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HomeMy WebLinkAbout006-1027-10-100 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 552347 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: En lebretson, Jacob . C Ion, Town of 006-1027-10-100 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town/Range/Map No: app /Yl j G'SA' 13.31.16.1828 TANK INFORMATION ELEVATION DATA 6 /bd TYPE MANUFACTURER t, CAPACITY STATION BS HI FS ELEV. ~Aj _7t /6_7 Septic y.~-. Benchmark ` Ab Dosing b 7~o S Alt. BM/ `LA. Bldg. Sewer (Jp T U Holding St/Ht Inlet $c?r p TANK SETBACK INFORMATION St/Ht Outlet TANK TO ~P/LI WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom $ 5 ~7 Dosing / _ Header/Man. 75v ~ g~o 3g c3g b .b5 Aeration Dist. Pipe / 1,03.9-5 loo Holding Bot. System Z . /a3 - 35-0 ~ . / /6 6 PUMP/SIPHON INFORMATION Final Grade O•'j Manufacturer De Aand St Cover t t O fP Model Number GPM 14 11.~-~ / 3 4 s ~Ol . 5 TDH Lif~• a Friction L0# ~ System Head T 36,59 /d6 , 3 Forcemain Length66 Dia. Dist. to Well / d SOIL ABSORPTION SYSTEM BEDITRENCH Width ! Length 1No.OfTrenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /Q O e SETBACK SYSTEM TO P/L BLDG WELL ' LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f System: } ✓6 , ESQ UNIT Model Number: J dJ A /JA- DISTRIBUTION SYSTEM All Tom. Header/Manifold Distribution I x Hole Size x Hole Spacing Ve t _Air Intake Pipe(s) 3 Z "~7 1Length_ Dia 2j1 Length -N Dia Z Spacing 3• 5 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No - .Xs No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: s / / ~Z '{fin Inspection #2: 1 i~~d-- v 1 Parcel No: 13.31.16.182B Location: 2180 Hwy 63 Dge~rk, %(VI 54007 (NE 1/4 NE 1/4 13 T31 N R1 6W) NA Lot .J~s~►- 61J S 6 d-e w•~ 1.) Alt BM Description = Y~ " {AIL G dn.-% a 6~ 2.) Bldg sewer length = (0✓ Q Y - amount of cover = P 't _ IT, 7 to / o n JJ - Plan revision Required? ❑ Yes No F51" se other side for additional information. (p U Date Inse ors Si ture Cert. No. SBD-6710 (R.3/87) RE C.'EiVED Safety and Buildings Division County 1 t com erce ~rb ~ aca COUN 2 1 W. Washington Ave., P.O. Box 7162 Madison, Wl 53707-7162 Sanitary Permit Number (to be filled in by Co.) is 55 23 4) 7 tleps J State Transaction Number Sanitary Permit Application It D Zd 7 77/S mmA - In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approprialve unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned P e Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u oses in accordance with the Privacy Law, s. 15.04 1. (m , Stats. 1. Application Information - Pleas Pr' t 11 Into mation parcel # Property Owner's Name r e a e.9 Zz~ Property Owner's Mailing Address Prorm y I oc:,.on Govt. Lot / Z v 6-3; City, State Zip Code Phone Number y, Section trcie~,o It. Type of Building (check all that apply) Lot r 2 Family Dwelling -Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial - Describe Use _ - " ❑ City of CSM Number [I Village of ❑ State Owned -Describe Use - own of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System lacement System ❑ Treatment/flolding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued 11. L1 Permit Renewal ❑ Permit Revision ❑ Change of Plumber [I Permit Transfer to New / Before Expiration Owner 0~ 11111 IV. Type of POWTS S stem/Com onent/Device: Check all that a I Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ Al-Grade ound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)_ / J V. Dis ersaUTrea ent Area Informati • pdso Dispersal Area Requi (s~ Dispersal Area Propos (s System Elevation Design Flow (g pd) Design Soil :Applic ' ;iJRa1e(, ~ ]v~ . Tank Info Capacity in Total # of Manufacturer Vl o Gallons Gallons Units 0 New Tanks Existing Tanks o w ` U v, m rn It 3 C7 P+ Septic or Holding Tank X Dosing Chamber 7~2? VII. Responsibility Statement- I, the undersigned, assn esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb ature MPIMPRS Number Business Phone Number Plumber' Address (Street, City, State, Zip Code) I VIII. County /De artment Use Only roved Permit Fee Date ssued1 Issuin ent Sign re LL rven Reason nial ~ • IX. Conde M*M*Reasons for Disapproval 1. a'601 tank, iffluant fiker and ~r, dispersgl cetl must all be services I maintained e,a sc` P a& per management plan provided by plumber. n 2. Atsefbat:k requtfemettts trust betttaintaittdd Av. Attach to complete plans for the system and submit to the County only on paper not s than a 112 111 inches in sin SBD-6398 (R. 02!09) PLOT PLAN PROJECT Jacob Enalebritzen ADDRESS 2180 Hiahwav 63 Deer Park Wi 54007 NE 1/4 NE 1/4S 13 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX SYSTEM ELEVATION 103.1' BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST GF10-8 ❑ BOREHOLE O WELL *H,R,P. Same as Benchmark Highway 63 oWell Old System is to be pumped and Scale = 1/4" = 10' buried Existing 4 b______-Overf`Iow Bedroom House B.M.* Tank is to be properly bedded and provided 350' with lockdown covers with approved warning labels Huffcutt Combo tank Area 15' below system is to remain undisturbed 6% Slope B-3 Area of poorer soils 100' 101, 300Slop /Slope ' 102' Area of poorer soils -1 102.1' -2 660' Property Line Grading is to be done to divert run-off 103' Ci away from system ART'~kT Safety and Buildings 141 NW BARSTOW ST FL 4TH °WAUKESHA WI 53188-3789 P Contact Through Relay P S www.dsps.wi.gov/sb/ o www.wisconsin.gov Ossrnr~[+ti5~ Scott Walker, Governor Dave Ross, Secretary May 03, 2012 CUST ID No. 226900 ATTN.• PO WTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 0.,8103/2014 Identification Numbers Transaction ID No. 2079918 SITE: Site ID No. 778805 Jacob Englebritzen Please refer to both identification numbers, 2180 Hwy 63 above, in all correspondence with the Town of Cylon, 54007 agency. St Croix County NE1/4, NE1/4, S13, T31N, R16W FOR: Description: Mound, 4 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1369040 Maintenance required; Replacement system; 600 GPD Flow rate; 43 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706 P (N.01101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). O The building sewer and distribution network piping shall be of material IAse l 384.30-5, Wis. Adm. Code.• In the event this soil absor ption system or any of its component parts malfuncta th hazard, the property owner must follow the contingency plan as described in the approaddithe owner must comply with the operation, maintenance and monitoring duties as descri11 of the mound component manual. A copy of this information must be given to the owner upon completi the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 5/3/2012 of the filter is Maintenance information must be given to the owner of the tank explaining that periodic cleaning required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code: ,7633 (262) 397-6005, Fax: (608) 283-7481 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. - Cover Page RECEIVED APR 2 0 2012 Shaun Bird SAFETY & BUILDING. Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 4/ 16/12 Owner:Jacob Englebritzen Location:NE1 /4 NE1 /4 S13 T31 N,R16 W 2180 Highway 63 Cylon System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specifications d cross section Shaun Bird Signature. , 11V License numb G6900 G, ti PLOT PLAN PROJECT.Jacob Enalebritzen ADDRESS 2180 Hiahwav 63 Deer Park Wi 54007 NE 1/4 NE 1/4S 13 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX SYSTEM ELEVATION 103.1' BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEST GF10-8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Highway 63 oWell Old System is to pumped and Scale = 1/4" = 10' buried Existing 4 &___~Overflow Bedroom House B.M.* Tank is to be properly 350' bedded and provided with lockdown covers with approved warning labels Huffcutt Combo tank Area 15' below system is to remain undisturbed ~6% Slope B-3 Area of poorer soils 100' e 101 ' 300' Slop /Slope 102' Area of poorer soils -1 102.1' -2 660' Property Line Grading is to be done to divert run-off 103' away from system Mound System Cross Section and Plan View Dimension Feet J r t A L r - 'r r B 1 r T - r D A W r E r F r 1 G Z. 5 r' - t r H. I I f a J r K Or L K B Z Q, C7 L Slo e % r,1 = Topsoil = ASTM C-33 r r Cap Material =Clean aggregate = 4 in. sch. 40 pvc sand fill '/2 t02 %z in. dia. O observation pipe Geotextile Fabric H F IL3 Ft D / Q. Ft Contour Plowed Surface 1 Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a inch inch soil wi when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately e after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one Boot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 1.0/07lgj Page of Perforated Pitt DVOR 0 • r'~ nd Vi w Perlorored PV(; Pipe e 1tolos Located On NWOVA, C Are Equally $Poced /~!e7n ,Ut.C?fr f i r~ f t+ r } 4 sPa'~ar / PVC Force Main-" ' l~IRSlT M04L . NatZ'1" tiro Cen~tC~~o~ PVC Manifoia Pipe l~. S~/e~p O~taiayi,an r/~;~• f _ ~ Pie J Gc t t'~-/~S (}islriDufiOn PjP0 Layout P S S Ft. R Ff. X Inches Signed; Inches Mole Diameter S~, /3z Inch License Number: Lateral Inch(es) Hater Manifold " Z Inches farce main " Z Inches of holes/pipe :30 Invert E'1ev4tion of Laterals D ) 6Ft'.. Septic-Dose Tank Cross Section And Pump Performance Specifications 1 Pump Manufacturer ,e Tank Manufacturer •~-C„t, - - _Tank Model Number Pump Model Number T' ~.1 3 Total Tank Capacity ; s -7 6 Alarm Manufacturer Ue_c Max. Bury Depth Alarm Model Number -tJ Switch Type C-C _Filter Manufacturer ,mac s r _ Total Dynamic Head (TDH) - Feet Filter Model Number - Elevation Head Distal Pressure > S^ - Network Loss, , Minimum PUMm erffo-r~mance Required Force Main Loss GPM; ~J Ft TDH Total _ ' - Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole With Locking Device < b" Below Grade Sealed Watertight Securely Mounted Weather-proof i Junction Box r... a" Finished Grade ''Vent Min. 12" Disconnect • Above Grade Means With Vent Cap ! . i I r . . > . > a ! I > f 1 >;Y;a<1•Y •a.fr/•>", ","I / r~ I > >a) i"• a > •i 1.1;1 ! ;<< ' 1*4 Outlet Filter Inlet Baffle - Inlet Switch Sett}ngs and Reserve Capacity ; A 1/451 Tank Volume = GPI Weep Hole 13 Dimension ; Inches Volume Gal. (reserve) A ! Off Elevation C (alarm) B 2 3 7 3 Ft (dose) C 3 Bottom of ; Elevation (dead) D 5 3 D Ft Total <Y r . < < < < < < <,a ; < < a,< . aa,S"r•a;a r'I•, Ii::.. < <•< < f < f < r < r < < i < < f < f , >;>ir , f,f");1 ) 1 f; ,Y > a a<, a > Y; ~ ♦ a•>>"~ ! a GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable sail to prevent settling or sagging. The force main is sleeved with 4 Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 Ll Page of TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERfNG MODEL 152/153 w w MODEL 152 153 M U_ 50 Feet Meters Goi. Liters Got. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 23t 70 265 0 15 4.6 53 201 61 231 C-) 30 20 . 6.1 44 167 '52 197 8 25 7.6 34 129 42 159 d 30 9.1 23 8MA 2 35 10.7 4 40 12.2 10 Lock Valve: 38.0 Fl. (11.01 09 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 3320 s 1/4 " 3 27/32 ¢ 5/8I FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 732 32 14 • Timed dosing panels available. • F~fectrlcal alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for'outdoor installations. See FM1420. • Over 130°F. (64°C,) special quotation required. i 15?J153-Bodes' 121/e ' 152!153 MODELS Con ro S on N152 111 2or3 1/8 Modal volRN.DnU a Sim ex Du lax EIN152 115 6 Included 2or3 E152 230 1 2or3 sxzaa4 BE152 230 Included 2or3 N153 115 5 1 2 or 3 SN153 115 5 Included 2or3 SELECTION GUIDE E163 230 1 2or3 .1 1 eE153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. CCAUTION 2. See FMO712 for correct model of Eiechical Alternator E-Pak. All Into stlon of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, s 1 licensed elechlclan. All alectdcai and safety codes should be followed Including the most peaty dupfltx recent National Electric Code (NEC) and the Occupational So* and Health Act (OSHA). or (4) float system, RESERVE POWERED DESIGN For unusual conditions a reserve Safety factor is engineered into the design of every Zoeller pump. MAIL To., P.O. Box 16347 Loufsvlk KY 402560347 manuJlishrrarsof. SIRP 1'0: 3649 Cane Run Road LouisWi le, KY 40211.1961 QLfALJw TY (502) n&2731.FAX (502) 1(800) 928-PUMP 774-3624 htipJ/www zoeJJer. eoni zitirlo 0 Copyright 2000 Zoeller Co. All rights reserved. - POWTS oVi!'r4eWs w%NUAL. & MANAGEMENT PLAN sY~•r~ st*~► IL FCfw~ATioM _ e3eptfo Taerrlc osspfti anlr ~ ~ mbir 13 A FARAUff rg-w 11 114A MOO n rriA S Putttp•Tw* 040* unft ° f Pump TW* UeW r MA a ..1nt rd llorlr(mil ~O .bump l to. elk,, ,c Tool AAMMOSSOM ROW pump eweiar ~ /u S 0 Na Domorw MO m n m..p•~~ sew. ~ Off isr. tam" QtnlNl~t D tn-Ornctt~d C~+~ _~~'$~"'d (Pr~su~l wadnmwa St10 'OIL D ound ©Other TOM ~ Some ~ Ala MWL AVqrW9 Food !Dorn!, and :Ktnohdbs neW Mu m im E1MWK Ptddo so ~ yr wsr"'rs NrrseMwat~r. MAtNIYt~PiA~ $etVfets FrvgUWW Swo" swag 93 month s) (Uwdnmm 3 ym-) enspact oareditlon o!' herrk(s3 least ono every When combined sludge and scsr+cjn ~ W"" (K) of tank volume CPVMKS) (wcimum 3 yrs.) ~ imp ~ cxrntetds of ttrrtk(s) W ad(s) At west once every r3 monttrs inspect dhPr<s~d At leeaat once sw+erY s) O MA Ckasrt eetelttsrtttttesr EE At tsirist onos en+ery p O NA knspscE ptrrap, mnt S etetrrn At lowit once every Q year() Flwh 1 lp'r* tort t7 rnsand~ Y ) At /east once sorry At least txtoe ewwy Q rsw+ft C yaw(s) 014A i rm,u: ' am dop ~ cats rtl au boa a%Wo by on itedlwl" oeatybtg avers of the ~ o nspeo0rsrs P*mv w qwomml~d sewer: Po r[ a Er. , MW ~ a Male , fhe voh►rne of ooe~lMod the m wwrn WW 0 al jp boped"d to c ft " twporj rr~, trwwll► eptr~- The d ceelt('ee~ oW be ~ of ~tewet t l erns of wiloW on *w ~mwW abb. vwdork pow and fa do* for any va 0 of a lumd art The grand SWftM rb 10961 rs gUWWY WMW eeefios am inam r s 10164 amuMM erg' rsquhw the lmm4dift mgftw§W of the audlock. or M" of the tank v::lterr~e. Me MW the ~ sow nr''~'~e'"'$'murn to Auly p eerld °f ~ s~ wbh ceri. era ~,l~e aoeeoeiMe elf ~ t~tk s~ be nem ~ 113, WOMMM tebatTn"° gods. - snls; and am T10 S&*ft orts1 mos. madwo* or • set mere iAor manse mvo or mon st wwwbof 92 mor" sttefl be SMAP n sW be p oWW fic tw loco mpkkxY at&A* whin 10 dIP Of =WbdO of VW i ARr UP AM QPMTWN POW= ~ ~~s3 ~ ghee pvowm ofAa~9 ~'rds Or°a' 1 tf h °OA°snb or reeve per` oa ealte sf` thee sred<or a dM MM OW4 wint ' ' 10*1 do an ~ by a s sen datng opoWW pftr to UM ;'S~t hsY+d tits ti0w1~ Page of_,___ at the infittratNe surface- • • ~,r,d'stiansare frozen ~+d the e=m testi7rand may n uft in the SrAl R start up shalt not dccurwTeen ~Tto above normal h`ghwater kwels. When power ips (8). tng the ,mss psunnp ttutks tLc~au(s) in one large dose, arrer of the purtt¢ fsrdc °d by a Ouclr+c~ power ied be dia~9e to n d avold ,this situation have the cvnter►t Or pOWTS Mdrttaireer tD t) rl a w they eflmue nt pump or c o0tact s Piu[tibe6 t)ataic~up sory~ opmew pv+K normal levels within the pump Wk 66006 010 PUMP Wnt` ols to rem" s C)r Cgh d7tilfb or ooMpea n mencr~Y ° "'g ow &sCa o805_ 00 not drive or pa i mo , or at-grade sdt absorption area and p the rye po nt l: drive or Pat Vatichn ow t M of OW itie fe 'ce wlhln 15 ila dorm i Waotewsw stns am may im degreasm- danCaC tie : &ai &V- Fteductian n1" of"fa 9 *°nt fiche >i cidee meat or-pmt Witte butts- condOftu, cotton `mss' -baW , Br; fruit arid v,gelabts peew,9li~ toga;gam •~ine. difiril c~~- fat ~ pes'des; sanitary napkins tampo~%' water disirdg+dants: _ scwc' st1~i tp adwn to insure that the the fr~AaaMin9 steps Coder gWhen 40 POWT traps art~dlor is p„manently_~~ with mm 83cut 'Of service iss ft .33, W Atin> sysef the POWT a~ ~ in oomp and the h- abandoned pipe °ien~5 , nks ta red P a disconnect ed All p and properly disposed of ~ S8M1dng Ot~tor l9 10 tanks -tie ds of an tactics and p96 SWA be removed rs '""""d 'and the.natdE $ Atw 11W indl t~ del to excavated and removed or Itherr cv+ • purrapoll all ~or anoth~C Inert solid matstial. ~d '~i, a code CONT 39NCY PLAN the following measures have been, ar must be taken, to Provide if the FNJWTS fads and carmlot to MPBRW irtettt soil caomprientrep has been 6VOluated and maybe utilized for the lo~On of a MPlece e[tt systettY` and should net O A suifal" VOP181o m°nt- t and should be prate ted from disturba nae lot and fines and Gorttpa wells. Failure to absorption system- rap fc° m existing and proposed structure valuation tr, establish a suttabie be inftin9ed upon t~ ws~~~ in the reed for a new soil and s~ ` at that time. protect the replace Re t, systems must comply with the rules in effect advances in POW r$ repfacerneirt t area is not svailabte• due to setback andJor sotl tirnitaltOnS. Baunn9 O A sudabNe MIDI . stalled as a last resort to replace the failed POWTS- a so~.and technology a holding fartlc. may be i" cement area. upon failure of the POWTS eveL~i to ~ntifjr a suitable repia e,nt area is available a. elite has rxatbeern to ate a suitable repkscxmentarea, if no raptacern evaluation must be tL~v► as a ~t art to replace the failed POD oe Cnriowing rename of the biomat at -Aou.d tank ~ systems may be r~eCOnstructed P the rote in etit at fiat time. ~Vtouncr and at-grade s of such systerrts must camp Y OXYGEN 1~tte infiltrafi►s suriWe. ~ ~4l~rDloll INSUFP!'CtEHrT ccWAR , mind OTH TM T TANKS MA ti' CO, Amt LETNAt ClRCEIMSTANCES. DEATH MAY ge DIFFICULT OR lMP0SS113L E- gEp tiC PUMP AND ER Tt*F.~rl ER TREATMENT TANK UNDER AI1l1C U NO 'r jRWjrER A ~MC' - jup ~OM i~ tNTERrUti UP ATAMK MAY UF_ OF A PERSON RIESUL'Ir. •tiESG ADOMMAL couei[Rl+ TS powrs„ AWER POlfltTS INSTALLER Name Q Name S c~. Phone L ph We LOCAL REGULATORY AMORtTy MCP j ` SEPTAGE `ERV[C~6 0KRATOR J'ugericy_ Nartee Phnree/--' ! meets phone _ ofinectea .ntteandwausi,ardeCounty ~pa ~tsrn~a °'rad~- jy doau ner' e does cwt ~vc~jl clots doosr«,za~ eiadLed irYS+e ~ ~r3Cdl~0 and a3_.5i(t (2! & (3), ma a+ir~4n m j.v rM of tdL CAMM guam'fm t%r p ertamance of the t - .1.. .a fh TO ~ ~ z ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _~A Co r4 Mailing Address 24'? 0 PM Y0 Property Address (Verification requi om Planning & Zoning Department for new construction.) City/State Parcel Identification Number Q0 6 YTCo 7_lp LEGAL DESCRIPTION ~W, Town of Property LocationplE _ '/hr /VE `/a, Sec, T ~N R/ a Subdivision Lot # Certified Survey Map # Volume _ 4ol page # 2 Warranty Deed # Volume Page # Spec house yes EO) Lot lines identifiable es o SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumpins 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(1) 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 owner 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 tank is less than 1 /3 full of sludge. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. i/we certify that all statements on this form are true to the best of my/our knowledge. 1/we amlare the owner(s) of the deed recorded in Register of Deeds Office. property described above, by virtue of a; Numb r of bedrooms , , __4 -1: i SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) II INII JJNlllllf ll+ !11111 I IN ~ 1119111~1111(lllllll~ll ill 8055471111 STATE BAR OF WISCONSIN FORM 1 - 2000 Tx: 4041314 955342 Document Number WARRANTY DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between Debra K Brantner fka Debra Swenson, ST. CROIX CO., WI a single person, Grantor, and Jacob E Englebretson, a single person, 04/30/2012 12:21 PM Grantee. EXEMPT#: NA REC FEE: 30-00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 312.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot One (1) of Certified Survey Map filed December 15, 1986 in Volume 6 of Certified Survey Map, Page 1756, Document No. 420295, being located in part of the Northeast % Northeast Section 13, Township 31 North, Range 16 West, St. Croix County, Wisconsin. Subject to Easement for ingress and egress over the existing driveway to remaining adjoining land. Recording Area Name and Return Address: Title Onoe PO Box 16 Amery, W154001 File#17527 Together with all appurtenant rights, title and interests. 006-1027-10-100 Parcel Identification Number (PIN) This is Eat homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except reservations, restrictions and easements of record, if any, and public highways, zoning and building regulations. Dated this 12th day of April, 2012. * Debra K Brantner * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) POLK COUNTY. ) ss. authenticated this Personally came before me this 12th day of April, 2012 the above named Debra K Brantn an' a sin 'e erson to * me known to be the person(s) 0 ecUer egoing TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledged s 4" 10Tq,Q ~(P (If not, y m6w - 5nir-r- authorized by § 706.06, Wis. Stats.) *Sidney P. ones N V THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin*9~~C My commission is permanent. (I !not, sta ~Se Eir~a n date: July 19, 2015 1=h"47 N ) Michael H. Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 I I D 7, CERTIFIED SURVEY MAP NO. LOCATED IN PART OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER OF SECTION 13, TOWNSHIP 31 NORTH, RANGE 16 WEST, TOWN OF CYLON, ST. CROIX COUNTY, WISCONSIN. FOUND CO.MONUMENT N. E. CORNER SEC.13, T.31N., UNPLATTED LANDS ® R.lew. I P.O.C. S8902247"E 763.4l'-- - - EAST LINE NE I/4 SEC. 13 I r . I LEGEND ov ® oPUBLIC LAND _ CORNER OF T -80 - RECORD IN COUNTY. co ' C"p p N 91P N i 1 Q e I INCH BY 24 m s, I ~'I INCH IRON PIPE U) U Q f ' r SET, MIN. WT. 1.13 Q q, O 435,600 Std. FT, c IOACRES ~ W N FOUND WISC. C~ q 1 D.O.T. R16HT-OF- Q M^" ~~W++~ 1 r- WAY POST. W ~ M ~ I I I o HOUSE pO pRIVE ON 2~ m p \ WAY _ 1 M p !q, \t SOgo~2~ s Iw~ , z OOD 100 R.I 6 R. 15 W. i Fp SHED^~ / 1w" v 5048'd S1400857"ly I I W I 32.70. - _ _ _ _ _ 'y h FI F - --N89059'58"W 70 3. 99'-- cV O _ L~Ii'LATTEDL~ P. O. B. 2 3 2.40' APPROX. SOU H LINE NE 1/4 NE 1/4 SEC. 13 0 O NORTH SCALE I 200' BEARINGS REFERENCED TO THE EAST LINE t OF THE NE 4 OF SEC. 13-31-16 AS m 0 50 100' 200 303 S00046' 27"E, WHICH IS ASSUMED. SURVEYOR'S CERTIFICATE FOUND CO. MONUMENT E. 1/4 CORNER I, Ronald F. Johnson, a Registered Wisconsin Land Surveyor, do SEC.13-31-16 hereby certify that I have surveyed, divided and mapped a parcel of land located in the Northeast Quarter of the Northeast Quarter of Section 13, Township 31 North, Range 16 West, in the Town of Cylon, St. Croix County, Wisconsin described as follows: Commencing at the Northeast corner of said Section 13; thence, on an assumed bearing along the east line of said Northeast Quarter, S00046127"E a distance of 1250.71 feet; thence N89°59'58"W a distance of 232.40 feet to the point of beginning of the land to be described, this being on the westerly right-of-way of United States'Highway No: 63; thenc N89°59'58"W a distance of 703.99 feet; thence N00°00'02"E a distance of 598.98 feet; thence S89022147"E a distance of 763.41 feet to said westerly right-of-way; thence, along said right-of-way, S08018108"W a distance of 260.40 feet; thence, continuing along said right-of-way, S00°13'37"E a distance of 202.27 feet; thence, continuing along said right- of-way, S08022129"W a distance of 100.13 feet; thence, along said right-of-way, S14008'57"W a distance of 32.70 feet to the point of beginning. Containing 10.0 acres more or less. Subject to all easements of record. I further certify that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin State Statutes and the St. Croix County Zoning Ordinance on Minor Subdivision in surveying and dividing the same. T\r.+.. li -1 -I n~ A V, 'Ile 911 1 J1,30 NOSNHof WA, 'J GIVNO~ ZTOtlS uzsuooszM 'pT~zau~g d~,, IpUl 'N psoaaL u~ u.z ' LL p ~p •r tMIzTTTM 2RNto A spaooa~ 'OD xzoaD 'IS Jo 6LSS9Z # ooa 'ZL ofud LLS ownToA uT pagzaosop sz T 407 uMous Jo - sL,a ~rmtj2zH at11, •spaooaN -OD xzoaD 'IS 30 ZbS89Z # 'DOG `S6S a2vd `b8S auInToll uZ pagzaosop (4aodoad juuj Jo 4apd uo qpuiV -N usoaagL PUB 'a1C '4puaV 'I tUPzITTM Jo 4sonboa auk ju auop spm XoAans szu,L 'osz ',(aa TOOtiS M wV `b6T xoff •p . Awnsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings .0 in accordance with Comm 85, Wis. Adm. Code ~I► County Attach complete s' rl on paper not less than 8 1/2 x 11 inches in si Pfan must l ro include, b i 5=M nd horizontal reference point (BM), ion and Parcel percent se north arrow ead location and distance to nearest road. lo -~~CJ Please irint all fo Reytewed by Date Personal iMorrnaGo you provide may be used for ndary a 04 (1T( P Owner Prop ocation - I Y 13 3 / 6 ( C,) A,-,, Go j. Lot 114 1 /4 S T N R E VIA ) Property Owner's Mailing Address L # Block # Subd. Name or CSM# City State L'Zip Code Ph k; City ❑ Village Town Nearest Road ❑ New Construction Use~esidential / Number of bedrooms _ Code derived design flow rate GPD eplacement ❑ Pu is or commeraa~ - be: Parent material ®u-~OLt~~/ Flood Plain elevation if applicable ft. General comments and recommendations: l L 1 LAG System Type ~~//LOLL n-l System Elevation 10311 Boring # ❑ Boring M c Q F) Pit Ground surface elev. a~, 5 ft. Depth to limiting factor ✓ 00 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 z 8- 7S 7 N1,4 F'71 Boling # El-Boring : pit Ground surface elevJD~ R. Depth to limiting factor EJ r/ 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 t,2-8 0 m/ - -s- g,- 6 /0 r Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST Nams (Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 r t J Property Owner _ Parcel ID # Pa9a of Boring # ❑ Boring F151 Pit Ground surface elev. 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 Z A 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF A Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 I it Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 < 30 mg/l_ and TSS < 30 mg/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. saa8330 (8000) Property Owner _ Parcel ID # Page Boring # ❑ Boring r Z Pit Ground surface elev. 'le~!t rnn ~ ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#i 'Eff#2 0-) L r e' n r F] 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff1t2 ❑ Boring # El Pit Boring Ground surface elev. _ ft. DePfl► to limiting factor in. Soil AVOIcation Rate . Horizon lepth Dominant Colo Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munseh Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Etf#2 Effluent #1 = BOD6 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODr,<_ 30 mg& and TSS < 30 nVL 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. SOD-8330(R.60) Soil Test Plot Pla Project Name Jacob Englebritzen S n rd Address 2180 Highway 63 Deer Park Wi 54007 STM #226900 Lot Subdivision Date 4/18/12 NE 1/4 NE 1/4S 13 T 31 N/R16 W Township Cyln Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding System Elevation 103.1' *HRpSarneas Benchmark Highway 63 Scale is 1" = 40' unless otherwise noted o Well Scale = 1/4" = 10' Existing 4 Overflow Bedroom House B.M.* 350' i I 6% Slope B-3 Area of poorer soils 100' Slope 101 300' Slope 102' _ Area of poorer soils 1 -2 660' Property Line 103' Page 1 of 2 Pam Quinn From: Joyce, Jean - DSPS [Jean.Joyce@Wisconsin.gov] Sent: Thursday, April 26, 2012 7:09 AM To: Pam Quinn; debkb57@yahoo.com Subject: RE: WI Fund grants for septic replacements Good Morning, Just to clarify, Pam is right, the owner at the time the system is installed OR at the time that the county verifies that there is an existing failing system would be eligible to apply for a grant if they meet all of the other eligibility criteria. Jean Joyce ieanJoyce(fti.gov 608-267-7113 From: Pam Quinn [maiIto: Pam.Quinn@co.saint-croix.wi.us] Sent: Wednesday, April 25, 2012 7:35 AM To: 'Deb Brantner' Cc: Joyce, Jean - DSPS Subject: RE: WI Fund grants for septic replacements Looking through my information, the owner of the property at the time the septic system is replaced would submit the application form. You may need to work this out with the new owners - they would have to qualify for the grant based on their income, etc. I am copying our state coordinator, Jean Joyce, on this e- mail in case I'm incorrect or if there are options for a situation such as yours. Pam Quinn, Zoning Specialist (POW73) St. Croix County Planning & Zoning Dept. not Carmichael7toad Hudson, 'Wl 54o16 715-386-468o Pam. quinn(a)co. saint-Croix. wi. us From: Deb Brantner [mailto:debkb57@yahoo.com] Sent: Tuesday, April 24, 2012 5:02 PM To: Pam Quinn Subject: Re: WI Fund grants for septic replacements Hi Pam, say I was wondering I have sold my place but do have to put in a new system...... can I still turn a application in or does the new owner have to do it just wondering and thanks so much for your help with this. -Deb From: Pam Quinn <Pam.Quinn@co.saint-croix.wi.us> To: 'Deb Brantner <debkb57@yahoo.com> Sent: Friday, March 9, 2012 3:32 PM Subject: RE: WI Fund grants for septic replacements We accept WI Fund applications all year until DeceMber, then we forward the applications to the state for their review in January of the next year. Once the state determines who gets grant money, those checks typically are sent out late spring or early summer. For example, septic systems replaced in 2010 that were granted award money received checks in 2011. The applications must include the cost of the 5/1/2012 Page 2 of 2 replacement septic system (with receipts for work completed) as well as tax information and other support documents. Each replacement system will need to have a soil & site evaluation done to determine what type of treatment system is appropriate and then a sanitary permit must be obtained by a licensed plumber. We have lists of qualified soil testers and plumbers (some also have certification for soil work) here in the office if you need that information. Hope that clarifies the program. Pam Quinn, Zoning Specialist (PO Wg'S) St. Croix County Planning & Zoning Dept. not Carmichae(Road Hudson, -WI 54o16 715-386-468o pam. guinneco. saint-croix. wi. us 1 From: Deb Brantner [mailto:debkb57@yahoo.com] Sent: Friday, March 09, 2012 3:08 PM To: Pam Quinn Subject: Re: WI Fund grants for septic replacements Thank you Pam for the info...... I was reading on here the deadline is Jan 31st...... so if I was going to redo my sewer this spring then I have till Jan 31 st. next year to send in paper work ? but you did say there was paper work that needed to be filled out before the sewer goes in ? From: Pam Quinn <Pam.Quinn@co.saint-croix.wi.us> , To: "'debkb57@yahoo.com"' <debkb57@yahoo.com> Sent: Friday, March 9, 2012 2:50 PM Subject: WI Fund grants for septic replacements Deb, here's a document sent to us by Jean Joyce, the WI Fund coordinator. WI Fund information is on page 15, but this has other information that may be helpful to you. Pam Quinn, Zoning Specialist (POWI~S) St. Croix County Planning & Zoning Dept. not Carmichael Road Hudson, -WI 54o16 715-386-468o pam. quinnkco. saint-croix. wi. us I 5/1/2012 Y J Parcel 006-1027-10-100 05/01/2012 11:30 AM PAGE 1 OF 1 Alt. Parcel 13.31.16.182B 006 - TOWN OF CYLON Current OX 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 - BRANTNER, DEBRA K DEBRA K BRANTNER 1974 220TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 2180 HWY 63 SC 1127 SCH DIST OF CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 10.000 Plat: 1756-CSM 06-1756 006-86 SEC 13 T31 N R1 6W NE NE LOT 1 CSM 6/1756 Block/Condo Bldg: LOT 01 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-31N-16W Parcel History: Notes: Date Doc # Vol/Page Type 09/26/1999 611088 1459/237 TI 07/23/1997 784/36 10/14/1988 442230 825/073 WD 2012 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment ' I Valuations: Last Changed: 06/10/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 50,000 169,300 219,300 NO AGRICULTURAL G4 5.000 900 0 900 NO I Totals for 2012: General Property 10.000 50,900 169,300 220,200 Woodland 0.000 0 0 Totals for 2011: General Property 10.000 50,900 169,300 220,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/2009 Batch 09-12 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 3 0CD o ~ I ~ I ov w a v ? ~ E m a V .C O NO E m y Ct E w ° (n U N d w m c s m O Ii a> pc(~ I 0 o v s N p H w O V C N O N N C z c Oc 00 p 3 m O= L M (L C N _ 3 o3 ado Q z rnm I 0 ' 3 c ~ I z m tll ~ W E a~ z ° d N M H Z a m ° 3 o w o CL d o c C7 o z v a v o m o N Z C 0 y 7 E a) O a N V V N ' -0 C rC N ~ H O ~ t moayi a O (n ~n Q I ' O z z Z 1 C N Ll d y d C a o w y d ; o ° C C IL a 0 Z H H c a O O O = • N o a. a a N m a o N o ' (q J U :I p W z cMD ~ ~ a•°i °o I o o - U N = O O 7 D E m c a o (n Q m w N p d Q z (n m 41 w o y c Al ° co o I N ° a~i a~i O+ N O 3 N C C (D G N f0 FO- c 4) € C 40. O ' 1~ M O C N N 'OD C (D a0+ 7 t • o C.) Q O z N z z U) O y d € a L: a a E ` -1 A Ua~ ',0U)0