Loading...
HomeMy WebLinkAbout032-2176-01-000 Z o o NO " p Go, (D M c ~Y O ! ti ~ c N ry ' N ~9 O l N W N N S' ~ w O N v O J Er ca Ca n L n.N N 1- 0- c i a) C C ~ .o Z ats m U I G r 'O r U. c : '00 0 O c a v n Y 3 Co v is rn W _ o v Z N z E d m c°n w a m H U r E Z c in P c' m a~ E N NN N 0 C :l 0 d G N N N O a) Q O O O z z q N Zoo CD II' w a _ u' e. ~ Y ww (D G a a u) v) cn J C F- F- F- v (v X333 a`" v a a a a ~ j ' 3 I ~l 3 0 y O C7 M N v N J U Z rn a) 0) rn ~ 0) O O 2) z c° 0 m oo oo ~l c r _ Q N N Q O O p O N co c w O co CL .0 I N_ 7 a~+ U ^l O C, C ! y C O C COO O N U N O a) c 0 0 0 U CL. a o 0 0 0 l C € G ~O N N N N O N a0 C a) p G V O (O W C N (D -o N t r _N O V « j -O H L O O co Z ly ' co U) ! CO 12 O z Z 7 cn cO ~ at c a 3 C C d G rr~~ 7 L) a. 2 0 U) L) Parcel 032-2176-01-000 02/25/2011 08:49 AM PAGE 1 OF 1 Alt. Parcel 11.12.30.19.1486 032 - TOWN OF SOMERSET Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 01/28/2004 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - MEDINA, JOHN & ANNETTE JOHN & ANNETTE MEDINA 812 160TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 812 160TH AVE SC 3962 SCH DIST NEW RICHMOND SP 1700 WITC / Leg i Acres: .000 Plat: 09-099-LAKESIDE ESTATES 1/22 032-04 SEC 11 & 12 N R19W PT SE SE & PT SW Block/Condo Bldg: LOT 01 KESIDE ESTATES '04 LOT 01 (3.OOAC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-30N-19W SE SE 12-30N-19W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 04/16/2004 759955 2551/298 WD 04/16/2004 759954 2551/295 EZ 03/04/2004 755883 2521/431 QC 01/28/2004 752813 9/99 PLAT more... 2010 SUMMARY Bill Fair Market Value: Assessed with: 65473 196,900 Valuations: Last Changed: 10/12/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 50,000 133,000 183,000 NO 05 Totals for 2010: General Property 3.000 50,000 133,000 183,000 Woodland 0.000 0 0 Totals for 2009: General Property 3.000 60,000 115,200 175,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09107/2005 Batch 05-7 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t ~1.3c~.1~•cogs,4 AS BUILT SANITARY SYSTEM REPORT OWNER ✓ `r Jea-vrJ;na4-) TOWNSHIP ~wynPr~ SECTION--/-L-T_ Sa N-R-L?-W ADDRESSScy9xes^5,e-,~ V ~ ST. CROIX COUNTY, WISCONSIN 4~ff SUBDIVISIONS a arre s LOT . LOT SIZE PLAN VIEW h SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ivo [d r ~9 ~Q r color/ INDICATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark- 5a---z a3 r ~ SEPTIC TANK: Manufacturer: ym; ~~s! -Liquid Cap. A/: ~ Rings used:jManhole cover elev: Final grade elev: Tank inlet elev.:- Tank outlet elev.: No. of feet from nearest road : Front , Side 'C, Rear Ft . From nearest prop. :line:Front , Side, Rear Ft. l No. of feet from: Well 711 , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAFER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench:_ Seepage Pit: Width: Length Number of Lines:_ 2 Area Built Ekist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: hta-~C No. feet from nearest prop. line:Front , Side_ Rear Ft.,Z_- ' No. feet from well:--?-S- No. feet from building --77' HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: DATE : PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj LQ 'r ,Q ,artn l 11. 30.19 PR9A9S*A69SYSTEM County: Labor and,H uman Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 193468 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: TFF SOMERSET ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: CiU !1~ c l~r C (c:. 032-2043-10-000 TANK INFORMATION ELEVATION DATA A9300130 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ieC~ GUS Bencghmar~k~? Aeration Bldg. Sewer Holding St/ Inlet ~0a.4 TANK SETBACK INFORMATION St 20 Outle t 7 L, TANK TO P/ L WELL BLDG. VAe Intake ROAD Dt Inlet Septic NA Dt Bottom Dos NA Headers 97s r 3©4 s~B Aeration A Dist. Pipe z F. 8 Holding Bot. System PUMP/ SIPHON INFORMATION 'ray ` . Manufac Demand -v ° n` 77- i e c~ ovcr 3, A3 Model Number GPM TDH Lift Friction sxe~n TDH t Forcemain Length Die. Dist. To we SOIL ABSORPTION SYSTEM BED/TRENCH width Length i No. Of Trenches _PIT,.__,..._ No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of 12,,, ✓ CHAMBER el tuber: System: &e,p)C, f OR UNIT DISTRIBUTION SYSTEM Header Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake i Length Dia. Length Dia. ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sya.1=111~ %J111 Depth Over Depth Over xx Depth Of xx Seeded/ Sod xx Mulched 3 /Trench Center /Trench Edges Topsoil No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 11.30 19.645,SE,SE,160TH `C- U 110 tC d Plan revision required? ❑ Yes No p Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Sign ure Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ` i I R SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Coul :EOIL aarin„v,rv aaaamwu~s.a.aawa,~ns~ ~ STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check i# r3isio previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION fc Ala"., o~/xc+raa~ - %_-Vj!E S l! Tad, N, R V E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # O V, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER / 7 - 4Cd 42 00.4c Qrce -171 II. TYPE OF BUILDING: (Check one) ❑ State Owned 13 VILLLLAGE NEAREST ROAD 4OWN e T 7X El Public ®1 or 2 Fam. Dwelling-# of bedrooms A x Nu III. BUILDING USE: (If building type is public, check all that apply) Q ZQ~I d 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ 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 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) led. 5- a ELEVATION 715-6 ?SYl . 4' `37. Feet Feet CAPACITY VII. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed 77 F1 I El Septic Tank or Holdin Tank DOG iG~ SST Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: S' !rj C 3 /.2? Plumber's Address (Street, City, State, Zip Code): rl s IX. C LINTY/DEPARTMENT USE ONLY J❑ Disapproved S'Otary Permit Fee (Includes Groundwater s to ssue Issuing A lent big a No m s Approved ❑ Owner Given Initial Surcharge Fee) / Av e 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 re iewal 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 (BBD 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 & 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. 111. 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 replacement, reconnection, 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 gallons, number of tanks and nianufacturer'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% X 11 inches must be submitted t:) the county. The plans must include the following: A) plot plan, drawl to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wel;s; water mairis/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems„ rE placement system areas, and the location of the building served; B) horizontal and vertical elevation refort_n^-e points; C) complete specifications for pumps and controls; dose volume; elevation .differences, fiction loss; pump performance curve; pump model and pump manufat,turer; 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 (fries) for a number cf regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. I SBD-6398 (R.11!88) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Lathr 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 St. Croix 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 REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Jeff Boardman GOVT. LOT SF 1/4 SE 1/4,S l l T30 N,R 19 fQ(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # R.R.#5 Lot #8 Woodbridge Ct. n/a n/a n/a CITY, STATE CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Flew Richmond, WI. 54017JP / (715 246-7164 south art Somerset 160th. Ave. [xkNew Construction Use [ *Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 100.50-97.40 ft (as referred to site plan benchmark) Additional design / site considerations step down trench system 3.5' below surface level Parent material outwash Flood plain elevation, if applicable n /a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem M ❑ U RkS ❑ U RkS ❑ U Eas ❑ U ❑.S A U ❑ S Eau 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 Trench 1 1 0-8 1 r2./2 none L. 2/m/sbk mvfr d./w 2/f .5 .6 :r........... yr sil. 2/f_/sbk mfr g/w 1/f .2 .3 2 8-23 10 /4 none Ground 3 23-46 7.5yr4/4 none Ifs. 0/sg mvf_r g/w n/a .5 .6 elev. 105.60 ft. 4 46-80 7.5yr4/4 none fs. O.sg rivfr n/a n/a .5 .6 Depth to limiting factor >SO Remarks: Boring # 1 0-11 10yr2/2 none I,. 2/m/sbk mvfr d/w 2/f. .5 .6 'i` 2 il`' 2 11-2.8 10yr4/4 none sil. 2/f/sbk mfr g/w 1/f .2 .3 t':::_........ . Ground 3 28-84 7.5 r4/6 none fS. ON- n/a n/a .5 .6 elev. 10(L-Q- ft. Depth to limiting fact$~.4 Remarks: CST Name: Please Print Gary L. Steel -6200 Address: 1554 2, h. AVe. clew Richmond> WI. 54017 , Signature: Date: CST Number: 4-7-93 2298 PROPERTY OWNER Jeff Boardman SOIL DESCRIPTION REPORT Page of PARCEL I.D. # - Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tmnch 1 0-9 10 r2/2 none L. 2/m/sbk mvfr d./w 2/f_ .5 .6 2 9-36 10yr5/4 none sil. 1/f/sbk mfr g/w 1/f- .2 .3 Ground 3 36-F2 7.5yr4/6 none S. 0/sg mvfr n/a n/a .7 .8 elev. 103.50 ft. Depth to limiting factor >82 Remarks: Boring # 1 0-11 10yr2/2 none L. 2/m/sbk mvfr d/w 2/f .5 .6 k < 11-40 1 r5/4 none sil. 1 /f/sbk mfr p,/w 1/f .2 ::.3 Ground 3 40-82 7.5 r4/6 none lfs. 0/sg mvfrr n/a n/a .5 .6 elev. 100.70 ft. Depth to limiting factor ?~32_ Remarks: Boring # 1 0-13 10yr3/3 none L. 2/m/sbk mvfr d/w 2/f .5 .6 5 2 13-30 10yr4/4 none sit. 2/f/sbk mfr g/w 1/f_ .2 .3 3 30-82 7.5 r4 6 none ~fs• 0/s mvfr n/a n/a .5 .6 Ground elev. 105.20ft. Depth to limiting factor >82 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE 1554 200th. Ave. Gary L. Steel §6WNO9FffMODffW C.S.T. 2298 Jeff Boardman T New Richmond, WI 54017 MPRSW-3254 SE ;SVT14 S11-T30N-R19T~. 715 246-6200 town of Somerset 5 { v 1~ ~ ~o 74;r/i7/ [04 S 'oo, ~ 5 1001+ A'/ r - ~f/~ h-~oa rcl i~a~-✓ ~ ,$"G S~~y S' ll T d L✓ DGr/-~ S G g~ 1" II ~ac 9e fj s fG I ~ ~~45 t° s ~f ^^4 /f C- et 1 ild c` _ SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~~~~pGr~~ jna.d ADDRESS: FIRE NO: o~ LOCATION : Sl 1/4, .SC 1/4, SEC. T LFZJ N-R_Z? W, TOWN OF: Sim ex 57e-'7' ST. CROIX COUNTY SUBDIVISION: wQ LOT NO. 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 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 to help with the cost of the 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 the St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: I// U DATE:_ 0/ St. Croix County Zoning office 911 4th St. Hudson, WI 54016 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 Location of property 1/4 S,,C1/4, Section Tfcl N-RleZW Township < 7 Mailing address /G ~7 ~vr Address of site Subdivision name Lot no. Other homes on property? yes No Previous owner of property ;Ce Total size of parcel 0.('6t,~rss Date parcel was created 440 ti 22 Are all corners and lot lines identifiable? -Yes No Is this property being developed for (spec house)? Yes P No VolumeZJA?_and Page Number S24~ 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 & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available would be hel delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified survey Map shall also be required. I 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 County Register of deeds as Document No._ .1 i a re of applicant Co-applicant Date of Signature Date of Signature i • DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3 -1982. THIS SPACE RESERVED FOR RECORDING DATA 73 QUIT CLAIM DEED ` 497773 11 '01 P REGISTERS OFFICE . ST. CROD(CO., N iames Bont........ Rsc'dforRecord Senjamin__J. Boardmank/• Benj....................................... aN(a Ben _J._ Boardman, and Elaine G. Boardman, his wife APR 2 2 1993 8.80 A. '♦V~ quit-claims to _-Jeffrey__S.__Boardman---------------------------------------------------- ofDaft - - , the following described real estate in at.---Cr. x.....• County, State of Wisconsin: RETURN To Tax Parcel No: The Southeast Quarter of the Southeast Quarter (SEJ of SEJ) of Section Eleven (11), Township Thirty (30) North, Range Nineteen (19) West. WMET Y , This "..I}Qt........ homestead property. (is) (is not) Dated this -•-•------20th day of April..... , 1993..-.. (SEAL).a.,.-~..-------- (SEAL) . • * ' B ~a> in J! Boardman (SEAL) -•-----•------•--•-••---•-•--(SEAL) . (SEAL) * * Elaine G. Boardman . AUTHENTICATION ACKNOWLEDGMENT Signature(s) .Benjamin J. Boardman and STATE OF WISCONSIN / --Elaine-.G...BDaxslmaxL----------------------------------------- ss. ......................................County. authe ted kti.s 20.-._da of__._ r , 19 93. Personall came before me this ................day of i ......................y 19 the above named • • • • • . Hendrik W.' Van Dvk TITLE: MEMBER STATE BAR OF WISCONSIN (If not, • authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY .Reinstra,...Y.an..Dyk-.~._Heedham=._S. C______________ 201 South Knowles Avenue, Box 127 j i,W-•Ricliinotid; ••Wg----540t7-`............••°• Notary Public `....................County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permaner~. (If not, state expiration are not necessary.) , 19 date: ) QUIT CLAIM DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 3 - 1982 Milwaukee. Wis. V October 28, 1993 To Whom it May Concern: An inspection of the septic system for the Jeff Boardman property, located in the SE, of the SE; of Section 11, T30N-R19W, Town of Somerset, was conducted on September 17, 1993. At the time of the inspection this septic system was found to be code compliant for a three bedroom home. Should you have any questions, please feel free to contact this office. Sincerely, James Thompson Assistant Zoning Administrator mij