS„ )' Inspections . `of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications t� f Master Plumber; Master 'Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, 3 -` ! S measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface', t' ; The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for -any pending; I of effluent the ground surface. The ponding of effluent onthe ground surface he may.indicate a fa�I, on condition and requires t i mediate notification of the local regulatory authority. a When the combined accumulation of sludge and sc tthe um in any tank equals one third (Y,1 or more of the tank volume, entire i contents of .the tank shall be removed by a Septage Servicing Operator and disposed of m accordance with chapter NR ;113, Wisconsin Administrative Code , SC 1 is of 2 'tL''3 .j� Ali other _sernces, mcludmg but not limned to the servicing of e ffluent ftiters u mechanical or pressuµ�zed compo pr �. shall ied f .. POWTS Ma units, and any servicing at intervals of 512 months, be performed by a certif�ntamer a f? �¢' ; r . ;.• � . �`•�: � ?;� ,.. « c�tri �� .�... 'a - _ t } (;',. A sernca report'shall be provided_to the local regulatory authority within 10 days of completion of any .servlce event gg x .�- ''• w¢:: y.. [p 5 ?1.�r� r J 4 F9:.. ,'t ,�.� di �,k �+t k.'. A� �Y s �� 4 F �Y� ' S, '`r� . L� f � i t � §� i.r •?' x t 3 t r��4y 5 � #q r � _� 4 � \s rro fib � . x Page of START UP AND OPERATION For new construction, prior to use of the POWTS check.treatment tanks) for the presence of painting products or other chemicals that may impgde 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 or surface 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; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat 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 its shall be removed and properly disposed of b a Se to a Servicing Operator. I P P P Y P Y P .9 9 • 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. 3 CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant s replacement system: ■ 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. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances i(V POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. h si has o en evalu a to identi suitable rep ment area. Upon failure of the TS a s ' site v lu m s be erfor to Cate suita le repla meet rea. If no replaceme area is available a holding t ay e i stall as a esort to r ace the fai S. :. ❑ ound 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 ,M POWTS INSTALLER POWTS MAINTAINER r Name - Name 4 ' Phone Phone _ _ }s SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY.AUTHORITY tJame� a ;Name ` Phone �� G E t �' ea a y y x ; a3 I i 4 yc Y x Phone PW . /,.f` ...::' ,,, , i . .'� y This . document was drafted �n compliance With chapter Comm 83 22(2)(b)(1)(d) &(f) and 83 54(1), (2) & (3), �1/isCOns AdmWitrativa Code r� , ; '� ,c.: . ��,� � � t _� � z 33 r v t S ' ", � `��, S b5 ✓.s+. - Y s'k } rit } f ;,f. 7 . � r ,� ..." •, s -a. 'sfp'Sf {�;�� -�v*y, �.� ;15 r �t e is � � r` Y- � .- ±si3`: f C. S sY� �`''��r Y Parcel #: 032 - 2177 -05 -000 08/12/2005 03:16 PM PAGE 1 OF 1 Alt. Parcel M 11.31.19.1509 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/01/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner JASON A & JANINE M CROTTY O - CROTTY, JASON A & JANINE M 298 232ND AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 622 222ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.070 Plat: 10/13- HIDDEN HILLS 032/04 4/15 SEC 11 T31N R19W PT NW SW HIDDEN HILLS Block/Condo Bldg: LOT 05 '04 LOT 05 (3.07AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 11- 31N -19W NW SW Notes: Parcel History: Date Doc # Vol /Page Ty pe 05/12/2005 794732 2801/310 VID 09/21/2004 774921 2660/238 QC 07/27/2004 769897 2624/467 VID 07/01/2004 767565 10/13 m T 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2 05 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.070 54,300 0 54,300 NO Totals for 2005: General Property 3.070 54,300 0 54,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charl es Total 0.00 0.00 000 U. 2 8 0 1 P 3 1 0 7 947 Z32 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS ' WARRANTY DEED ST. CROIX Co., WI Document Number Document Name RECEIVED FOR RECORD 05/12/2005 09 :25AN WARRANTY DEED THIS DEED, made between Richard L. Plourde a /k/a Richard Plourde E(EIPT # ( "Grantor," whether one or more), TRANS FE E: 171.00 and Jason A. Crotty and Janine M. Crotty, husband and wife COPY FEE: ( "Grantee," whether one or more). CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Rohm Address First National Bank Lot 5, Plat of Hidden Hills in the Town of Somerset, St. Croix County, Wisconsin. PO Box 89 New Richmond, WI 54017 I Part of: 032 - 1031 -95 -025 & 032 -1032 -30-00 P Identification um r PIN arcel Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated May 6, 2005 (SEAL) (SEAL) * *Richard L. Plourde (SEAL) (SEAL; AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ) authenticated on ) ss. St. Croix COUNTY ) * Personally came before me on , TITLE: MEMBER STATE BAR OF WISCCNSIN the above -named Richard L. Plourde a /k/a Richard Plourde (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. JULIE C DODGE THIS INSTRUMENT DRAFTED BY: i t ry PubliclState of V�sconsin Attorney Kristina Oland * Julie . Dodge Hudson, WI 54016 Notary Public,State of Wisconsin My Commission (is permanent) (expires: 04/02/06 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 " Type name below signatures. INFO-PRO" Legal Forms 800- 655.2021 www,infoproforms.com