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004-1055-20-100
/ ¥ ) CD p_ 22 / ) ° H % 0 . 2 7 � E 4 ƒ 0 C § E . 7 \Q) � ) Gk\ e }§a LL S2 � 2 ƒ7 � $ » E \£b « E � w a / � { � & � / § 0 . m . \ \ § _+ ) �z� ® 0 I m _ § / � � � • 7 } § Q ) k k \ " ' \ g % k a ] � CL / § \ ( § _ o � V) ■ U) § » \ $kkk ®co § � -� $ ) E a a CL 'S 0 � 2 -j 0 k \ k ƒ / �/ / C _ � § % IK 2 E � / % \ 2 \ / ) E _ ® — C) _ c .± q § 2 g \ k } / # ) \ 2 7 $ \ k k / § 7 § f \ \ _ - w / \ G 3 7 0 } / ) ) \ C4 ■ C i « L L ) % CL , . k \ a 2 ik k Parcel #: 004 - 1055 -20 -100 03/23/2005 02:26 PM PAGE 1 OF 1 Alt. Parcel #: 23.28.15.372B 004 - TOWN OF CADY Current X!; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner * WILSON, CURTIS L & LYNN S CURTIS L & LYNN S WILSON 3271 30TH AVE KNAPP WI 54749 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 3271 30TH AVE SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.000 Plat: 0883 -CSM 13/3682 SEC 24 T28N R15W PT NW NE BEING LOT 1 Block/Condo Bldg: 10. LOT 1 CSM 13/3682 10.00AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 24- 28N -15W Notes: Parcel History: Date Doc # Vol /Page Type 07/29/1999 607664 1445/205 WD 07/23/1997 1120/542 WD 07/23/1997 1116/613 TD 07/23/1997 1050/574 WD more 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 55537 Use Value Assessment Valuations: Last Changed: 04/11/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 13,000 61,300 74,300 NO AGRICULTURAL G4 5.000 600 0 600 NO Totals for 2004: General Property 10.000 13,600 61,300 74,900 Woodland 0.000 0 0 Totals for 2003: General Property 10.000 13,600 61,300 74,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 516 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY RE Owner /M2 ('�hr2, s 60 w m Ah Property Address 3 3 7 1 3 o o�t' 'q-6- City /State Ko g e . b - i 5 y 7 , 1 9 ; F , �, 1 „� Nf NT Legal Description: b 1 a, Lot �_ Block m.4, Subd><vision/CSM # loG 6 0 7 1 /4 Ne 1 /4, Sec. _!�±, T QS N -R is W, Town of C P SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer M',lweslc-run P RE Size ST/PC ool / bA° Setback from: House !S� Well h�O P/0 Pump manufacturer Zd c-► l ,--rz. C s`} Model 9d Alarm location I Y s Lp- ! 4 / P' A � , u- h� �— (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of syste= — d u.r\ d Width a'l• q ' Length j k), 4 ` Number of Trenches L Setback from: House 804 Well > ► -o P/L i s 6 1 _ Vent to fresh air intake N.a . ELEVATIONS Description of benchmark Elevation 1bc,, o Description of alternate benchmark Elevation _C 7 Building Sewer R a.0 ST/HT Inlet q f -1 ST Outlet PC Inlet M. a PC Bottom "? - 7. S N Header/Manifold (o� �� Top o ST Manhole Cover 1 - 7 Distribution Lines ( ) G 6 • « O ( ) Bottom of System O '15 • & O ( ) Final Grade ( ) q,7, Date of installation / 151 q Permit number # 3 State plan nu tu ber 1�3V3 ffd Plumber's sig a License number M p 5 ' 5 Date / L9l 9 9 Inspector U LK Complete plot plan Or I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW N 5 A e.1�An_ owl• N 4�4,. 19' %4^ z a vo n rd `o D" P wmp 3n,.k mPn bait p �• X �'&11 n Z r 1 4 �• ^�S loa,or ' I i S T ARROW INDICATE NORTH O 606067 CERT I F I ED SURVEY MAP LOCATED IN THE NW 114 OF THE NE 114 OF SECT 24, T. 28N. , R. 15W., TOWN OF CADY, ST. CRO I X COUNTY, WI SCONS IN PREPARED FOR CHR IS BOWMAN !� 3 D Ot 1999 v NORTH QUARTER CORNER NORTHEAST CORNER SECTION 24 - FOUND SECTION 24 - FOUND I" IRON PIPE .UNPLATTED „LANDS ALUMINUM CAPPED MOW. NORTH L I NE OF THE NE l i4 NE COR. _ _ 26 NW-NE N89 1 40 ” E w N89 f 9' 40" E 660. 02' a► _ S89 19 40" W__� 676. 9' N89 19' 40 'E ' 660. 02' O �_ 1336. 1' _ - IJR I VFW w SEPTIC VENT APPROX. 3' E. w g WELL HOUSE g g OF N -S FXL .......................... o.j4 ❑f ..... Z HIGHWAY SETBACK f c m A ,r SHED p o y NZ � :Z 'SHED L ininf D o> — LOT 1 O Z :D p 10.00 ACRES o r' 435,604 SO. FT. N :D 9. 50 ACRES EXC. Ro W 413, SO. FT. f APPROX. 4.5' E. OF N -S F.-IL 6. S89 19' 40" W 660.02' At 2I 2 UNPL ATTED L ANDS ... ............................... C) NS w BEARINGS ARE REFERENCED TO THE NORTH DAMES M. LINE OF THE NE 114, SECTION 24. WBER MEASURED AS N89 19' 40" E (ST. CROI X 8-1804 COUNTY COORDINATE SYSTEM.) LEGEND < OPP mm. Qs O N SET 1" X 24" IRON PIPE WEIGHING 1 N - 200' 200 1.13 L BS. PER LINEAR FOOT 'YO S U Rv giii� nnnnru►u��'`� O 100 200 400 JAMES M. WEBER S -1804 SHEET I OF 2 NEL SEN -WEBER LAND SURVEYING DATED 99148 THIS INSTRUMENT DRAFTED BY JIM WEBER 1.13 Page 368 I N JWS g S QW w ,.j .Nita 0 4xo U. www mowo e. �OQW� o� Y CG tff DESCRIPTION A parcel of land located in the Northwest' /4 of the Northeast' /4 of Section 24, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Northeast Corner of said Section 24; thence, South 89° 19'40" West along the north line of said Northeast 1 /4, 1336.41 feet to the Northeast corner of said Northwest' /4 of the Northeast 1 /4, which is also the POINT OF BEGINNING, thence, South 00 °05'08" East along the east line of said Northwest' /4 of the Northeast 1 /4, 660.02 feet; thence, South 89 °19'40" West, 660.02 feet; thence, North 00 °05'08" West, 660.02 feet to the north line of said Northeast 1 /4; thence, North 89 0 19'40" East along said north line, 660.02 feet to the point of beginning. Containing 10.00 acres or 435,604 square feet. Subject to right of way for 3& Avenue as shown, also subject to any and all additional easements, right of ways or conveyances of record. SURVEYOR'S CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Chris Bowman, I have surveyed and mapped the above described parcel of land and that this map is a correct representation thereof. nur n�nnii� y Dated this ��day of 2LN� 2 1999 ��$C Oly V JAMES M. - ire -.� • �,.� �..[► � James M. Weber S -1804 WEBER Sseo4 NELSEN -WEBER LAND SURVEYING, INC. . 9tio s NOTE u�m The parcel shown on this map is subject to State, County, and Town laws, rules and regulations (ie. Wetlands, minimum lot size, access to parcel, etc.). Before purcasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. 99148 This instrument drafted by Jim Weber SHEET 2 OF 2 Vol. 13 Page 3682 1101 Carmichael Road Hudson, WI 54016 Phone: (715) 386-4680 Croix County Fax: (715) 386-4686 Zoning Department Fm To: First National Bank of Hudson From: Shawna Moe Fax: 715- 796 -2422 Date: July 20, 1999 Phone: Pages: 2 Re: Septic Report — Chris Bowman CC: ❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle •Comments: v ST. CROIX COUNTY WISCONSIN ' ZONING OFFICE p l 'INN u 6 n ST. CROIX COUNTY GOVERNMENT CENTER "■" 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 July 19, 1999 First National Bank of Hudson 915 Davis Street Hammond, WI 54015 RE: Septic Inspection for Chris Bowman located at 327130' Avenue, Town of Cady, St. Croix County, Wisconsin To Whom It May Concern: A septic inspection of the above referenced property was conducted on July 15, 1999. This property is in the NW% of the NE'/ of Section 24, T28N -R15W, Town of Cady, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, Kevin S. Grabau Zoning Technician /sm Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST, CRC IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], 3 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: BOWMAN, CHRIS CADY CST BM Elev.:- Insp. BM Elev.: BM D tion: Parcel Tax No.: e Si 004- 1055 -20 -000 TANK INFORMATION ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic rA z&WeZ, Benchmark 12 /O /.Z/ 01 Dosing ���bSO �,'..vj �. "" 3•G q" s`� Aeration Bldg. Sewer 9 Z Holding St/ Ht Inlet 9, 5< 1'4 TANK SETBACK INFORMATION 4ti Ht -eurtlet Vent to n+� TANK TO P/ L WELL BLDG. Air Intake ROAD Septic DSO ' > 5V 12 / ✓ NA Dt Bottom ?7% IT Dosing `' " rt 2 NA Header/ Man. Aeration NA Dist. Pipe .ov Holding Bot. System S ?2 " Z PUMP/ SIPHON INFORMATION Final Grade Manufacturer - -.7 o Demand Model Number '�`� g a�GPM TDH Lift �� Lrictio ` o System "� TDH D Ft mead oss Forcemain Length go Dia. 2 Dist. To Well > S0 SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of T es PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS l l '{ +� _ DIMENSION S SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type of CHAMBER Model Number: System: > 1 > /at OR UNIT DISTRIBUTION SYSTEM S " 1-L — t Header / Ma Mol � Distribution Pipe(s) 90 2 I x H; 1 Size x Hole Spacing Vent To Air Intake Length, Length � Dia. � Spacing ��^ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) C°vk.,• 9 ; 9' , o l :7. LOCATION: CADY 23.28.15.372,NW,NE 3271 30TH AVENUE � �LOT�1 t � g1.21 A�.g�^= �. ��s �;�,. (r�� . �, _,s - �� �� PCB •�)-T,� ��� , Plan revision required? ❑ Yes IX No Use other side for additional information. Date Inspector's Signature Cert. No. SBD -6710 (R.3/97) ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: _ i E Kno - r t 9 e v e « " r = x x . ..mvv V A- . emm. m .,tee =a ..... n. .ee.. ... .. _ ma_ E x c 3 x { a 3 A S ; } qm _.. .. :.. w . _ .. ,.... .... _.,.,.. _ .. _, _ ..._ ._., 1 A A [All 4- 2 } j t � i i. Y x x F S t _ x } .,_� .....� x t PT s m. 3 m E. kx _ >. ...m <_ __.^ .. .. .. ..�.. ... .a .. �. .. .... .._ i F � 3 ._a .e ...,e..,.... £ _., „'.. __ .,..,...- { ...... 3 .. .... W . J .2— "i j t j ! g C 4 d i _ 44 - 4 1 1- r c i t o 3 r a ti fl $ t _. F. F e . m .,,.. .,.� is v.. .� « »' €==.,m— E 1 41 3 e t � ...�,„ z .. ... e 4 � � _ = t A s j i i + e V J e.,x e =. ,ry .. ,.. ...... ,..« k..., _.,,... ...e == } a a e x e i t E e F 3 } r+ = s >f a € x € Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue �scons�n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • . Attach complete plans (to the county copy only) for the system, on paper not less County , than 8 1/2 x 11 inches in size. ,r • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes E] Check it revisio� l IPrivacy Law, s. 15.04 (1) (m)]" St to Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location '< , 's A ll r 1/4 Alr 1i4, S Z T 2y , N, R Property Owner's Mailing Address Lot Number Block Number ',? 7 C_ '` A — 4. City, State Zip Code Phone Number or CSM Number ,� W $�7* 9 ( 7 15 > ��Z- 69 1>��� �� ..� L� CrA4 13, -W. Tr II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms _3 jM Tow OF 04 111 BUILDING USE (If building type is public, check all that apply) Parc Tax Number V� 1 [j Apartment/ Condo 3 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2_ In Replacement 3 ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________System _____________ Tank Only______________ Existing System _________ExistingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number 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 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill v✓ 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 L� > Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq_ ft.) (Min. /inch) Elevation - 1 C 3 c 5 7 N- /Q 5 d Feet 97.3 Feet acct VII. TANK in Cap Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st noted Steel glass Plastic App Tanks Tanks Septic Tank clr_HD dingJanl 0e n CC C / r n ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/SiphoaZhamber 1 ��.SG — �.�0 Yl�tEZ�z ") ® ❑ 1 ❑ ❑ 1 ❑ 1 Cl VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite WWage system shown on the attached plans. Plum er's Name: (Print) Plumber's I nat tamps) MP .. Business P one Number: 7 � GK /�• �JWr�� _ 5 �5 7.7 71 5 0,36 -(.?� Plumber's Address (Street, City, State, Zip Code)• - 2 i 9 5, i7 rr7 i rzta 15V76 IX. COUNTY/ DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuina Agent Signature (No Stamps) proved [:]Owner Given Initial _ urcharge Fee) Adverse Determination _ �tou X. CONDITIONS OF APPR VAL / REA ONS FOR DISAPPROVAL: V - kim,ew 1pft- SBD- 6398 (R.11197) 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 a 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 and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide tKe 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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 1/2 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 takes; 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 contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary July 07, 1999 CUST ID No.260751 ATTN: POWTS INSPECTOR ZONING OFFICE BOWMAN PLUMBING INC ST CROIX COUNTY SPIA 2819 KNAPP ST 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 07/07/2001 Identification Numbers Transaction ID No. 234388 SITE: Site ID No. 175802 Site ID: 175802 Please refer to both,identification numbers, St. Croix County, Town of Cady above,, in all correspondence with the, agency. NW1 /4, NE1 /4, S24, T28N, R15W Facility: Chris Bowman FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 477740 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The existing septic system must be properly abandoned. • The downslope edge of the mound shall be a minimum of five feet from the property line. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 06/25/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 6erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiSTco�633 MOUND SYSTEM DESIGN 2 g 1989 SgFETY & Residential Application 8t®GS INDEX AND TITLE SHEET nIV, Project Bowman Owner Chris Bowman Address 3271 30th Ave. Knapp, WI 54749 Legal Description NW NE 24 28 15W Township Cady County St. Croix Cond itionally Subdivision Name N.A. Lot No. N:A. EPART B W E 1) D SA OY COMB Parcel ID Number 004 - 1055 -20 piwsl Plan Transaction Number ONDENCE SEE Cop Index and title sheet Page 1 Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump Information Page 6 Site plan Page 7 Attachments - soil test Page 8 Designer loretta/ Jack A. Bowman License Number MP 5875 Sig2 e Jtune Phone No. (715) 235 -4634 1, 1999 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 146.10, Ws. Stats. Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). t SBD- 10462 -E (R.05/98) Pagel of 7 i MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metric Residential or commercial? r (r or c) (y or n) Replacement system? Creviced bedrock site? n (y or n) Slope 4 % Wastewater flow rate 450 I gpd 1703 Lpd Depth to limiting factor 12 in 30.5 cm in situ soil infiltration rate 0.5 gpd /ft z 20.4 Lpd /m Contour line elevation 93.0 ft 28.35 m Use standard fill depths? x OR eslgn epth? in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold a (c or e) Hole diameter 1 0.25 in 0.125, 0.156, 0.188 0.219, 0.25, 0.281, or 0.313 inch only. Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. Estimated hole space 3.80 ft Not a final calculation. Number of laterals 1 Pump tank elevation 88 ft Outside bottom of tank. Forcemain length 80.0 ft Forcemain diameter 2.0 in 1.5, 2 3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 1/8 = 0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric W2=0.156 9/32=0.281 Estimated daily flow 450 gpd 1703 Lpd 3116 =0.188 5116=0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gl�� 375.0 ft 34.84 m2 Linear loading rate (LLR) 4.79 gpd /ft 59.4 Lpd /m Design width (A) 4.00 ft 1.22 m Cell length (B) 94.0 ft 1 28.65 im Depth of cell (F) 10.0 in 25.4 cm Sand filter Upslope fill depth (D) 24.0 in 61.0 cm Downslope fill depth (E) 25.9 in 65.8 cm Basal area required (gpd /infiltration rate) 900.0 ft 83.61 m Supporting components Topsoil depth , 6.0 in 15.2 cnt Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (In 13.24 ft 4.04 m Up slope toe length (J) 10.30 ft 3.14 m Down slope toe length (I) 13.60 ft 4.15 m Total mound length (L) 120.48 ft 36.72 dm Total mound width (W) 27.90 ft 8.50 m Project: Bowman Transaction Number Page 2 of 7 MOUND PLAN VIEW observation pipes (typical) E 27.9 ft A� A = 4.00 ft 1.22 m 8.5 m...... ......................::.:.:.:. B = 94.0 ft 28.65 m W J= 10.30ft 3.14m K I = 13.60 ft 4.15m K = 13.24 ft LL24 jm L _ 120.48 ft 36.72 m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension O = plowed area (LxW) K = end slope dimension s° (152 mm) T MOUND CROSS SECTION D = 24.0 in 61.0 cm lateral topsoil subsoil cap E = 25.9 in 65.8 cm invert 95.50 ft F= 10.0 in 25.4 cm elev. 29.11 Im F G= 72 .0 in 30.5 cm ASTM C33 H 18.0 in LAL7jcm D Sand Fill E sys. 95.00 ft y elev. 28.96 m 93.00 ft contour 28.35 m elev. � 4 lope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: Bowman Transaction Number: Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch - pounds Metric Width (A) 1 4 Ift 1.22 m Length (B) 1 94.0 Jft 1 28.65 Im Lateral specifications Number laterals 1 Holes /lateral 24 holes Lateral length (P) 90.08 ft 27.46 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 27.96 gpm 1.76 Us Sys. dis. rate 27.96 1.76 Us Hole spacing (X) 47 in 119.4 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) m, Place X in red "X" one choice 1 114 in (32 mm) box of chosen from the options 1 1/2 in (40 mm) diameter. provided. 2 in (50 mm) x x 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) "X" one choice 1 1/4 in (32 mm) None required. from the options 1 112 in (40 mm) No choice necessary. provided. 2 in (50 mm) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 1 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Laterals centered over the A & B dimension end cap • Last hole drilled next to end cap kE x I Laterals & force main of PVC Sch 40 Holes drilled on the bottom of the lateral (per COMM Table 54.30 -5) equally spaced • =permanent end marker Inch - pounds Metric Lateral length (P) 90.08 ft 27.46 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 47 in 119.4 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 in 50 mm Forcemain diameter 2.00 lin 1 50 mm Project: Bowman Transaction Number: Page 4 of 7 I I " TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 6.90 ft 2.10 m Are laterals the highest point in the Friction loss 1.09 ft 0.33 m system? Yes "X" here. Total dynamic head 1 1 10.49 I 1 1 3.20 1 1 m If no, what is the highest elevation Dose Volume downstream of pump?� Dose is > 10 times lateral volume Forcemain drain Lateral void volume 15.7 gal 59.4 L back to tank? C'x' one) Minimum dose 157.0 gal 594.3 L x Yes Drain back 13.9 gal 52.6 L �No Dose volume 170.9 gal 646.9 L Typical Pump Chamber (Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with 7� weather proof warning label and locking device grade levels junction box - � rade levels disconnect g alternate 4" vent pipe electric as per NEC 300 and IE outlet Comm 16.28 WAC location 18" (46 cm) min. wall of pump L- approved chamber or outlet joint combination tank A Provide 1 W weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 88.6 ft C - pump tank manhole = (10 cm) off elev. 27.0 m minimum above finished grade D - vent =12" (30.5 cm) minimum above finished grade 88.0 Ift Pump tank elevation 3 " (75 mm) of bedding under tank 26.8 1 m bottom of tank Tank manufacturer Midwestern Precast Inc. Pump tank capacity 16.9 galrn Pump tank volume 660 gal P ump ma nufacturer Zoeller Inches Gallons n Pump model number 198 A 22.3 377.7 B 2 33.8 Alarm manufacturer JSJ Electro C 10.1 170.9 Alarm model number S41 Dir�ns 4 67.6 r Project: Bowman Transaction Number: Page 5 of 7 Effluent and Dewatering Pumps " • Non - automatic r•48" MODEL "42 - 116V- I PH - 6 amps ®• Pumps down to Within IN of base CAST IRON SERIES � v�R UL bled 8', 3 -wire polder cord and f/ pl • Corrosion resistant • Auto ITY PUMP 011-filled motor • 1 o0ingle Phasers0 Cycle, 4 HP • Rotary shaft seal • 11-Filled Hermetkaly sealed motor • Thermal overload protected Passes 3A8'solds (sphere) • 1 W NPT vertical discharge with a • 1 W N PT Discharge garden pose adapter • Rugged cast Iron motor housing. • Compact design will fit In a 6' • Efficient heat sink for Heat dissipation opening • Engineered thermoplastic Motor COM& base l,M • Non -Clog Vortex Impeller Engineered CAPACITY HEAD Glass filled HEAD Meters Lbs. • Automatic Reset thermal overload Feet Meters Gel. Ltrs. 5 1.52 15 57 protected 3A 1.06 29S 112 • UL Listed 9', 3 -wire cord and plug 5 1 b2 29. 110 10 13 5 513 . bon Al Ceramic Rotary Seal 15 4 8.5 32.3 • Waterilghtneoprene seal between motor 10 3.55 25: 95 20 .10 7.6 and cover 15 4S7 18 68 20 L Valve: • Stainless Steel Screws (No sheet metal Loa Va16w10 7 26S Dom) _ "53" CAST IRO ERIES' � " 57 " CAST IRON SERIES "55" 59 " BRONZE SERIES * / " BRONZE SERIES .✓ • Automatic or Non- attorrW • .3 HY,1 Ph.,115Vor280V. • Non - clogging vortex Impeller design. CAPACITY • Passes % Inch solids (sphere). HEAD UNITWIM • 114' NPT dbcharge. Feet Meters CA Lis. • goat operated, submersible (NEMA 6) 2 pole mechanical 5 1.52 43 163 sue• 9.05 K. 129 • Automatic resettlwmal overload protection. 15 07 1k. 72 • Stainless steel screws and switch arm. • Cast Iron switch case, motor and pump housing. Lock 1925' • Engineered, glass tied impeder wdth metal Insert' . 8 e ,, Mo W & PWW eWAhaeaw • Glen Sod poWopylen base.' ...e�wwmomraedrurro nw.+�a ow" am base 53 sales SGM25 Models 55 and 59 have stainless steel handle guard. o 55 SwW 8B -1415 57 Soft SC- 229 AIW mpg n�a 59 Salve 811-1115 MUM "98" CAST IRON SERIES • Automatic o0o"utomakj nIN CAPACITY • % H.P.,1 Ph., or 30V. HEAD ulufllMlN • Non - dogging vortex impeder design. „ Feet Me Gal. Uri. • Passes S4 Inch solids (s SGSai.s �5 5. 1 32 72 273 • 114' NPT discharge. 10 w 3.05 fit., 231 • Float operated, submersilble (NEMA 6) 2 pole mechanical sue' 16 157 170 10 26 95 • Automatic reset thermal overload protection. 20 6. ���....,,,...ddd��� • Stainless steel screws, guard, handle and arm and switch Lock valve: 23' assm. • Watertight neoprene '13' ring between motor and pump Cam Sanavds housing. © � asbowroMh ewNebN OM no- dubaekAmNeWPWftWWftha0plryAaekmmulyrtwr "* - 0 ava :■�■■■■ ■■■ ■■ ■ ■■r -- ■►I■■■■■■■ ■■■■■1 A t , ■■■\■■■■■■■■■ ■1 OWN c�reee�°e \` \ ■ ►� \ ■ ■ ■ ■ ■ ■ ■ ■ ■1 HEN EK3 13MEEMMM13MMVIMM ■ ► \ ► \ ■ ►� ■ ► \ ■ ■ ■ ■ ■ ■1 \\\\hI■■\\ INNS ■1■ \� \� ■,� ■ ■ ► ► ■ ■■ ■Icy ■ ■■►`\ ■11 \■■\\\\■ ■ ■1 ■■■■ ■►1 ■ ■ \ ■ ■ \ \� ■ ■ ■■ RI■■■■W'■■■■MM■■■ 0 % 4 !i ■0■\\■■■\\ ■ ■■ s`\\►�%716■►®■■ ■MME ■11 \ \ ■i� ►r�� \ ■ ■ ■ ■ ► \■ 1 N ' ' WILWALL Im 1 V. .I I 1 I 1 Ol�iE�OC:7�A0�C■0© §3"IM©K�nme7�mmr--'MMKMUM L 70im Malmo ■ ■■ ■ice e. � � X • 3 # P4 WW J V2 cd LLJ I y o C) - o EO U O� L LJ sa '" p, - 0 rn O 1 24 4-) - v N f�!] U N d' s co W N O O t1 En ON 0 co OUP - �OIS 76 0�1� a $� " 8 a� vm~ 8 ; 3 s�IV6!`i'?f11d'idNh' w "a f i 1 4 a h 70. ° Oqq AI.90 .90#OON ve t 31 0 g a rn - $ ❑ �� I to �p w R `� rir 7 3f11 !D' 3N/ 7 1SV3 �1 w i� c a a r • J � .. 3 � r � � C JQ�1 0311$ldNl1 • � � � O l o l l t Wisco Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x i 1 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and -A C a K percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # (",I /_ - a C'� APPLICANT INFORMATION - Please print all information. R e Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). • Property Owner Property Location r � z r S L o �_ l� i Govt. Lot i'� 1/4 k 1/4,S T a N,R �S (or& Property Owner's Mailing Address of # •,Block# Subd. Name or CSM# City , State Zip Code Phone Number N arest Road =- n i 7y� ( 7/6 ) 717,1-��9c El city ❑ Village M] Town ❑ New Construction Use: ® Residential / Number of bedrooms • Addition to existing building Al 4 Replacement ❑ Public or commercial - Describe: A/ A? Code derived daily flow gpd Recommended design loading rate ,L--y- gpd/ft trench, gpd/ft Absorption area required bed, ft �'- trench, ft Maximum design loading rate - '5 bed, gpd/ft 0• — & trench, gpd/ft Recommended infiltration surface elevation(s) e6e, , 'an i' 6GA 73 O ` ft (as referred to site plan benchmark) Additional design/site considerations , 1/ << + >r6�ru', � (! c� Aleo // (jy . . Parent materi _�il ' q 'n'� n Flood plain elevation, if applicable I/,47 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I ❑ S 2 U ®S ❑ U ❑ S 91 U I ❑ S Q U ❑ S 12 U CIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench �� / _ ", o y� 3 �a �- �� /Y1 c 6 k �r S �� 6 v Ground 5� r,' S I' % `, s�' C -� /r� �2�,k ri r elev. r , q 3..3 ft. 7 -_3D 7 6 Yr Depth to limiting �'Lr- M r Remarks: Boring # ( , q 1, V - 7 l V/" " y'� —' _ i !h C cy `1 7 C t.5 Ground 1 40 ' , 7 0" � fi' G �. �` C j° �° L s g elev. Depth to limiting fa oRCi~ /� in. Remarks: CST Name (Please Print) /Signature j T(15)235_& I7 Tess Ms- loretta A. larrabee r ' Address Business: Date CST Number Bowman Plumbing Inc., 2819 Menomonie, 54751 CSTM 3719 > ' REPORT , SOIL DESCRIPTION � � PROPERTY OWNER �2 %�% - �'m��2 Page of PARCEL I.DI Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Ground k elev� ft. N -36 N -_3 7� �% cad �.5 2 "� Depth to limiting facto t, �- / . Remarks: Boring # ' 51 c i I� k �. Ground /� -• � - 7 � YK h/6 C d d. °7 $ y �` � °' �� .S / '1 S 6 �� ,, 7• ._.. ,.� f . elev. Depth to limiting facto, 0 ILDn. Remarks: ,� ac; ,� �� a � r ,G,• y C� Li 2 I s�i < +z E Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # V 4, 31 *s Ground elev. qa_ Depth to limiting factp� y M i n. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor ' Remarks: SBDW -8330 (R. 08/95) go M It H w O 91) r• t� " C o a� 0 H- � � � O O NU7 • Q 0) H• 4 t0 c+ • o fi lo� ct a C) �+ rc (� ( W r ! J F—� J r S' En c � H O ro i c ; 'fit 1 r ST CROI K COUNTY SEPTIC TANK MAffMNANCE AG[tEEMENT AND_ O WNERSHIP CERTIFICATION FORM i Owner/Buyer Mr. Chris Bowman Mailing Address 3271 30th Ave. Property Address - Knapp WI 54749 .. (Verification required from Planning Department for new constructi on) City /State Knapp, WI Parcel Identification Number 004 - 1055 -20 LEGAL DESCRIPTION Property Location Nw. i ' / Sec. 24 . T 28 N -R 15 W, Town of Cad, Subdivision N.A. Ut # 1 Certified Survey Map # (P b (o0 (0 . Volume 1 Page # 3 G . Warranty Deed # SZ �o ✓ Volume l Z© . Page # _ 5`12—_ . Spec house O yes ® no Lot lines identifiable O yes U no SYSTEM MAINTENANCE ImproW use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out. the septic tank every three yew 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 agues to aabmit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, joutneymanplumber, tesh ctedplumber 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. 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 of the expiration date. 7 C,;�z .Lr_ 7 F SIGNATURE OF APPLICANT DATE OWNER CERTI aC_AnON 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 \ above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT 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 I� DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -19821 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED ---- - - - - - - r ~ r c- - — ST. CROIX O0 , `; I - -- — -- - Radd fur i' : This Deed made between "! .. Yera..t �o. �celi _,...a.s(nglo . .. ........... MAY 8 1995 person........................ - •••••- •- -••--- -- - - - - -- ................................ .............. . a 9:45 ` A. , Grantor, ' n *' nd Bowman, ........... ... �!'►.��: h .u.5,f�.an.(l -- and.. wife._as..sV. yiyorship • - ma_rital.._property._.._._ ................ . . .. ................................. ......................... ....•. - -•- - •-- ••- •-- •...... --- -•• - -- -•-----•-- •--- ••-- ---------------- - - -• -- -- - - - - -- ------ '------------- •- -• - - -- --- ......, Grantee, Witnesseth That the said Grantor, for a valuable consideration...... �0461� .. ................................................................................. ........................ ....... conveys to Grantee the following described real estate in ....... t.....CrQJX......... F County, State of Wisconsin: �> b�ow� Z1�..JO �,•� ece Tax Parcel No: --•- •-------------- ------- --- ------ The West Half of the Northeast Quarter (Wj of NEJ) of Section Twenty -four (24), Township Twenty -eight (28) North, Range Fifteen (15) West. ' iI I' 5 V, �' F�� I I! ` i This .....-- .J.S . ................ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And. ..... .. ... ..... .... ...... ...•• ... ....... ...................... . .. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all easements, restrictions and rights of way of record. i and will warrant and defend the same. Dated this 2.8 . day of ............. AP-r.il . .................... .. ............ 19 --- 5. -. ------- --- - - - - -- -- ............. .. ..... ..................... .(SEAL) - 0_'A 1� -� - -- . ................... (SEAL) . ..... .. . . . . .. ............................................ Vera -- Bowel{........------ - - - - -- ...................... ............................ (SEAL) . - -- ---- ....•.... .(SEAL) * ' ---•--• ...........................•---- -- ....•-- ...............• -- AUTHENTICATION ACKNOWLEDGMENT Signature(o) ... eCa ^ _1.OYY).�,- ..s1..I1��1�..�rQn_ STATE OF WISCONSIN ss. -4 -\ ...................................... County. icated- .8.. y -------- A_ priJ..... - - - -- 19.95. Personally came before me this ................day of ........................................... 19 ........ the above named ................................•---.....-------------------------- -•-- . - - - -- .lennJ.fQr_ Rieh__ -------------------------------•------------............----•-•-----••---------- TITLE: MEMBER STATE BAR OF WISCONSIN .....................•---.......---•------................---.......----------- (If not, ................................ ...................... • - - - -•. authorized by § 706.06, Wis. State.) to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY i JENNIFER A. R I C HA RDSO N ................. ..................... .............................. ........ --- Aftorney a { ...................... •• - - - - -- • -• -- -- Spring...Vl AL.. • - - -•• •-- •-- •- ••- - -• - -- Notar Public - - -- ------- •••• - -- ...................... County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ------•---•-------•----•---- -- ••------- -- •-- - .......... 19.........} •Names of persons signing in any capacity should be typed or printed below their signatures. _ I �••+ �i r �nry ~ vurvrruCPl I INL Subm all p to R e' •r of Deeds with document(s) to be recorded. V. PHYSICAL DESCRI. ..JN AND PRIMARY USE .. BUweil 15. Kind of property 16. Primary use I � ,rew address If property transferred was primary residence ❑ Land only a. ❑ Residential W 528 Park Drive © Land and buildings ❑ Single family /condominium Apt. #11 ❑ other (explain) ❑ Multi-family - # units WI 47 Sprin . Valle N,1 5 67 17. Estimated land area and type [:J Time share unit 3. Grantor is ff ❑ Partnership ❑ Corporation ❑ Other a. Lot size x b.❑ Commercial b. TOTAL ACRES c. us ren 11° II. GRANTEE: Christopher A. Bowman and Manufacturing bua1oepuee 4. Name An M. Bow c. MFL / FC / WTL acres d.® Agricultural S. Address d. Ft. of water frontage Adjoining land within 3 miles? ❑ Yes No 3271 30th Ave. e.❑Other(explain) Knapp, WI 54749 VI. TRANSFER 18. Type of transfer: © Sale ❑ Gift ❑ Exchange C] Other (explain) 6. Grantor /grantee related: ® None ❑ Corp/Shareholder/Subsidiary ❑ Partnership [❑ Finandai ❑ Family or other, explain 19. Ownership interest transferred: ® Full ❑ Partial (explain) 20. Does the grantor retain any of the following rights ?❑ Life estate ❑ Easement 7. Sel� tax bill to: Name and address 21. [:J Deed In satisfaction of original land contract? Dated? Same as t S , 22. Pants (prepaid interest) paid by seller $ 23. Value of personal property transferred but excluded from (25) $ III. ENERGY 8. Is this property subject to the Rental Weatherization Standards, ILHR67? 24. Value of property exempt from local property tax included on (25) $ ❑ Yes ®No Exclusion codbA =1 N W -11, explain VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION N. PROPERTY TRANSFERRED Q. ❑ City ❑ Village ® Town Cady 25. Total value of REAL ESTATE transferred $ 85,000.00' County _ St. Croix 26. Transfer fee due (line 25 times .003) $ 255.00 10. Street address 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 11. Tax parcel number 28. Grantee's financing obtained from a. ❑ Seiler 12. Lot no.(s) Blk no.(s) Plat name N box a or b Is checked, b. ❑ Assumed existing financing 13. Section Township omplete Part vill c. Financial institution / Other 3rd party P Range Financlrtg Terms 14. Legal Description metes and bounds: (afhach 4 copies. if necessary) d. ❑ No financing involved The Wi of the NEJ of Section 24, Township 28 North, Range 15 West. Vlll. FINANCING TERMS (FOR SELLER)ASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment $ (Line 29 = Una 25 minus Lines 30a, b and c excluding payments for personal property) 30. Amount of mortgage/land 31. Interest 32. Principal and Interest 33. Frequency 34. Length of 35. Date of any lump sum 36. Amount of lump contract at purchase rate (stated) paid per payment of pymts contract (balloon) payments sum a. $ % $ - -/- -/- -- $ b. $ % $ - � $ -/- -/- - $ 37. - If the dollar amount paid per payment (32) Is scheduled to change (not as a result of a change in the interest rate), fill in the line letter from above Enter the date of change -/ - -/ - - and the amount it will change to $ D(. CERTIFICATION We declare under penalty of law, that this return has been examined by us and to the best of our knowledge and belief it is true, correct and complete. Grantor or agent Date Grantor's telephone number SIGN 04/28/95 ( ) HERE Grantee or agent Date Grantee's telephone number 'I 04/28/95 P ( ) riot name and address of grantors agent Agent's telephone number Document number VoIJJac. Page/Im. Date recorded Date and kind of conveyance Conv. code FOR 5:'SG3E' :i:,C 54 5 /Es � 4 5 ;,rat 1 2 3 4 ASSESSORS Parcel number Assmt. year 19 _ ❑ Field Sales number USE L County _ _ Parcel classification ❑Use I ONLY RES COM MFG AGR S/W FOR Tax dist 1 2 3 4 5 6 T Assmt. dirt. [] Reject Wisconsin Department of Revenue Q�cSOD.d9:2'&t1'. , .. PRO.PERTY'OWNFR'C rnPV .......... ........ ........ .