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HomeMy WebLinkAbout040-1161-30-000 i C) fn O 3 a C7 r~ C) d F c o 0 o .0 M M M c ...7 v 1 y # fD A 14 C w O cNn ° 'C ? Gf 61 N O O O Oa • a 3 O N N a) S -G W SD 0 C:) O n Q N O N O O, M N O3 O N Q c7 2 G7 cn 3 W O A: Q Q Q Q 7 (n O C C w ~O cn D <y a m (o b c m (n (o N a h c?J (o c C co ° ` " 3 3 ^VN c~ • X CD o m l~ H !7 z H Q Q m cD cD o n r U7 Z ~o N N w co w cn o c H W 0 ~e G` z O O O 4 -n C7 _ o O 3 f~ N fI NC 3 i ~ Q < O Li 'a C,71 QO CD o O W < ^ N d c ~l ~ oN ~ t3o - N a ` ~I 00 O z co z O W D a CD 0 Q N rn m m m • z z D Cl) tai CD m CD N' G\ N W a • o a 3 5 -1 (o z m fn 1 O O_ A z CD Q Q _ti c A 0 R Cl A O N UN W m m w z 3 a o z o 3 z :5 m W F oo? a O 'O N Q C O ,o - G (O p N p - N -a Z, T _ m Cl) N C N - 7 CD D~ Z a ~ No CD a) N N N n' + a) 24. 7 7 7c O b N p O O C2. W O ~ O m CD C)-P. CL O N O H W O q O Op i (D ti W O O ti Parcel 040-1160-50-000 12/13/2005 09:31 AM PAGE 1 OF 1 Alt. Parcel 25.28.20.627A 040 - TOWN OF TROY 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 - LINDALL, SCOTT A & NANCY J SCOTT A & NANCY J LINDALL 216 GLENMONT RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE SEC 25 T28N R20W 10 AC E1/2 111/2 SW NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 25-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1068/319 WD 07/23/1997 765/306 07/23/1997 693/112 07/23/1997 662/445 2005 SUMMARY Bill M Fair Market Value: Assessed with: 103283 17,700 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 10.000 17,000 0 17,000 NO Totals for 2005: General Property 10.000 17,000 0 17,000 Woodland 0.000 0 0 Totals for 2004: General Property 10.000 17,000 0 17,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1161-30-000 12/13/2005 09:30 AM PAGE I OF 1 Alt. Parcel 25.28.20.628B 040 - TOWN OF TROY 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 - LINDALL, SCOTT A & NANCY J SCOTT A & NANCY J LINDALL 216 GLENMONT RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 216 GLENMONT RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 20.000 Plat: N/A-NOT AVAILABLE SEC 25 T28N R20W 20A SE NW EXC E 20.01A Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1068/319 WD 07/23/1997 765/3Q6. 07/23/1997 -j693f1-t2-- \ 07/23/1997 662/445 2005 SUMMARY Bill Fair Market Value: ssesse 103291 315,100 Valuations: -----~ast Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 66,000 210,100 ~276,100 NO UNDEVELOPED G5 16.000 27,200 0 27,200 NO Totals for 2005: General Property 20.000 93,200 210,100 303,300 Woodland 0.000 0 0 Totals for 2004: General Property 20.000 93,200 210,100 303,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/27/2005 Batch 05-20 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~L WEST PART TROY T28N:-R.20-19W 13 e SEE PAGE 25 sme FP ° 2- -7.5 dwa"y c wnay" 72." ef¢/ C Qety F e 77nd.rrv 1'7.m61ch Q,fe stadt- LAKE M. 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Thomas ,T ee.ncM:::::.-s nx•; cc:: Str/ar-.e 2 T~+Crs:::::: 4B-s E ~7oh.~ J 160 0 -Dom o✓.B~ow,7 ~o~Ci 6 Leo, g ,a/U • ROLL I G /6$'42 .Pobf LMy~a N nF' w e~e~ °/E- 2744 Par 9,ZW 40 4Oan z14 .7 dqe /Ve'-A - /°a trio' e - .3. e Pea /so., • • Kosa .~.MGTS . • 30.4 PLAN /BO V/fw C r • µ/ebe~ /Z O A m /SO C~ ` 296' v Ulu ' 40 f~/vi ~C' ? i. Bo °vE N it. v F ~ F}' Sh Z : Q: e ` C C ova o o o c3 . n 7673 ~o h 14 .HF QE sta/ . H 0 E.D.° Ch:/dt K ye e 5 ci ~ C C J zz Bo "9 ~ - J ~/fs `"0 p ~ h~ Leo, Maw/n X ::h 4B Z~ h 0 tl~ 0 mb~usl- e r/°hoc.s p U Z~ /.'K f 6 i~/ G EB. 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Box 846 STEVE MOORE AGENCY Amery, Wisconsin 54001 f 732 North Knowles 715 - 268-7117 New Richmond 425-8989 246.2488 704 North Main Street Insurance Of All Kinds River, Falls, Wisconsin 54022 WEST PART TROY T. 28 N.- R. 20-19 W 's SEE PAGE 25 k~ Lya~ - °e 7 r dwand a Fa'w. uz F w /Na.Ja%' .2a7vh ~ ~ebent S W/'7ayen 72.6/e era/ C .C3ery i • ~ i Flnd.tw /%"'bach ,(3`je srizdt- ' LAKE • Ma a co yMC9~6a.7s era/ /sB. y6 2 A:1"' p O z dd O lN.i/ia.~[ ST CROIX ° e. qn/ ° y ` En/ e, T /B7 /z ~i Ze33Q 2 esux • 60.67 ~ 71 3 La 9/¢ay .s oM: fob ~.~~r 1Y RK • 77 ~ N • ~QI ~ `c ~ V Mcv a ar y /4y w d ff ~ ~ ~ ~ FF Co A s../ 2 40 /3/.7 F7/dc~ N ch 5 f F/om ~ Feye~eisen h Ro L 6 3.45 .Wi • y~ E -rw • t /y4 Z '.;d e~ E/.sf ~ .BCyoe~ ~e~ z 76 • B A f ene.;sen 672 O tQ~v ~a° •9as ~o 1 ~n z Tac.F No ¢ y ~ OIhN cS~` /ey E d an S'¢/mon .[,T Zo F 27 • R1, 7 3/3 6/ °dah/ R - h ° /,4.s /44 s s Martha H bant zo • so. ove SnAL:, rrACrs Mo/den- _Day Y 3r~ALl hQUen YaA¢YS' 9~- /do /55.2 ~ A : 2s. RO, 4 ~v 29. es o ri 6 cT¢cob N! 4o KFBHles W cSchoco BEACIA ~ cf' Thomas T Tf{q CT9 :st 4BS f John J /6o Bo -Z71- 2 ~ .Puemrn / 1,6 y ,goo n io7C% e E 260 e E ~ h ROLL/ G ' 942 Rob i' fMyna • qFf amen on/e_ W 4 Pa 19 z74 "I 'ZW 4a ao n 2,G.7 dqa NBwt n v. Pa/ fr d e u . e PBa/l50/7 9 /ex sMq` y_ eta/ 15" RncTy • ::+;ii5 ~ ,BO band L. /Bo • • iNahen 3 .4 PLA/N VIEW Coi /10 UI 296 UL 4o ft/vi ~C " ~~Pu _y a O uo WJ~~~ ~:3a e 767_3 ' ~y b3 Ir. s. ~ y ~ f. t d u w~ ~v'~ ~'y ~ a 5 : ~ ri s ~-ed sf o,E i l p ~ ~ 0 ' '4 c.s • De/ H lja yG. . E.D. .~`r[ oE'ness, ha:/dr ~ ~ x ~ z~ B°e ta/ "y J e ae h p ~ 9i G'eo. Ma.-~.. rs X :::y 0 tl~ 0 n bnusf e ~ohous ::V Z~oi9~Pen men,/ y,B. •RO.• sB. 477n ~3zo U - 1 .95 dye .mss. sz W ibe f A/d/ Vf =`Zv, 4i BS /67 /7{{o/tan PQU/S' ~oe.>.~ S' Leo 1 Knnbuc „6 F 9 `'No6 -9 Bohusma~ 0 Enl~ ~nisas, Ltd. 64e/ ~ tl'Qp c5'ta.r .B. 3M v rTen,r.~ys N f.z C'/ausen t'st5 C v ° ~6/-os none 76 /s.6 w h /s6.s h a ~sas3 ,eay Dusek L .ss c o~ 0 'DOE /y.3 J n,s s ~//and 3 i C Lro f h N D CiChHm~C~i c;/Cn `~F~I G~i X5/1 S ~s w. v. . /LWAC • Rp. esor, 4O F: 7T7nsr ~ Mo ~YBo 9~B c.Ffon MaP Pub/sy I¢1,.PeI/979P/ERCE COUNTY R. 20 W- I -R.19 W. st c o/x oun/y w,:s. J& J SALES AMERICAN FAMILY UNION STATE - Arctic Cat & Yamaha - WEBSTER, INC. Cycles & Snowmobiles AUTO NOME BUS/NESS NEALTH LIFE John H. Jacobson -Owner P.O. Box 846 STEVE MOORE AGENCY Amery, Wisconsin 54001 732 North Knowles New Richmond 425-8989 715 - 268-7117 246-2488 704 North Main Street Insurance Of All Kinds ' River. Falls, Wisconsin 54022 S AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. .FrTaN ADDRESS ST. CKO.IX COUN'T'Y, WISCONSIN. SUBDIVIS10N LOT- LOT PLAN VIEW C'2 0 Distances and dimensions to meet requirements of 1163 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM iTl- rn LL 6 __.Z c I aid r -J~L&-'mw M24 > 57 ~ S r -1+H1 • n I di at N r h rra w Aelt 1 ' ~v . v~ wOo~Y /nom kC r BENCHMARK: (Permanent reference Point) Describe: y Q~ / /°ASfllf41~ ~l{~los.0 ~ e~ Elevation of vertical. reference. point: Iat site: 110 SEPTIC TANK: Manufacturer: Liquid Capacity Number of rings on cover :__jV&-k e _ Tank manhole cover elevation: /vm.D Tank 1n.1et Elevation: Tank Outlet Elevation: ri'8ji g PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cyclc gallons; Total capacity of distribution lines- Balton: size of pump head; gallon per minute - horsepower --;brand name of pump and model number Type of warning HOLDING TANK: Manufacturer Number of gallons _ Elevation of manhole cover SliOW 1?vERYTHINC WITHIN 100 FEET OF SYSTEM Ve rn ' A; IV beA vf. re i 94 r- , a s /Ory ^ I di at N r Fh~rrqw 1 13ENCIIMARK: (Permanent reference Point) Describe: 12 ~~Q/sw ~~'/°Q w~O~ /saae~Cr aSS~ls~l~ t~{~• les.D ~ ~ Elevation of vertical. reference pointSlope at site:__/ SRPTTC 'DANK: Manufacturer: Liquid Capacity: LTA Number ail t 1.ug:j on c(Ivcl -Q tank m<inliul-a coven elevation: /4'm.0 -------Tank Inlet Elevation: Tank Outlet Elevation: y8, 33 PUMP CHAMBER Manufacturer:: Number of gallons Number of gal: pump set for a cvcle gallons; Total capacity of distribution lines -gallon: size of pump head; gallon per min~cte 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 of pits feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage it elevation feet. SEEPAGE BED SIZE: number of lines 3 widtlength 'VS depth SEEPAGE TRENCH: widt1 _ length PERCOLAT [ON RA'Z'E AREA REQU LRLll - j/~ AREA AS BUILT Q IN SPECr0It- --f-T. D A'r E D. __/Q___ PLUMBER ON JOB LICENSE' NUMBER: _,T~`~ _ ~ 7p~, F_ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7 69 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Numbe, lf assigned) ( ❑ Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPECTION DATE. Cano.2 n Gohtike R# 3, Box 42, Hudson, W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. LEY.: CST REF. PT ELEV. SF NW, Sec. 25, T28N-R20W, Town ojj Tnoy Name of Plumber. JMP/MPRSW Nn. 1C.-ty. Sanitary Permit Number: D. B. Fogerty 3289 St. Croy 43664 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAP ACITV. TANK INLET ELEV.'. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER D ^ ^ PROVIDED. PROVIDED ❑ Do 9 L, S2 YES ❑NO YES ❑NO BEDDING: IVENT DIA. y VENT MAT L. HIGH WATER NUMBER OF ROAD. PROPERTY WELL. BUILDING VENT TO FRESH / ALARM FEET FROM u(AIR INLET YES ❑NO G~ ❑YES ❑NO NEAREST I ----EGG} DOSING CHAMBER: C 1401 1 MANUFACTURER BEDDIN ILIOUIL) CAPACI iY 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 PROPERTY WELL BUILDING. I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROLINE AIR INLET PUMP ON AND OFF) ❑YES ❑NO NSOI L ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NI TH DIAMETER MATERIAL 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: WIDTH LENGTH IND OF JDISTR. PIPE SPACING COVER JINSIDE DIA =PITS LIQUID BED/TRENCH THE 7ES / M*T-E-R IAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO. 7R NUMBER OF PROPERTY WELL. BUILDING'. VENT TO FRESH BELOW PIPES ABOVE COVER ELEVINLE I ELEV. END I / PI FEET FROM LINE -y, ~ Al R6IN EFi. `5U '31 W% 1.3,5 W. v NEAREST s ~ '74 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENC77' D DEPTH OVER TRENCH: BED DEPTH OF TOPSOIL SODDED JSEEDED MULCHED CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH No.OCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TREN DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. JD~STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEVELEVDIAELEVPIES DA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING: FEET FROM __~LINE ❑ YES 1:1 NO ❑YES 1:1 NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNA UR E: TITLE DILHR SBD 6710 (R. 01/82) i. ,D•EPARTMENT OF' APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOReND PERMIT P.O. BOX 7969 ' IUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'% 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. Prop y Owner: Mailing Address: Property Loca ' n: City, V lage or I ownship: County: .2F t/a /aS iT " N/R E (Or A?e S Lot Number: Blk No.: ubdivision Name: Nearest Ro ,Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number of ❑~--,/Public* ❑ Variance* ❑ Other (specify)* - Bedrooms: V~ 1 1 or 2 Family *State Approval Required. / l , 3 Nom !nf 200,er /MO , TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench 30 Watteer, SS Ply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plu nature: MP/MPRSW No.: Phone Number: Plumber's Addr s Name of Desigr COUNTY/DEPARTMENT USE ONLY Signature o ing Agen F Date: j~ APPROVED Sanit y Perm/it Nu er: U ❑ 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 DILHR-SBD-6398 (R.07/81) Form - S T C 100 1 Owner of Property Location of Property Section T' N Ric' W ~C, ~c°Ca / ti c i .1 LLc c;t L sC, J,$ ~i~>>>. 171. Township J~ L%}~ ` J 0 ✓ Mailing Address Subdivision Name - Lot Number Previous Owner of Property. Total Size of Parcel Date Parcel Was Created Are all corners identifiable? l/ Yes No Include with this application one of the following: .Certified Survey Map .Deed .Land Contract, or .Other legal Document which describes the property PROPERTY OWNER CERTIFICATION 1 (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. SIGNATURE OF OWN _ SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNE DATE SIGNED p, '"'Wisconsin Department of tevenue WIS~~ONS!N REAXESTATE=CRANSFER RETURN gRAN0: ' ' GRANTEE: c4aTit IL To i Bwdta D. Te Name Carolyn Cohllice Name I ff I ~1 t Social Socugny Number (Voluntary) Suctai Security Numbar (Voluntary) ~ 1 ~ + • Full Address - New address if property transferred was residence Full Address R, , Hadrian 1 UAwjl In . S401b r nY w :Js grantor.related to grant"?.Relationshlp includes Name and address to which tax bills should be sent if not the same as above marriage; blood relative, partner lesseeaessor ~1(:~i 'y B 4:~ v co-owner?pa corporation ofloint owner ❑ Yes ~o rv i ~t3iY 7 s;; e•, t~» l -F3 _:.r t's'»• .,r.a. Other 'Granteelsr Indi47dua1 ❑Partnersiii Go rporsA' ti •Tele-phone::xGran tor-- a_ OrlC.".`~ir8nt6e {~.'.i. .J,'4) PART 1 =-PROPERTY TRANSFERRED s« - and/or fire number and/or `Check proper box and enter name of municipality and county Street address of property transferred include road name -t~ Village .own Croft Legal Description .(Fill in complete legal description in space below or if metes and bounds description attach 3 copies of-it as shown on the instrument pf ` , conveyance. ~f certified survey map number is used in description list town, range, section.and acres) n o - a t ,t of No.: Blk No Section Town Range: Plat Name-'-'..."...- Ns J`,f Ir ~ S.1 >,kYj.i V i i ...n ly r4M r 1 3 'i ,}p -Property Parceltilumlxr t c t:3 r«~fl ti 4t Cr? } t J t f~ag~l (-4ct3 ! + -L "1,~;ny 7 - A ° h s u~ V'~ • y; t.- { i v,':y ~y: y,.r. F' r .r~ y+ wa " ~.pg yj;~ ~ ~y~, ~ ~~•~~~-r ~e - IJ•G+~;ita• ~r.•i" tf ~ ':a ;'c 1 ~I.!i'+~i4+rt►is •1AM rt, i R 4^!wYa Y7 L: 3"?;~ v4 "w"ed. '31 t'. q... P++A ~ r ~ Ana _.t x~ ~ .t ,t,,,.s• tF t: aa. r`~Fr + ar' ~t .3,.-t. t.,L ly 4`, t ,'n ~ ~ ;.ei r'v t tiro y . > i j~ r2 xr a _ .tr t a $ : ti rr ' r Std T 11 If T?;• 4 d S - 1 h t 1 ~ W e 'Y 2 ~ ~ r ,a"; ~ ~ ~ ,g t. Y - ~ ~x ~ c { tiv f . 1 3.4 - ~ } i 5 ~ z .i ~ t't _"'t; x +iT`w ~.t, a_°~~3"T'`?iYii~'~"~>:~.?'.~~t~f"Y~'~"~:~'~94`^w`:.~df4~°2}? +•t,15 ;e"OV'~'xa~.a,`,,,^...nti„j' ta'•+h >;^•c_ ~"~,e ,3,? ,.r•. ~.,c-~1~-`a'~"z. a"''~w3s stYt :€a~`►es •.w'' s,3+' .f", t~4 z•4 PART 11- PHYSICAL DESCRIPTION AND,INTENDEO USE,; { 1 z irtdef Property; Residential Units ifan"y;'2 'Principal intendedUse 4 3, 1 an~:Area arils Type k Estimated ' ry a I + 8 t ot'si On 41 x A r x r [ z One Famil a: Residential d Agr~°`cti(tu H rid ly nd 3 ustrial l , e Recreational =yb rota Aches z f r[ New Constnictiprt`' i is ❑ 2 a tiniu , its ' rb. ❑ Commerc+a A f.:.flttter 1Ex Is 1 Tillage cres 4.or moreiunlts'4 in);; si x t rJnd P t q k ❑ Building Previously Used l-".' y 8:k yw &dx t'~s iiri"1a .M1 Wii7 ~.4. ACrBf 4 _°o Solar Design ' •c Rental " t . . e ❑ Earth Shattered Homa 't t =rte r t g' + F.C. Acrs t n El Condominium^. of Water Frotage PART III TRANSFERdAnswersmenyas apptyly r '"..'aa. c., "!,"t~. fir•y" •t~sr•,.ar -S•.a ;"'°a d."..+: *.P,,,.-"r„•.9.rfi+rr.,~w•• ,u; •7+yT,,,°R iiE':"ytir..hw.r7Xl' ~.:Wc ",Yn{lR,a '9"K"^ #,y ofrtarfdzontractt IVhatwacshe.dateHhebrlglnal:rlandicontractt F~ '7'. Safe` 2 Grftk•' u3 ©'Exchange # A: ❑Deedinsatisfaction , b`,Q 'Oth`er transfers (Explain below) S Owners hip interesi;iransferred ❑ Full -.~Other"(Explan below 7: WFiat~s the amount'of mortgage yssdmed t by>3rantee2.. $ r - $ Daes.the rantorret6in s of th 'foflow"in ri' `ts` r L a'es te` a mans ❑ done ` s *M-a;.;o.,,......,».,: ~.t~a,Sww~i,.~w~51A:wws ~nw*.w~ '.+gar'-:.~w,k^..yw•,..~._,,.y~.s•,..,`,:.~Z+e.ut,...,,•t-.~u.<wwxa«:, .c... k - ' PART IV -COMPUTATION OF FEE OR STATEMENT,DF EXEMP~;TIONt AFCs a 4 g qtr :`I 1 IM~.'- v,,t. Wi"t" w, . 'j' 7 M4.•%~v , 42 e 5tDo- N . Total value ofREAL,ESTATEtransferred:ii rir iese#ince"atc,roundedto:nexteven ttundred~Donot~nc1udepersonatpropert y► 2. Value`of personal property transferred but exeludid from )ilia 1 3, Value of tax exempt property (solui, wind, waste treatmont, mfg. M&t other) included in line 1 $ % t ' 4. TRANSFER EXEMPTION NUMBERA exampt.for Reasons 1-13 (cue jjnstructlon). t See 77 2 { ° ~r •"y . f t, N' y E t t a.a« t• f 4.` 'th >'5sr /w . sea b)<'~a nit / r ' r 5 :l ee T tFiirty cents per one hundred doilars fi"luei lin' "t3imss .0031Make, i ec(c b~e~tq`Regstetot,Daeds171"rtiss"~& i ;kir, Y,, tAt';?'q;"t a+ ~t rc 't"Xi~=:'±ttp9r.E±Ral'*r'"" 4"a., ;'ee#_3? ~a: . PAR Tv-CERTIFICATION r..... .,.rted d ,a..:yy,. [P9'"- y QLa, iyv,. ~y'ra4> K:The tranafer.rrtustbe rep,.o nee tlnformationt+or~ltftrsfietr(ft7a+trUl be used~o~dm tster=Wisconrrirf incomu.an Franchrserf {x e regarctleasbf ,thy rantors°state- ''Kf resi M1 M C=Tax Laws: Disclosure of;the`social securlty'bu bar-3s✓oluntary -,a ^s a' s r rri la ker,~y:•w„?.a«a N+'.wr~''K7' i•z'.r..k;:r- C~~b f rt f1 L w y sY iT.,e . ie e y, rn'llnclu`dirig'any-a8t F o1 nyi ngscheduie7 has been examirredbya{sand+:to'the best of our.knowi e Bean a Vye decla rlinderpenalty o{-lawr^t -rt.thisretu e-:, X X53 s:v v! r• isR+ ..~i A is true `correct and com late. er r I rs~• a t ka?= +C,ds" i,+ft`"- = ire I FA4i1 6= ,t, a .:yrxs 3' e r.,' not or y nt s Na _ Signature of antororAg t =Dalew- P T pe+Age me . Ke £X ~ tr `w M der yd,y at air ~3 t y aka ~r t Sx SIGN % . HERE r > n Print or Type Agent s Name Sisnature of Grantee or Agent r r ` Date V ty+t+t .t •2 r~x': r ..,"#'i x iir f .s•" Y,_ ~.S,i. "1 rw ~7 R ..t _a... ytw?r,a±a .:`a ;'h•. Rf. ,.•r'•Y -3 .-Document ~No,• x zr, ,Vol., (Reel) Page (Image) Date 'Recorded Date and Kind of Conveyance YuJ r, - LEA VE .J OU53 y '"`s+~cr°~. ~ w "445 2 ' t41+C ~t+R,'sl:' • aT~ ~ `x..$! lk .7; tyS C ux :,aLA >Z`Distnct #.:Assm~t~ist e~ THIS Parcel _Number< v 19 9';'r iCode.`,•Coun , (-Ta tr+r ,%trtr 2 'S aR .t.' a+.~Li ~Wi } _ 4 n3se,,, Reject' trwx.. c.`YF , t7 BLANK, r a.J W fail l i ` +l f au,.irK~ c`i-nrxs .l +'St#n t3ki; J~ Offica r~ .,,field. li r raUOn i`s t A B G .D r+ tE ` F" f f t'„- Rat o f Co,tde 1A.., ~,as. . h i; -u it d,a,fiib ..t, w c„YI~-mss M'3.'•,k + ,v e:=.- t +''•'•;f a ,.w,p M. « .k, I1:..o- r ♦ > ,a,r~.-ti $•4- Tgyd, PE-500 (R:'-11-81) c i~ + C; La ~v•t k x+ rw i a = xr .l .s+ r ' A 4 yr r,ri t s. pray :'rd, t ,Gw, School District N0: - - PROPERTY OWNERS 1COPY DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, c DIVISION LABOR AND PERCOLATION TESTS (115) MADISON W 7969 HUMAN- RELATIONS (H63.090) & Chapter 145.045) LOCAT!0'4: , SECTION: TOWNSHIP/MUNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: '/4" :1/ /T. N/R E (or)W COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRfPTION: IPR FI E DESCRIPTIONS: IPEHUULAI ON TESTS: ❑Residence ❑New ❑Replace I( RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: ISYSTEM-1N-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑u ❑ s ❑u I ❑ s ICEIS ❑u ❑ s ❑u ❑ s ❑u If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- B- B- B- _ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER D PER INCH P- P- P- P- P Y 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 P o i , ~ _ rr { ( t ,Y , d, pe Jt ~C k q, i a i o - J c r . , x fi I G ~ r i ( r IJ 71, 4 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 (print): TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): C, 5 ~ ~lGNATURE: l,Ul,a1"l-~~.~If:`~I ~'G'~Vj`:'i'' '>('il:~%y' , - . 7_. ~ DEPARTMrNT OF REPORT ON SOIL BORINGS AND SAFE Y & I INGS INDUSTRY,, DIVISION .LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 MADISON, WI 53707 ,,tt. (H63.09(1) & Chapter 145.045) LOCATION: SECTION TOWNSHIP/MUNICIPALITY: LOT NO :BLK NO.: SUBDIVISION NAME- , y /T 'N/R1t'E (ors'w COUNTY: _ OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: [AResidence New ❑ Replace ~c__ Z_/. RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) o s ❑u o sou DS ❑u a s au ❑ s EA } N(;11-f ev '-V If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate:'1 Floodplain, indicate Floodplain elevation: FEE 1 PROFILE DESCRIPTIONS /N 7 £ 1. 7` BORING TOTAL DEPTH TO GROUNDWATER-H#et#ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH>K, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) S o Av 5 B- -7,0 r?.tn co lt/£T '7 ~ ~N.SLi '~f B- //.Or' j NO B- r > 0 17 1134, /,D' 5'.I_ , 70' Pace-/34) .D/1y B l/ U FT NO D e r y' /U, , 10 /31), 5Z "'-/'J(, 6- A~ ~l 9~3 y F7' 13N, s~ f, 15 P,) 54 c 41 B~ /1.C" la~.yI/` r).A,). PERCOLATION TES S fr::' r TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER TidG#ES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH P_ z 3 y Z ll, 1-k f141 /a It v 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. 5' yS7E ,i./ iO/ 77," ^ ! z Fr r F/i t,,-l oa~ SYSTEM ELEVATION 9y v r- _ ( E E F }I f , 3 r € i t I r 1 I , i t C 5 S r, S ' To Cu T S ~ i~ -oso~ _ u,f// N~~ To / cv_ fo,~ j_ TN , i E ~ I ( I 3 "Apo - ~ , Oil 0A tat _ 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;bh L,d~ta recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: yy ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CJ1 Zr z- r C CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER