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HomeMy WebLinkAbout032-2047-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552309 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID 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: Boardman, Barry I Somerset, Town of 032-2047-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 11 IJ . 0 0` D 13.30.19.674 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0 U Benchmar /y Dosing Alt. BM Piz to,) Aeration .Sewer 6 ey zl Holding f/ t In_ let St/Ht Outlet TANK SETBACK INFORMATION / w / LI TANK TO P~L WELL BLDG. Vent to Air Intake ROAD Dt Inlet n t k Septic ~'f 1 Z2 J Dt Bottom Dosing b G Header/Man. n it Aeration Dist. Pipe 2 S/ sl C f f -7 2 G-/ Q Holding 139L-System l Gr e PUMP/SIPHON INFORMATION Fina I Manufacturer Demand S er I GPM .Cov C-Cx w 2,(iS ~5 Model Number N1 / rr I- ~j TDH Lift Friction Loss System TDH Ft / C [ Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM jj 0 a. BED/TRENCH Width Length ' No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLD WELL LAKE/STREA LEACHING Mangj#cturer/l~, - INFORMATION CHAMB ''-Y YI-}-/ Type Of~System ) NIT Model Number: 2 RIBUTION SYSTEM ~ r!ngthr /Manifol d l / Pipe(sDistribution x Hole Size x Hole Spacing Vent joAir Inta() ~ Dia Length Dia_ Spacing SOtL x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth BedlTreOnch Ce, vv ~ / Bedlrren h Edges Topsoil h of xx Seeded/Sodded xx Mulched Yes R No Fw~ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:D/ ( (7- Inspection #2: Location: 1561 89th Street New Richmond WI 54017 NE 1/4 SE 1/4 13 T30N R19W 40 acres Loot Parcel No: 13.30.19.674 1.) Alt BM Description I 2.) Bldg sewer length = - amount of cover 4- Plan revision Required? ❑ Yes to Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~a~ ~ ~"ia~ ~Gyf~Or~.YI H/.f J'y~~~7 ~~.vPi=s.°Sr `~6 %v 1 j i ~ ~ ~ 3 a ~ ~ 1 _ - / f b i 0 r y . ~ ~ i " 98 II /=~s~~ z-z ' , . Safety and Buildings Division County COf11 201 . Washington Ave., P.O. Box 7162 , by Co.) ■ Madison, WI 537016 sc sin® Sanitary Permit Number (to be fill in rn Late Transaction Number S niter lication in accordance with s. Comm. rssion of this form to the appropriate governmen unit is required prior to obis-' permit. Note: Application forms for state-owned POWTS are Project Address (if differed than mailing address) submitted to the Department o Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy, Law, s. 15.04(1 )(m Stats. 1. A lication Information - Please Print All Information Parcel # Property Owner's Name - / l 032,-~D 90i0V Property sMailingAddress Property Location 1,41 Govt. Lot City, to Zip Code Phone Number yy~ Section 1 ucle orre /T _~~N, R E (check all that apply) Lot # , Subdivision Namei,~~ 1 or 2 Family Dwelling g/- Number of Bedrooms /'~G%v ~ .5)6L~dL!t~l `42G-nl't Block# ❑ Public/Commercial - Describe Use Y ❑ City of CSM Number ❑ Village of ❑ State Owned-Describe Use Town of 'l.trr~lSF M. Type of Permit:" k only one box on line A. Complete line B if applicable) New System,,. ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) Previous Permit Number and Date Issued List B. ❑ Permit Renewal 11 Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Con onent/Deviee: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil O X PK- ❑ Pretreatment Device (explain) ,3 ❑ Holding Tank ❑ Other Dispersal Component (e lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf~ Dispersal a Required (sf) Dispersal Area oposed (sf) System Elevation y i VI. Tank Info Capacity in Total # of Manuf~turer Gallons Gallons Units V ° d New Tanks Erosting Tanks I D K~ S ^ / / 0. U v] w h Septic or Holding Tank -7 ~~ry J" Dosing Chamber VII. Res risibility Statement- I, the undersigned, assume res ibility for instn on f the POWTS shown on the attached plans. Plum N e III: 1 Plumber' Si MP/MPRS Number Business Phone Number umber's Address (Street, City, S e, Zip Cod `-51 - one /De artment se On Permit Fee J Date Wueo Issuing A t S Approved ❑ Disapproved L/ h~h ❑ Owner Given Reason for Denial $ / / J IX. Conditions of Approval/Reasons for Disapproval skX U i e 4~ a Age, A SYSTEM OWNER: / U 7 y' 1 Septic tank, effluent filter and ~GL GC"✓> dispersal cell must all be serviced / maintained i t~ as per management plan provided by plumber. tpCpm r submit to the County only on paper not less than 8 vt x 11 inches in size ` as per applicab e concelo m nces, n l~ ~~~✓n ~GZ4~ 1r~t~s Gut . 'IS i0(~ SBD-6398 (R. 02/09) Valid thru 02111 SAP Wisconsin Departmen f Com OIL EVALUATIO Page of 3 Division of Safety and B 'Idings GNU ~~G with Comm 85, Wis. Adm. Code G C=* Attach complete site plan S than 81/2 x 11 inches in size. Plan must -ms~ 112 Include, but not limited to: nd horizontal reference point (BM), direction and Parcel I.D. percent slope, sc or dim ions, north arrow, and location and distance to nearest road. (d / Please print all information. 1 Date personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1M- I Property Owner Property Location Govt. Lot AIZ 114-::~ 114 S T N R E (or)® Property Owner's Mailing Address Lot # B # Subd. Name or CSM# City State J Zip Code Phone Number ❑ City Village 0 Town Near,,, New Construction Use: O Residential /Number of bedrooms Code derived design floor rate -3~ GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material i-? n ( al~s✓ /cp 3:i e Flood Plain elevation if applicable it/.4-- ft. General comments and recommendations: J~s~~✓as~4 s, ys•~ F f ' v1~ c ✓ Boring # tb~l Boring F 71 tai Pit Ground surfaceelev. 92 y_ ft. Depth to limiting factor >h-~S _ in. Sol Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz- 92 Mt Cow Gr. Sz. Sh. •Eff ll •Eff#2 / 4 4 S - Ali Boring # n Boring ® Pit Ground surface elev. ft. Depth to limiting factor y ZZ2. - in. Soil ApTlication Rate Horizon Depth Dominant Color Redox Description Texture Struckre Consistence Boundary Roots GP" in. Mansell Qu. Sz. Pom Color Gr. Sz. Sh. 'EW •Eff#2 4 9 Z-Z 4 All #1 = BOD > 30:5 220 mg/L and TSS >30 5150 rtg/L ' Ef lent #2 = BOD < 30 mg& and TSS < 30 mg& CST Name ) I $ CST Number Address Date Evaluation Conducted Telephone Number l ~S('rcel ID # 03 2 90 'i U3 Page of I-V Property Owner, ,X2 2 L-51 - ❑ doting 7 Boring # co pit Ground surface elev. ft. Depth to limiting factor .11-1!T- in. Sal tier Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPDlfP- in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 •Eff#2 r e~ J") tie Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sa8 ration Role Horizon Depth Dominant Color Redox Desaip w Texture Structure Co mistence Boundary Roots M fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 •E11f#2 Bori ~ ❑ ❑ Pit Ground sum eWev. ft. Depth to limiting factor in. Sol Apopkation Rate Horizon Depth Dominant Color Redox Desafption. Texture Stnr*re Consistence Boundary Roots GPDff in. Munsefl OLL Sz. Cont. Color Gr. Sz. Sh. 'Effff1 `Eff#2 Effluent #1 = BODS > 30 < 220 mg& and TSS >30 < 150 ng& ' Effluent #2 = BODS < 30 mglt. and TSS < 30 mglL. 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. SOD4330 (8.6/00) ~ /D ~ 7 f ,,,5~'S~Gir, ,,s~s.E~ I ~ c~ _ _ i 3 0 i ~Q~~n ila+~5~ I I - ~ ~ - . _ _ ~3~ 9~ / `98 / / f ~ ~ ~ ~ D s~.t ~ ~a ~Gr--,-.,.~ ~ ,~z' CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Z4 1-4 Owner's Name: z"i~~_,~,c~ny,~ f~ Owner's Address: Legal Description: Sir? - T~f?i✓`'~¢~~ Township: County: Subdivision Name: Lot Number: Parcel lD Number: ()32-- 2 D 2 - _ YO 60- Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 g Septic Tank Maintenance Form Page 8~c' Warranty Deed Page 9 CSM or Plat Designer/Plumber: License Number:/ Date: Phone Number 7j Fffj - Z?z 7 Signature Designed pursuant to the In-Ground Soil Absorption component manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 4ro~ '%,Ind, k); J'~/ff/7 }ea+lr=rPSr'/ /D I/Y ~ d -39 P ` 31 1 /9a P ~zPJIG ~ /l/ lv~Q qr~ ~ 1 ~r s/~,.,~~ tom c~ B,so+(oom 4~2 1 s -~~y~'~ x~6 ~ ~ GDS a 0 l/i4 Oni .3X 1 i Soil Absomtion System Cross Section ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching Chamber ♦_5' 7 ft System Elevation -03~? ft i Soil Absorption System Plan View W/-? ft { ft ~ft Trench 1 Vent Or Observation P Leaching ipe Chambers 4" Dia. I Trench 2 Header Leaching Chamber Specifications Manufacturer And Model EISA Rating, sq it per chamber Soil Application Rate _,:[:~gpd/sq ft gpd Design Flow Soil Application Rate + _ EISA = _-5O Chambers 2 rows of chambers each. i Page of Z 0 P V FA k A I wIm"O ~`7I,4 INSTALLATION INSTRUCTIONS Iana.auos in Preczy,;,}ziaace Lei- § +asfev.,,erPraducs Pat~fok Ap;iSsiartv! h+a PL-525/PL-625 FILTER VSTALLATION INSTRUCTIONS Center filter with opening AM. EA, } x ® e Additional pipe or . ' Polylok Extend & Lok'° Glue forcento ng- ep 1: Step 2: Step 3: Locate the outlet of the septic tank- (A) Before installation, place the (A) Glue the filter housing on the j Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. iecessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. AINTENANCE INSTRUCTIONS i::; j if _-W ®a' p 1: Step 2: Step 3: ate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure (B) Pull the filter out of the housing. the filter is properly alighed (C) Hose off the filter over the septic tank. and completely inserted. USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover -WHEN' CLEANING FILTER septic tank. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _~of FILE INFORMATION SYSTEM SPECIFICATION Owner Septic Tank Capacity al o NA Permit # S5 Z 3 Sept c Tank Manufacturer - o NA Effluent Filter Manufacturer o NA DESIGN PARAMETERS Effluent Filter Model S 5 o NA Number of bedrooms ❑ NA Pump Tank Capacity al d NA Number of Commercial Unit ❑ NA Pump Tank Manufacturer L2(-NA Estimated flow (average) al/da Pump Manufacturer -6 NA Design flow (peak), (Estimated x 1.5) _3 gal/day Pump Model ce NA Soil Application Rate , a al/da /ft Pretreated Unit Influent/Effluent Quality Monthly Average* o Sand/Gravel Filter o Peat Filter Fats, Oils & Grease (FOG) <30 tng/L n Mechanical Aeration o Wetland Biochemical Oxygen Demand (BODs) <220 mg/L o Disinfection ❑ Other: Total Suspended Solids (TSS) <150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly Average** Dispersal Cell(s) <30 m Jid In-ground (gravity) ❑ In-ground (pressurized) Biochemical Oxygen Demand (BODs) g/L ❑ At-grade ❑ Mound Total Suspended Solids (TSS) <30 mg/L o At- -line ❑ Other: Fecal Coliform (geometric mean) <104 cfu/I OOML Drip Maximum Effluent Particle Size inch diameter * Values typical for domestic (non-commercial) wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve o months 9 ears (Maximum 3 rs) Pump out contents of tank s) When combined sludge and scum equals one third ('/3) of tank volume Inspect dispersal cells At least once eve ❑ months ears (MaAmum 3 rs) Clean effluent filter " tZ4 At least once eve o months o year(s) Inspect pump, um controls c4't. alarm At least once eve: ❑ months' ❑ ear(s e NA Flush laterals and pressure test At least once eve o months ❑ ear(s) aNA Other: At least once eve o months ❑ ear(s) NA Other: At least once eve ❑ months d earls .6NA ;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 cell(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 (%3) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less 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 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by-a septage servicing operator prior to use. ~ Page-7- ot START UP AND OPERATION Page For new construction, prior to use of the POWTS check treatment tank(s) 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 dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and 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 be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: i/A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil (imitations. Barring advances in POWTS technology a holding tank may be installed as a fast resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 WTS iNSTALLE POWTS MAINTAINER Name / Name Phone Phone PTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULAT RY AUTHORITY Name Name Phone Phone = this document was draf;et -_=-fi ance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r~ Mailing Address 1 i property Address CS n rJSk c j (Verification required from Planning & Zoning Department for new construction.) Cif/State Parcel Identification Number 02 2--)©V -2- J'DZ 67V LEGAL DESCI NC S property Location 4 %4 , Sec. /3 , T; ?D N IZJ_21_W-, 'down of ~_Fl Cli J1Slon :3 r; Ll)t 7 Certified Survey Map # Volume , Page # E ty Deed 15Y 5/ `s Volume 13 Page # 62 Spec house yes no Lot lines identifiable (es) no SYSTEM MAINTENANCE AND OWNER CERTMCATION 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. Owner maintenance responsibilities are specified in §Comm 83.52(l) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the cv;aer and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tack is ss than 1/3 full of sludge. I v-~-e, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the :wards set forth, herein. as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. `e. urca o :stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zo:u Department v -ithin 30 days of the three year expiration date. Y--e certifv that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register ofDeeds Office. Number of bedrooms GNATURE OF AP LICANT(S) DATE * -Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department * -de rzth this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if -e _e-ence is made in the warranty deed rLZ 0-) VIt X346 Pau 196 584 05 STATE PAR OF WISs _N5IN FOR." 3 - la&2 QUIT CLAIM DEEIa DOCUMENT N`0. Frank Keith Boardman a!k/a F. Keith `Boardman, C~TA7P_ 5T CRO- !X Co., W! c oer'on a_~ S: 1 .zr3 quit-claims to --arry-Boardman AI 01998 9:30 .A ~ d,.e foRavvtg d,scrtbed real exate in - St. Cro2-x County, State of N scoman_ I toS SPACE REJEAVE-0 FCA REC70no.wt; OLTA HE 1/4 of S£ 1/Z-, SE 1/4 of ME 1/4, and the NE 1/4 of R-kME Amu RETLW,4 ADDRESS NE 1/4 EXCEPT Lots 1, 2, and 3 of Certified Survey Map filed July 7, 1997 in Vol. "i2", page 3295 as Document VA14 DYKi O'BCYLE S SILER, S.C. No. 561969, all in Section. 13-30--19. Post Office Box 127 New Richmond, `r1I 54017 032-2047-80-000, G vuscEL ID., nf!CATtora trCRASEr? 4ft 032-2046-50-0000. and 032-2046-10-000 This _ is not homestead property. (is not) Dated this day of A.D_, N~9.! f~ P r~ <<-AL) (SEAL) pFrank Keith Boardman - - (SEAL) - (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Frank Keith Boardman State of Wisconsin, f ~ ~s County lJ authentica this _ 0th da of tl 19 g8 Personally came before me this day of ^-----'~i`~ 19---, the above named Hendrik W. Van Dyk TITLE: MEMBER ST%TE• BAR OF WISCONSIN - (If not, - authorized by $706.06, Nis. Scats.) to ma known to be the person who executed the foregoing instrument and acknowledge the saute. THIS INSTRUMENT WAS ORAFTED BY Hendrik W. Van Dyk iV DYK O'BOYLE & SILER S.C. ost ace ox 1 - New Richmond, 4lisconsin 54017 Notary Public, County, Wis. (Signatures may be authenticated or ackno vledged. Both are not My commission is pe_rrtlancnt. (if not, state expiration date: necessary.) _.19 ) Na.mrs of parsons s~g-g i. any .apathy A-1-1 bC typed u: pb-d below their Agnamra. STATE BAR O-e W15CON5'.N. - wiu: _%in Legal StaN: Co.. Inc. QUIT Ci_Atbl DEED Form Ns. 3 - 1982 - - M.L42sis?o, tYa. Parcel 032-2047-80-000 03/05/2012 09:51 AM PAGE 1 OF 1 Alt. Parcel M 13.30.19.674 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BOARDMAN,BARRY BARRY BOARDMAN 1590 89TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 SCH DIST NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 13 T30N R1 9W 40A NE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-30N-19W Notes: Parcel History: Date oc # Vol/Page Type 08/06/1998 584505 1346/196 QC 2011 SUMMARY Bill M Fair Market Value: Assessed with: 135032 Use Value Assessment Valuations: Last Changed: 04/07/2011 Description Class Acres Land prove Total State Reason RESIDENTIAL G1 1.000 5,000 15,100 20,100 NO AGRICULTURAL G4 39.000 6,300 0 6,300 NO 10 Totals for 2011: General Property 40.000 11,300 15,100 26,400 Woodland 0.000 0 0 Totals for 2010: General Property 40.000 11,500 15,100 26,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 032-2046-50-100 03/05/2012 09:50 AM PAGE 1 OF 1 Alt. Parcel 13.30.19.665A 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0-BOARDMAN,BARRY BARRY BOARDMAN 1590 89TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 SCH DIST NEW RICHMOND SP 1700 WITC Legal Description: Acres: 13.240 Plat: N/A-NOT AVAILABLE SEC 13 T30N R1 9W SE NE EXC PT TO Block/Condo Bldg: BOARDMAN ESTATES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/06/1998 584505 1346/196 QC 2011 SUMMARY Bill Fair Market Value: Assessed with: 135020 52,400 Valuations: Last Changed: 10/12/2010 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 13.240 53,000 0 53,000 NO Totals for 2011: General Property 13.240 53,000 0 53,000 Woodland 0.000 0 0 Totals for 2010: General Property 13.240 53,000 0 53,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00