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HomeMy WebLinkAbout036-1073-80-000 � q j 2 \ K 0 2 � ƒ L » §s ƒ {m f/ ƒ > \ L= co \g 0 LL§ $ mom 0 E - 3 \ m E 7 @ (n ± � / c) � ® k§ f ' � § z ) � c \ . � 5 k k 7 ( k 2 E 2 . I Cl) . 0 $ z 'a 7 � .. cc c d a w k 0 $ § / o o a E _ � \ k k k b E o 0 •� \ a 2 a IL U) \ C \ k \ \ 0 } d \ = § \ E ' © c = m 2 a Z� ; « co 0 = E o w 0 2 0 § 6 � ¥ : c g = 9 \ / a o p � ; o r \ § ) 7 / � o § s z D a g . k \ ) ' \ 2 co $ § k \ i f d o o e z ■ m � ® I « { I EL IL 0 CL E ) 'E! k a i k J a 2 0 2 v • ' Parcel #: 036-1073-80-000 07/05/2006 10:46 AM PAGE 1 OF 1 Alt. Parcel#: 30.31.17.463E 036-TOWN OF STANTON 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 O-LEVERTY,APRIL L APRIL L LEVERTY 1406 HWY 64 NEW RICHMOND WI 54017 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description * 1406 HWY 64 SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.240 Plat: N/A-NOT AVAILABLE SEC 30 T31 N R17W.24A PART SW SW COM Block/Condo Bldg: 200' E OF SW COR E 66', N 160',W 66', S 160'TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 30-31 N-1 7W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1167/594 WD 07/23/1997 872/295 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.240 10,000 106,600 116,600 NO Totals for 2006: General Property 0.240 10,000 106,600 116,600 Woodland 0.000 0 0 Totals for 2005: General Property 0.240 10,000 106,600 116,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 131 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 '.DEPARTMENT OF INDUSTRY, 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: Sw1,,Sw,1-4,S30,T31N-R17W ® CONVENTIONAL ❑ ALTERATIVE (Ifassigned) I f I- U4 Stanton ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound R OLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: CaAt Vue.ttz Route 3 New Richmond W1 54017 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: Kim A. O'Cannett 3259 St. Cnuix 119387 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST---00- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE I DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST 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 PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST--* Sketch System on Retain in county file for audit. Reverse Side. sIGNAruRE: TITLE: SBD-6710(R.06/88) Zoning Adminvsxtca�on C' ILHR SANITARY PERMIT APPLICATION COUNTY �V�\/ In accord with ILHR 83.05,Wis.Adm.Code (2 .� ::�.o......�..o. STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8'/s x 11 inches in size. —See reverse side for instructions for completing this application. PETITION �J 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES L1SI NO PRO PITY WNE PROPERTY LOCATION '/4, S T� , N, R �(Or PROP TY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK UMBER SUBDIVISI NAME .4- C STATE/,/ ZIP CO E PHONENUMBEP My NEAR T ROAD,LAKE OR LANDMARK VILLAGE 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family. OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.K Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Z Seepage Bed b. ❑seepage Trench c. ❑ See a e Pit 2. PERC LATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Feet Private ❑Joint ❑ Public VI. TANk CAPACITY Site in ga ons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installati4 of the private sewage system shown on the attached plans. Plumb 's Name(PriVt)• - Plumber' Si atur t s MP/MPRSW No.: Business Phone Number: ft,mber's Address(Street,Ci y,State, ip odej:�7 Name of Designer .✓p VIII. SOIL TEST INFORMATION Certified oil Tes er(C T�N e CST# C 's ADD SS(Street,City,State,Zip ode) Phone Number: 7X. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary r Permit Fee Groundwater ate �j Issuing Agent Signature(No Stamps) (2c�C�0 S charge F� �O b ir�U l�L�/1 •l� FflApproved ❑ Owner Given Initial Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT 4•` APPLICATION TO THE APPLICANT: 1. This 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; 4, 3. All revisions to this permit-must be approved by the hermit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed ' pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given wht!n application is disapproved. Complete plans and specifications not smaller than 8',/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn 'to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; dosing or pumping chambers; 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. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change,in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater'bill Ground atgr— included the creation of surcharges (fees) for a number of regulated practices which Wisco in can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reasturB' is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) � �/c�,��,� ail s�i7 •-�'��J��./ J Yt l�, 3o' PAGE OF CrUSS Szcjlon Ot' A & e0 SyStern Fresh Air Inlets And Observation Pipe r—Approved Vent Cap 4) Minimum 12"Above Final Grade 20-42"Above Pipe _4"Cast Iron To Final Grade Vent Pipe Mash flay Or Synthetic Covering Min 2"Aggregate Over Pipe Olstribullon —Tee Pipe — 0 0 0 0 0 Pe Beneath Pipe ii—Coopling Perforated Pip e Below Terminating At Botlom Of System i Propose r SOIL FILL DISTRIBUTIOU PIPE-7 APPROVED S4WPETIC COVER ° MAT�RI^I OR 9" OF STRAW rOFJ%GG EEGATE. —�� OR fjARSN HAy (o�OF12-zl/2 AGGREGATE ELEV OF9SI FEET, b DIS-r'RIfSUTIOU PIPE TU BE AT LEAST INCHES BELOW ORIGINAL GRADE AQU AT LEASTZO INCHES BUT AIO MORE THAQ X12 INCHES BELOW FINAL GRADE MMIM4 DEPTH OF EXeAVATioo FRoM oR vvu 6RhoF- WILL BE 1� INCHES PUMMUM ®F-Prtt OF EXCAVATION FROM 01�14IINAL GR49€ WILL BE INCHES i i SIGNED: I LICEMSE AJUMBER: DATE : ,�•S�"O!P 110 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 53707 HUMAN RELATIONS (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT :BLK. O.: SUBDIVIS N NAME: 1/4s.t� /T N/R/ (o COU TY: OWN R'S BUYE 'S N E: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER9AL DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS: Residence ❑New Replace RATING:S=Site suitable for system U=Site unsuitable for system r O�NV EN TINAL: MOUND. RYTEM-I ILLHODING TANK RECMMEN T7 (optional) `JS OU Z S S ❑u SSS FAUU OSS 1 If Percolation Tests are NOT required DESIGN ATE: 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 THICKNESS,COLOR,TEXTURE, AND DEP H NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- '09 _ s - B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. —PERIOD PERIO 2 PER PERIOR 3 PER INCH P P- 3 P- 3 ' 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 on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION - _. - - _ � _ . . f E 1 I 33� 1 N , I t gg e I,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. NAME( ri TESTS WERE COMPLETED ON: A /101 1-5"� ADD SS: CERTIFICATI NUMBER: PHONE NUMBER(optional): Nd CS NA / DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DI LH R-SBD-6395 (R.02/82) —OVER — L INSTRUCTIONS FOR COMPLETING FORM 115 - SB® - 6395 To be a complete and accurate soil test,your report must include; 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 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; , MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet:may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 0, Complete all appropriate boxes as to dates, names,addresses,flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain,elevation) does riot apply, place N,A,in the appropriate box; 1 1. Sian the form and place your current address and your certification number; 12. Make legible copies and distribute as required. 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") BR — Bedrock cob Cobble (3- 10") SS — Sandstone gr — Gravel (under 3") LS — Limestone *s — Sand HGW — High Groundwater cs -- Coarse Sand Perc — Percolation Rate med s — Medium Sand W — Well I's Fine Sand Bldg -- Building Is — Loamy Sandj — Greater Than sl - Sandy Loam < - Less Than *I .— Loam Bn — Broviin #sil - Silt Loarn BI -- Black si — Silt Gy — Gray cl - Clay Loam Y - Yellovv scl -- Sandy Clay Loarn R — Red sicl — Silty Clay Loam mot -- Mottles •sc Sandy Clay wi - with sic — Silty Clay fff - few, tine,faint X - Clay cc — corornon,coarse pt — Peat rn+n — Many, medium m Muck d — distinct p — prominent HWL — High water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP -... Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A cornrlete set of plans for the private se,vage systern and a permit application most he subnflited to the appropriate local authority in order to Obtain a pennit, The sanitary permit must be obtained and pasted prior to the start of any COHAructiorr, H z W r STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a OWNER/BUYERjj�� J ROUTE/BOX NUMBER lvC� ( � Fire Numberi—L-., 6 CITY/STATE ? Z 1�/.� ZIP 0 PROPERTY LOCATION : , :L) 14, X14, Section_, T _N , R W, Town of 1 CAI,z4z 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 I! 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 . Croix 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 . H 0 £ I z I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- v 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 . SIGNED 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 . APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty 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 5&1 �ti/�h;, Section TZ _N-R W Township Mailing Address Address of Site ; Subdivision Name LIZ Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for resale (spec house) ? Yes 2", 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I We) centi•6y that att Atatement�s on th,i�s ohm ane t ue to the best o6 my (ouh) hnowtedge; that I (we) am (cute) the ownen(6� 06 the pnopehty deacAibed in thiA .in6ohmat.ion 6ohm, by viAtue 06 a waA.anty deed neconded in the 066.ice 06 the Colintyy RegtAteA o6 Oeed�s as Document No. ; and that I (we) pliesemay w on ixe proposed Aite bon the sewage disposat sya em (0n I (we) have obtained an easement, to nun with the above deAchi.bed pnopehty, bon the con.6tnucti.on o6 6atd eyatem, and the came ha.a been duty neconded .tn the 066.tce o6 the County Reg•c,aten o6 Vttde, ab Voement No. ) , SIGNATURE Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED WISCONSIN REAL ESTATE TRANSFER RETURN Wisconsin Department of Revenue Name of Grantor Name and Full Address of Grantee Is grantor related to grantee? (Blood or Marriage) Lj Yes No ftute 3 t Address to which tox bills should be sent - New RidbMadip Wiscomi n 54017 Route 3# New Richmilmdr Wi=0=LU* PART I — PROPERTY TRANSFERRED County of: Check proper box and enter name of municipality Street address of property transferred ❑ city ST M1011 Route 3 s ":,;t x Village OF:---'�'��1�;---------- . l,2"O1n Town — �'+ii'+tt► R3.G3Qt2dP +�iDG�1:3�.�'1. ��.? Legal Description (Fill in legal description in space below or attach 2 copies of full legal description from instrument of conveyance) Lot No.------------------Block No.-------Plot Name------------------------------------------ or metes and bounds description: .East 669 of Vest 2669 of South 160* of SW-4'- of SW-iv Section 30°31Ns PART II — PHYSICAL DESCRIPTION AND INTENDED USE 1. Kind of Property 2. Principal Intended Use 3. Land Area and Type a. 1:1 Land Only a"L'1 Residential a. f.Size•Esttetd ❑ j U 10 ❑ New Construction b. ❑ Commercial X � i Ij`Building Previously Used c. ❑ Industrial b. Total Acres.Estimated El b. Residential Units, if any d. ❑ Agricultural 1. Tillable Acres '--One Family e. ❑ Recreational 2. W.T.L. Acres ❑ 2 thru 7 Units f. ❑ Other (Explain) 3. F.C. Acres ❑ 8 or more Units C. am Feet of Water Frontage - I Estimated ❑ _ I PART III —TRANSFER 1j0 Sale 2. ❑ Gift 3.❑ Exchange 4.❑Deed in satisfaction of L.C. dated 5.❑ Other, Explain Here PART IV — COMPUTATION OF FEE 171000.00 1. Total value of real estate transferred (purchase price, etc.). . . . . . . . . . . . . . . $ 2. Ownership interest transferred Q Full ❑ Other (Explain) — 17-00 . 3. Fee. . . . . . . . . . . . . . . . . . . . . . . $ 4. In your opinion, was this sale or transfer made at fair market value? ffYes ❑No ❑No Opinion (If no or no opinion,, plain I(We)declare under penalty of law, that this return(ingWding any accompanying schedule) has been examined by me(us) and to the best of my(our) knowledge and belief it 4 true, red and complete Sign S)gndtur gent Date�uf�,r"}3�3'�i 8tJ1* s 3 /1 ,' i �. Here i. Doculrrent No. Vol. (Reel) Page(imoge) Date Recorded Date and Kind of Conveyance LEAVE r. 3 l 7 503 29 9/11/73 6/29/73 r:1 THIS Parcel Number 19 19 County Code District Code AREA L q 6 C D E F 1 Office 2 Field 3 Use 4 Reject BLANK I I Ratio Consideration T T PE-500(R.6-71) f'ROPEPTY OWNER COPY uuuumtN i nth; I WARRANTY DEED (' I� THIS SPACE RESERVED FOR RECORDING DATA II Hilda Karlstad, formerly Hilda__ . REGISTERS OFFICE THIS DEED, made between , Bulman , and also formerly known as Hilda M . Bulman , __ ST, CROIX CO., WIS. _Grantor Rec'd for Record this_11th_ Carl Voeltz -- day of_-S_PP-t!-----A.D.19-?3 and 1:30 P. _ M. t ee - Gran 4RETN f sseth That the said Grantor for a valuable consideration — __ -0 -D-e-e-d e , ReRfat of Deeds St. Croix _County, TO conveys to Grantee the following described real estate in State of Wisconsin:. Harold D . Olson Beginning at a point which is 200 feet East of the Sout - west corner of Southwest Quarter of Southwest Quarter Tax Key a --- (SWu of SWµ) of Section Thirty (30) , Township Thirty-one This is not homestead property. (31) North, of Range Seventeen (17) West, St. Croix County, Wisconsin ; thence East along the North boundary line of State I-Iighway "64" a dis- tance of 66 feet; thence North 160 feet; thence West 66 feet ; thence South 160 feet to the point of beginning, being contained in the Southwest Quarter of South- west Quarter (SW--14 of SW-4) of Said Section Thirty (30) , Township Thirty-one (31) North, of Range Seventeen (17) West, St . Croix County, Wisconsin . That the former husband of said grantor, Hilda Karlstad, was Herbert Bulman also known as Herbert N. Bulman. TRANSFER $/ 7-. 00 .Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; FEE And said Hilda Karlstad i warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except- and will warrant and defend the same. Executed at New Richmond, Wisconsin this 29th day of August 19 73 r r (SEAL) SIGN SEALE P SENCE OF H�l c a -------------------- (SEAL) Paul 0. Swenb (SEAL) Nan y C . Olson (SEAL) a Signatures of authenticated this day of 19 • ' . . Title: Member State Bar of Wisconsin or Other Party - - -- -- Authorized under Sec. 706.06 viz. STATE OF WISCONSIN l } as. St Croix County. JJJ ._ 73 Personally came before me, this twenty nlntrl day of AU_�USt_-_ __ �9•` --- the above named Hilda Karlstad, formerly Hilda Bulman and also formerly known, aS ,I€��1d_�. M Bu l man � , to me known to be the person- who executed the foregoing instrument an �c d the se r,e. This instrument was drafted by Paul 0. Swenb St . Croix Harold D., Olson, Atty .. Notary Public My Commission (Expires) CT,�?I Oct . 21 , 1973 The use of witnesses is optional. Names of persons signing in any capacity should be typed or printed below their signatures. GRAPHIC PRINTING CO., EAU CLAIRE, WIS. WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. I - 1971 503 i.4cL 29 r �n V yC ST . CROIX COUNTY ABSTRACT COMPANY HUDSON, WISCONSIN CONTINUATION OF ABSTRACT NO. 1st day of August Iq�— at 10:00 o'clock in the A M. From the i . of the land described as: :�4�, E 66 feet of W 266 feet of S 160 feet of ST of SWu of Section 30-31-17. 72 Satisfaction of tg. i Amery Federal Savings and D-,ted Sept. 1.1, 1973• Loan Association, a Ack. Sept. 11, 1973• corporation, by Pres. , Rec. Sept. 13, 1973• Secy. and Corp. Seal, In n503n, page 72, #318479• -to- Satisfies mortgage recorded Hilda Bu.lman. in "388", page 91. Ii Warranty Deed. I;; Hilda Karlstad, formerly Con. Valuable. i Hilda Bu] rtan, and also Dated Aug. 293 1973• formerly known as Hilda Ack. Aug. 293 1973• j ii M. Bulman, Rec. Sept. 113 1973• II, In "503n, page �9� #318447. -to- Beginning at a point which isI 1i Carl Voeltz. 200 feet E of SW corner of SW,—� of SW,—� of Section 30-31-17; thence E along P: boundary line of State Highway "64" a distance of 66 feet; thence N 160 feet; thence, w 66 feet; thence S 160 feet to point of beginning, being contained in SW,—� of SW of Said Section 30-31-17 said gra Recites : That the former huseTbertlN. Bulmanntor, Hilda Karlstad, was Herbert Bulman also known as H This is not homestead property. i .._...._�.�._,�..�.. . . Tax Receipt No. 7946 Treasurer of St. Croix County, Dated Aug. 33 1973• -to- Payment of Taxes for the Hilda M. Karlstad. Year - 1972. II ' ii r, �i i� j I ST . CROIX COUNTY ABSTRACT COMPANY CONTINUATION OF ABSTRACT i 1 � Xf' 3't State of Wisconsin County of St. Croix ss THE ST. CROIX COUNTY ABSTRACT COMPANY hereby certifies that the foregoing abstract consisting of entries No. . . .71 to _ bo'` - -s. _ e_ es• ._ e s .:< Part of SW,—� of SST,—, of ���c .�oi� .;�_�_1-.�7 . That, for the period covered by this certificate, said abstract correctly shows all matters affecting or relating to the said title which are recorded or filed for record in the office of the Register of Deeds of said County, including Federal Tax Liens and Old Age Assistance Liens filed therein against the parties listed below. For the period covered by this certificate, except as shown by this abstract, there are no unsatis- fied mechanic or material liens affecting title to such lands docketed in the office of the Clerk of the Cir- cuit Court in said county for the past two years. That, except as shown in this abstract,. there are no unsatisfied judgments, including delinquent In- come Taxes, docketed in the office of the Clerk of the Circuit Court in said County within the past ten years, as and against the following named persons which affects the title to the real estate above described, to-wit: Hilda X. Ida Carl c ? That for the period covered by this certificate, all instrui ::-As appearinq This -abstract contain Th., necessary number of witnesses and acknowledgments unless oti: rw se noted. have c,refull Y exarnine We further certify that for the period covered by this certificate that we the records in the office of the County Treasurer for St. Croix County, Wisconsin, and find no record of un- paid taxes or assessments standing as a lien on the real estate described in this abstract, except as shown herein. Such examination covers up to and including the taxes for ,'ne year 19 That this certificate and an abstract and also any prior ceriificates, if any, made by the ur.- dersigned, covering the same land, are furnished for the use ar benefit of any :ind all owners of the lard described in said caption and their successors in title, includinc mortgagees and ;uarantors of title. A. Dated at Hudson, Wisconsin, this _____ � �- ---- day 19-73- at ---jJQ Q—-- o'clock in the ---AM. ST. C C)1 'COUN Y A COMPANY By - - - --- ecreta SEAL Form 3 — 1956 1 x: �1 nom, '� •'. 1.trXPv.,w br