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Form - S T C - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER � �� J TOWNSHIP S '� ,,,fit SEC. T, N-R A9 W
ADDRESS � I ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOT LOT SIZE
PLAN VIEW 030-c�w 3 --q 0— 66
Distances and dimensions to meet requirements of I•1HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point usedJ z"
Elevation of vertical reference p oint: �n �� Proposed slope at site:
SEPTIC TANK: Manufacturer: ;, Liquid Capacity:
Number of rings used: _ Tank manhole cover elevation: 14LIQ�
Tank Inlet Elevation:_2� Tank Outlet Elevation:
Number of feet from nearest Road: Front, Side, Rear, O feet
From nearest- property line - Front,0 Side,ORear,0 feet
ber of feet from: well building:
g�
this information of the above plot plan)( 2 reference dimensions to septic tank)
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PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufacturer: Pump Size
Elevation of inlet: Bottom of tank elevation:
Pump off switch elevation: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest property line: Front, O Side, O Rear,Q Ft.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: - Trench:
Width: Length: � , Number of Lines: Area Built:
Fill depth to top of pipe: 3�
Number of feet from nearest property line: Front 0 Side, O Rear,wPt .
Number of feet from well:
Number of feet from building:
b
(Include distances on plot plan).
SEEPAGE PIT
Size: Number of pits: Diameter:
Liquid depth: Bottom of seepage pit elevation:
Area Built:
Has either a drop box O or distribution box been used on any of the above soil
absorbtion sytems? (Check one).
HOLDING TANK
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
Number of feet from nearest property line: Front, O Side, O Rear, 0Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Dated: — Plumber on job: //J,,V 64;�c
License Number:
3/84:mj
DEPARTY�ENT OF INDOSTRY, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR&HUMAN'RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707
State Plan I.D.Number:
NF 4,MA,-,S1,T30N-R19 4 4K] CONVENTIONAL ❑ ALTERATIVE (If assigned)
Town of Somerset ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
MOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Steve Olson Route 1 Somerset WI 54025
BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
Calvin Powers Jr. 1563 St. Croix 119449
SEPTIC TANK/HOLDING TANK:
M TURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
• ! PROVIDED: PROVDED:
PUFoz �� I rl f CYd4+� 'M YES ❑NO ❑YES OC7 NO
BEDDING: VENT DIA.: VENT MATL. I HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM; FEET FROM LIN : 1 ` AIR INLET.
❑YES NO . ❑YES NO NEAREST—�� 14 U r
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVDED:
YES ❑NO NJ YE NO EYES ❑NO
GAL ONS P9A LE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PRO TY WE BUILDING: VENT TO FRESH
(DIFFERENOE B WEEN7 FEET FROM LINE: AIR INLET:
PUMP ON AND OF ❑YES ❑NO NEAREST
SOIL ABSORPTION S YISTEM.ABSORPTION Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETE : ERIA,AND KING:
or excavation. (If soil cdn be rolled into a wire,construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM: .
BED/TRENCH WIDTH: LENGTVi: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
TRENCHES: 1 MATERIAL: PIT DEPTH:
DIMENSIONS I lc_� to
GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: O. TR.iAREST MBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: ET FROM LINE: AIR INLET:
told 6LO + JDI�S —►
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
[--]YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING:
ELEVATION AND ELEV: ELEV.: DIA.: ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS' PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
/1 FEET FROM LINE:
Q V ❑YES ❑NO ❑YES ❑NO NEAREST-110-
V ,
Sketch System on Retain in county file for audit.
Reverse Side. 36-x�TUR E: TITLE:
SBD-6710(R.06/88)
Zoning Administrator
DILI-fR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05,Wis.Adm.Code CO / I CAJ/
STATE SA(VIT��PE,
—Attach complete plans(to the county copy only)for the system,on paper not less than ��// 77''
8%x 11 inches in size. ❑ Check if revision to previous application
–See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION–PLEASE PRINT ALL INFORMATION.
PROP RTY OWNER PLOT R PERTY LOCATION
%a Y4, S T , N, R 9(or)e
PROPE W+N'ER'S MAILING ADDRESS # r� BLOCK#
J o•�
CI TATE rr ZIP C-Op E PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
y 0 2
/u/4 All/-,
,
II. TYPE OF BUILDING: (Check one) CITY NEARE RO D
��ryry State Owned VILLAGE: I
❑ Public (x.11 or 2 Fam.Dwelling–#of bedrooms .3 R TAXI B ( )
111. BUILDING USE: (If building type is public,check all that apply)
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
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Cr Wa
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 14 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. ❑ 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 [K seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ 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 13.ABSORP.AREA 14. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED(sq.ft.) PROPOSED sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION
s 499�91bl Feet Feet
VII. TANK CAPACITY 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
Septic Tank or Holdina Tank
Lift Pump Tank/Siphon Chamber
Vlll. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's ame(P ' t): Plum is Signatu :(N Stam s) /MPRSW No.�s., Business Phone Number:
Plum 's Ad ress(Street ity,State, ip Code
3
A0 1A
IX. Coll 11 USE ONLY
❑ Disapproved S nitary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signature(N Stamps)
Approved
El Given Initial S Surcharge Fee)
Adverse Determination Iqv , W
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 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 & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
I. 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 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 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.
Vlll. 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 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, ground-
water contamination investigations and establishment of standards.
SBD-63M(R.11/88)
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Fresh Air Inlele Anil Obrervolion Plpe
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Minimum 12"Above
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D15tRI(9'JT1OA! P►PE T() 8E AT l. Ati"Y j .HE'S Ci4.wOW ORIGIIJAt_ GRADE
AQU AT LEAS,rzo WCHES BL)T R_i'. xai °t2 4P,_tCI:E.„ FJEtOW FINAL GRADE
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t M1INIMWM gp C 1CCAJT9a�a.� +�y�". �g � 1 WILL E3E `,Z'.
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SIGA.IED.
9
L.ICE►DSE ►DUMBER: s€
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DATE
a
T 10 1�
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUDI V
INDUSTRY; C P.O. BOX',
LABOR AND 3 PERCOLATION TESTS (115) MADISON,WI 53t
HUMAN RELATIONS (H N(1)&Chapter 145.045)
L ION: SECTION: .1111111IT9JEW/MUNICIPALIT LOT 0.:BLK. : SUf3Dl SION NAME:
NTY: O NER'S BUYER'S NAME: A RESS:
DATES OBSERVATIONS MADE
NO.BEDRMS.: COMER I L DESCRIPTION: PROFI E D ESC RIPTIONS: R
M TI N ES S:
Residence New [E]Replace
RATING:S=Site suitable for system U=Site unsuitable for system
U'S VENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTE (optional)
DU ®S ❑U S DU EIS U EIS 21�
If Percolation Tests are NOT requir d DESIG RATE: If any portion of the tested area is in the
under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKKN SS,CO R,TEXTURE,AND DEP H
NUMBER DEPTH4, ELEVATION OBSERVED EST.HIGHEST TO BEDROCX IF OBS R (SEE ABB V.ON BACK.)
B- ..
Z B-
B- > ...
B-
B- / -
B-
PERCOLATION TESTS
TEST DEP H WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER OAN4L+S AFTERSWELLING INTERVAL-MIN. PERIOD PERT 2 P 'R PER INCH
P- [
P,2 _3 41"61C J10 J_X2
J J W
P__
P-
P- _
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location n the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION �
__ .
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__...._... ._._.._... _..._� ,....��,_. � _.... 11. '.. _..._.�......_.. _. .�....1__ .....__._... _. _..._._ _�
1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAM print) TESTS ERE CO PLATED ON:
A S: CERTIFICATION NU BER: PHONE NUMBER(optional):
CS 1#N U
DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester.
DILHR-SBD-6395 (R.02/82) —OVER—
J
INSTRUCTIONS FOR COMPLETING FORM 115- SBD - . . �
To be a complete and accurate soil test,your sport must include: .
1. Complete legal description;
2. The use section must clearly indicate whether this is a residence or commercipl project;
1 MAXIMUM number of bedrooms or crrrnn;ercial use planned;
4, Is this a new or-replacement systern;
5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS;
b, PLEASE use the abbreviations shown here, for writing profile descriptions and completing the plot plan;
7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing_to scale is preferred. A
separate street rmay be used it desired;
B. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent;
S. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp-
tion, if appropriate;
10. If file information (such as flood plain,elevation)does not apply, place N.A_in the appropriate box;
11. Sign the form and palace your current address and your certification number;
12. Made legible copies and distribute as rerfuirecd. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION,
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
Soil Separates and Textures Other Symbols
st - Stone (over 10") Bit - Bedrock
cob _. Cr=l)ole {3- ltd`°. SS --- Sandstone
Cray>i trrncier 3°`) l..f, - LirYaes'torie
xs Sarrtd 1-I G,,,1 - High Giokw d4°,at-cr-
c;F coarse sa rd Pear r � colatioil i`61t 31
rrie d s Mlladklrn Sf,nd
Bldg _. B t !dirt~¢
15� I-na gty Sand Grcater Tip irr
,,I — Sandy Learn ! _- Less ThOl l
`I Lo,im tall ,-- R ov!n
Silt L�mrn bi _. tia<r Ck
s€ --- S It Gy _. Gir'iv
�cI -- Ckiv I oarm Y - rrr>vv
Clay Loan-, R -__ Reed
sicl Silty Clay t_oaln riot -- € I0"lI S
�- = CC.
Cl,ly
e
dl,?t7 ..� "l;l r-9Y; (tit r '.°'i rn
p _. par'r)n;llieIit
¢€t.";rL _.. High v,!at ! ievre#,
Six ge're r-.' soil texir.rres Sur-face,v .P€r:r
ftyr lifwi , 4 is e{disposal BM -- Bench Marl;
VRP -- VI£rtica!
TO THE OWNER:
This soil test report is the first step in securing a sanitary permit. The county or the Department rnay request
verification of this soil test is, the field prior to permit issuance. A complete set of plans for the private
-1vdlrge systern and a permit application nrust be s,ubn,iitted to the appropriate local authority ill order to
obtain a permit. The sanitary permit must be obtained and prior to the start of any crrrr°truc ti(
n.
APPLICATION FOR SANITARY PERMIT
o
z
` STC - 100
This application form is to be completed in full and signed by the owner(s) °f the
property being developed. Any inadequacies will only result in delays of the p
CS
isquance. 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
9
Location of Property ;�/�''� _'�• Section
�_ T 30 N - R , _ W
fbawnship
Mailing Address
Subdivision Name
Lot Number
Previous Owner of Property
Total Size of Parcel o-s s
Date Parcel was Created
Are all corners and lot lines identifiable?
Yes _�/� No
Is this property being developed for resale (spec house) ? Yes x No
Volume ,7 and Page Number as recorded with the Register of Deeds
INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
they rec iled with the Register of Deeds Of
In addition, a certified survey, if available, would berhelpful so as to avoid delays
of the reviewing process. if the deed description
Map, the the Certified Survey Map shall also be required.
.— — — — — — — — — — — — — — — — — T — — — — — — — — — — — — —
— — � � —.
. PROPERTY OWNER CERTIFICATION
! that aU &tatement6 on this jonm arse true to the beat 06 my (Ours)
I (we) ce; by the a ent d"cAibed in thiA
Iznow.Zedge; that I (we) am l tee) the owners(4) o b � � . y .ice o b the
.in6ovnation bonm, by Vi tue of a waAAanty deed neconded ina dew I (we)
County Reg"ten o6 Veedb as document Na. oba�. �bybtem (on I (we) have
pxe&entZy own the pt ed a.i to f an the b v�uage p
6on the.
obtained an ebement, to nun uu th the � ve d e bed p
condtnuc tion o b d acd A yb tem, a dQ be necocdedin the
066ice
)
ob the County Reg-ibten o6 Deeds, as Document No.
yam+ �^ , �` ` ,• 1 _ l
"TGNATURE OF OWNER SI �TURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED
J
S T C - 105 r
r
y
SEPTIC: TANK MAINTENANCE ACREEMEN'r
St . Croix County
C
OWNER/BUYER
ROUTE/BOX NUMBER Fire Number
CITY/STATE_ ZIP _A=W .5ypas"
PROPERTY LOCATION :. AJ _14 , 14, Section_, T ?0 N, R 15? -W*'
Town of 59101e scf St . Croix County,
Subdivision Lot number
Improper use and maintenance of your septic system could result in
its premature failure, to handle wastes . Proper maintenance con-
sists 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 treat-
ment 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 systems properly
maintained.
The property owner agrees to submit to St . Cr'bix County Zoning a
certification form, signed by the owner and by a master plumber ,
Journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating .condition and (2) after inspection and pumping (.if nec-
essary) , the septic 'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration .
c;
I/WE, the undersigned , have read the above requirements and agree CA
to maintain the private sewage disposal system in accordance with
the standards set forth , herein , as set by the Wisconsin Depart-
ment of Natural Resources . Certification form must be completed
and returned to the St . Croix County Zoning Office within 30 days
of the three year expiration date .
SICNED\A t_�
DATE_
St . Croix County Zoning Office
P. O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address .
Parcel #: 032-2003-95-100 11/14/2006 10:24 AM
PAGE 1 OF 1
Alt. Parcel#: 1.30.19.477C-10 032-TOWN OF SOMERSET
Current X' 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
CYNTHIA LOU FONSET
O-OLSON, CYNTHIA LOU FONSETH
OLSON
1795 82ND ST
NEW RICHMOND WI 5401
Districts: SC=School SP=Special Property es *=Primary
P Y Address :( )
Type Dist# Description * 1795 82ND ST
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 4.840 Plat: N/A-NOT AVAILABLE
SEC 1 T30N R19W 5A IN N1/2 NW1/4 LOT 2 Block/Condo Bldg:
CSM VOL 3/893 EXC PT TO HWY PROJECT
1559-08-22 Tract(s): (Sec-Twn-Rng 401/4 1601/4)
01-30N-19W
Notes: Parcel History:
Date Doc# Vol/Page Type
10/10/2001 658667 1735/49 WD
07/23/1997 1233/429 QC
07/23/1997 839/155
2006 SUMMARY Bill#: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/24/2003
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.840 57,200 84,300 141,500 NO
Totals for 2006:
General Property 4.840 57,200 84,300 141,500
Woodland 0.000 0 0
Totals for 2005:
General Property 4.840 57,200 84,300 141,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 140
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
/ M
,.,,FORM N0.985•A
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