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006-1012-50-000
St. Croix County Planning and Zoning Wednesday, March 28, 2007 at 11:00:30 AM Detail Sanitary Information Page I of 1 Computer #: 006 - 1012 -50 -000 Sub /Plat: NA Section: 6 Parcel #: 06.31.16.92A lot: 1 TN /RNG: T31 N R16W Municipality: Cylon, Town of CSM: Vol. 01 Pg. 273 1/4 1/4: SE 1/4 SE 1/4 Owner: Kittel, Marlene 2048 Cty. Rd. H Deer Park, WI 54007 State Permit: 487970 Issued: 11102/2005 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 11/04/2005 POWTS Detail: Infiltrator - Quick4 chambers Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Utgard, Brady Re -using old 1000 gal. Septic tank and adding 750 $0.00 Kevin Grabau Signed 7ff: Yes dose tank with in -line Simtech filter to 2 dist. Cells with 59 chambers in 0.4 gpd /ft2 soils. Received certification form regarding existing tank and service date. 3/28/07 found soil report in sec. 12 folder Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 11/4/2008 Owner: Olson, Royal & Marlene 2048 Cty. Rd. H Deer Park, WI 54007 State Permit: Issued: 01/01/1979 POWTS Dispersal: Non - Pressurized In- ground Permit: New County Permit: 0 Installed: 01/01/1979 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Unknown check archives under Kostka or Olson for an $0.00 Not determined Signed Off: No original permit on 3 BR house with 1000 gal. Septic tank to bed drainfield @ 1978 -80 vintage. Found a soil report from 1976 for a Royal Olson, who paid $1200 on 1/31/77 for something per note on the form. Wisconsin Department of Comme ALUATION REPORT Page of Division ofpfety Buildings A � p � in accordance with Comm U Code County Attach completb site plan on paper not lesA �S 8(1 /�x es in ize. a r include, but not limited to: vertical and hori b4ital referen�'liit (BM directi Parcel I.D. percent slope, scale or dimensions, north arrow, and location and dis nce to nea road. OO Please dnt' 461' 1 Y R wed b Date /��( Personal IMama ' provide ry purposes Privacy Law. a. 15.04 (1) (m)), 7/2- 3 r'/ er Property Location Govt Lot 114 1 /4 S J N R I& E (or)9 Property Owner's Mailing Address . _�,Q Lot # Block # Subd. or CSM# / 3 city State Zip Code Phone Number ❑ City ❑ Village ® Town earest Road ❑New on Use: Residential / Number of bedrooms — y Code derived design flow rate '7'-'7 (o c GPD Replacement ❑ Public or commercial - Describe: Parent material �� (/ Flood Plain elevation if applicable it// ft. and recommendations: S y �T CiYI el<v 0,0 �Ils rh�� F-11 Ong # ❑ Boring qn pit Ground surface elev. 06 ft. Depth to limiting factor in. Sa'I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 I -q 0►ab1 ml f s �� '(0- /1 y3 to "J G lof 1 - C 5 � 6, � a Boring # ❑ Boring ® pit Ground surface elev. S ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 'Eff#2 0 lu- L r C S I t 'd U / /r CG../ ► 4 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 1 150 mgA- ' Effluent #2 = BOD 130 mg/L and TSS 1 30 mg/L CST Name (Please Print) ignature CST Number vv` 05'33 a Address Date Evaluation Conducted Telephone Number S —o 57' 7/ -5 -+a z ,7- y Property Owner Parcel ID # Page of _ Boring # 4u Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o,g rs c tv o Z - a l — S 2►�I r c G • O ,37 J& j o sc ( v — A ti F-1 ring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ F Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 nVL and TSS >30 1150 mg/L ' Effluent #2 = BOD 130 mg/- and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 2648777. seo•uwtrt.sroo) L �l a PAG E OF � NAME ' ei LOT# LEGAL DESCRIPTIO S T N R E OR i SCALE: I " BM 1 ELEVATION Lo o,c) BM 1 DESCRIPTION W D t or, St. 0( BM 2 ELEVATION BM 2 DESCRIPTION —� SYSTEM ELEVATION SYSTEM TYPE � 'ev, f"1 l.y 6' 6 " 1 G�^ S i. ca SIGNATURE DATE a C Iq Parcel #: 006 - 1012 -50 -000 09/23/2005 08:25 AM PAGE 1 OF 1 Alt. Parcel #: 6.31.16.92A 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, A CC = Current Co-Owner ROYAL J &MARLENE OLSON O - OLSON, ROYAL J & MARLENE k - i ZTeL--. 2048 CTY RD H DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description * 2048 CTY RD H SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 16.990 Plat: N/A -NOT AVAILABLE SEC 6 T31 R1 6W 16.99A IN SE SW LOT 1 Block/Condo Bldg: CSM VOL 1/273 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 06-31N-16W Notes: Parcel History: Date Doc # Vol /Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.990 25,000 180,500 205,500 NO PRODUCTIVE FORST LANC G6 12.000 28,800 0 28,800 NO Totals for 2005: General Property 16.990 53,800 180,500 234,300 Woodland 0.000 0 0 Totals for 2004: General Property 16.990 53,800 180,500 234,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 9 J 1 2179P 634 as TERMINATION OF DECEDENT'S 6 PJ S 22 1 PROPERTY INTEREST KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI DECEDENT'S NAME DATE OF DEATH RECEIVED FOR RECORD ROYAL J OLSON AKA ROYAL JOE 00 .26 - 1996 OLSON 09/01/2005 12:45)" ADDRESS OF DECEDENT AT DATE OF DEATH CITY ST ZIP 2049 CTY ROAD H DEER PARK WI $4007 TERN OF DECEDENT PRO EXEMPT # REC FEE: 25.00 PRESENTATION OF DEATH CERTIFICATE TRANS FEE: I certify that I have viewed a certified copy of the decedent's death COPY FEE: ficate. CC FEE: PAGES: 3 e _ REGISTER OF DEED'S SIGN RE DATE �~ Recording area Interest In property Is terminated under (please check appropriate statute): Name and return address: IN s. 867.045 which pertains to property In which the decedent was a joint tenant, MARLENE KITTEL had a vendor's or mortgagee's Interest, or had a life estate. (You must provide 2048 CTY ROAD H a copy of the document establishing joint tenancy or life estate.) DEER PARK WI 54007 E3 a. 867.046 which pertains to (1) property of a decedent specified In a marital property agreement, and also to (2)survivorship marital property. (You must provide a copy of the document establishing survivorship marital property.) 006- 1012 - 50 - 000 Parcal Identification Number ❑ s. 705.20 Nonprobste Transfers on Death. A provision for a nonprobste transfer on death in a trust, conveyance deed of gift or marital property agreement(You must provide a copy of the document establishing transfer at death.) Presentation of recorded document establishing joint tenancy, life estate, survivorship marital property, vendor Interest, or mortgagee interest in real estate. DOCUMENT VOLUMEIREEL PAGEAMAGE RECORDSAXEDS 337720 11 a 013 RECORDS Description of the real estate. _, • . �y; .', ,•, Include only the f ownersftip (or vendor or mortaggee's Intergst) in of death If the extent of land is exactly the some as on the document, a copy of that t may Q. At ch'ed to describe the real estate. Attach tax bill(s) for year Immediately preceding death, If4)ZPlicabli ee , directions.) The legal description of the property and the persons receiving the propert? are a& f9 lows: Vtf more space is needed, attach pages.) ® See Attached • ^ A Description of personal property (if any) being transferred. �' c You may list savings accounts, checking accounts and securities on attached pages. Indicate personNj'')sceiving property. DECLARATION: I(Ws) declare that this document Is, to the best of my(our) knowledge and belief, true, correct and complete and is in conformity with the provisions and limitations of the Wisconsin Statutes. (it more space is needed, attach R Name and Address of Persons) Relationship to Signature(Notarized) Date Receiving Prop Decedent MARLENE OLSON NKA SPOUSE MARLENE KITTEL f /QS 2048 CTY ROAD H DEER PARK WI 54007 This document was drafted STATE OF WISCONSIN, County of ST CROIX by:(print or type name below) MARLENE KITTEL Subscribed and sworn to before me 09 -01 -2005 by the above named on: NOTE: SEE DIRECTIONS. Signature of Notary or r other other p erson Wisconsin Register of authorized to administer an oath (as Deeds Association Form per s 708.06, 706.07) HT -110 Print or type name: PAULETTE ORF Website Version 6/2003 Title: FIRST DEPUTY Dote Commission Expires:12- 31/2006 3341 ST, CROIX COUNTY SURVEYOR'S RECORD LUEST -562.48 UNPL A7'TE17 LAND UN/ // T TED LAND 334194 /6.99 AGES s NJ Lq SCALE' / "= 4 400' Sao' '� BEAM' //V65 REFEfe TO 4 } "i >ew.saz THE EAST L /NE OF THE Z� a p0 - o SU) y4 SEC. 62, ASS �0 ° 0 BEF�R /I✓G NORTH C. 7 N " EAST -L 2.46 O / "N 30 " /RON P /PE 7'3/ A/ ,e16 w C ER Tl F /ED SUR VL Y MAP r )0,1 , 07 DF T SE %4 o r THE SW V-4 SEC. 6 = T3 / Al 2/� L✓ TOL✓AV OF C VZON S T. C, 0AV CO UN TS k11SCD/V S /N . - e� a ��� DESCRIPTION Part of the SE! of the SW4, Section 6, Township 31 North, Range 16 West, Town of Cylon, St. Croix County, Wis- consin described as follows: Commencing at the South 4 corner of said Section 6 in the center of C.T.H. "H ", this being the point of be- ginning of this survey; thence North 1315.5 feet to a point, thence West 562.48 feet to a point, thence South 1315.5 feet to a point; thence East 562.48 feet to a point in the center of C.T.H. "H" and the point of be- ginning of this survey. This parcel contains 16.99 acres more or less including lands released for highway purposes. SURVEYOR'S CERTIFICATE I, Paul J. Slight, being a duly qualified surveyor, do hereby certify that by order of and under the direction of Joe Kostka, I have surveyed and mapped the property described. The plat shown on this sheet is a true and correct representation of the exterior boundaries of the land surveyed and that I have complied with the pro- visions of Chapter 236.34 of the Wisconsin Statutes to the best of my knowledge and belief. 1 aul J. Slight Registered Land Surveyor Hudson, Wisconsin �- ,,(UI.Y 5 � I �7� iiolu$te 1 Page 2?3 St. Croix County Planning and Zoning Monda y, February 12, 2007 at 11:21:40 AM Detail Sanitary Information Page 1 of l Computer #: 006 - 1012 -50 -000 Sub /Plat: NA Section: 6 Parcel #: 06.31.16.92A Lot: 1 TN /RNG: T31N R16W Municipality: Cylon, Town of CSM: Vol. 01 Pg. 273 1/4 1/4: SE 1/4 SE 1/4 Owner: Kittel, Marlene 2048 Cty. Rd. H Deer Park, W 1 54007 State Permit: 487970 Issued: 11/02/2005 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 11/04/2005 POWTS Detail: Infiltrator - Quick4 chambers Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Utgard, Brady Re -using old 1000 gal. Septic tank and adding 750 $0.00 Kevin Grabau Siumed Off: Yes dose tank with in -line Simtech filter to 2 dist. Cells with 59 chambers in 0.4 gpd /ft2 soils. Received certification form regarding existing tank and service date. Maintenance Scheduled Pump Date Puffed 1st Notification 2nd Notification 3rd Notification 11/4/2008 Owner: Olson, Royal & Marlene 2048 Cty. Rd. H Deer Park, WI 54007 State Permit: Issued: 01101/1979 POWTS Dispersal: Non- Pressurized In- ground Permit: New County Permit: 0 Installed: 01/01/1979 POWTS Detail: Bed - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Unknown check archives under Kostka or Olson for an $0.00 Not determined Signed Off: No original permit on 3 BR house with 1000 gal. Septic tank to bed drainfield @ 1978 -80 vintage. Found a soil report from 1976 for a Royal Olson, who paid $1200 on 1/31/77 for something per note on the form. EH 115 (11 -74) r OF HEALTH AND SOCIAL SERVICES fr IREAU OF ENVIRONMENTAL HEALTH 2.0. BOX 309 ►N, WISCONSIN 53701 1 �1 -�— )RINGS AND PERCOLATION TESTS ' 1 w LOCATIO�� —'!a ��'� W, Township or Lot No. , Black No._ County 1 Z6 auw,.mrvn Name Owner's Name: tyi / �� Cr .c✓ Mailing Address: TYPE OF OCCUPANCY: Residence _ No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW x ADDITION REPLACEMENT -7 DATES OBSERVATIONS MADE: SOIL BORINGS � - 7 ( PERCOLATION TESTS �f° SOIL MAP SHEET /J.:� - /.f SOIL TYPE 1 / ��o/tlfTf, 1 .L`.y ,F.<4!f&72,; .-y PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INC14E RATE NUM' INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 If.-5 0 !H /' i l� t c� I 4.- `' j` � • � Aid o2 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B_ B— 'f ''y /J ` PLAN VIEW (Locate percolationtests,eoil bore holes and suitable soil areas.) v+C� Indicate on the plan the location and square feet of suitable cate nurqber of square feet of absorption area needed for building type and occupancy. S Indicate scale or distances. Give reference point. Indicate slope. M I r• i • 1 d . I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the, procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) �� i Signat ti Certification No. v ; Name of installer if known Copy A - Property Owner ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the nkved Y residence located at: sr 1 /4, <W 1 /4, Section (o Town 31 N, Range I(-- W, Town of tv' , St. Croix County Wisconsin. Upon inspecti n, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: /000 Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): 20 yea r-s (Licens d Plumber Signature) (Print Name)��� y �- (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) N t T. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 2 d qk Gk . d l-f residence located at: 1 /4, Se 1 /4, ection Town 3 I N, Range ! (� W, Town of St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) St. Croix County Planning and Zonin Friday, November 04, 2005 at 5:06:04 PM Detail Sanitary Information Page I oft Computer #: 006-1012-50-000 Sub/Plat: NA Section: 6 Parcel #: 06.31.16.92A Lot: 1 TNIRNG: T31NR16W Municipality* Cylon, Town of CSM: Vol. 01 Pg. 273 1/4114: SE 1/4 SE 1/4 ........... . ........ ........ ......... . . .... . ..... ....... Owner: Kittel, Marlene 2048 Cty. Rd. H Deer Park, WI 54007 State Permit: 487970 Issued: 11/02/2005 POWTS Dispersal: Non-Pressurized In-ground Permit: Replacement County Permit: 0 Installed: 11/04/2005 POWTS Detail: Infiltrator - Quick4 chambers Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Reauirements Additional Notes Money Owed Kevin Grabau NA Utgard, Brady certification form regarding existing tank and Re-using old 1000 gal. Septic tank and adding 750 $0.00 Signed Off: Yes service date dose tank with in-line Simtech filter to 2 dist. Cells with 59 chambers in 0.4 gpd/ft2 soils Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 11/4/2008 - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Owner: Olson, Royal & Marlene 2048 Cly. Rd. H Deer Park, WI 54007 State Permit: Issued: 01/01/1979 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 01/01/1979 POWTS Detail: Bed- Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Inspecto As Built Plumbe Other Requirements Additional Notes Money Owed Not determined NA Unknown check archives under Kostka or Olson for an $0.00 Signed Off: No original permit on 3 BR house with 1000 gal. Septic tank to bed drainfield @ 1978-80 vintage - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety andouilding Division INSPECTION REPORT sanitary Permit No: 487970 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan I No - Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Kittel, Marlene I C Ion, Town of 006- 1012 -50 -000 CST BM Elev: ( Ins p. BM Elev: BM Des ription: Section/Town /Range /Map No: .p QD Q 8 d 4 . 4 06.31.16.92A TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 9y a Benchmark ,Z, 1pZ. 1100.0 Dosing T� -*SD Alt. BM Aeration U Bldg. Sewer •- Holding SUHt Inlet j TANK SETBACK INFORMATION St/Ht Outle TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet '�• / Septic , '? S', � 1 IZ / DtBottom O.So W'S Dosing ' 9J lf , Z 2. Z rf Header /Man. Aeration Dist. Pipe •� S � ap o i Holding Bot. System Op .a .� PUMP /SIPHON INFORMATION final Grade vl.� Manufacturer S Demand St Cover •� i GPMh Model Number 0 `6 C 0 O 1 1-ift � Fricti Loss Syst�e gf TDH ,O Ft • Forcemain Len 2 p Dist. to Well V 5 0 2 ? S SOIL ORPTION SYSTEM , :I 61D RE Width !! ?.� No. of Tr riches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ! 2 1 SETBACK SYSTEM TO P/L 113 IWELL LAKE /STREAM LEACHING Manu u r: INFORMATION CHAMBER OR Type Of System: -;,SD' > �l ---- T UNIT Model Numb DISTRIBUTION SYSTEM Has r /Ma ifold., Distribution x Hole Size x c ing Vent to Air Intake .M Pi (s) y Le th Dia L mg is Spacin SO OVER x Pressure Systems Only xx M ound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Q Yes FN� No ® Yes Q No CO MM' NT : (Includ c e discrepencies, persons present, etc.) Inspection #1:NO G Inspection #2: Location: s 2b48 Cty. R Deer Park, WI 54007 (SE 1/4 SE 1/4 6 T31 R1 6W) NA Lot 1 r ' Pa rc No: 06.31.16.92A 51v^ STS- I tq7- -�- 1.) Alt BM Description = / �'� �r 2.) Bldg sewer length = *> ' v ? I `„ _ -•� - st�� ��� amount of cover = I- _ _ n 1N �, V�+d�1 Plan revision Required? � Yes XNo 0� Use other side for additional information. � Date CerL No. /�_ _ - (� , /► p [y,� Insepctor s Signat /urey n $RD 10 R�� 0 'C� ✓ Gal' OJT >�i i�'� , _• �' +o uk � i i HOC . / ECEIVEn Safety Buil Diyr ipn Co unty . ► 201 W. Was gton .0.' $x 802 �T �s Madi , WI 53707 — 7082 Sanitary Permit Number eonsi n (to be filled im by Co.) De artment of Commerce 8) 2 OIXCUUNT), Sanitary Permit Applied io "`e Plan I.D N b" n In accord with Comm 8321, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Addr (if different than mailing address) I. Application Information - Please Print All Information Property a's Name � Parcel M Lo[ Block X Property Owner's Mailing A Property Location as c_ � h` �' �' City, Stare CC ``""'' Y., 50 '/., S / ' , CO Zip C �J P Numb 4Q A � C C C ltcl; IL Type of Building (check all that apply) T N; R l E o()yJ t Su lion Name umber 1 or 2 Family Dwelling - Number of Bedrooms U ❑ Public/Commercial - Descnbe Use _ ) 3 AQ7`� ❑ State Owned - Describe Use ❑City ❑Villa a ownship of C IM Type of Permit: (Check only one box on line A. Complete line B if applicable) S ~ ❑ New System R lacement S tem ys eP Ys ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New L' t Previous Permits Nuumb / a and Date Issued Before Expiration Plumber Owner �i47 11?► Kth pQ��/ IV. Type of POWTS System: Check all that a I S k Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil a soil ❑ At -Grade C3 Single Pass Sand Filter C1 u Coaswed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter An.1ching Ch Line ❑ Gravel -1 i ❑other ( p in) q V. Dispersal/Treat ment Area Information: �9./ 4 CA Design Flow (gpd) Design Soil Appli tion Rate(gpdst) Dispersal Area Required (sq Dispersal Area Propos st) em Elevation 41 21- 25-0 11112il"17-11 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw istina Tanks Tanks Septic of Kotdina Tack .,_ Aerobic Trcumea Uait "in` t3arobcr O I — VII. Responsibility Statement- I, the undersigned, assume responsibility for Ins Ilation of the POWTS sbown on the attached plans. Plumber's Name (Print) Plumber' igna t&WPRS Number Business Phone Numbcr 0 3S' 7 O/S = a6 9 Plumber's Address (Street, City, Sw , Zip Cod VIII. Cjpd'nty /De artment Use Onl pproved ❑ Disapproved Sanitary Foe) Permit Fee includes Groundw ter Date Issued Iss g Agent igna a ps� t (f( C3 Owner Given Reason f7De"nial IX. Conditions of Approval/Reasons for Disapproval //-- YSTEM OWN � �'�rt✓��.IT7��a' /n. 1 ep Ic tank, effluent filter and 4 6" 6'Y!V'_ - 93-33 944/,,(�� L dispersal cell must all be serviced / maintained as per per management plan provided by plumber. 2. All setback requirements must be maintained � {1l�. as per applicable code /ordinances. I��� G ✓1 1-- yo T -/ a aE � P6 0 0 NAPO o 0 a ? t � - w po ISO O do /8 �y-h� /f • 3 • aJ , �D 1, 1-- yo T -/ 1 .1 3 � Co o� �A r �6ko r p OP q A4Y 0 �L/ � % t Aso �?aa3s� do y8 C7- 1�4 PA(;f GF PUMP CHAMBER CROSS SECTIOU ANG SPECIFICATIOUS vENT cAP • '1 C.I. VENT PIPE �r WEATHERPROOF APPROVED LOCKMIG JUNCTION BOX MANHOLE COVER � 25' FROM DOOR, WINDOW OR FRESH 12 "MIU. AIR INTAKE GRADE I 4" MIJJ. ✓ L�..r 18" /Miu. COAJDUIT 18 "MM. � --- - - - - -- • \ X1 PROVIDE I - - - -- IAILET AIRTIGHT SEAL ALARM I *APPROVED � (/� I I oN c JOINTS WITH ELEV. FT. APPROVED PIPE 3' ONTO PUMP -� OFF D SOLID SOIL COIJCRETE BLOCK RISER EXIT PERMITTED GNL9 IF TANK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIONS DOSE TA NKS MAMUFACTURER:: IJUMBER OF DOSES: PER DAy TANK SIZE: _ 75 GALLOWS DOSE VOLUME ALARM MAAIUFACTUR I'I xa INCLUDING BACKFLOW: 7 o? GALLONS MODEL NUMBER: P_A CAPACITIES: A= 2 OR J CALLOUS SWITCH TYPE: B= � INCHES OR � !/ ALLOklS PUMP MANUFACTURE & C = S.L��S imr-HES OR ©� �GALLOLIS MODEL NUMBER: �^ �d D- J INCHES OR 2fll4�GALLOUS SWITCH TYPE: �J`"'1 NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM ��IN��STALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE 6ETWEEU PUMP OFF AND DISTRIBUTION PIPE.. - FEET + MIM NETWORK SUPPLH PRESSURE / .. . . . .. . . . . � + 2-Y- - FEET OF FORCE MAIN X ` /, `W /IoO FL 5 FRICTIOAI FACTOR. 211 FEET TOTAL DYNAMIC. HEAD = FEET 0 IMTERNAL DIMEWSIONZ OF TANK: LENGTH ;WIDTH - ;LIQUID DEPTH 38 51GIUED: LICEMSE WUMBER: o?�a g ? DATE: LE S XGOULDS PUMPS Submersible Effluent Pump EPO4 & EP05 1Fm1W Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion • Heavy duty sump matic models include resistance. 0 Canadian Standards Association • � Fite # tR38549 Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer Goulds Pumps is 150 9001 Registered. factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic • Solids handling capability: FEATURES cover with integral handle and 1/4" maximum, ■ EPO4 Impeller: Thermoplas float switch attachment points. • Capacities: up to 60 GPM, tic semi open design with ■ Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1' /z" NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) Intermittent. METERS FEET • Fasteners: 300 series 10 - -- ......... ...... ... .. .................. stainless steel. • Capable of running 9 30 5 GPM dry without damage to - -- - - -- s _ _. .._ components. 2.5 Fr 25 a Motor: _ t • EPO4 Single phase: 0.4 HP, U 6 zo 115 or 230 V, 60 Hz, 1550 ; a , RPM, built in overload with } 5 automatic reset. ° 15 • EP05 Single phase: 0.5 HP, o a ........................ ...... _ ..................... _...._ ..... EP05 11 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with automatic reset. EPO4 .. .. • Power cord: 10 foot 5 standard length, 16/3 1 - SJTW with three prong .......... _ .... .. ................ . I grounding plug. Optional 20 0 10 20 30 1 i 0 0 -' � --------- -�_... foot length, 16/3 SJTW with 40 50 GPM three prong grounding plug (standard on EP05). 0 2 4 6 8 10 12 ml /h CAPACITY 75 Gou lds Pu ® 2003 Goulds Pumps Effective July, 2003 93871 ` .6;6? .$` ITT Industries RECEIVED E jsconsin Department ofC merce IL EVALUATION REPORT Page of — division of Safety and Buildi gs N 0 V it i4o@ with 5, Wis. Adm. Code County 5 • Attach complete site plan paper not less than 8 1/2 x es I Pla ust include, but not limited to: ertic$jFng�q�pQ@J BM), nd Parcel I.D. percent slope, scale or di ension0}4grppr1� locatio an nee t rest road. — —000 Please print all Information. awed b Date l Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location A Govt. Lot 5 r= 1/45iq1/4 S T 3 1 N R 14 E (o W Property Owner's Maili Address Lot I Block # Subd. N OW / City State Zip Code Phone Number ❑ city ❑ Village ®Town Nearest Road ❑ New Construction Use: EPP Residential / Number of bedrooms — `J' Code derived design flow rate `/ 0 ° GPD Replacement ❑ Public or commercial - Describe: _ Parent material �r r' Flood Plain elevation if applicable General comments S t rri t AC C" / ul • od and recommendations: Y F-11 Boring # ❑Boring —/ 19 pit Ground surface elev. � ft. Depth to limiting factor 7 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 G 4 r 5 G .Q a Boring # ❑ Boring _ Pit Ground surface elev. • 5 v ft. Depth to limiting factor --' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 C), V <u v L r L` S lot sa (� cr 1 O /// ' C J . L u /nt CL Effluent #1 = BOD > 30 ZZO mgll. and TSS >30 t #2 = BO < 30 nd TSS < 30 mg/L CST Name (Please Print) Ignature CST Number 11:�S'33 Address Date Evaluation Conducted Telephone Number b �S S 7/ -5 Z� W Property Owner Parcel ID # Page 2-- ,f _ 3 n Boring # ❑ Boring f ) I (} Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 v F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKI in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDKf in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mgA- ' EMuent #2 = BOD < 30 mg/L and TSS < 30 rng/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608 -264 -8777. sau4330 ("W) PAGE OF—,3 DAME k ( LOT# LEGAL DESCRIPTION 1 /a 1 /a,S T ,N,R E(OR)W SCALE: v/V BM 1 ELEVATION Lo v, o BM l DESCRIPTION ���� �� Slt e� rvl�ci OM1 SI d BM 2 ELEVATION ^--� BM 2 DESCRIPTION SYSTEM ELEVATION g`� , (, �• SZ' SYSTEM TYPE C�G'i1U� rte-+ j yr�ct v i / 2 BEd N • 6-1 SIGNATURE DATE S— ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND n , OWNERSHIP C;:RTIFICATION FORM Owner/Buyer Mailing Address O C-7`1 Property Address (Verification required from Planning Department for new construction) City /State ) e � L44-r Parcel Identification Number 6 0 (o - /0 /a -,70- O Oo LEGAL DESCRIPTION Property Location S %., S W �/,, Sec. c� , T 3 / N -R A W, Town of C 7� Subdivision . Lot # Certified Survey Map # 33 y / , Volume �_ , Page # 7 Warranty Deed # 8 osaa I . Volume 7 Page # Spec house 0 yes 0- no Lot lines identifiable 16 yes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The propen)r owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumperverifying 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 three year expiration date. a �<A b / 05 SIGNATURE O P ICANT DATE OWN ER CERTIFICATION I (we) certify th t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the described ve, by JRje of ed recorded in Register of Deeds Office. l0 /028/ SIGNATURE OF APL DATE «s « « «* 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 1600 g a l ❑ CIA Permit * 0 Septic Tank Manufacturer CkAXa L ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Ag, ;5,� NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 9 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity '? al ❑ NA Estimated flow (average) Ott g al/day Pump Tank Manufacturer ' ❑ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ❑ NA Soil Application Rate i al /da /ft2 Pump Model lj ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L D Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (SOD.) 530 mg /L X Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L �1 NA D At -Grade 13 Mound Fecal Coliform (geometric mean) 510` cfu /100m1 ❑ Drip -Line O Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other` ❑ NA Other. ❑ NA Other. ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum 3 ears) ❑ NA y ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Q y ear(s) Clean effluent filter At least once eve / 13 months) every: !/ 41r earls) 13 NA Inspect pump, pump controls & alarm At least once every: Q month(s) 13 NA ear(sl Flush laterals and pressure test At least once every: D month(s) ❑ NA D year(s) Other: At least once every: [3 month(s) D earls► ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page 2 of ?/ For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot b4raired he following measures have been, or.must be ttpken to provide a code compliant replacement system: ���,�'���� C] A suitable replacement ab n evaluated and rr(ay be utilized for the location of a replacement soil absorption system. a rep acement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS . r technology a holding tank may be installed as a last resort to replace the failed POWTS. I" T 4UrFTCrVCWn.16L 010. 1. ..a alua ' t b e ai a 9RD41 nEZ. nP- AI&J f1 p tank ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone �ls_ 6 S� Phone - SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ( Phone Phone — This document was drafted in compliance with chapter -Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. Parcel #: 006 - 1012 -50 -000 11/02/2005 04:31 PM PAGE 1 O 1 Alt. Parcel #: 6.31.16.92A 006 - TOWN OF CYLON Current LX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KITTEL, MARLENE MARLENE KITTEL 2048 CTY RD H DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 2048 CTY RD H SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 16.990 Plat: N/A -NOT AVAILABLE SEC 6 T31 N R1 6W 16.99A IN SE SW LOT 1 Block/Condo Bldg: CSM VOL 1/273 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 06 -31 N-1 6W Notes: Parcel History: Date Doc # Vol /Page Type 09/01/2005 805221 2879/634 TI 01/19/1977 337729 548/13 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.990 25,000 180,500 205,500 NO PRODUCTIVE FORST LANDS G6 12.000 28,800 0 28,800 NO Totals for 2005: General Property 16.990 53,800 180,500 234,300 Woodland 0.000 0 0 Totals for 2004: General Property 16.990 53,800 180,500 234,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 9� 2 3879 P 634 s TERMINATION OF DECEDENT 4g4D5z 1 PROPERTYINTEREST KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO. • NI DECEDENT'S NAME DATE OF DEATH RECEIVED FOR RECORD ROYAL J OLSON AKA ROYAL JOE 06.20-1896 OLSON 09/01/2005 12:45PK ADDRESS OF DECEDENT AT DATE OF DEATH CITY ST ZIP 2441 CTY ROAD H DEER PARK WI j 04007 TERM OF DECEDENT PRO EXEMPT i REC FEE: 25.00 PRESENTATION OF DEATH CERTIFICATE TRANS FEE: 1 certify that I have viewed a certified copy of the decedent's death COPY FEE: peci �— CC FEE: PAGES: 3 REGISTER OF DEED'S SIGN RE DATE Recording area Interest In property Is terminated under (please check appropriate statute): Name and return address: ® s. 867.045 which pertains to property in which the decedent was a joint tenant, MARLENE KITTEL had a vendor's or mortgagee's interest, or had a life estate. (You must provide 2048 CTY ROAD H a copy of the document establishing joint tenancy or life estate.) DEER PARK WI 54007 j] s. 867.046 which pertains to (1) property of a decedent specified In a marital property agreement, and also to (2)survivorship marital property. (You must provide a copy of the document establishing survivorship marital property.) 006 - 1012 -50 -000 Parool Identiftstion Number j3 s. 705.20 Nonprobste Transfers on Death. A provision for a nonprobsts transfer on death in a trust, conveyance deed of gift or marital property agreement(You must provide a copy of the document establishing transfer at death.) Presentation of recorded document establishing joint tenancy, life estate, survivorship marital property. vendor Interest. or mortgagee Interest in real estate. DOCUMENT # VOLUMEIREEL PAGEAMAGE RECORDS/DEEDS 337726 "1 013 RECORDS Description of the real estate. Include only thl! extent o f ownership (or vendor or t goage's interest) in land at t • t f death If the extent of lend is exactly the some as on the document, a copy of that t may ke 4t child to describe the real estate. Attach tax bill(*) for year immediately preceding death, -if4Rplfcabit. ee directions.) The legal description of the property and the persons receiving the propetft? are as fgtlow:: %(rf more space is needed, attach pages.) ' • ••` ® See Attached :k Description of personal property (if any) being transferred. • • • • • • • • -• You may list savings accounts, checking accounts and securities on attached pages. Indicate perso property. DECLARATION: I(We) declare that this document is, to the best of my(our) knowledge and ballet, true, correct and complete and is in conformity with the provisions and limitations of the Wisconsin Statutes. (if more space is needed, attach pages. Name and Address of Person(s) Relationship to Signature(Notarized) Date Receiving Property Decedent MARLENE OLSON NKA SPOUSE MARLENE KITTEL 2048 CTY ROAD H DEER PARK WI 84007 This document was drafted STATE OF WISCONSIN. County of ST CROIX by:(print or type nsma below) MARLENE KITTEL Subscribed and sworn to before me 09 -01 -2005 by the above named person(*) on: NOTE: SEE DIRECTIONS. Signature of Notary or other person Wisconsin Register of authorized to administer an oath (as Deeds Association Form per s 708.08, 708.07) HT -110 Print or t Website Version 8/2003 type name: PAULETTE ORF Title: FIRST DEPUTY Dote Commission Expires:112- 3112008 - S: ,,}}•etta wa.a ` s'� trst.5,1 Maw�Aar'r'....a..ss iw utr,pti s c . 54 Ft n� 13. o rrw v S � y. � - 17 2 (] - Tessa .matt a,ntt o" wt±c aaot.+s Wa4 �, a Joie h J REC31SlS' Thi D sea m.a. peewee ► ...� :. F._._..� Ko f t_k a a . J '�f .S� ..___ _ +� Edna �. lcnaf.ka his wife t CRO(X CO f>ti _ . ^N a.._ . �. yi R.ceiL for W1S. cs Reoo►d a„r._ . ........... _ ........ ..... ._.. _.�_.�_._ ___ �. ._ _ . Grantor day — A A.o �VZ . w and ....Poy�11, �.....G.�Q9.f!+ firm. S? .1aan,..hi.e...xifee..aa._._.__ o of CID 1? *.... nantof .. ..... ...... _ ...... ..... ...- _......_............_....._ ___ __ __......._..__ M -v _.,."' .- .._-.- .................. .._..._ _._.__...._.._ ....., Gran•ee. @ ' ' of One �) a. ee aaatra w Wttaesxth, That d' W said Gtan+ot fnt a valuabb cnnuSeration......_..... ___..__ V Dollar, artd�othgo�c�, end- .- ya2��ghg...SonA�+�)'!ftfo_rp ........... W cnnvcy% to Grantee the EaftlWrtns dewm real estate Couwtr. $ta /C of Wisconsin - _ tt.ru v. A parcel of Iarlti located in SF} of S,It; of Section 6 T31N - R. 1641 more particularly described ass Tax Key a►._..� .. Sltk of SA of. 3eotion 6 - T31N - 4. 16W ereert 'nest This is - eomesteas Preperay. 825.76 feet ;Lereof in St. Croix County, Wisconsin ? i This is a correction deed to correct previous deed recorded as llocument No. 335992 in Vol. 544 page 32 in the Registers Office, St. Croix Co., Wisconsin on Oct. 13th, 1576 at 8130 A -4. EM : # 3 EXEMPT Togethe with all and singular the hereditaments and appurtenances thereunto belonging or in any vise appertaining: And - . fo3eph_J._ Kastka�...Jr.__and FQnc ..g.�...Koatka..-- - ........... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except.. ZQ17�Iif [..StiCU�.9.Li,Gtlf3_...: $lfid.. Qee49�1'��iEL..S?. ..T'4. rosy ..... ..... ....... ................ _...__ ......................................... �.._. .......... . ........ .............. --_-...... _-.-._ ......... ....... and will warrant and defend the same. Executed xt.._ SfF.. $X1Sa -.? S4T10ii1 ............... this...-- 17Jth. - -__. day 19..77- - arON16D A140 errALCOIN Pit ssiSlnci » _J aei>ti J. Kolstka, Jpi Sdra F. Kos ka Is Signaturesof _...... ......... . ............ ........ .......... .I ........ ... _.__. .........._...- __._... _..._... authenticated thin... ��. ._........_,_.....__,..._._.._. Jar of:......._......._._..... .___.......,...._..... :..,..... 19.:..::....: Y' Title: Member State Bar of Wisconsin or Other Part) Authorised under Set. 706-6 As. STATE OF WOCON'SiN \/) L u .......... ... rs�.t rs 9,L�. .._Cottntr. S Personally came before we this.. ._ ✓.� tom....... dtl of.__..._ the above .nam to me known to be the pe sons..._ w1ho esetuted the foregoing instrument and acknowledged ssr same: ' THIS INST!UNtWY WA* pwAITiD sr ....... . ... ......... ......_............ :.. «._... ..... ...... Allen J. Carnirie The use of witnesses is ionsL Notary Pubkir, ..._.t1C7X_: _ ----- County. V16 Any commission (expires) - Names of persons si in any capacity should be typed or printed below their signatures. . �-' frA11 IVAJK Olr wtaCONaW Nnawrt4 tweet aluk c.mpasr a WAaANTY DiiO !'O N.. 1 - 1671 - ' 1tli� awe.., wilt l a.a 1211111 .. i LOIS BURRI -TREAS OLSON L T n TOUN OF CYLON STATEMENT OF REAL ESTATE TAXES FOR 1995 006 - 1012 - 50 c l RE I S HUY 46 TOWN OF CYLON A S DEER PARK VI 54 0 07 cORRE PDNDE%E RE R Tp THIS TAX PARCEL NUMBER L E 26 9 -S 145 COUNTY OF ST. CRO I X SEE REVERSE SI FORPORfANT INFORMATION R STATE OF WISCONSIN BILL NO RECEIPT NO. ASSESSED VALUE LANG ASSESS. VAL IMPROVEMENTS TOTAL ASSESSED VALUE I AVE. ASSMT. RATIO ESTIMATED FAIR MARKET VALUE A S AR IN THS BOX MEANS UWAD PRIOR YEAR TAXES. CONTACT MM TRFJISURER NET PROPERTY TAX BEFORE LOTTERY CREDIT 1 , 668 1 1 12,000 54,700 66,700 .9143 73,000 LOTTERY CREDIT 124.99- 1. TAXING JURISDICTION 2 TAXES BEFORE ESTN ATED & ESTIMATED MINOR STATE AIDS 4. TAXES AFTER ESTIMATED 0 MINOR STATE ADS 6 CREDITS USED TO REDUCE TAXES MAJOR STATE AIDS T STATE 14.57 .00 14.57 M COUNTY 462.31 71.59- 390.72 R TOWN OF CYLON 508.87 355.39- 153.48 SCHL -AMERY 21898.52 1,786.57- 11111.95 cd VOC SCHOOL DIST 159.29 36.64- 1£2.65 0 TOTAL 70 e� TOTALS 4,043.56 2,250.19- 1 ,793 • • FOR FULL PAYMENT' SCHOOL TAX CREDIT 125 — PROPERTY TAX BEFORE LOTTERY CREDIT 1,668.11 1 , 54 3. 12 iF THIS TAX BILL IS FOR YOUR PRIMARY RESIDENCE { LOTTERY CREDIT L OTTERY IT 1,543.12 P Y A T Y AN R 1996 MUNICIPAL SOLID WASTE OR PAY 1 st INSTALLMENT AND PAY 2nd INSTALLMENT COLLECTIONIOISPOSAL COSTS 32 OS 0 TOTAL NET TAX RATE' . 02S00-9327 TO LOCAL TREASURER TO COUNTY TREASURER IMPORTANT: BE SURE THIS DESCRIPTION COVERS YOUR PROPERTY. NOTE THAT THIS 709.07 834.05 OEBCRIPTION IS FOR TAX BILL ONLY AND MAY NOT BE A FULL LEGAL DESCRIPTION. By 1996 SYJULY31 1996 a 506/T31 /R16 ACRES 16.990 3p ftv specw PCL# 6.31.16.92A TAX hw SEC 6 T31 N RI 6W I S. 99A IN SE ROYAL J & MARLENE spurn Tool SW LOT 1 CSM VOL 1/e73 OLSON AnewMmlPda AmamlPW 2048 CTY RD H T n DEER PARK WI S4 0 7 PAD BY RECD BY DATE IF 1ST INSTALLMENT IS NOT PAID BY 1/31/96 THE TOTAL DUE IS DELINQUENT LOIS BURRI -TREAS 334194 Uo_ES T 4&A4eLAT7*EO LAND of UNPL9TTE0 LANG 334194 /6.99 �ac,eEs %,q Z SCALE. / "- 400' " Ll r O 40O' Soo /' -, �� " °` +'• ���J THE EAST L /NE OF THE S[.1Y4 SEC. 61 AssvMEo �o • Cb SZCAR //V /VO.PTH C. 7 Al. 'NJ EA d G2.98� o _ / "X 30 "IRON P /PE Sy4 cop. SEc. 'r�' 7'3/ A/ ,eZ6 w if ER T / /ED SUR VE Y MAP PAUL J. Acer ox 7 SE %r of 7wAF Sal W SEC. 6 SLIGHT 7 / N , /2/lAr LA/ , 7 OF C SQL OIV , HUDSON, W1. S T. C eO /X CD UN TSB ; WISCOAIS /N. �,reeuriUis-J� �%w DESCRIPTION Part of the SE4 of the SW4, Section 6, Township 31 North, Range 16 West, Town of Cylon, St. Croix County, Wis- consin described as followsc Commencing at the South a corner of said Section 6 in the center of C.T.H. "H ", this being the point of be- ginning of this survey; thence North 1315.5 feet to a point, thence West 562.48 feet to a point, thence South 1315.5 feet to a point; thence East 562.48 feet to a point in the center of C.T.H. "H" and the point of be- ginning of this survey. This parcel contains 16.99 acres more or less including lands released for highway purposes. SURVEYOR'S CERTIFICATE I, Paul J. Slight, being a duly qualified surveyor, do hereby certify that by order of and under the direction of Joe Kostka, I have surveyed and mapped the prc;erty described. The plat shown on this sheet is a true and correct representation of the exterior boundaries of the land surveyed and that I have complied with the pro- visions of Chapter 236.34 of the Wisconsin Statutes to the best of my knowledge and belief. Va'ul J. Slight Registered Land Surveyor Hudson, Wisconsin JULY 5, 1917C Volu#z 1 Page 273 (b • 9q� �c Q) oof � /��Z - 5 - o00 �7taio�- St. Croix County Map Output Page Page 1 of 1 St. Croix County Ma pin VArnC2 AnC2 s JOB AnD2 AnD2 cm t PG 27 SoC2 AnC2 6 Cyion SOB SE 114-SW 114 SW 114- 114 soA A GO AmB SoC2 FrO +ssa s � M 7 �5t } ", `ray• '+.�a'!' ., t° k Legend YvYcjpgd Yoaridales St. Croix County Planning Department 3ibtl1i1flo 1101 Carmichael Road Q cerdi/e d C.rvey OAaps Hudson, WI 54016 0 "`a °'s Phone: (715) 386 -4674 R O O Q Pa�road dal wage DISCLAIMER: The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Dam prepared. It is not intended as a substitute for an accurate field survey. lerrenlal C*emn nbnnl Oen1 3rem, AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist SA61e presently in the County may not be present in the photos. http: //72.21. 230.178/ servlet /com.esri. esrimap. Esrimap? ServiceName= StCroixOV &CIientV... 8/1/2005 St. Croix County Map Output Page Page 1 of 1 St. Croix County Mappin 6 y1on CX0N TOWN< F CSM VOL 1 PG 273 Stanton LM "T FR WN 111 1 , p 2 W4 i .74X 12 s r Ay yy h "A� k h Q r " �y 1. ' � Leland YvYClpal lOck"arles St. Croix County Planning Department aib dlvlrlaM 1101 Carmichael Road Cerl d 3rvey Maps Hudson, WI 54016 p Cms Phone: (715) 386 -4674 a°nd Q aarnaad Drai rage DISCLAIMER: The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Yam prepared. It is not intended as a substitute for an accurate field survey. nerreryal beam tmlerrnl Ilenl 3�+eam AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http: //72.21. 230.178/ servlet /com.esri.esrimap. Esrimap? ServiceName= StCroixOV &ClientV... 8/1/2005 St. Croix County Property Report Page 1 of 1 LISTING UPDATED ON: 8/1/2005 4:18:00 AM Location Information Tax & Assessment 2005 2004 Information IL 11 11 PIN: 006- 1012 -50 -000 Status: Mapping Number: 6.31.16.92A Assessed Acreage: 16.99 16.99 Municipality: -� TOWN OF CYLON Total Land Value: $53,800.00 $53,800.00 Site Address: 2048 CTY RD H jffoial Improved Value: $180,500.00 $180,500.00 Section: 16 Total Value J $234,300.00 $234,300.00 Township: 1131 Fair Market Val 1$0.00 $230,300.00 Range: 1116 11 Fair Market Ratio: 0 1.0173 Quarter - Section: Original / Net 1$0.00 1$3,502.32 Quarter-Quart IFSpecial Assessments: $0.00 11$0.00 Plat Block: 11 Special Charges: $0.00 $0.00 Lot Number: Delinquent Utilities: 11$0.00 11$0.00 School: 0119 -AMERY Woodland Tax: 1$0.00 11$0.00 Managed Fo 1$0.00 71$0.00 Private Forest: $0.00 1 1$0.00 Total Amount Due: $0.00 $3,502.32 Ownership Information Total Lottery C 1$0.00 $85.96 Primary Owner Name: ROYAL J & MARLENE OLSON 1st Installment: $0.00 $1,665.20 Due: Due: 1/3112005 Secondary Owner Name: 2nd Installment: $0.00 $1,751.16 Due: Due:7/31j2005 Billing Address: 2048 CTY RD H -_ - -- Total Amount Paid: -1 $0.00 $3,502.32 DEER PARK WI 54007 1 Balance Due 1$0.00 $0.00 Document Number: Interest: 1$0.00 3 $0.00 Volume: Penalty: 11$0.00 $0.00 Page: 11 11 Total Due: 11$0.00 $0.00 If you are paying taxes based on this report, please print & attach with your payment. Legal Description SEC 6 T31N R16W 16.99A IN SE SW LOT 1 CSM VOL 1/273 http: //72.21. 230. 178 /website /pasystem /pro /final_report.asp ?IDValue =006- 1012 -50 -000 8/1/2005