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HomeMy WebLinkAbout030-1026-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569535 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: city Village X Township Parcel Tax No: Mau in & Ness, Lucas &Audra St. Joseph, Town of 030-1026-30-000 '4 CST BM Elev: Insp.BM Elev: BM Descriptioeo Section/Town/Range/Map No: • #6t,4 �- „ _ 06.29.19.104D TANK INFORMATION ELEV ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic BeAchmark 'b 10a(-I-6,w., n� k A 13- 04 Alt. BM Aeration Bldg.Sewer 7,25 -7 -q Holding St/Ht ,7. 35 /� !(01 SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ve it Intake ROAD Dt I Septic Dosing l� Header/Man. A�, Aeration Dist.Pipe Holding Bot.System iz.a X3 . 0 Final Grade PUMP/SIPHON INFORMATION 6•�o Manufacturer Demand St Cover 3. b I VL Model Numb TDH ft Friction Loss System He TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length NlTren s I PIT DIME S►J IONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS ---- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: \ INFORMATION Ty—pe Of System: CHAMBER OR v� oI A //�' UNIT Model Number: \ DISTRIBUTION SYSTEM J► �1J/y Header/Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedrrrench Center �� Bed/Trench Edges Topsoil R Yes r';p No Yes El No GL vV U COMMENTS: (Include code discrepencies,persons present,etc.) nspection# / / In pectin #2: / Location: 355 River Road Hudson,WI /54016(NW 1/4 SE 1/4 6 T29N R 9W) metes&bounds Lot Parcel No: 06.29.19.104D 1.)Alt BM Description= �'•� �o.k� 2.)Bldg sewer length= 7 �� 2 �(�ei;p� , � -amount of cover= �/ d- Plan revision Required? W Yes No Use other side for additional information. /r 4 SBD-6710(R.3/97) Date Insepctor's ignature Cent.No. DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR Q SAFETY&BUILDINGS PRIVATE SEWAGE SYSTEMS ' oi• I-gQ_ DIVISION LABOR& HUMAN RELATIONS BUREAU OF PLUMBING P.O.BOX 7969 WI 53707 CONVENTIONAL ❑ALTERNATIVE ooO State Plan 1,13.Number. MADISON, Of assigned) ❑Holding Tank ❑ In-Ground Pressure El Mound ADDRESS OF PERMIT HOLDER: - INSPECTION DATE: NAME OF PERMIT HOLDER: ��i d. I'� n r[A Q �( i UPS ofR REF.PT.ELEV.: CST REF.PT.ELEV.: BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM ALAN: } 5 ) I i �-_ 1 \ Sanitary Permit Number: IName of Plumber: MP/MPRSW No.: Counry:~ SEPTIC TANK/ LOING TANK: MANUFACTURER: - LIQUID CAPACITY TANK INLET ELEV.: TANK OUV PROVIDED:DLAeEL PROVIDED:OVER ` OYES ❑NO ❑YES ❑NO ' R MBE.R OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH BEDDING: VENT DIA.: V T ATL: IG ATE LINE: AIR INLET: AL M: FE, T FROM ❑YES NO YES NO NEAREST DOSING CHAMBER: P/SIPHON MANUF ACTLIRER: - WARNING LABEL LOCKING COVER MANUFACTURER BEDDING: LIQUID CAPACIT PU MODE PROVIDED: PROVIDED: DYES ONO ❑YES ONO ❑YES ❑NO P MP AN O ROLSO ERATIONAL. NUMBER OF PROPERTY WELL BUILDING:I VENT TO FRESH GALLONS PER CYCLE: LINE AIR INLET: (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ES ONO NEAREST LENGTH JUJAMLTER- MATERIAL AND MARKING SOIL ABSORPTION SYSTEM.Check the soil moisture at the a all o plowing FORCE or excavation. (If soil can be rolled into a wire,construction shall ease until MAIN the soil is dry enough to continue,) CONVENTIONAL SYSTEM: INSIDE DIA. PIT LIQUID WIDTH: LENGTH IND.OF DISTR.PIPE SPACING. COV DEPTH: BED/TRENCH TRENCHES: moos AL' b:: PIT DIMENSIONS 15 �� . NUMBER OF PROPERTY WELL` BUILDING: VENT TO FRESH GRAVEL DEPTH FILL DEPTH DISTR.PIPF DISTR.PIPE DIS P�E TERIAL: PIPE°,IS FEET FR LINE: ` AIR INLET: BELOW PIPES ABOVE COVER ELEV.INLET ELEV.��� �� �'/` 3� I.t o �/ NEAREST lJ IW TI�J 1 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the to t re o he fill ial for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: and sys ms m < ertain that it ON REVERSE SIDE.SHOW ELEVA- m ets the iter' for dium sand. TIONS MEASURED. DYES El NO PERMANENT MARKERS: OBSERVATION WELLS. SOIL COVER. TEXTURE OYES ONO El YES ONO DEPTH OVERTRENCH;BED DEPTH OVER TRENCH/BED DE TH F TOPSOI SODDED SEEDED: MULCHED: CENTER EDGES: ❑YES ❑NO DYES ❑NO El YES ONO PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH AaovE covER: -.WIDTH:, LENGTH: TRENCHES: nV AVEL DEPTH BELOWPIPF.: BED/TRENCH DIMENSIONS MANIFOLD PUMP MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.: ELEV. DIA. PIPES: DIA.: ELEVATION AND DI STRIBUTION COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING. DRILLED CORRE V. PLANS: DYES OYES O NO NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: PERMANENT MARKERS: O SERV TION WELLS: LINE: FEET FROM ❑YES El NO ❑YES ONO INEARES T ©. Ioiii3 61 3, ,n1-f Lw � n S county file for audit. Sketc h System on( Reverse Side. sICNATURE Tf LE: R SBD 6710 (R.01/82) PLOT PLAN PROJECT Lucas Maunin ADDRESS 355 River Road Hudson Wi 54016 NW 1/4 SE 1/4S 6 /T 29 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX SYSTEM ELEVATION BEDROOM 3 CONVENTIONAL X00C AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .71 ABSORPTION AREA 630 # of chambers none BENCHMARK V.R.P. Bottom of system ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL H.R.P. SW corner of lot River Road 10' ell 35' Existing 3 Bedroom House Property Line 20' New Huffcutt ST in same location as old tank Old steel tank is to be pumped and buried a 15' X �, , h �(D 18A 35' bed 0' 26' Property Line �. l�� r v o o 0 3 o O 6 rn O ° a) ti 0. 0 0 ts cc CL-- c o'a� o � �cc 2 CD N `iO c L N O ca N ! a N N O 0 0 0 7 .S 0 a 3 '.. COO)O N am N 'D ') O 'Ct O N C N y t E 03 N x O y N N'6 H al U)W.L 3 o M-.2 m d y 3 _m o a)c No c o L iO a ti o y v o U N m 3M o c 0 7 cca c Z m co ma m a o Z U c o°�o u� w LL c N � - N U N {L c 9'x U Y 3 am "t w g N O-X O j,> 'O O N E Q o ( a)m vr0 M Q m O�� a M V n O N CL /7 v € o a) � � c ! C� Z d a�i C14 a. Co CL a) a) 3Q C7 E v Z a E c a) ly o zv' y v Cl p w 0 Z v I,', ° c 2 7 C o c CL U) F '! C' N C' N 2 0.0 2 m N M C N 0) C) N f0 a) w 7 d. ._,. h Q Q' O= u! a) N a) N 'O U) N a) a) a •Ai t 4. � L d L7 a1 a) O w O c m o N Q m z O o ate) Z co Z o Z Z � N a ° Lot ° m R £ R E '° o 7 C . r`3 m O o w m r o o 4) U) y d Q m v 0 G a E ao CL U) n n a N V) t v a na m LO o 0 0 0 O O O o � a. aa 0 � n. a (L FL cr r+ O N N V) Q' a) N 0o 00 u) J cNi ! u) O �' Z 7 0 p } LO N v v N cn co Z � -0 CO 0 O O Cj O O O l 'O M . O' O O r r - 'O O M Cl) LO I' Q ° O O N T = Q) CL M N M QI A U) ►� L7 O J H H iO N a) IV o D �n w O �n r�U W t O o N q o O p v H a) a) C L a) t� c U d 0 0 0 0 0 0 V M O Z U O c N N N N N N L f0 d C C C m N C O O M O N a) 7 +�-. —_ a) r 7 M M N M a LO G ° of o a M N a� O v c c°) aNi o o Z c a°i v v ~ d N M m O) O N w O O r O chi N O @ U • ' o o to LO o z '• a Z r` o z �' 2 1- u) in r� at v cl 4 € � a L CL CL Z �� `wN o �`a il', 3 0 3 oo Ln O m U O m 0 ' s ,a County c r x ti Industry Services Division r - 1400 E Washington Ave Sanitary Permit Number rto be filled in by Co.) �� . P.O.Box 3 Madison,WI 53707 707-7162 t/J- Sanitary Permit Application State T�,sa�uop Ntynber In acoordan SP 383.21(2),wis.Adm.Code,submission of this form to the approp' to governmental unit is required pno ob ining a sanitary permit. Nofe:Application forms for state-owned are submitted to Project Add 's(if different than mailing address) the Depa Safety and Professional Servies. Personal information you provide may for secondary u ses in nce with the Privacy Law,s.15.04(1 m,Stats. 1. Application-information-Please Print All information Property Owner's Name �b s`' Parcel# Property Owner's Mailing Address /� Property Location -, IV Govt.Lot City,State Zip Code Phone Number ,p� /V(,J 1/4, Section _7 C? 4pircle o N -R orW _ I ,Type of Building(check all that apply) Lot# r2 Family Dwelling-Num .fBedrooms Subdivision Name /57771 � Block# ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number Village of Town ofy 7 �O III.Type of Permit: (Check only one box online A. Com to line B if applicable) A' ❑New System ❑ Replacement System reatme Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal 13 Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and DatVlued 2 Before Expiration Owne W.Type of POWTS'System/Component/Device:. Check all that a pl7k Non-Pressurized In-Ground El Pressurized In-Ground. ❑ t-Grade ❑ Mound�74 inn suite le soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) -"UJ Pretreatment Device explain)- V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation 11,51p P � � C/5 J0 VI.Tank Info Capacity in Total #of Manufacturer B Gallons Gallons Units 0 New Tanks Existing Tanks o a a U ii A Septic or Holding Tank Dosing Chamber VII.Responsibility Statement-k the undersigned,a responsibility for installation of the POWTS shown on the attached plans. Plumber' , ame(Print) Pl ignature MP/MPRS Number Business Phone Number ZZff Plumber's Address(Street,City,State,Zip C 'I VI11. un /De artment Use Only Approved ❑ Disapproved Permit Fee Date Issued !King Agent Si ature ❑Owner Given Reason.for Denial $ IX6C(tjr l3,g roval/Reasons for Disappro'al .� �� . i J '� GC% 1,Septic tank,effluent filter and Ct �j�yrL dispersal cell must be serviced/ma I _._interned (�� J /C) as per management plan provided by plumber. n 2.All setback requirements must be maintained ' � r I�topfplaos for th tem e d submit to the County only on paper not less than g 1/2 x I t inches.in size e C 6391(103-VI3� S 1 �7 L i. `� Rio G✓ �` Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/26/14 Owner: Lucas Maupin Location: NW 1/4 SE1/4 S6 T29 N,R19W 355 River Road St. Joseph System type: Septic Tank Replacement Manuals Used: Safety and Buildings Septic Tank code Page# 1. Cover Page 2. Plot Plan 3-5. Maintanance and Contingency Plan 6. Filter Speci ' ations Sheet Signature License nu er#226900 PLOT PLAN PROJECT Lucas Mauoin ADDRESS 355 River Road Hudson Wi 54016 NW 1/4 SE 1/4S 6 /T 29 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX SYSTEM ELEVATION BEDROOM 3 CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .71 ABSORPTION AREA 630 # of chambers none IL BENCHMARK V.R.P. Bottom of system ASSUME ELEVATION 100' ❑ BOREHOLE O WELL H.R.P. SW corner of lot River Road 10' Well 35' Existing 3 Bedroom House Property Line 20' New Huffcutt ST in same location as old tank Old steel tank is to be 10' pumped and buried 5' 15' 18'X 35' bed 0' 26' Property Line POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of PILE INFORMATION SYSTEM SPECIFICATIONS w Owner Septic Tank Capacity — _ gal . ❑NA Permit# Septic Tank Manufactuler ❑NA Effluent Filter Manufactl►ner 0.NA DESIGN PARAMETERS ---- D NA Effluent Filter Model + NA' !Number mber of Bedrooms — - of Public Facility{{nits — NA Pump Tank Capacity f. ''E "* al 'NA Pump Tank Manufacturer '{ NA Estimated flow(average) Zan aula _ Pump Manufacturer ? NA Design flow(peak),(Estimated x 1.5) yJ b al/day - z Pump Model NA Soil Application Rate aUday!ft NA Standard Influent/Effluent Quality average` Pretreatmont Unit;:r Fats,Oil&Grease (FOG) <_30 mg/L O Sand/Gavel Filter CI Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑NA it Mecharical Aeration ❑Wetland Total Suspended Solids (TSS) .<_150 mg/L ❑Disinfection ❑Other: Monthly average, . Dispersal t'ell(s) ❑ NA Pretreated Effluent Quality Y g Biochemical Oxygen Demand (BODs} 530 mg4L' -Ground(gravity); D fn-Ground(pressurized) Total Suspended Solids (TSS) <_30.mg111. X' ❑At-Grade ❑Mound a p Other: Fecal Coliform(geometric mean) 510 cfu/100rR6 _, ❑Drip-Line Other. 0 NA Maximum Effluent Particle Size lib in dia. . - ❑ NA _ ❑ NA –6—her — Other r. �»-� _ n ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other —� MAINTENANCE SCHEDULE - Service Event Service Frequency y -- month`s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: r si Pump out contents of tank(s) When combined sludge and scum equals one-third( )of tank volume _ ❑ NA pe dispersal ( ) — At least once every: _C} month,s) (Maximum 3 years) D NA Inspect di ersal cells X6-ye ( � monthi s) D Nq Clean effluent filter At least once every: ear(sear ,_ ------— — u mona (s)- ❑ NA Inspect pump,pump controls&alarm At least once every: _ p years;!__ 0 months s) D NA Flush laterals and pressure test At least once every: ❑year(s)-- — L"1 month{s) 13 NA At least once every: Q years) Other: DNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber;Master Plumber Restricted Sewer;POWTS Inspector;POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground stirface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to chect:for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of ti ie tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechar ical or pressurized components,pretreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POW1�S'check treatment tank(s) for the presence of panting products�x other chemicals that may impede the treatment process and/or darrage the dispersal cell(s). if high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill ab3ve normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose, overloading the oell(s)and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Oi:)erMor prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal ceps. Do not drive or park over, or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundations drain(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83,33,Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. XThe site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such sys#Ims must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK PRAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - POWTS INSTALLER � POWTS MAINTAINER Name S, , —�— Name Phone --7 !�J Phone - SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AUTHORITY Name , ' Name r, /jL Phone Phone f '� � This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code. ST. CROIX COUNT''.' SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning&Zoning Department for new construction.) City/State_ Parcel Identification Number x'30 LEGAL DESCRIPTION / Property Location AAO V4 , r/4 , Sec.�, T 2 f N R,/ W,Town of Subdivision . Lot# Cerdffed Survey Map# ,Volume ,Page# Warranty Deed# If/-- 9 J / i , Volume ,Page# Spec house yes 6D Lot lines identifiable( yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the was to disposal system Owner maintenance responsibilities are specified in§Comm 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 frill of sludge. Vwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Departirxont of Natural Resources,State of Wisconsin. Certification stating did your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Depart wont within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms. SIGIqAVft OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Ciffi'ice and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) IIIilll III I IIIII II IIII IIII II 8217524 Tx:4178785 STATE BAR OF WISCONSIN FORM 1:2000 993546 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between William R Whitaker and Susan M Jamison, ST. CROIX CO., wI 03/17/2014 10.56 AM EXEMPT#: :5 husband and wife, Grantor, and Lucas A. Maupin and Audra L. Ness, husband and wife as survivorship marital property,Grantee. REC FEE: N/A TRANS FEE: 674.70 Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 2 described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Title One File#: 20395 Together with all appurtenant rights,title and interests. 030-1026-30-000 Parcel Identification Number(PIN) This is homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways,Easements and Restrictions of Records I Dated this 14th day of March,2014. •William R Whitaker * Susan M Jamison * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST CROIX COUNTY. )ss. authenticated this 14th day of March,2014 Personally came before me this 14th day of March,2014 the above named William R Whitaker and Susan M Jamison, * .. •••.., husband and tfe to a known to be the person(s)who executed C..Schh� for ' ego gin ment and acknowledged the same. TITLE:MEMBER STATE BAR OF WISCONSIN :�D• (If not, :'NOTARY'• authorized by§ 706.06,Wis.Slats.) '• PUBLIC * c C S-qlm ttt THIS INSTRUMENT WAS DRAFTED BY •:IV, ••...• otary Pu low&ate tsconsin oFw... .IL1y commission is permanent. (If not,state expiration date: 7/1/2017 ) Michael H Forecki,Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature St.Croix CO�ARRA9YTV DEEar�ge 1 of 2 STATE BAR OF WISCONSIN FORM No.1-2000 File No.: 20395 EXHIBIT A Part of the Northwest Quarter of the Southeast Quarter(NW % of SE `/)of Section 6,Township 29 North,Range 19 West,Town of St.Joseph, St.Croix County, Wisconsin described as follows: Commencing at the Northwest corner of said Southeast Quarter of said Section 6 and running thence East for 8 rods to the point of beginning; thence 16 rods East to a point;thence South on a line parallel to the West line of said Southeast Quarter of Section 6 for 12 rods to a point; thence West on a line parallel to the North line of said Southeast Quarter of Section 6 for 16 rods to a point; thence North on a line parallel with the West line of said Southeast Quarter of Section 6 for 12 rods to the point of beginning; SUBJECT to River Road(flca 115`x'Street)right-of-way. Tax ID#: 030-1026-30-000 St. Croix County 993546 Page 2 of 2 (D 0 x BO (D 0 r o E Cc .41 C.4 .2 ;5 o CL c » 2& 2 LL 0 (D 0) cv) 0 06 § R � } � � � r_ (D F- z o z CL (D (D E (D N tM 04 .1 :3 IV = I (x Q ( ) ) / IL I�D $ \ca CL 21) 10 cL 4) U) U) CL E I.- cc 0 0 0 OVA CL CL IL CL 2 1 0 CN 04 00 0 OD -i E LO 0 C, (D 0 m 64 '0 Cl) co cr) >- iT) ■ 0 Lo LO 0 r : co E w :3 LO co 0 LO r- 0) 0. a- Co U) m a Co r Q a * * 40. C-04 C—ri 0 ■ z Gi 00 Ce) C, Cl c 0 E Cl) 0 0 0 CD w 0 2 Cl) CD z 0 m F- 2 U) � � � % . \ � ) ) � EL ; L: r 0. CL ID r E 2 o m o 0 CL 2 1: 0 (j) o DFRARiTVIENT OF INDUSTRY, INSPECTION REPORT FOR Q SAFETY&BUILDINGS LABOR& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS �� 1--Sa. DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,`JVI 53707 • CONVENTIONAL ❑ALTERNATIVE o0O (1f assigned)State Plan l.D.Number: ❑Holding Tank El In-Ground Pressure ❑Mound NAME OF PERMIT HOLDE"arLl�cr UV' ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Q i a, Q 1,UP,r Road, , BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. S T qa- R I Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: i4 i SEPTIC TANK/ l-DING TANK: �. MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV, WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: V DYES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: JKI G ATER ;ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH "a AL M. a LINE: AIR INLET: ❑YES ❑NO YES NO DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACIT PU ODE P/SIPHON MANUFACTUR ER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO I 10YES ONO ❑YES ONO GALLONS PER CYCLE: P MP 77ES ROLS O ERATIONAL: PROPERTY WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN LINE AIR INLET. PUMP ON AND OFF) ❑NO f _ SOIL ABSORPTION SYSTEM.Check the soil moisture at the ep/ho..plowing :LeNCrH DIAMETER MnrERIAL AND MARKwc or excavation. (If soil can be rolled into a wire,constructionshase until , the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGT`H''.7 NO.OF DISTR.PIPE SPF)CING. COV ;-b�INSIDE DIA_ PIT LIQUID . / TRENCHES- 1 - M •ALt - DEPTH: GRAVEL DEPTH FILL DEPTH UISTR.PIP' DISTR.PIPE DISTR.PIPE MATERIAL: NO.DIS PROPERTY WELi1 BUILDI G. VENT TO FRESH BELOW PIPES ABOVE COVER: LEV.INLET.ELEV.ENDS PIPE INLET: LINE�T AIR 72 3a loot s 1(ot MOUND SYSTEM: Mound site plowed perpendicular to slope Check the tot re o he fill rial for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: and sys rn ma< ertain that it ON REVERSE SIDE.SHOW ELEVA- m ets the it for dium sand. TIONS MEASURED. ❑YES 1:1 NO SOIL COVER. TEXTURE // I / / 1 PERMANENT MARKERS OBSERVATION WELLS. El YES 1:1 No ❑YES NO DEPTH OVER TRENCHBED DEPTH OVER TRENCH/BED DE TH F TOPSOI SODDED: SEEDED: IMOYEs ULCHED. CENTER EDGES. ❑YES 1:1 NO EYES 1:1 NO ❑NO PRESSURIZED DISTRIBUTIO SYSTEM: WIDTH. LENGTH: NO.OF LATER SPACING. GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: - TRENCHES: Trv'-MANIFOLD PUMP MANIFOLD D R PPE NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV. DIA. V. PIPES. DIA.: HOLE SIZE HOLE SPACING: DRILLED CORRE V. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: DYES O ❑YES NO COMMENTS: PERMANENT MARKERS: V V or SE TION WELLS: PROPERTY WELL: BUILDING: LINE: ❑YES ❑ RV NO ❑YES F-1 NO Io, 13 S �I'1 3 -17 - o Ierfj3 q3 0�� � I Sketch System on( n county file for audit. Reverse Side. SIGNATUR E,„„_�.•- TIT LE: R SBD 6710(R.01/82) AS BUILT SANITARY SYSTEM REPORT r + . OWNER_ � � �y,�'/re/�e f TOWNSHIP _j $ /O/V SEC . TN-R/9W ADDRESS - Z- ST. CROIX COUNTY, WISCONSIN. 1 o So/ 0j SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 R nu THING WITHIN 100 FEET OF SYSTEM t! a f — t I di a e o Ch Arrow ' I SC L BENCHMARK: (Permanent reference Point) Describe Elevation of vertical reference poi t .. Slope at site : SEPTIC TANK: Manufacturer: ;P1 I Liquid Capacity : IMP 6AI10A) Nu—m er o Tings on cover Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation:, PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cyc a gallons ; total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer-- Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number ot pits feet diameter i -elevation it ine�re ee p seepage p p p bottom of seepage pit elev�on feet . _SEEPAGE BED SIZE: number of lines___width /letigth�tile depth EEPAG :i th length PERCOLATION RATE AREA REQUI /,- RE AS BUILT l5— INSPECTOR DATED 167- / ?/ PLUMBER ON I B LICENSE NUMBER `' �; c- ,J , PLB � 7 pt or and CRO55 �./-3/V ,uJ SECTION P I A A S po a1- v TEE p �'/sA/W6- 40etZ �elle� w �o /� D f ..��' %S /D0� d f r' I�Ta�,¢«-.tiE.0 r SyS7�� f f 23 v H `1.� � STt�G SQ�b fiG `\ �'�1 Ex�sr�,v� E 130 O� Sl uy�E- 1�RyloFGL � 0 Cho t 1 i AT oUrp�irAl Hr�ASa-V �v/S • ` `6 NED Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade � f•���a� n�� � �gXib� 4" Cast Iron S Hy Above Pipe Vent Pipe To Final Grade 1 iT Marsh Hay Or Synthetic Covering Mina 2" Aggregate Over Pipe Distribution Tee Pipe --'` -00 0 0 0 Via` Aggregate Beneath Pipe o Perforated Pipe Below o Coupling Terminating At Bottom Of System ARTMENT OF APPLICATION C P • SAFETY&BUILDINGS INDUSTRY' - FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON,WI 53707 Attach plans for the system on paper not.less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed,sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: , n� i Mailing Address: � . A45. 14f1'& A4, w1 A7-2- 18,vii lfcQ • Igo,( /YZ f/vP.s®.,v 4� Property Log tion: City,Village or Township: County: NW 11, �/4S& iT 2-? N/R /9 E (or) S� TOS ✓�7� e*0/)( Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D.Number: (If assigned) AM— TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERG NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE LASS INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY a'/ST/ 6— HOLDING TANK CAPACITY /V,4 LIFT PUMP TANK/SIPHON CHAMBER N+ MANUFACTURER: pW EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PRO`POS D(Square feet): ❑ New .� Replacement El Experimental Seepage Bed ❑ Seepage Pit 43 �/✓ �8 a,3J( ' El Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): —7 Private ❑ Joint ❑ Public I,the undersigned,hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber. Si awwPmmew re: MP/MPRSW No.: Phone Number: 6�� I 16zcZ Plumber's Address: Name of Designer: 7�2 ✓�D.t/�0� S� o� lJ9Sdc> /S COUNTY/DEPARTMENT USE ONLY Sig azure of Iss ing ge Fee:ILDe O 1Daite:p o ❑ APPROVED Sanitary Permit Number: I I�p^C , ❑ DISAPPROVED Reason for Disapproval: Alternate course(s)of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County,Canary-Bureau of Plumbing,Pink-Owner,Goldenrod-Plumber -.1RSBD-6398(R.07/81) NSflUSTRY,�T OF REPORT ON SOIL BORINGS AND SAFETY& B DILDINGS IVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.090)&Chapter 145.045) LOCATION: SECTION: 4 TOWNSHIP/MUNICIPALIT LOT NO.:BLK.NO.: SUBDIVISION NAME: NW 1/ 1/ G /T�l N/R19E (or -joJ4e'Ah, COUNTY: . OWNER'S BUYER'S NAME: MAILING ADDRESS: y¢.G�i fj/u�sa,v USE DATES OBSERVATIONS MADE NO.BEDRMS,:1COMMERCIAL DESCRIP71-6 (PROFILE DESCRIPTIONS: A ION TESTS: Residence /V New Replace I1ar/ z7 /9�Z qe f•17 /%? RATING:S=Site suitable for system U=Site unsuitable for system Df �4mj /+ �,Lr 1�/�/Ma 14v hke zeA1 /-1 CONVENTIONAL:IMOUNI OUND-PRESSURE: SYSTEM-IN-Fit L OLDING TANK:RECOMMENDED SYSTEM:(optional)6 1J'Jrlp•FT Z S ❑U I ®S 0 S D ❑S ®U I ❑S 0U NlIEuTo*/, ,BED ZEE(3- ' If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORINGI TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER IDEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) I�0 0 J f, ��0� I�LL.�:SiL�// ���1. S1'L, 8�'Gi �l. S�'L, /� r.L f Qv —O,P B- j (� " J24 - SL " 6,f. _S .. gee- 8A) CS . B-24/0 9i l(y r r �l _ ///o nv 16A) .5,1 �y,r H''••+4i. -OR;, s/L, /� 'r�^ , .5,z �(U'� " A)-e W of -a es B- 3 /0-5--17, 00 F >/a //1'/3,v• sj,- i&„ B,'j- s:L, /y„ �'aa.edu4, c S , s . B- B- Or& Wlk iN fr PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES FTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PERI05 3 PERINCH P- r 2., -c 3 P_ wi}IM 6. S�!4J P- y r g w. s < P /tai CA, £ P- S%'Ts— < 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 II borings and the direction and percent of land slope. /3omm s /k/7 7b LiE AOAM-y 6,�U FT. Rc-'Ow v&7PcAL Rerfe Pew C6' X•JT SYSTEM ELEVATION f3,13 Fr. y , t , r Eli 0 . _ __ _ � �3 Or ���>�9.�p � � � 3�' a � Job sVC al k­ {____ t _ _ _ _ _ w __ ___ ,._ �. -Poy 0 : i__4 E i ! r P 3 I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods s ified 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(print): ' TESTS WERE COMPLETED ON: hh,ar 41h If/ -hT” &c - z7 /9fJ - ADDRESS: CER-�JFICATION NUMBER: PHONE NUMBER(optional): 3 D�cl�rL U1�so v Gr�iS �' -o"1, CST SIGNATU E: DISTRIBUI-ION: Origina!anri one ropy to local Authority,Propei ty Owner and Soil Tester. DILHR-S,P,ID-6395 (P?.02/R?` r INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 • h 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 oir commercial.project; 1 MAXIMUM number of bedrooms or commercial use planned; , Is this a new or rerflacement system; S. 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; 6. PLEASE use the abbreviations shown here for writing profile descriptions and,cori pk� ting the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale; is preferred. A separate sheaat may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates,names,addresses, flood plain data, percolation test exemp- tion,if appropriate; 1£1, If the information (such as flood plain,elevation) does riot apply, place N.A.in the appropriate box; 11. Sign the form and place your current.address and your certification IlUmber; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30'DAYS OF COMPLETION, a ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures . Other Symbols >r i St — S=mic (ovor 10") BR Bedrock � col - Cobble (3- 10"), S — Sandstorm; gr. C i avel (under 3") LS Limestone Sand F-IGVV Ntith GI.OUndi"vater Sand Perc _ P ercolei(jn Rate._- we"! 's muci.tur-n sand W yv"�ll e t�'d�l 1. Sandy i — `.,yarn L41 Biack gilt (t - 'ca - Cray Lo"ia;, `p ... yc, i)v1r -- ny, : ia4 are R I'ec{ it ('1,iv Loam nno — ,r',I ottie E S �e:rl r;I o;i , xrt!rt°°a iF�fc= ti at=.," t V Rr _. f rt!(,-,a" R e i ce, i i t �1 ,f TO TEL NIW � Lest rem " is the f kt t lOr) ir) Sff'M'k, Q c=san,tar"y porn-iit. The, county or'tr ee D (Ss3?"tr7 ont nlay retJue,St V, '< i�" fi)i> St�ti L,,SJ j�1 ill,, ?iC'(i:l jlt'it,( `..? } 1C3!',: iSS..i it.t , G; ('C7IYlol„?t, St±t of tor %d1 t' t3%;V<3tE' �J;Jfl a pe °,_t ' ripplrcati.oi” mu, l lea "ohn,�.t_"o ,« 'ho local aut_hovi'v M ordr;r to d oenno must b:. ohiairet'€1 A;;id gift', To t; of errs. {t}.3,?'?UCt?i}n. - k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 4� 911 FOURTH STREET • HUDSON,W154016 (715)386-4680 May 20, 1991 Bill Seiffert Coldwell Banker 126 2nd St. Hudson, WI 54016 Dear Mr. Seiffert: An inspection of the septic system on the property of Mike Manni, located at 355 River Rd. , Hudson, WI was conducted on May 20, 1991. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis . Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years . Therefore , the prolonged life of this system may be dependent upon proper maintenance of the system. , Sincerely t .00/ Mary Jenkins Assistant Zoning Administrator cj -COMMERCIAL TESTING LABORATORY, INC. .514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. MIX ZONING REPORT NO,: 45418101 PAGE 1 ST. CROIX COUNTY REPORT HATE: 5/22/91 [OIXTHOUSE BATE RECEIVED: 5/21/91 HUDSON, WI 54016 ATTNS THOMAS C. NELSON f oho � o OWNER! oMikeManDi LOCATION: 355 River Rd., Hudson 7 COLLECTOR*# M, Jenkins SOURCE OF SAMPLE*# Kitchen faucet COLIFORM. 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: i 1ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 mi Nitrate-Nitrogen, mg/L f LAB TECHNICIAN: Pam Gane WI Approved Lab No. 19 'I .OF-\NDECENDEHT (.ice V D A < Means "LESS THAN" Detectable Level Approved by: o PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE ✓ �� P. 0. Box 98 Hammond, WI 54015 G ,J Telephone - (715 ) 796-2239 or ( 715 ) 425-8363 ' The St . Croix County Zoning Office offers the service of septic and water inspections- to Lending Institutions, Realty Firms, and private individuals . Completion of this form is essential so that the property can be located . Please provide the following information, enclose appropriate fee made payable to St . Croix County Zoning Office, and mail, along with form to the above address . Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25 . 00 (For nitrates and coliform bacteria) WATER TESTING FEE: $127 . 00 (For VOC ' S ) SEPTIC SYSTEM INSPECTION--------- -,------FEE: $25 . 0 0___ -_ (Determines if system is properly functioning at time of insbection) Property owner ' s name t — tiK�� Property owner ' s address J t/ErL � J�S�tiJ Legal Descri ti on 1/4 of the 1/4 of Section IF T N-R Town of .f 1-4 Lot Number Subdivision Name FIRE NUMBER SS� LOCK BOX NUMBER Color of house�,���i- Realty sign by house? - ' If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted . W-I TER ='TING: Many 'Mmes water lines are turned off, cocks a--.-e turned off, making access to the home necessary. If this is the Case, please make nroDer arrangements wi--h tijiS office to ensure time when entry may be gainer . I i°CLtZX�est ng�\/s,; (_ y ceF, V1\KC. _ r .J..o.. . 1:.i b t_ Parcel #: 030-1026-30-000 09/25/2006 09:57 AM PAGE 1 OF 1 Alt. Parcel#: 06.29.19.104D 030-TOWN OF SAINT JOSEPH 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 SUSAN M JAMISON O-JAMISON, SUSAN M 355 RIVER RD HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "355 RIVER RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.200 Plat: N/A-NOT AVAILABLE SEC 6 T29N R1 9W PT NW SE COM 8 RDS E OF Block/Condo Bldg: NW COR,TH E 16 RDS, S 12 RDS,W 16 RDS, N 12 RDS TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 06-29N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1123/446 WD 07/23/1997 904/40 07/23/1997 446/633 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.200 51,100 128,800 179,900 NO Totals for 2006: General Property 1.200 51,100 128,800 179,900 Woodland 0.000 0 0 Totals for 2005: General Property 1.200 51,100 128,800 179,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 115 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00