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Parcel 032-1042-20-100 04/25/2006 08:34 AM
PAGE 1 OF 1
Alt. Parcel 15.31.19.208C 032 - TOWN OF SOMERSET
Current CI ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - ATZMILLER, JULIE M
JULIE M ATZMILLER
PO BOX 425
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
egal Description: Acres- 5.000 Plat: N/A-NOT AVAILABLE
SEC 15 T31N R19W PT NE NE BEING LOT 2 OF Block/Condo Bldg:
CSM 10/2823 5 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
15-31N-19W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1057/399 QC
07/23/1997 782/468
2006 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 58,000 84,300 142,300 NO
Totals for 2006:
General Property 5.000 58,000 84,300 142,300
Woodland 0.000 0 0
Totals for 2005:
General Property 5.000 58,000 84,300 142,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 147
Specials:
User Special Code Category Amount
' I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
II
I
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSM# LOT #
SECTION _~s _T_?/ N-R_ZC
W, Town of
ST. CROIX COUNTY, WISCONSI
PLAN VIEW
SHOW EVERYTHING W THIN 100 FEET OF SYSTEM
i
~p
i
~0
i J 4~^' INDICATE NORTH ARROW
Provi ~
~ - and etion information on reverse of this form.
Provi e' ime. to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
1
Manufacturer: Liquid Capacity:
Setback from: Well Housed Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width:' Length 1-4_Number of trenches
Distance & Direction to nearest prop. line: L~~,A _,5111S
Setback from: well House_~ Other
ELEVATIONS
Building Sewer J ST Inlet. 2 ST outlet ,A~,4.2C
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system 59
Existing Grade °f31 Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:-
3 / 9 3 : j t
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Lab,or and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.:
ATZMILLER, JULIE "i Op
CST BM Elev.: Insp. BM Elev.: BM Description: SemeFset Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
GU
t~ e S L~yI@ . ..35 /661
Dosin ( 6N1 7 9 c1o
Aeration Bldg. Sewer 7,
93.
Holding St/F4 Inlet
a~ TANK SETBACK INFORMATION St/)A Outlet
Vent
TANKTO P/L WELL BLDG. AirIto ntake ROAD Dt Inlet
Air
Septic NA Dt Bottom -
Dosing Header=J, Q7'
Aeration Dist. Pipe
ding Bot. System OAS-,* /d '
PUMP/ SIPHON INFORMATION Final Grade
u~'S -77
Ma f turer Demand
7 gZ 0 5 3'
Model Number
Friction TDH
TDH Lift
I oss ead 7
Forcemain Dia. Dist. To Well
SO ABSORPTION SYSTEM
BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia.
DIMENSIONS ~a ~5z DIM N I
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC ufacturer:
SETBACK CHA
INFORMATION Type O r/ew Sa- en A Moe Number:
System: 0 ^-Y-5ud NIT
DISTRIBUTION SYSTEM
Header /Manifold r, Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake
Length ~0 7 Dia. Length Dia. ~ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grad ems O
Depth Over Depth Over „ xx Depth Of xx Seeded/ Sodded xx d
Bed /Trench Center Bed/Trench Edgesp_ Topsoil ❑11Yes ❑ No ❑ es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) ~ ~ ` _ Z
LOCATION: Somerset.15.31.19W, NE, NE, Lot 2, 60th Street
Plan revision required? ❑ Yes R-9-0--
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Sign atu a Cert No.
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
III
SANITARY PERMIT APPLICATION
70ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
s.7<
T'R~U(~Pf~J lYT j
-Attach complete plans (to the county copy only) for the system, on paper not less than STATE WpOCC))
8% x 11 inches in size. ❑ Check if revision previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPE TY NER PROPERTY LOCATION
AIZ % Y., S T9 , N, R E (or)V
PROPERTY OWNER'S MAILING ADDRESS L LOT # BLOC 7#
7
STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
11. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) 17 State Owned ❑ VILLAGE ~ CoJ ~'7
❑ Public [X 1 or 2 Fam. Dwelling-# of bedrooms PA L TAX NUMBER(S)
Ill. BUILDING USE: (If building type is public, check all that apply) 32 - X02,
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.~ New 2. El Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - 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
12 ❑ Seepage Trench 220 In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
1140 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.) (Mi /inch) ELEVATION
Feet Feet
J1 (Vjc~2 CAPACITY
VII. TANK Site
INFORMATION in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
New lExisting Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for inst ation of the onsite sewage system shown on the attached plans.
Plumbs s Narge (Print): Plum rSig ur Sta MP/MPRSW No.: Business Phone Number:
1:; 114~-ell 1 1 ~e'
J Q
Plufnber'if AddrWw- ( reet, City, State, ip Code):
2& S-4z
IX. C NTY/DEPARTMENT USE ONLY
Disapproved SanQ#ry Permit Fee (Includes Groundwater Date Issued suing Agent Si
Approved ❑ Owner Given Initial ellp (/l1 .,auroharge Fee)
I ~V /~'!d•~
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS ,
1 A sanitary`permit is valid for two (2) years.
2 Your sanitary permit: may be renewed before the expiration date, and at the 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 per rnit issuing authority.
4. Changes in :ownership or plumber requires a Sanitary Permit Transfe°/Renewaf Fora SF.3i., 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systr,ms must be properi., rnaintainec he t.ptic tarn rr,- .t be,{:c!i a rir-Arrsed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning Your onsite sewage system, contact your fugal code a.drr . Est, ator or the
State of Wisconsin, Safety & Buildings Division, 6C8-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provicle the legal description and parcal tax nr. rnber(s) of
where the system is tube i.nstafl0d
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family ;'iwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacer-lent, connection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing; tank, list the total gs ;Ians number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Co rnriete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval t:niy if arks 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'f 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 rnains, l.vater service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorotion systems; repla,:,ement system
areas; and the location of the building served; B) horizontal and vertical elevation reference taoints;
C) complete specifications for pumps and controls; dose volume; elevaton 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 numb,3r of
regulated practices which can effect groundwater.
The monies collected thro;jgh these surcharges are used for -nonitorin ; or,,ndwater '_tround-
water contan;irration investigdtions and estabhshrncc,-i or standrxrds
SBD-6398 (R.11/88)
x/946 tiq
A
.,/a All
N
I.
Wisc`,iDepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Pagel -of '-Z
Labfr and Human Relations
{Division of,Safety 8 Buildings in a tl ~I15, Wis. Adm. Code
-f,,, . COUNTY
must include, but
Attach complete site plan on paper not less th 4b x 1 ctili" n size'"
#
° 1--a
not limited to vertical and horizontal reference oii (BM), P cf?! d /o of, scale or PARCEL I.D.
dimensioned, north arrow, and location and stance to.nearest road"
r-. p REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT ALLAN F'`6;Ri AttON
PROPERTY WNER: / Rai ERTY LOCATION
LOT 1/4 1/4,S T N,R
W`
I Z/-- " PROPERTY OWNER': MAILI G ADDRESS e AOT # BLO K# SUBD. AME OR CSM #
CITY STA ZIP CODE PHONE NUMBER"" []CITY VILLAGE [OTOWN NEAREST ROAD
tN
6(J New Construction Use Residential / Number of bedrooms [ ] Addition to existing building
Replacement Public or commercial describe
Code derived daily flow ~~Q gpd Recommended design loading rate _bed, gpd/ft2__,~trench, gpd/ft2
Absorption area required bed, ft2. trench, ft2 Maximum design loading rate bed, gpd/ft2trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material 6 ,0 ~2 Flood plain elevation, if applicable ft
r=Uunisuitatilor abe fsystem CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
fors stem ®S ❑ U S ❑ U ®S ❑ U LZ S ❑ U El S ]81 U ❑ S [8f U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground
elev.
ft. -
Depth to
limiting
factor
>9l
Remarks:
Boring #
s-
eye
Ground
elev. - -
ft.
Depth to
limiting
factor
Remarks:
CST Name: Please Prin Phone:
Address:
Signature: ate: CST Number:
1
PROPERTY OWNER SOIL DESCRIPTION REPORT Page- of
PARCEL I.D. # i
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. Bed Trench
77-77
♦t
Ground .21 Z Z2
eeley.
S ft. _ '
I,
- 7 I
Depth to
limiting
factor
>/D8
Remarks:
Boring #
AJZ
-2 Z Se"
/Z) ve'o
Ground
elev.
g•
Depth to
limiting
factor
Remarks:
Boring #
<s S
411-1
Ground
elev. 7
ft. zzw A4~
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
er
OWNER/BUYER
MAILING ADDRESS " I C h u-ne, f--\ Y 1 P (I 2d, R ~C Q
PROPERTY ADDRESS D- 16 604
(location of septic system) Please obtain -from ~ the Planning Dept.
CITY/STATE C,-JC
PROPERTY LOCATION S 1/4, _ 1/4, Section T__~N-R ,J!? W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , 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.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: q q
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
---------------------I----------------------------------------------
Owner of property J ,Ij Q t..2my1k
Location of property, 11,41_1/4 " 1/4, Section /S-,T_LN-R_/?_W
Township Z.-h of S Mailing address -Z6 ,
r
Address of si e 4 5L
Subdivision name I J J2~ Lot no.
Other homes on property? -Yes A~'_No
Previous owner of property , t - t 1 J f~
Total size of property
Total size of parcel
Date parcel was created C(~ 1 '
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes _ No
Volume and Page Number 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.
III
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. and that I (we) presently
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.
Signature of Applicant Co-Applicant
Date of Signature Mafia nf SinnatiirP
t~} ^•~5, ;`i{•KO t~i. sk'' ~.4~~"Y. ,C''.-.. , :t',' . r. ~41" 2''~'c. _tkl ~lF,'
.r
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDfNG DATA
STATE BAR OF WISCONSIN FORM 2-1982
522157 jj~
1Q98Pa~E42 _ -
ST. CF
lOIXCO. Mil
JuliP..M• -Atzmiller... a single person---................................
Rrx
Pn'd i^r _ .vd
- OCT 5 1994
- - I,
11:30
_ A.
ngle
I conveys and warrants to _...._.M~ AM
.....person,
^tsr of Ceeda
.
the following described real estate in ._.....St. Croix I ~s.: •3,, be
Count
t'
State of Wisconsin:
Tax Parcel No:
I I
Located in part of the Northeast Quarter of the Northeast Quarter and in
part of the Northwest Quarter of the Northeast Quarter, all in Section 15,
Township 31 North, Range 19 West, described as follows:
Lot 1 of Certified Survey Map recorded September 29, 1994, in Voiume 10 of
Certified Survey Maps at page 2823 as Document No. 521879.
I
I
14-1 S0111
This I-S homestead property.
(is) )Doom
Exception to warranties: Easements, restricthns and rights-of-way of record,
if any.
Dated this 30th............................ day of September - 19 94
----..(SEAL) `V ........`-`.~(SEAL)
Julie M. tzmiller
-
-------------(SEAL) - (SEAL)
• a
i
AUTHENTICATION ACKNOWLEDGMENT
I
Signature(s) STATE OF WISCONSIN
I
ss.
s St Croix
County.
authenticated this day ot___________________________ 19 Personally came before me this QtY~-_---day of
September..---------. 19__.94_ the above named
Julie M. Atzmiller
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06. Wis Stats.)
to me known to be j1+*,8er3on,•_ who executed the
forego' Iin.t e li3nd•ederioU
edge the same.
,r
THIS INSTRUMENT. WAS DRAFTED BY - Y
,
Kristin O gland
Attorney at Law -
Notary Publit ti!t.i cmIX:a . • County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission'.is ern1Vherftc(IVJiQt, state expiration
are not necessary.) date. November 47....... ~ 1996,....)
< =
- f
'Names of persona signing in any capacity should be typed or printed below their signatures. -
WARRANTY DEED STATE BAR OP WISCONSIN Wisronsin Legal Blank Co.. Inc.
FORM No. 2 -1882 Milwaukee. `N:sconsin
,tea. . I +Y' d> A x-?,, ' % . i 4
A .7,