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HomeMy WebLinkAbout030-2008-90-100 o o0 h ~ O ~ ' d rn'v g c O 0 C h O O N ti N Y d ~ I w V 0 I i fy i N O O C Z 7 C: LL C D 3 ~ I a 3 M z H co o Z € ` Z V z a m 0 o Z Q~ r : N f% IZ- _4 2 N O 5 E v rn M N CL N :3 4) d L L O c O 0 ° a _ Z H Z o N Z a) co 'a N t0 E 0) N d A 0 o G G G W1J Z e- = S S S a O •N ~ ~aaa Z N 7 O N LO LO CD M T Cl) CN O N O E L_ 7 m y C a Q7 CD w N Q Cn Q O W U) 0 1V O E co ~O m E N d V 0 c a M L Y C 'O Q. z F- N O O ~ 0) O C M -2 f~ 7 N 1.7 q-t (n LO - I~ N M M r N C= ce) O _ N O O N N to O •O O M `1 N 0 z C U) v~ `m R € a a a • e~ a d v m rr`1~V y E t c c ~1 A c°~ CL A LO) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ T110,#4-# , L/Z ADDRESS / ?-,5 9' qr'l " J SUBDIVISION / CSMV LOT SECTION 341 T 30 N-R / Town of S~7- J-OsAeH ST. CROIX COUNTY, WISCONSIN ND~.T,4 cQ? L~ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEMf i A 1E2 ~e - L V r i W Ap,,F,p ~ i l . 4° v 4~ ~ V ~ N r i r 3 6,42E - I AQ ~VF_ w A Y Z~'{3L i~v WELL 75 I Xptf At of 11-~~ -91 0-S' x So ~~,LN6'rYE-T /NSTOLLU I S C A C s y5Ti5w f It 'T/V i:'i'i 1 1;1) 1 CATI-' NO Provide setback and elevation information on rr1vc>rsO ~~f t1:i~ fon~. Provide 2 dimensions to center of ~;(-;)t i(~ t.Iiol BENCHMARK: NAIL IN YA41 L OA /L T2 eE E /O o. ocl ~6 q~ ALTERNATE BM: ~DQ o f 40- )5f~ r0UN ATI0 47(o 10, 19 SEPTIC 7~ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (,u F / SF Liquid Capacity: tooo 6A4 Setback from: Well 7S House t > ' Other 7o VF ~dQ f e Hduir Pump: Manufacturer - Model# - Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: z Length (p o Number of trenches Distance & Direction to nearest prop. line: a~S7O WEST 107 L/NE Setback from: well : f / D House Vf Other qp sr ELEVATIONS ~v I Building Sewer ST Inlet./Z, ZC% I0~ST outlet PC inlet _ PC bottom Pump Off Header/ManifoldstZ tZ•-7 Bovydmof systems Z t3 ,q7 = X02 98'~ Existing Grade d,Or~ Final grade (0 D DATE OF INSTALLATION: PLUMBER ON JOB: I_,ICENSI: NUMBER: At l ,S 3 S-~~ ~j INSPECTOR: 3/93:jL Wisconsin Department of 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.: Peffi1, N OMAS & LIZ El City El Village [ Town of: State Plan D No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0--0 ~ Benchmark C/15 /bd _ d G Dosing 7 Aeration Bldg. Sewers Holding St/Ht Inlet la- a4 /oil, G y TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. Airrl to ntake ROAD Dt Inlet /LID `S ' NA Dt Bottom Septic /T l ai7i; fou a.. ' Dosing NA Header / Man. G?~ a g Aeration NA Dist. Pipe /,295 ' Holding Bot. System D J3,9s -3- A/_ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand " -e S. Model Number GPM TDH Lift Lricti Syesttem TDH Ft Forcemain Le Did. M Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~O DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER ~u~ , ✓Lo Model Number: System: jjj,/~ 35 y~ cc~(L /f-144 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) ix Hole Size x Hole Spacing Vent To Air Intake Length Dia. I Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over , Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges 1 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.34.30.19W, NW, SW, Lot 1, 60th Street r a-t 0( r Plan revision required? ❑ Yes C9'No Use other side for additional information. IP SBD-6710(R 05/91) Date In pe oSignature Cert No. Safety and Buildings Division ~•■l`~r■r■ SANITARY PERMIT APPLICATION Bureau of Building water system: 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 n than 8 1/2 x 11 inches in size. - 1. Q • 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 it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Prqperty Location KoM s L/Z ItFLGE/~ V14-c4</1/4,S 3cl T 30 rN,R/y E(or' Property Owner's Mailing Address Lot Number Block Number Z 3 5~1 G 7 t W 12X07- City, State Zip Cod Phone Number Subdivision Name or CSM Number 1/OS 0111 W1 Y;y0% (SV9) Sq 716 5 iv► q IL TYPE F BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road Public 1 or 2 Family Dwelling - No- of bedrooms iff Town OF Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) o "/0 d 1 F1 Apartment/ Condo Q 30 - ZooT p 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. 17 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _ System System Tank TankOnly _____-________Existing System Existing ----ystem B) ❑ A Sanitary Permit was previously issued. Permit, Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12X 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./inch) Elevation y Sa S 3 C,! a 8 0 2, Feet ~OS, 3(a Feet VII. TANK Capacity allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank Q E F 0- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ r VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatur No Sta ps MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City State, Zip Code): Wf~ QtZF_5:N MILL LANE Ub JA LA) Vo V UNTY / DEPARTMENT USE ONLY C ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Age t Sig ature (No S ps roved E] Owner Given Initial Surcharge Fee) Y Adverse Determination G~ <J~lGP~ l'2~ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Ruildings Division, Owner, Plumber i - y j INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. 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. V11. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. W O ~ O\ owl `w N J v 13 ~ o M M 3 W ~ J v ~ i \ W T 2 N J J O v Q 3 ? Al Q ° Q v VI A( t e~ \ N ~ \ w` \ fi 4 199CY1S Li 0 7 Vi LLI co ~i A o ? • I ~•n W I 93 .o T a I M ~ Z I /V p l w Z i I I n- ~ I I o ' I ' I W I _o to a i W M ~J I o w I ul , U fr 4 W I I W a Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations ` Division 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 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 nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDBY DATE P OP RTY OWNER: PROPERTY LOCATION Z, 'Z Aelle GOVT. LOTNw 1/4Jw 1/4,S~yT~a ,N,R E (or& PROPERTY OWNER MAI)N ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, TATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST RMD / dN ® ( ) ~t 0-ii New Construction Use [ ] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate . 7 ed, gpd/ft2 9 trench, gpd/ft2 Absorption area required bed, ft2 6Z trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) /o ~6 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ~!]S ❑U ❑S 0U 0S ❑U ❑S ❑U ❑S mU ❑S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend 0-7 rc k-11 S4 S V .3 Ground Z 7 6 a, Cr ~S - ,2 , 3 elev. 14, 96 ft. 1 Depth to 3 - 5'- 3 L s s limiting factor Remarks: Boring # ktitiy4: - e h jms, YG Z d - S 6 ''I`*'`~ rxt6~' wr ><r s 2 3 Ground elev. t fl-ft. Depth to limiting factor .b Remarks: IV pxf / Y(-I;h CST Name:-Please Print F Phone: 7 r TLTG Address: 0 10 0 Apr 7~- w_r 5~0 3 Signature: Date: CST Number: ~r It 7 f :r -it A 3 r / PROPERTY OWNER ~~C(®2 SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Baxxiary Roots Bed Trench /os l 0- 9 /d 3( c S~f< tv~tr S v~ 2 3 Ground elev. /off ft. Z o o s 6 c/ c s Depth to limiting factor 3 v- 0 .2. S- 3 s w. _ - , Y Remarks: Boring # /p0,•~~• ~ l - D . ~ - C I C ~i BLS ~ ~ i . 7 Ground elev. ~oS /L ft. Depth to 3 Sys -9/ 7.5-- , s oh- limiting factor Remarks: Boring # p Ground i - l sd k ►K u s elev. l v, ^3G ft. :8-67 •s - S o tM l 7 p Depth to limiting factor Remarks: Boring # Ground elev. ft. goo A", wvw & Pith est plunber Depth to limiting ~{N C A023 factor ' Remarks: SBD-8330(R.05/92) L 1 16 n DAVE FOGWY PLUMBING Ucensed Perk Tester b Plumber 93233 93289 Fo erty Hee~' his Road RoaEO ISS SIN 54423 Phone 749-3656 ' i ! \frlCif 12,,A `06 ~ I t a~ ~2 k j 90 ist 2 s i I f 1 A 13, b" YI'!R YJCt•e~ ~r N~ IOh s'~Yap~ Li'SSNN[e /fJO•D itY X = 6©rt N9 j s g 'll 1'E2 ~~iryc C~dArcc ~r ~lc X-- .2 f X x'~ s = G6 E ~ i k - X"~.z yS ! r~ Ak l X " Y _ X' 5 , yo a Ac a *15 Gae r ~ Cr ~ f, -Z C T' 7c:"r/'X YOW 1. e,T ! o Y N P Y T aria. - 74 o~Lca S A Ale r 531743 51iza4e& k _ h t w 05 5-M p This instrument drafted by Ed Flanum Job No. 95-50 FILED 3 r Ot JUL 2 6 1995 ► a KATHLEEN H. Regisw ~u T 6 SL Cmix Co M LO L 1-0 I jj S.M (t VOL. 1, 210 / 60TH STREET S00°31'28"E K) West line of the SWk of Section 34 SQ003112811E O u! S00°31'28"E 300.00' 1-h n~- v, r Ln CA CA v c0i ~ 1662.63' p o 670.62' 0 ~ N o ' S00°31'28"E 185.08' o M~ E w ° O N (n n a 0 m to F+• 00 m I ` o m I~ o o I-0 w C--) ° IF- to to IF- p. M ly ly I -I -I C2 V W N W ~'I w -n M 4 (n f lD 1 rl Z M i.D I U to F a - D N ICJ t~ i --i 70 Cn 00 _ n .0 n -0 -n ~ O ° C= N N Ln 70 Ln -n ' > v ~t X :t ~ J E I~ m• j u 0 ;o o ICJ y -G o° 1(n o ~X ~f o E : N 0 O Cd e. o i fD 0 ` fD ~ 7 (n 0 M -i 0 1~1 Or _ C o _ - ti N00°31'28"W 300.00' o Co :3 6) .o N r D. 7 'J t" (7 y c z ED N D S CL N: 3 d J.nJ.r,~ t_,~i i L,~ (J ~ o 1< CD o °c cr d 0 CD N -3 L N• o~ M Bearings are referenced to the N 0 rrtI 3 West line of the SWk of Section 0 34, assumed to bear 500°31'28"E. C vI 3 F,. m ,to Ct VOL. 10 PAGE 2969 S ~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _F0 N\ L L-1,51Z- MAEU NG ADDRESS/ z In S 7T PROPERTY ADDRESS S O f S/' P V O S 6~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE {--f CJ 2 ; O Af PROPERTY LOCATION /V LL) 1/4, 5 W 1/4, Section 3 T 3 a N-R D TOWN OF (t y D 0 N ST. CROIX COUNTY, WI SUBDIVISION e" ` LOT NUMBER CERTIFIED SURVEY MAP VOLUME I , PAGE 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. 1/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set i DNR. forth, as set by the Wisconsin Certification stati n that our se tic has been maintained m be ~ompl ted and returned tot e$ County Zoning Officer within 30 days of the three year e iratiq'n dat . SIGNED: X I / DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wl 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 TO /-M i L. / Z Lf LLE--oZ Location of property / 1/4 5W 1/4, Section 3`/ ,T 30 N-R Z L--q) Township ST, --r05T-P j4 Mailing address / z 3 / s 7,ef0T t-yDsoN wr qd/G Address of site ! 2 3iS- (-e T H 5 TCE F_T H v O 5o K w) yo Subdivision name C 5 M ( 7 3 Lot no. .E Other homes on property? Yes X No Previous owner of property 30 ~ XI T. 5c ~I E0- Total size of property 47 k C F Total size of parcel i /4 r g C 5 Date parcel was created 7 - L~ - `7 r Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? k Yes No Volume 113-7 and Page Number 'ry8 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. S 3 31 S1 Z- , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Z- iSi nature of Applicant Co- plicant /0 l S /p - 7-5-- Date of Signature Date of Sicnature IS IN REAL ESTATE TRANSFER RETURN -CONFIDENTIAL Submit alI parts to Register of Deeds with document(s) to be recorded. .ANTOR: V. PHYSICAL DESCRIPTION AND PRIMARY USE 1. Name JOHN T. and GEORGINE M. SCHOTTLER 15. Kind of property 16. Primary use 2. Address - New address if property transferred was residence EX] Land only a. [X Residential 1374 County Road I ❑ Land and buildings OX Single family/condominium Somerset, WI 54025 ❑ Other (explain) ❑ Multi-family - 0 units 17. Estimated land area and type 0 Time share unit 3. Grantor is ~X] Individual Partnership Corporation Other a. Lot size _ 300 x 575 b. ~ Commercial business use b. Total acres c. Manufacturing II. GRANTEE: c. MFL / FC / WTL acres d. ~ Agricultural business use 4. Name THOMAS R. and ELIZABETH R. KELLER d. Ft. of water frontage Adjoining land? Yes 0 No 5. Address 1234 64th Street e. Other (explain) Hudson, WI 54016 VI. TRANSFER 18. Type of transfer: 0 Sale 0 Gift 0 Exchange E] Other (explain) 6. Grantor /grantee related: 0 None ❑ Corp/Shareholder/Subsidiary ❑ Partnership 19. Ownership interest transferred: ©Full Partial (explain) Financial ®Family or Other, explain Parents to dtr. & 9crt-in-law 20. Does the grantor retain any of the following rights?0 Life estate 0 Easement 7. Send lax bill to: Name and address Same as Grantee 21.0 Deed in satisfaction of original land contract? Dated? 22. Points (prepaid interest) paid by seller $ 0 23. Value of personal property transferred but excluded from (25) $ 0 Ill. ENERGY 8. Is this property subject to the Rental Weatherization Standards, ILHR67? 24. Value of property exempt from local property tax included on (25) $ 0 0 Yes ® No Exclusion codeld7_ If W-11, explain VII. COMPUTATION OF FEE OR STATEMENT OF EXEMPTION IV. PROPERTY TRANSFERRED 4t- 9. 0 City 0 Village ~ Town s ToGPOh 25. Total value of REAL ESTATE transferred $ 1SDanCounty ~ .~__(`roi x 26. Transfer fee due (line 25 times .003) $ _ - 10. Street address 60th Street 27. TRANSFER EXEMPTION NUMBER, sec. 77.25 11. Tax parcel number 030-2008-90-100 12. Lot no.(s) Blk. no.(s) 28. Grantee's financing obtained from a. Seller Plat name if box a or b is checked, b. ❑ Assumed existing financing complete Part Vill - c. 0 Financial institution / Other 3rd party 13. Section Township Range _ Financing Terms d. ~ No financing involved 14. Legal Description metes and bounds: (attach 4 copies it necessary) A parcel located in the NWJ of SWI of Section 34, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, more fully described as follows: Lot 1 of Certified Survey Map filed July 26, 1995, in Vol. 10 of CSMs, Page 2969, Doc. No. 351743, in the office of the St. Croix County Register of Deeds. VIII. FINANCING TERMS (FOR SELLER/ASSUMED FINANCED TRANSACTIONS ONLY) 29. Total down payment S (Line 29 = Line 25 minus Lines 30a, b and c excluding payments for personal property) 30. Amount of mortgage/land 31. Interest 32. Principal and interest 33. Frequency 34. Length of 35. Date of any lump sum 36. Amount of lump contract at purchase rate (stated) paid per payment of pymts contract (balloon) payments sum a. $ % - - i - --1- - $ 'he 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 the date of change- _ - - and the amount it will change to $ TION 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. 1gent Grantor's social security number or FEIN Date Grantor's telephone number ? 469-46-2360 y S ( 715 ) 540-6013 Grantee's social security number or FEIN Date Grantee's telephone number (715 ) 549-5476 itor's agent Agent's telephone number Vol.'Jac. Page/Im. Date recorded Date and kind of conveyance Conv. code 533182 1137 1548 8/29/95 8/27/95 WD _ t 2 3 4 Assmt. year 19 _ Field Sales number L County Use I Tax dist 51W FOR T--- - Assmt. list. Reject 4 5 6 Isconsin epartment o evenue DISTRICT SUPERVISOR'S COPY I I~ II DOCUMENT NO. WARRANTY DEED TMS SPACE RESERVED FOR RECORDING DATA ;STATE BAR OF WISCONSIN FORM 2-1982 - 5331,82_ vA13PACE _48 - ~I JOHN T. SCHO__TTLER and GEORGINE-_M._SCHQTTt~,------ n+oC'fii;r.. I' husband- and wife. e, - i~ AUG 9X955 I { conveys and warrants to -THOMAS R,--.KELhER-.and..ELIZABETH--R---------- 12:20 P. I ~P li KELLER-,-_husband--and..wife,--holding-.as--surviuorship rt marlta P y V y - l - - - ii Pr_o f . - - I i - - - - - - _ _ - _ - (I_RETURN TO Mrs. Thomas Kel for $1.00 -and -other--valuable- cons iderate_on__ 1234 64th Street . Hudson, WI 54016 II - - the following described real estate in St. Croix .........County, State of Wisconsin: Tax Parcel No: 0307.2008.-90-100 I ~i A parcel located in the NW4 of SW4, Section 34, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, more fully described as follows: Lot 1 of Certified Survey Map filed July 26, 1995, in Vol. 10 of CSMs, Page 2969, Doc. No. 351743, in l the office of the St. Croix County Register of Deeds. i i SEE it ,I This .__i_$_Ylo------------- homestead property. (is) (is not) Exception to warranties: Subject to town road right-of-way over the westerly side of Lot 1 as shown on said Certified Survey Map, and also subject to recorded ease- ments, reservations and restrictions, if any. I Dated this L--- 46 day of -_...-.August- - , 1995... f (SEAL) (SEAL) II _ John. T_. Schottler * _.M-. _Sch9tt.ler Georg _i ne - (SEAL) c- -."_m.-~" ~'a i (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) of John T. Schottler_ and ATE OF WISCONSIN i Georgina M. Schottler Ss. St. w 01X - County. ss. F &&;his y o A aiast--.-----., 1995.- Pers sally came before me this...:- ..day of II - 19~sj - the above named c -AUgAlSt------ - I~ William_J.__Gi],bert John _T - _S_ ott {__az>d----------------- . ~1 TITLE: MEMBER STATE BAR OF WISCONSIN -------Georgina-M.-- attler (If not, authorized by § 706.06, Wis. Stats.) to me known to the Pers -_-S------- who executed the i foregoing inst ment and ackn wledge the same. THIS INSTRUMENT WAS DRAFTED BY ...Willi_am-J...Gilbert.---1ttQZney-------------------- 206 Second St., Hudson, WI 54016 - N ary Public --St_._CrAix-..---------- '.County, Wis. (Signatures may be authenticated or acknowledged. Both Commission is permanent. (If not, state expiration are not necessary.) date- 19 ) *Names of persons signing in any capacity should be typed or printed below their siRnatures. WARRANTY DEED STATE, BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 2- IJ82 Milwaukee. Wisconsin CURVE DATA CURVE LOT RADIUS CENTRAL CHORD CHORD ARC TANGENT TANGENT NO. NO LENGTH ANGLE BEARING LENGTH LENGTH BEARING BEARING 1-2 1 868.51' 07036132' S04019'441E 115.25' 115.34' S08008'00'8 500031128'E SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify, that by the direction of John Schottler, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: Located in part of the NW1/4 of the SW1/4 of Section 34, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; described as follows: Commencing at the W1/4 corner of Section 34; thence SOO031128"E, along the west line of the SW1/4 of said section, 670.62 feet to the in of beginning; thence continuing S0003112811E along said line, 300.00 feet; thence S8905711611E, 575.00 feet; thence N0003112811W, 300.00 feet; thence N89057116"W, 575.00 feet to the point of begjnning. This parcel contains 3.96 acres (172,491 Sq. Ft.). Above described parcel is subject to right-of-way for town road (60th Street) and all easements of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and appropriate Town Board for advice. TOWN OF ST. JOSEPH CERTIFICATE I hereby certify tha this Certified Survey Map is approved by the St. Josep Town Board. Clerk Date I VOL. 10 PAGE 2969