HomeMy WebLinkAbout032-1082-70-110
* UP1
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS 2 W'j
r
• 4
SUBDIVISION / CSM#_ LOT
SECTION P_T~_N_R~_W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN.VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t/a us.r
7V~
~r
INDICATE NORT A OW
Provide setback and elevati n information onoreverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other c
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line:_
Setback from: well: - House L Other
ELEVATIONS
Building Sewer X7.9- ST Inlet: g ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system-2/.-5.
Existing Grade Final grade
DATE OF INSTALLATION: ,
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Ddpartment of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division CountyST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar rJRii,No.:
Personal information you provice may be used for secondary purposes [Privacy LRVVI s.15.04 (1)(m)). L y yy yy
P it "tje5 ~~`HARD [ b6gEjgje ❑ Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel &5 ~Q 1082-70-110
U + 466- O Q.U J
TANK INFORMATION V 4/ ELEVATION DATA A9700214
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV..
Septic,
Benchmark l
f
oil
Dosing
~ S.b3'
Aeration Bldg. Sewer 93 ' q7 q
Holding St/ Ht Inlet Q~.v I' +
TANK SETBACK INFORMATION St/ Ht Outlet 9-O v 1$ 1 r
Vent
TANK TO P/ L WELL BLDG. A
ir Ito ntake ROAD Dt Inlet
Air
Septic r D 95' ! f NA Dt Bottom
Dosing NA Header / Man. S,
Aeration NA Dist. Pipe a
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Lrictio System TDH Ft
Forcemain Len Dia. Fi I Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type Of CHAMBER model Number:
System: $ + OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. I Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over I xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges c.9 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOMERSET 28.31.19.399A-10,SE,SE 479 192ND AVE LOT 3
-11~p _0
0
Plan revision required? ❑ Yes ❑ No Use Use other side for additional information. ^ 4,; (Q
SBD-6710 (R.3/97) Date spectbr's signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water Systems
fii•~L~'■f1 201 E. Washington Ave
in accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• 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.
• See reverse side for instructions for completing this application State Sanitary Permit Number
R9,7359
The information you provide may be used by other go~vverr'nmm~ent agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. (San " State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Prope caner Name Property Location
1 /4 1/4, 5 T , N, R (orYW
1
Propert Ow er's Mailing Addr ss Lot Number Block Numb r
No 1
Cit State Zip Code Phone Number Subdivision Name or ber
II. TYPE O BUILDING: (check one) ❑ State Owned ❑ It Nearest Road
❑ Village
❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of '
X11. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
❑ /Condo 1 • l ? • 3 99~10
1 Apartment
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 1Z New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
-----System --------System Tank Only______________ Existing System ---------Existing System
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
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7_ Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min //inch) Elevation
Feet ' Feet
VII. TANK Capacity
Total # of Prefab. Site Fiber- Exper.
INFORMATION in Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic: App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank Imor _ Z ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 0
VIII. RESPONSIBILITY STATEMENT
I, th undersigned, assume responsibility for ins Ilation of a onsite sewage system shown on the attached plans.
Plumb 's Si a to ps) MP/MPRSW No.: Business Phone Number:
Plumber' Nam : (Pr lb
P u ber' Address (Street, City, Sta Zip Code):
l~'d
IX. COUNTY/ DEPARTMENT I IE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing Agent Signature (No Stamps)
Surcharge Fee) ~
P Approved ❑ Owner Given Initial ~
Adverse Determination 3,0/9 7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SRD-6398 (R. 05194) DISTRIBUTION: original to County, One copy To: Safety & Buildings Divi ion, 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, fz 8-266-3815. ,
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one 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 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
- GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
w ,
cesn71
~-x ~ = ~ ,~-begs /I
P,4
G
380 136 J8`'
A
Wisconsin0epadment of Commerce 9 D SITE EVALUATION
Division of Safety and Buildings / Page of =
Bureau of Integrated Services inordance Wit s. ILHR 83.09, Wis. Adm. Code
RECEIVED t ` County
Attach complete site plan on paper no I than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical an 4& zontal regcp PI MM), direction and
percent slope, scale or dimensions, n rrow, a[~~¢ liAoL~atilm distan4t4 nearest road. Parcel L D. #
Sl` cPolx ;
wLATY
APPLICANT INFORMATION - a Reviewed by Date
Personal information you provide may be used for oral q1Q { Oy s. 15.04 (1) (m)).
Prope ner Property Location
Govt. Lot 1/4S - 1/4, T N,R V(or)gl
Property Owner's Mailing Address Lot # Block Subd. Name or CSM,#
City Stl~te ate) Zip Code Phone Number ❑ City ❑ Village (L~ Town Nee est Road -
G ~
f New Construction Use: JZ Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate L bed, gpd/f12_ls_trench, gpd/f1?
Absorption area required w bed, ft2 ,5 ~ trench, ft2 Maximum design loading rate ~ bed, 9pd/W__x trench, gpd/ft2
Recommended infiltration surface elevation(s) , S- ft (as referred to site plan benchmark)
Additional design/site/ considerations -
Parent material p f~s~c &A2 .4er.2- - .c L2;. Flood plain elevation, if applicable 4~ 14 it
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system [Z S ❑ U 0S ❑ U RS ❑ U 2 S ❑ U ❑ S U ❑ S 0 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
a
S -
Ground 't /6
elev.
/222sft.
Depth to
limiting
factor
?in.
Remarks: -
Boring #
6iJ
Ground
elev.
1412-ft.
Depth to
limiting
factor
amain. Remarks:
CST Name (Peas Print) l Signature Telephone No.
S'
_2L- 757~
Address Date CST Number
~~v
4~Lszo SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
i
13 0-9
Ground
7.19 -22~ 44
elev.
ft• ,
Depth to
limiting
th?~in. ,
Remarks:
Boring #
- S
13 L7
Ground
elev.
ft• ,
Depth to
limiting
facto
>,7 in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
O- 3
Ground ;
elev.
Depth to
limiting ;
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R. 07/96)
S
,s~rivt d~fi:t i
31 ( 8
3 _
f I
36 007
0
ao~
DEPAR?'MENT OF REPORT ON SOIL BORINGS AND J~' L I i a DU ILU1iv~j.,
'INDUSTRY, 1 DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 796
N W1 3709
HUMAN RELATIONS
LHR 83.090) & Chapter 145)
LOCATION: SECTION: OWNS MUNICIPALITY: OT NO.:BLIC NO.: SUBDIVISION NAME:
COUNTY: / MAILIN ADDRESS:
rl~o
USE DATES OBSERVATIONS MADE
NO. B DR CO AL DE R TION: 7S:
~4ftesidence New ❑Replaca
RATING: S- Site suitable for system U- Site unsuitable for system 70 x Q ~r .0
;
ONVENTI NAL: MOUND: GROUND-PRESSUI : S E FILL OLDIN TA : RECOMMENDED SYSTEM: (optional)
(9S ❑U ❑ $ $ ❑U ❑ $ ❑ $ k/5~ i
If Percolation Tests are NOT required DESIGN RATE: if any portion of the tested area is in the
under s. ILHR 83.0915)(b), indicate: (Floodplain, indicate Floodplain elevation: I
PROFILE DESCRIPTIONS
BORING TOTAL P T -R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
(NUMBER DEPTH IN, ELEVATION pgSERVEO i MS T TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B
B
B- y 45 z7
3 1 -~I s /6 72
„g:
B- jC'
PERCOLATION TESTS
_f Or DEPTH . WATER IN HOLE TEST TIME D I WATER LEVEL-INCHES RATE MINUTES
NUMBER I AFTERSWELLING INTERVAL-MIN. RI D t P RI_ODl PER INCH
P- A6 e o2
L
P-
Z4
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are th•
zontal and vertical. elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and ;
of land slope.
SYSTEM ELEVATION 0'6. -
i`
I
I
i
S p~
j
NV,
i
i~
~ I I I ~ i 1 r
;
i
4499%
CERTIFIED SURVEY MAP
Located in part of the SE4 of the SE4 and in part of the SW4 of the SE4,
all in Section 28, T31N, R19W, Town of Somerset, St. Croix County,
Wisconsin.
b
N"
s~
OWNER
0 a
0 LO
-W 0 LO
Wallace Belisle E} Corner of
L, N CD R.R. 2 O Section 28
V) 0
o° Somerset, WI 54025
w O Z
a) Ala L 6 Fit r"
F_ WW
y JUL 2 41989..
Unplatted Lands JAME;. `Ell
E Ro91s.: 3
as
N St. Croix j.u. W,
m co
Q
--S89°59' 24"W-528.00' - C,n9 5912411W
192nd AVENUE 845.99'
North line of the Sj of `V
EN190ig' 0 311W 28.01the SEJ of Section 28 00 LO
own Road R/W M
N I C, _
00 I Ln O
~t I O
O
.I O
Ot I Z
i
-I O
in 1 O
O h Uj O CO
O O
OI
I _0
O O
al ~O _A__
4 441 NI
~p %.0 v I y
NI 4-4- l0 roi U
EI O O -JI M N
> CM w M O H LOT 3 _ M o
L I n w a, c0 lfl 'M I M
i ~ N
.n i M 4J 441 ~ M a
-
CD l
0 0 o Area Including R/W: to° ; 3 L LO 41
v i 0° 348,480 Sq. Ft. (8.00 Acres) ° -
I c c O 4_
a I O
L C) Area Excluding R/W: o o 41 320,113 Sq. Ft. (7.35 Acres) z
..a
1 to Co
N I N a) Z .--1
I w 3 41
O i y
J I N
W
N89059'24"E 528.00'
Unplatted Lands
V~t
SCALE IN FEET ''r•~.
n . nn n.... ~ I' A f 1 t~►.t r. 41 .
}
SURVE'YOR'S CERTIFICATE
I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, do hereby
certify that by the direction of Wallace Belisle I have surveyed,
described and mapped the land parcel which is represented by this
Certified Survey A.ap; that the exterior boundary of L-he land parcel
surveyed and mapped is described as follows:
A parcel of land located in part of the S -E4 of the S.s4 and in part. of
the SW4 of the SE4, all in Section 28, T31N, R19W, Town of Somerset,
St. Croix County, lisconsin; further described as follows:
Commencing at the Si corner of said section 28; thence N00000'15"W,
along the east line of the SE'4 of said section, 1331.8 feet; thence
S89059'24"W, along the north line of the SE4 of said section, 845.99
feet to the point of beginning of this description; thence continuing
S89059'24"W, along said north line, 528.00 feet; thence SOOoOO'36"E,
along the east line of Lot 2 of Certified Survey t'lap in Volume 5,
Page 1482 recorded at the St. Croix County Rogister of Deeds Office,
660.00 feet; thence N89059' 24"E, 528.00 fccL; thence H00000' 36"V!,
660.00 feet to the point of beginning. Subject to right-of-way for
'gown road (192nd Street) as shown on this map and all other easements
of record.
also certify that this Certified Survey Map is a correct representation
to scale of the exterior boundary surveyed and described; that 1 have
fully complied with the current provisions o Chapter 236.34 of '_-he
Wisconsin Statutes and -the Land Subdivision Ordinance of the County of
Sc. Croix in surveying and mapping same.
ALLE x
N}QpGEN .
1407
S'P
9 ~ 'Cis
WIS. U< by
~ ;rte `,r1 4~KOa►av`~ !
SUR
VOLUME 8 PAGE 2126 corm O
S TC-105
® SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
owNER/BUYER 06Pd k/4 TN /f Y41 ~4,
MAILING ADDRESS LO-A
PROPERTY ADDRESSG2~% / 4?~I,&d Ak~E
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE - o ZT
PROPERTY LOCATION SE 1/4, ~ 1/4, Section I T
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP ~yR~( , VOLUME, PACELOTNUMBER=
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I )
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
1/We. the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property &H,4g b V, r. 'eFl/ .Sl,- " y~~T#~y~ gajSIE
Location of property -5,k 1/4 1/4, Section _~,TW
Township SA- Sj Mailing address x
SO/yl S F T . 1~,ZsG yo a
Address of site ld AUK
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property /'4 ACt 4
Total size of property . Q S"
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes No
Volume and Page Number 5-2 7 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. YS-0,2 8 3 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
i
ignatur of Applicant Co- ppli nt
4~~- - C;?~- f A? ~ , Y//"
Date of Signature Date of Signature
AEASTATE TRANSFER RETURN
* CONFIDE : wf& n aet{~af Genus
a ! f a M r,i < -t ; 7T, i r , :713 ^ 6WAktDES0RW ANDtPR Y> USE
1. Name 1AWA"of- ~Rj ~ S_ 15. Ion of property 16. Primary use
f>artaostaras.resid~oe _ ;,~r1f1-!tea « iandson a
46
land and buildings . Single fartWy/opodog*duM
plain)
r e v E~ ; d ~i3R' .ox nu> f
area
Corpora
4... t, b; Total am ~ 4 w
no-
/ wTL acres M
Fl. of water frontage ❑ ±*etz
' e%hGl $ Ste.' e❑ n
TRANSFER
J8.,Type.oftransfer. ❑ Sale ❑ _Gift ❑ -Fxdtartge_,❑'.t(~::.
y t6rttoi; 1 Yes ❑ '
No
Wnera►tip interest transfeW. FuR ~ )
bil sho" s t if different than grantees r tit i' y
T + r r~ gr[ttor retain ar (the fo)lowing n8hts .Life to en,
' 21. LJ Deed in satisfaction of original land contract?' Datsd? 01 4. 1Ponts (Prepaid in%mt) Palftisollerl~, ~
- ww a'!d►i
ect;kr t
4 W-1 1. Weatherizatiorl Starlda r24; `1Palue of pro perty exempt locaflpropertyy
~'es fatolusioncode, . explain COMPUTATION OF EE OR STAT
,111, OPEA~! ~
ri < 4"
i 9.~ ❑ Ciry V 9 Tovgn l f Sd iF,/ y $'A' 25. Total value of REAL ESTATE transferred $
,
mlY -S' Z, 41 AQ/ le 26. Transfer fee due (line 25 times .003) $
10.. Street add{ess, 27. TRANSFER EXEMPTION NUMBER, sea 7725
L 11. fax parcel;numbw
t !sY~ i
Bik no.(s) 26. Grantee's financing obtained from
a:
If box or b is checked, )L
13 `Sgction : Township a ` complote pan Vl ll `
~FinancingTerms r a . ~ ` rt9rdParty
14:`I:egel oS iWw-id,bounds: -W.
~d.4
(attach ) ❑aa~r+g
' _ • , ...~<~~~'I~s .~3~f,~ ,gyp,
A9401 -LW_3 Cw examm =WW up 17W jaw
Pte' 0 xa. 449•
SELLER/ASSUMED FINANCED TRANSACTIONS "ONLY)
21 Total dowrj '
30 'Amount of, 31: (merest 32 Principal and interest 33 Fr any
equency 34. Length of 35. Date of lum on 36. nt of lur~p sum
s~` conyec let 01- rate4stated) paid per payment i, iof pymts contract
M.,
71
MIR ment (32) is scheduled,to change (not as a result of achange in the interest rate), fill in the line letter from above.
and the amount it '.W111
change b S -,r€
r
raider penalty of law, that this return has:beep ettBtr * by..A*%*Ioahe test of our k ow1odge and belt ar tittpo i~te
tQt,Or ' Date,
r y
'06- a_
ant'
V947 Of
1 2 3 4
r . Assmt year 19_ . Fj
a.
'.~741; M.11 bin; L I~ z, fr ;'F t tWYlityl{ ❑
,~pp
4 I Use
r. , Tax dist,
- -
t
f $ D F T Assmt disc ❑R
) Vol, OtWCMi,.^d;.
PROPERTY OWNER'S COPY
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
450283
Nct 747PAGE M _ REGISTER'S OFFICE
ST. CROIX
aRot, hI. C~~,~~s E CO.*
Recd -for Red
AUG,0409
at 8:00 A.
conveys and warrants to C
ro
All- .7
S ~ ;p r X k-1-1 ,a
RETURN TO
G S Sl/~t' U',/ I,P s / N
the following described real estate in County,
r StateOfWisc0n3 ri
Tax Parcel No:
APART OF THE SE 1/4 OF THE SE 1/4 AND IN PART OF THE SW 1/4,.OF THE SE 1149
ALL IN SECTION 280 T31N, R19W, TOWN OF SOMERSET, ST. CROIX-CCOUNTY, WISCONSIN.
DESCRIBED AS FOLLOWS: LOT 30OF CERTIFIED SURVEY MAP FILED JULY 24, 1989 IN
VOLUME 118111, PAGE 2126, DOCUMENT NO 449966.
L% V
This /S *OT homestead property.
(is) (is not)
Exception to Warranties:
Dated th day of
(SEAL) (SEAL)
A G~ 16~q/5le .
6
(SEAL)' (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN
ss.
County.
authenticatArt this A- M _ - .c
ST. CROIX COUNTY
WISCONSIN
tiny
ZONING OFFICE
I N N p r p son
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
October 7, 1997
Hartman Homes, Inc. -
-Attn: Becky
Somerset, WI 54025
RE: Septic Inspection for Richard Belisle located at
479 192nd Avenue, Somerset, Wisconsin, St. Croix County
Dear Becky:
An septic inspection of the above referenced property was conducted
on September 5, 1997. This property is located in the SEY4 of the
SE1/ of Section 28, T31N-R19W, Lot 3, Town of Somerset, 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,
4kA
Mary J. Jenkins
Assistant Zoning Administration
sm