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HomeMy WebLinkAbout038-1014-70-100 n O 3 -0 n 0 to I ~ A •D m 0 A I ~ O 0 N m o ° w -0 6 w °w ~c ~ v ° O_ a CD N ~ W 7 M CD = C, O' 0 Q ID v O 3 3 C~(D CD s ~ c° O eM (r 0 0) (D 'D m a, H I N cc m N C fl a N CA m E c Q W I'd V rt r Z rt m ` o ° -4 Cn n 0 H C w00 ::z a ~ r. O ~3' I N co (D W rt w W z n o c F,, ~ P 9 O 3 c In ~O CD (A (A ch a ! o ' D o rn o v rc3 rn m _0 c J d rn J j c00 n CL N N O I 00 I y ( D W o 00 0' O a a1 = m m m • Cl) U) *0 w OH `'(H~ CCD N tl (a N C CD CD w m CL (7 a 3 0 Pd (D F-h z (6 co o U) rt m a A Q ct n w 0 W C Lo j z W a 00 3 z Fl ; y * Z I w < N Q N vi O C G 3 OO w 07 n 0 o j N C ~ 3 C:) o a m =r O_ v c 20) cn t °cD E d BCD W T CL o, a, m R -o I fD.~~ A 21 a o CD n v a rn y p ~0R,0~ - fD p O. CD O O < 'r t~ CD =r O 0 p ~ ya Co CD I ° t ~ y ti Parcel 038-1014-70-100 09/08/2005 05:14 PM PAGE 1 OF 1 Alt. Parcel 3.31.18.38C 038 - TOWN OF STAR PRAIRIE Current [XJ'' 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 - NEUMANN, ROGER L & L TRST&BJORN C ROGER L & L TRST&BJORN C NEUMANN 2387 110TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2387 110TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 3.180 Plat: N/A-NOT AVAILABLE SEC 3 T31 N R1 8W PT OF NW NW LOT 1 CSM Block/Condo Bldg: 6/1685 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 03-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 03/03/2000 619131 1493/393 WD 08/06/1999 608195 1447/365 WD 07/23/1997 1224/45 QC 07/23/1997 1156/588 WD more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.180 37,900 177,700 215,600 NO Totals for 2005: General Property 3.180 37,900 177,700 215,600 Woodland 0.000 0 0 Totals for 2004: General Property 3.180 37,900 177,700 215,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ll~~r~"h T'r fircen • Srq r a: r.G ® ee Y f f { h a sly ~ rc~T AP_ "P i.3 DEPARTMENT OF INDUSTRY, 4 INSPECTION REPORT FOR z"I SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING !f MADISON, WF 53707 CONVENTIONAL ❑AL -R ATIVA =ate Plan I.D. Number: W V4 I~V.), 3 i 31 , (~J rJ F: l If assigned) ❑ Holding Tank ❑ In-Ground Pressure C:iN»P3~ To--j OF: ;o NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER SPECT ` A E w~oTi t~1 r (M11 AFT. 0,W c w b~ (2-fl «5m BENCH MARK (Permanent reference pomt) DESCRIBE IF DIFFERENT FROM PLAN. T - E .ELEV.: CST REF, PT. ELEV.- rtctln of 4fl.a<i; r✓ SinJ 40,-LSE C1;i~b1k~ " i(jj.oc~ 100.00 Name of Plumber: MP/AW No.. Cnuory. Sanitary Permn Number: I>ALt. HOE= C7C~SE3t SEPTIC TANK/HOLDING TANK: 13UiLpi4G. SEWS X-1 +ka,►SE g8,CA? MANUFACTURER: LIOUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL JLOCKING COVER i PROVIDE D: PROVIDED YV e V, 1000 CAI_ cIS•1`I- ol5 •(e Z.:- ES ❑NO ❑YES O BEDDING: Mffli DIA.: eMATT JHIGH WATER J NUMBER OF ROAD: PROPERTY LLJ.UILDING. JVENTTOFRESH W►}T- SI~CNn YN Sp, RiS. R INSP. R%sk ALARM FEET FROM LINE f AIR INLET DYES ❑NO it'` C.i ❑YES NO NEAREST N Is7 7~ NA DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACI iv PUMP MODEL IP.MP,SIPHON MANUF ACTUHEH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) ❑YES ❑NO INEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I l v-,11{ UTAMI TEH IIIATI HIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: S'iSTF-1kX EL. ft VEr 92,40' BED/TRENCH WIDTH LENGTH IN O OF J UISTH PIPE SPACIN(, COVEN NSIUL UTA -PITS LIQUID I TRENCHES I MATERIAL: DEPTH DIMENSIONS (F6 36 Nq 6.o $'IIhb1E2tC PIT AJR 0 GRAVEL DEPTH FILL DEPTH 1115TH PIPt UISTH PIPE DISTR. PIPE MATERIAL NO DISTH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER EIEV.INLII ELEV. END PIPES FEET FROM LINE t t AIR INLET: la I X3,33 q C PVC. Q Tim ~ -9 3 NEAREST----► 5 1 7 q~ 13~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ YES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER TEXTURE 1,11 RMANI NT MAHKI HS OBSERVATION WELLS DEPTH OVER TRENCH BED DEPTH OVER TRENCH BEU UCVTII OF TOPSn11 S(IOUtU ❑ YES SEI DFU ❑NO ❑ YES ULCHED ❑NO CENTER EDGES ❑YES. ❑NO ❑YES ❑NO FOYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH JLENGTH THE NCHES LATERAL SPACING GRAVEL DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV. CIA ELEV. PIPES DIA.. ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECI LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO [DYES ❑NO COMMENTS: PERMANENT MAR KERS: OBSERVATION WELLS. J'F UMBER OF PROPERTY WELL: BUILDING: M LINE ❑YES ❑NO ❑YES ❑NO EAREST-- I ~AXINiAI-r, filN1,St~ ~ CAF E S`O t; gtp. DILHR Leroy Jansky P.S.C: 13 E. Spruce Street Chippewa Falls, WI 54729 1:; 723-8786 Sketch System on Retain in county file for audit. Reverse Side. SIGNATU ITITLE DILHR SBD 6710 (R. 01/82) 5E 6E_ COP,)SULT"T w ~ 4" cgsEn W~~t I , I SGAL~ 1;40 G 3 B>=oF2cx~,M ~ I Hou,s~ ~01TUr.q of SAD ~A E~ AN1~ T'Ic,"6 . w£rv-S i-!8x 3~' ~?a~NE «~D r r r r/ r I i ! I ! i I VENT EZ ILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # F M S =Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION 1A--7 o fLi Alwj 1/a itlkl1/a, s 3 T 31 , N, R / E (or)OW PROPERTY OWNE 'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME / 7 A/ A l- IVA 6 -rrl Sr/r x CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK Ive /~iCLirrrO`I~ ,T4_0 / 7 7/S TOWN E:c~T~2 i~ //d of e/fl/Zl- M G G~/VE 11. TYPE OF BUILDING OR USE SERVED: X& . 63~=lQl~- Number of Bedrooms if 1 or 2 Family 3 13,E D OR n Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. ZNeW b. E1 Replacement c. ❑ Replacement of d. E1 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. L'!I See a e Bed b. ❑ seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet) : PROPOSED (Square Feet): a 3 W 30 7 ~`3 Feet Private ❑Joint 1:1 Public VI. TANK CAPACITY Site in gallons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xi sting Gallons Tanks Concrete stCon glass App. Tanks Tanks Septic Tank or Holding Tank j000 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam S), MP/MPRSW No.: Business Phone Number: b I e Ma , M Pv 00 S~ 1(2,/4 Z d Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION - Certified Soil Tester (CST) Name CST /,64 Jr 450 3-/77 CST's ADDRESS (Street, City, State, Zip Code) Phone Number: fir"-/ ~3oyc !P Ame_, .2!n fr- 76 i'~ IX. COUNTY/DEPARTMENT USE ONLY X❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Surcharge Fee Approved ❑ Owner Given Initial ,Jr -0 ,2 C Adverse Determination d19 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 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; 3. All revisions to this permit must be approved by the permit 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 systei,, 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: 1. Property owner's nar-ne and mailing address. Provide the legal description where the system is to be installed; II. 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; 111. 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 when application is disapproved. Complete plans and specifications not smaller than 8'/z 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 wate , included the creation of surcharges (fees) for a number of regulated practices which Wiscorts<rt's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried ireasure 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. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural P sources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (8.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 674-6 f`.g--e-Aq Location of Property AZkV1G Section .3 , T 3 / N - R Township ~T r ~r r Mailing Address ~~c era y s 6--71o17 Subdivision Name A/ x{ r Sez 4 7-7 j~~ Lot Number 111A Previous Owner of Property L eana rrl l , fG 4.t 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 r/ No Volume and Page Number -LL- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed- 2. Land Contract •r• 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) een'i.6y that att 6tatement6 on thiA 6oAm ane tn.ue to the best o6 my (oon) , know?.edge; that 1 (we) am ( cute) the owneA (d) o6 the pnopeh ty deb eh i bed in thia .in6o4mation 6onm, by viAtue o6 a waAAanty deed eeonded in the 066.ice o6 the County Regi4ten o6 Deed6 as Document No. Y/ ; and that I (we) p4e6 entt y own the pnopoe ed A to bon the d ewage ZU-po-Aa-776yAtem (on I (we) have obtained an eaeement, to nun with the above desert i.bed pnopen ty, 6o& the eonst4ucti.on o6 baid dybtem, and the bame hab been duty %eco4ded in the 066ice o6 the County Reg.ceten o6 Deed6, a6 Document No. SIGNATU OF 0 R SIGNATURE OF CO- ER (IF APPLICABLE) DATE SIGNED DATE SIGNED CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW} OF THE NW} OF SECTION 3, T31N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN NW CORNER SECTION 3 RAILROAD SPIKE FOUND o REPLACED WITH 111 IRON PIPE N 0 o m tr r• F o N v Cr S -1 m m = fD CD Z CA I i`i+ fD rt ~ W CD • unplatted lands owned by platter to 13 0 ° N88°05'1311W 250.001 Q -n rt It- 33.0 217.00' o- ° z w m N I CA I ~ I 6 6' I ICf. rt N O ; p SCALE IN FEET ° I r I c CJf ~ Cn 1 O r I d 0 -J CD Cn 1~ •i m O 1j 1 41 LOT 1 0 100 50 0 100 1 crtt I E I t Ln I= M 41 AREA INCLUDING R/W N C a 138,§17 sq. ft. V Inc 1 N I I 3.18 acres N 1 LEGEND M 1v w 111 x 2411 IRON PIPE WEIGHING a w a AREA EXCLUDING R/W 1.68 LBS/LINEAR FOOT, SET. 120,017 sq. ft. 2.76 acres to I rt I I t~ ;m y OWNER I LEONARD E. PEPIN I RT. 1 BOX 219 STAR PRAIRIE, WI. '54026 I S88 o 0511311E 3.00' 218.03' w w N860211 1911E TOWN ROAD - w platted lands owned by others this instrument drafted by Douglas Zahler job no. 86-19 W} corner' SECTION 3 COUNTY MONUMENT . • amps 6uTddpw pup 6uTAanans uT xtoaD • qS go Aqunoo auk. JO aOUPUTpao UOTSTnTpgns pupa auq pup saqngpgS pasTnag UTSUOOSTM V£'9£Z aagdpgo JO SUOTSTnoad quaaano auq u4TM paTTdwoo ATTnj anpi.; I gpuq !pagTzOSap pup paAanzns Taozad puaT auk go Azppunoq zoTaagxa auq go uoTgpquasaadaz goaazoo a sT daW Aanang paTjigzao STT44 4pr4s ®`9egg;~lASat~te aq.pp J u BPgAN • D uaT TEI < ~r~(1S pN~ dire ' `Nosanm y~ l LOti G-S Oft N3DVH kP1 NZIllb v~~%. Q~c~aec,~~►t~ •pzooaa 30 squatuaspa aau4O TTp pup dpw sTgq uo uMogs sp ppog UMO,Z aqq aOJ APM-;O-ggbTa oq goaCgns sT TaOapd pagTaOsap anogv •6uTUUT6aq JO gUTod aqq oq gaaj 00'OSZ 'M,,£T,S0o88N aOuau-4 ZS'Zt,S '3„L~.~SOTON 90uag4 :4a@3 £0'8TZ 'APm-30-40Ta ATzag4aou pTps 6uOTp 'S„6T,TZO98N aOuaLP !sppog uMOJ, OM-. au-4 -o sAum-90--40TZ ATza -g4JOu pup ATza4sp9 au4 90 uOTgOasza4uT aq4 04 4aag 00'££ 's,,£T.SOo88S OOUau~ :~aa3 £,i-£9S 'M„L3,VSoTOS 6uTnuTquoo aouauq !uoTgdTaosap sTgq JO 6UTUUT6aq go quTod aqq oq Haag 00'SL6 'NMN pTps 90 auTT -.saM auk. 6uOTp P.1,. Lip ,VSOTOS a3uau4 !E uOT409S pTps 90 aauaOO MN aq4 qv 6uTOuawwOo :sMOTTOJ sp pagTaOsap aagganj !uTsuoosTM 'Aqunoo xToao 'qg 'aTaTLaa ap4S 90 uMOl 'M$TH 'NT£Z UOT40as go NMN aqq go kMNauq 90 gapc uT pa4v OOT pupT 30 Taoaad V :sMOTTOJ sp pagTaDsap sT paddpw pup paAanans TaOapd pupT aqq go Aappunoq aoTaagxa auq gpuq !dpW AananS paTJT4zaD sTgq Aq paquasazdaz sT gOTgm Taoapd pupT aqq paddpw pup pagTzOsap 'paAanans anpq I 'uTdad papuoaq go uoigoaaTp 9L.1q Aq gpgq AgT4aaO Agaaaq 'aoAanans ppua uTsuoOSTM paaagsT6aa 'uaBPgAN 'D uaTTV 'I 94P3TJT4a93 s,aOAanans i WARREN W. WOOD, LTD. ATTORNEYS AT LAW 152 WEST SECOND STREET P.O. BOX 99 NEW RICHMOND, WISCONSIN 54017 WARREN W. WOOD AREA CODE 715 G. RICHARD WHITE 248_2146 July 24, 1986 'ZI Mr. Harold Barber' i~ St. Croix County zoning & Emergency Gov't Hammond, WI 54015 Re: Timothy L. Pitzen Dear Harold: I am informed by. Tim Pitzen that your office needs a registered copy of the deed from the Pepins before you can issue him a sanitary permit. My secretary called your office today to inquire if a certified copy of the deed was necessary, but was informed that a photocopy of the deed showing the recording information was su icient. That photocopy is enclosed. ery truly yours, W REN W. WOOD, LTD Warren W. Wood WWW:bjf Enclosure cc: Tim Pitzen URANTft: GRANTEE: Name Lacmard E. & Juletta• E. Pepin Name Timoth L. & Karen R. Pitzen Social Security Number Social Security Number Full Address - New address if property transferred was residence Full Address 'Route 1, Box 219 996 W. 8th Star Prairie, WI 54026 New Richmond, WI 54017 Is grantor related to grantee? Relationship includes, ❑ Yes' ® No Name and address to which tax bills should be sent if not the same as above marriage, blood relative, partner, lessee-lessor, co-owner, parent corporation or joint owner. 'If yes, explain how related Grantor is [R Individual ❑Partnershi El Cor oration El Other Grantee is Individual ❑Partnershi ❑Corporation ❑ Other Telephone: Grantor ( ) - Telephone: Grantee ( 7 15 ) 2 4 6 - 6156 PART I - PROPERTY TRANSFERRED PART II - PHYSICAL DESCRIPTION AND INTENDED USE Check proper box and enter name of municipality and county 1. Kind of Property 2. Principal IntendedUse ❑ City ❑ Village ® Town Star Prairie a. K Land Only a. ®Residential d. ❑ Agricultural County St. Croix ❑ New Construction b. ❑ Commercial e. ❑ Recreational Street address of property transferred. Include road name and /or fire number. ❑ Building Previously Used c. ❑ Industrial f. ❑ Other (Explain) ❑ Solar Design ❑ Earth Sheltered Home 3. Land Area and Type Estimated Legal Description (Fill in complete legal description in space below or if metes ❑ Condominium a. Lot size x ❑ and bounds description attach 3 copies of it as shown on the instrument of b. Residential Units, if any b. Total Acres ❑ conveyance. If certified survey map number is used in description list town, ❑ One Family 1. - Tillable Acres ❑ range, section and acres.) Tax Parcel Number ❑ 2 and 3 units 2. W.T.L. Acres ❑ Lot No. Blk No. Section Town Range ❑ 4 or more units 3. F.C. Acres ❑ Plat Name c. Ft. of Water Frontage ❑ PART III - TRANSFER (One answer is mandatory for questions 1-4, 5a or b must be completed, questions 6, 7 & 8 as apply) 1. © Sale 2. ❑ Gift 3. ❑ Exchange 4. ❑ Other transfer (Explain) 5. Ownership interest transferred a. ❑x Full b. ❑ Other (Explain) 6. ❑ Deed in satisfaction of land contract - What was the date of the original land contract? 7. Amount of mortgage assumed by grantee? $ 8 Does the grantor retain any of the following rights: ❑ Life estate ❑ Easement PART IV - ENERGY Is this property subject to the Rental Weatherization Standards, ILHR 67? ❑ YES K] NO If NO, enter Exclusion Code from instructions NOTE If YES attach the appropriate DILHR Transfer Authorization form (Cert. of Compliance Stipulation or Waiver) to be recorded PART V COMPUTATION OF FEE OR STATEMENT OF EXEMPTION (See instructions) 1. Total value of REAL ESTATE transferred (purchase price, etc. rounded to next even hundred). Include real estate exempt from local property tax (Solar, wind, M&E etc.), but exclude personal property $ 8,000.00 2. Value of personal property transferred but excluded from line 1 $ None 3. Value of property exempt from local property tax included on line 1 $ None 4. TRANSFER EXEMPTION NUMBER if exempt for Reasons 1-13 (see instructions) Sec. 77.25. (NA j 5. Fee - thirty cents per one hundred dollars of value (line 1 times .003) Make check payable to Register of Deeds $ 24.0 0 PART VI CERTIFICATION The transfer must be reported regardless of the grantor's state of residence. Information on this return will be used to administer Wisconsin Income and Fran- chise Tax Laws, Wisconsin Real Estate Transfer Laws and Wisconsin Rental Unit Energy Efficiency Laws. We declare under penalty of law, that this return (Including any accompanying schedule) has been examined by us and to the best of our knowledge and belief it is true correct d complete. Si re of Grantor or e t Date Pint or Type Agent's Name SIGN G ~6 _Fp Mem/ HERE Sig ture of Grantee or r Agent Date Print or Type Agent's Name If Signed By Age Agent Address Phone & ir ~ I - Document No. Vol. (Reel) Page (Image) Date Recorded Date and Kind of Conveyance ) LEAVE TH/S Parcel Number 19 19 Code: County Tax District Assm't Dist AREA L L BLANK 1 I 1 Office 2 Field 3 Use 4 Reject B C D E F T T Ratio s, School District No. PE-500 (R. 7-85) nMTR1[`T CIIDCDVI@norc nnnv A parcel of land located in part of the NWa of the NWa of Section 3, T31N, RAW, Town of Star Prairie, St. Croix County, Wisconsin; further described as follows: Commencing at the NW corner of said Section 3; thence S01°54'47"W, along the west line of said NW4, 975.00 feet to the point of beginning of this description; thence continuing S01°54'47"W, 563.63 feet; thence S88°05'13"E, 33.00 feet to the intersection of the easterly and northerly right-of-ways of the two Town Roads; thence N86021'19"E, along said northerly right-of-way, 218.03 feet; thence N01°54'47"E, 542.52 feet; thence N88°05'13"W, 250.00 feet to the point of beginning. z H ' a ST C- 105 r" r SEPTIC TANK MAINTENANCE AGREEMENT ~H+ 0 St. Croix County z d OWNER/BUYER ROUTE/BOX NUMBER Fire Number CITY/STATE V \ . / l.cJ i 5 Z I P ,SSG / 7 PROPERTY LOCATION: AJKl 14, 1V0V 14, Section 3 T 3/ N, R /k d Town of sTAr ~i c~ ~r 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. 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 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b 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. SIG 1~/~~ 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 7969 LABOR HUMAN., R RE E LATIONS PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN. (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: 9OWNSHIP/MUNI~41?AL.!TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: I I~~/a 3 /T3l N/R/ E (or ru r~ cr. - OUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: p'ro er7 ~~G GJ ~f~Sf c~h/h USE ATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Dspesidence i New ❑Replace I ~~Q~/ C, o,/~ RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUN~`D: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ro VV S oU J OU S OU EIS RS I a. 5- 5 If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 5/9-3016W/6 3o-- `d ~iJS~r o .-41,67,srj~t - 3~8~/5 /og shy B- 177 f? /p e B- 3 IJ04 W,3 c 7/ B- 7,2 -e B- C PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P_ , L P- h P- G 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' o?. 3 74 E 0 c~ PL rc. -rl -yry° y 1-7 - 4j wt~i AM, e- ~ _ f v r V o~- ~t~ E o''0y _ 'y6►f . 1 /f~Ga%// E e 3 E t I, the undersigned, hereby certify that the soil tests reporte s form were me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the locatio f o to the best of my knowledge and belief. NAME( ' : TESTS WERE COMPLETED ON: ~r - O - ADDRTSI CERTIFICATION NUMBER: PHONE NUMBER (optional): 0~ r 08 /5 006 $~6! CST SI ATUR ~ loop' DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R, 10/83) - OVER - sue, r k 1u r. 3 ALL _ lvVl H THE M TO TL h 61 test n , St an Ca. (7 4:' 3 .7 C. t Ctrut ;a. F7 rn 13 ;d 03 c op a ` , 2 ~ 4 ,~1 T C g n h~ L . 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