Loading...
HomeMy WebLinkAbout032-2046-70-200 ~ o o I 4 o I 3 o I ti O 6'9 M Ol N Q me N L m M O p N X f0 °'r I o E 3 x ~_p Y Y ; av m aw N ~p N N O N O N 0 a) -0 r C Z '2p > Ii c mN ycc C o my m a I °ov m m L Cc m3E0 I Z in rn z I o Z z m mm IL o 0 o Z c w N.. 'o tmo FZ- ! rn Z c E -o ~ m y (D m g 0 r -0 O I, Z ca z o N Z ~ E E `4 ) c:l N 8 Y 2 = a l E 2 ` 0 o 0 CL c C5 m L C O N N O 2 G C a E 0 y~~ a o co U) >U wo0 V~ Z~> 2333 o'O 0 0 0 0 0 z o ~ ILaaa N I a_ I~ c°p I 7 0 ~o in y O N J V ~ 01 Of } Q • N N N ^I 0a0 E O O co c CL 4~1 Q } U1 Q II ° ° I VyJ C E N 3 ' C 2] N r co CL c p N N in (O pOj N 7 O 0 c 7 C~ (D F0 N Lo O N E M EO ca M L) • 0- W N O Z S O ad x [ € m a/ ~ d R m a• 5•~ Lai *Ai o ` c o A L) (L N V i a f z ST. CROIX COUNTY WISCONSIN 1 ` = ti ZONING OFFICE I a x n x u x x■ „I.,,~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 June 21, 1996 Attn: Becky VIA FAX: 247-3622 Hartman Homes DEAN AND JACQUELINE SOLSVIG FOR JUDY RE: SEPTIC 77? ADDRESSTH AVENUE, SOMERSET, WISCONSIN Dear Becky: An inspection of the septic system serving the Judy Dean and Jacqueline Solsvig residence located at 805 160th Avenue, Somerset, Wisconsin, was conducted on May 21, 1996. This property is located in the NW, of the NW, of Section 13, T30N-R19W, Town of Somerset, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions with regard to the above, please give our office a call. Sinc rely, mes K. Thompson Assistant Zoning Administrator St. Croix County, Wisconsin db STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER _ r ADDRESS ~ 1) SUBDIVISION / CSM#_ LOT # SECTION T- N-R_ Town oft, ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM v µSV i i INDICATE NORTH ARROW Provide setback and elevation information on reverse 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 Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: f~2_ Lengthy Number of trenches Distance & Direction to nearest prop, line: f /,gyp Setback from: well: _Z House _ Other ELEVATIONS Building Sewer /a te 7 ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold '7 Bottom of systein__,2 _ Existing Grade Final grade ; DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: ' 3/93:jt Wiscons;r.-134artmentof industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST - CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI DEAN, JUDY & JACQUELINE SOLS G X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: d i . ,Z' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark a $t'j~ pjj, Cl~ Dosing Aeration Bldg. Sewer 3 Hol St/ Inlet ' 9760 TANK SETBACK INFORMATION St/' Outlet 5,7 OG TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > 11A NA Dt Bottom Dosing NA Headers Aeration Dist. Pipe 75' 56)5 Holding Bot. System PS~ 9.: aS~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Friction System TDH Ft oss Head rcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length , No. Of Trench PIT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS es DIM N I N SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING an urer: SETBACK INFORMATION Type O fie,- , CHAMBER Mo a Num er: System:~u; } a5 1 OR UN DISTRIBUTION SYSTEM Headers „ Distribution Pipe(s) x H e x Hole Spacing Vent To Air Intake Length Dia. ~ Length g7 Dia Z/ Spacing CO SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste my Depth Over Depth Over 11 xx Depth Of eeded /Sodded xx Mulched Bed/ J.F~ Center L 44a' Bed /4*egh.€dges `t a Topsoil E] Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET.13.30.19W, LOT 1, 160TH AVENUE -f Plan revision required? ❑ Yes 2.60 Q / Q Use other side for additional information. l' s SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety =Building Division ~~■~i■■,. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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 8 112, x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary' Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prop rty Owner ame Property Location r 1/4 114, S T , N, R ,K(or Propertwner's Mailing jc1re59 7 Lot Number Block Number Tom' Ci , to Zip Code Phone Number Subdi isi n Na a or CSM Number !t Nearest Road II. TYPE F BUILDING: (check one) E] State Owned 00 ge Public 1 or 2 Family Dwellin - No_ of bedrooms rowan of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 03~-t~y~- ~~-!oo 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. 0 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 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./' ch) Elevation Feet Feet VII. TANK Capaclt in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank - 14 ' S' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 610+ ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instal tion of th onsite sewage system shown on the attached plans. kPIte)mZber's)!(ddress Name: (Pjit)) Plumber' Si :rafur 7a5~ps /MPRSW No.: Business Phone Number: 72 VE Q _S~2 el (Stre;epj~~ity, te, Zip X Co S IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issu ng Agent Signature (No Stamps) ❑ Surcharge Fee) r P(Approved Owner Given Initial Adverse Determination ~7fP c~ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) - DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber , INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any ne;ni 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, 608-266-3815. 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 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; bu'ildi'ng 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) fora 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. Lw -44 lo *k) Y/ ,IU %,sEc 12 Duna' i~eeoas,~A~.~ SAM ~D~ Wi_lJRsin Department of Industry, SOIL AND ~ E ~y T I O N REPORT Page ~ of Labor and Human Relations -YA' 'Division of Safety Buildings in a h ILHAdm. Code COUNTY . Attach complete site plan on paper not less than x 11 inchesZ'ti Plan nclude, but S not limited to vertical and horizontal reference M), t~'rionn apd % of slop le or PARCEL I.D. # dimensioned, north arrow, and location and dist o nearest ru 1'995 APPLICANT INFORMATION-PLEASE PRI L IN~Q~TION REVIEWED BY DATE PROPERTY OWNER: •N" ` " ARRTY LOCATION . LOT AhJ 1/4 1/4,S T N,R (or)tP 21 PROPERTY 0 ER':S MAILING ADDRESS LOT # BLOC # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN NEAREST ROAD New Construction Use UA Residential/ Number of bedrooms _ _ [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow ,,.~4 gpd Recommended design loading rate ..!r bed, gpd/ft2,, / trench, gpd/ft2 Absorption area required bed, ft2 /eeG trench, ft2 Maximum design loading rate bed, gpd/ft2_,_(,, 'trench, gpd/ft2 Recommended infiltration surface elevation(s) _25,2 ft (as referred to site plan benchmark) Additional design / site considerations Parentmaterial Flood plain elevation, ifapplicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem OS ❑U 0S ❑U ®S ❑U ®S ❑U ❑S .®U ❑S OU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary, Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 4d Ground - elev. ft. 'ZEL Depth to limiting factor Remarks: Boring # -c 'V 1~4 Ground elev. ft. 14-1 Depth to - limiting factor Remarks: CST Name:-Please Print Phone: Address: ~ i r Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT PageL-Lo*-,~-, PARCEL I.D. # ` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Si. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ' ,Qz~ ft. Depth to .59 zT- A1 limiting factor 'le Remarks: Boring # - Ground elev. ft. Depth to s- limiting factor Remarks: Boring # z/ '14 Z.0 :5, ats- Ground elev. W-L ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ,N~~~ i✓~~~ see //7'..~©~t,/ x°/9~ ~i~1.fc's,ET X oCOC~~•o.J v.i- S', ~,e x ~~=y -57C m A,/O sm ' (as r -,o r FILED 11 J U L 5 1995 ► KAYt1UMH.WALSH C, HQ star tlf Oe~ds 5t;`~ral~t Co., WI 530870 . CERTIFIED SURVEY MAP S-4 A) Located in part of the NWJ of the NWi of section 13, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin. wT Scale in Feet 1" 100' j~ -N 0 50 100 200 B z W WS~j ~ F t7i ; IGO i H A\%ErJl1E U_IVPL_/_1 i T E_I3 l_~_1~_JI_S North line of the NWk 3 zo 0H NW Corner Section 13 of 589°55'08"W 579.92' W W - M WNW a+ m I S89°37'20"W 582.11' I o At o M M O M N 44.+ LOT I 3 10.00 Acres Inc. R/W •'435,644 Sq. Ft. I 9.58 Acres Exc. R/W 01 417,317 Sq. Ft. Zi \ r, JI 3 ~ M u1 tc Ln ' .t POND ° / o ARPROVED ~I 0-0 • o 75' water setback LE), line ST. CROIX COUNTY VMAG,,t• , f-' Comfxehansive'Ptwic q• Zoning and (~_1r _j Fark's' Ormmittes LAS 4°t, F 0_I Wis. d'°I } 4 If not recorded <'qNp within 1O days of I~SU STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER r I MAILING ADDRESS PROPERTY ADDRESS (location of septic system) lease obtain from the Planning Dept. CITY/STATE - - PROPERTY LOCATION -&tJ-1/4, 1/4, Section , T_,,,~N-R_J2_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP a ~ VOLUME fo, PAGk,-a , LOT NUMBER 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 (1) 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. I/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: Ca C , DATE: J~~ / ° 9w 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 - s Location of propertyA/,kl 1/41/4, Section _N-R" 9 W Township Mailing address Address of site Subdivision name ~,S/K~ /Do79`jg Lot no. _ C Other homes on property? Yes_-CNo Previous owner of property Total size of property 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 9 and Page Number :E 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. ~and that I (we) presently or the sewage disposal system or I (we) own the proposed site for' 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. C_~,Uxl Signa re f Applicant Co- ppl'cant Date of Signature Date of Signature 1 State Bar of Wisconsin Form 2 - 1982 / WARRANTY DEED 4 c i ~~~o~or- DOCUMENT NO. voi. 1129PAGE 6 .r 6rRt;4` G Redd for Gregory R. Boardman 4 0 1995 10:00 A. I . Romer oY da convegSnd wirr! tLtenan s ueline Solsvi and Jud THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS aA the following described real estate in St. Croix ~rz- County, State of Wisconsin: (Parcel Identification Number) Part of the Northwest Quarter of the Northwest Quarter (NW1/4 NW1/4) of Section 13-30-19 desribed as follows: Lot 1 of Certified Survey Map filed July 5, 1995 in Vol. 10, Page 2949. i I~ This is not homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. Dated this - day of July 19-95-- (SEAL) (SEAL) Gregory R. Boardman (SEAL) (SEAL) ■ AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gregory R. Boardman STATE OF WISCONSIN SS. 'lL _ County. I I :+bNSIN AL ESTATE TRANSFER RETURN - CONFIDENTIAL Submit all parts to Register of Deeds with document(s) to be recorded. GRAN R. V. PHYSICAL DESCRIPTION AND PRIMARY USE 1. Name 15. Kind of property 16.[Prlm,a ry use 2. Address New a: 1 1 s property trans erred was primary residence Land only a. eside ntial Land and buildings ❑ Single family/condominium ` ; ❑ Other (explain) Multi-family - units 17. Estimated land area and type ❑ Time share unit 3. Grantor is ® Individual ❑ Partnership Corporation Other a. Lot size x b.❑ Commercial II. GRANTEE: b. TOTAL ACRES us ness use Jacqueline SOlsvi c.❑ Manufacturing business use 4. Name g c. MFL / FC / WTL acres d.0 Agricultural 5. Address d. Ff. of water frontage Adjoining land within 3 miles? F Yes No t e. ❑ Other (explain) VI. TRANSFER 18. Type of transfer: ;Jj] Sale 0 Gift ❑ Exchange 0 Other (explain) 6. Grantor /grantee related: ®None ❑Corp/Shareholder/Subsidiary ❑ Partnership Financial ❑ family or Other; explain 19. Ownership interest transferred Full ❑ Partial (explain) 7. Send fax bill to: Name and address 20. Does the grantor retain any of the following rights?o Life estate E] Easement 21. ❑ Deed in satisfaction of original land contract? Dated? 22. Points (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 prail$rty exempt from local-property tax Included on (25) $ ❑ Yes ®No Exclusion Cotie--W7If W-11, explain VII. COMPUT4-ION OF FEE OR STATEMENT OF EXEMPTION IV. PROPERTY TRANSFERRED 25. Total value of REAL ESTATE transferred 4g ow- M 9. ❑ City ❑ Village Town - S0Me r_"t 26. Transfer fee due (line 25 times .003) $ R7 _ fXt County _St. Crni v 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 10. Street address 11. Tax parcel number 28. Grantee's financing obtained from a. Seller 12. Lot parr Blk no (S) if box a or b is checked, b. F-] Assumed existing financing Plat name complete Part VIII - Financial institution / Other 3rd party Financing Terms d® 13. Section Township Range d. No financing involved 14. Legal Description metes and bounds: (attach 2 copies if necessary) Pt of NWI/4 NWI/4 of Section 13-30-19 RAF: bDt 12 C.S.M. filed in Vol. 1#10", Page 2949. VIII. FINANCING TERMS (FOR SELLER/ASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment $ (Line 29 = Line 25 minus Lines 30a and b 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. $ 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 $ IX. 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 oragent Date Grantor's telephone number :HERE j r ) Grantee or agent ~ } Date Grantee's telephone number Print name a0 ad ress f g ntor s agent f Age s teleph number Document number ( ) Vol. ac. Page/Im. Date recorded Date and kind of conveyance' Conv. code FOR 531062 1129 Sb 7/10195 7/1/,95 WD 1 2 3 4 ASSESSOR'S Parcel number Assmt. year 19 _ Field. Sales number USE L County _ Parcel classification I - Use ur v nce r r%RA eecr, nrQ enet rna Tax dist ❑ Signature(s) Gregnr)l R Boardman STATE OF WISCONSIN ss. Wisconsin Department of Industry. SOIL AND SITE EVALUATION REPORT Page 1 of 3 Lahr and Human Relations ';ris~on of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to near road. 0 3 2 ' Zo tiv APPLICANT INFO RMATION-PLEASE;PEhINT ALL IfV MATION REVIEWED BY DATE PROPERTY OWNER: ~ j PROPERTY LOCATION , Greg Boardman Q l- V5` GOVT. LOT NK 1/4 NW 1/4,S13 T ;0",141,198 1]€ (Uor) W PROPERTY OWNERS MA!I_ING MESS ~ LOT # BLOCK # SUBD. NAME OR CSM # *T) Aj & na na csm endin 823 160th. Ave. "il) .rl CITY, STATE HONE NU ❑CITY ❑VILLAGE)WOWN NEAREST ROAD New Richmond, WI. 5 -5457 Somerset 160th. Ave. _W1616 A~_ dVew Construction Usex# Residential / Number of bedrooms 3 Addition to existing building J Replacement ( I Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • _5 bed, gpdm2 •6 trench, gpolft2 Absorption area required 900 bed, tr2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpdtft2 Recommended infiltration surface elevation(s) upper=93.22 lower=91.7 (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na It S = Suitable for system I CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ® S ❑ U 5S ❑ U ® S ❑ U ❑ S ®U ❑ S 01.1 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed Trertdl 0-13 10 r4/3 none sl 2msbk mfr CfW if .5 .6 2 13-80 7.5yr4/6 none 1 fs Osg mvfr na na .5 .6 Ground elev. 93.77ft. Depth to limiting factor +80" Remarks: Boring # 1 0-9 10yr4/3 none sl 2msbk mfr 9w if .5 1.6 2 9-29 10yr4/4 none sil 2msbk mfr 9w if .5 .6 .L'2 3 29-82 7.5yr4/6 none 1 fs Osg mvfr na na .5 .6 Ground elev. 93.77n. Depth to limiting factor +82" Remarks: CST Name.-Please Print Phone: Gary L. Steel 715-246-6200 Address: 1554 0th. Ave., Ne "Richmond, WI. 54017 Signature: Date: CST Number: 12-14-94 cstm 0229 PROPERTY OWNER Greg Boardman SOIL DESCRIPTION REPORT Paget of 3 PARCEL I.D. 8 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bandwy Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iTmnch 1 0-8 10yr4/3 none 1 2msbk mfr gw if .5 1.6 3 ` M... 2 8-29 10yr4/4 none sil 2msbk mfr na if .5 .6 Ground 3 29-96 7.5yr4/6 none 1 fs Osg mvfr na na .5 i.6 elev. i 95.97 ft. Depth to limiting factor +96" Remarks: Boring # 1 0-9 10yr3/3 none 1 2msbk mfr gw if .5 .6 i' 4 2 9-33 10yr4/4 none sil lfsbk mfr 9w if .2 .3 3 33-9 7.5yr4/6 none 1 fs Osg mvfr na na .5 €.6 Ground elev. 96.94t. Depth to limiting factor +90" Remarks: Boring # 1 0-10 10yr3/3 none 1 2fp1 mfr gw if np .3 5 2 10-3 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 36-5 7.5yr4/4 none s1 2msbk mfr gw na .5 .6 Ground elev. 4 58-92 7.5yr4/6 none 1 fs Osg mvfr na na .5 .6 97.57 ft. Depth to limiting factor +92" Remarks: Boring # Ground elev. j ft. f Depth to limiting factor Remarks: SBD-8330(R.06/92) STEEL'S SOIL SERVICE Gary L. Steel Greg Boardman 1554 200th Ave. CSTM2298 Nw4 NW% S13-T30N-R19W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246-6200 f N 1"=40' BM.= top of 1" steel pipe by power pole at el. 100' Alt. BM.= nail in power pole at el. 102.00' v- I~ 0 o~G E ~a,di. ear~rf2 ,?!50' to , 4- "vY0 -41 N g. 3 i3 2 °0 t~• 4 6(V 0 e: Gary L. Steel 12-14-94 - 1 tid I FILED J U L 5 1995 ► JUL I Z C~ WNLE"N H,WALSH R¢~ ~ ~ pi Duds ? St CROIX COUNTY St, Cr~EK Co„ WI r` SURVEYOR'S RECORD 5308'0 1Q. 00 - CERTIFIED SURVEY MAP -4-V Located in part of the NWi of the NWA of Section 13, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin. N Scale in Feet 1" = 100' ° o uzw 0 50 100 200 W x K F H ; W y_ wrn IGOiH A\iCrJUE Y o North line of the NW> a 1 z N~ F-y NW Corner of o ; U VS~eccZioh 13 r 9°55'08"W 59...92'_' a W LL W 0 S89°37'20"W 58 11' I o M M d O w • . LOT 1 • . ' cJ 3 x • ' ' " ~ 10.00 Acres Inc. R/W w •'435,644 Sq. Ft. I 9.58 Acres Exc. R/W a% 0`1 417,317 Sq. Ft. o Ln n~ Ln POND N w AR~ROVEO -j 75' water setback line ST. CROiXCl31T! li' Comprehensive ftwis ~i _ Zoning and ; ~i twp f ~ S J, Parks Committea , i t 0- j~ If not recorded witfiin 30 days of °ewa - approval date