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HomeMy WebLinkAbout038-1206-80-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 463461 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: Kosin, Chris & Rose Star Prairie, Town of 038 - 1206 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range /Map No: / YS �'� 14.31 . 18.1113 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER � CAPACITY STATION BS HI I FS ELEV. Septic � a 6 - 3 4 I&I-tj /M AI - 1 - 6 - 0 7d Z• L Aeration Bldg. tewer 79(a `Ib, Holding St/Ht Inlet q TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 24 1 I Dt Bottom \ Dosing Header /Man. s6. T 5 . �1 Aeration Dist. Pipe B .97 CM , 41 7 5 If Holding Bot. System /O • / 9 4 7% 7_5 0 L Final Grade 1 � PUMP /SIPHON INFORMATION d ,� t L � - 1 166 • 7-5 Manufactur Demand St Cover ` L4 • Q /66 � � 1 ,Z Model umber TDH Lift Friction Loss ead TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 9 CZ — Ice C SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: t INFORMATION CHAMBER OR id ` Type (System: / ((��yy��,� VA_ UNIT Model Number. DISTRIBUTION SYSTEM SaA� Header/Manifold I # Distribution x Hole Size x Hole Spacing Vent to Ai tales S.1 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 eded /Sodded xx Mulched Bed /Trench Center W \ xx Se .� 1 Bed/Trench Edges Topsoil �- J Yes No Yes N], COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2160 127th Street Star Prairie, W�-WII-54 26 (SW 1/4 NE 1/4 14 T31N R18W) Prairie View Estates Lot 18 Parcel No: 14.31.18.1113 1.) Alt BM Description = �(� p a— r, . �� -- o -66 6 & 2.) Bldg sewer length = Zq GaJel� O�f�D�nJ� T.�16��"'N� - amount of cover = 14 V p - Plan revision Required? Yes No Use other side for additional information. Date I r Insepctor's Si ature Cert. No. SBD -6710 (R.3197) Safety andLEWI& ` 201 W. Was rn nv,1 O 1 n in Madi I 7 - 7162 i Permit Number (to be filled in by Co.) SCO s 266 -3151 Department of Commerce Sanitary Permit Application ' Nj`( Te PIanLD.Number In accord with Comm 83.21, Wis. Adm. Code, personal inform tion yWp 1XCOU may be used for secondary purposes Privacy Law, sl5 (Ixm1ON1NG OFF Pro t Address (if different th lai1in ss) -° 7-W 21( 12� !� I. Application Information - Please Print All Information Property Owner's Name l/ Parcel # ( Lot Block # Property Owner's Mailing Address Property ion .2 © ( J O � ` � •�� y, � /e, City State / Zip Code Phone Number Section /''!i/7/Ie�t O( /7 Sal ",ja ✓� J� 7N R ) II. Type of Bui ing (check all that apply ; �S �' Subdivision Name CSM Number �1 or 2 Family Dwelling - Number of Bedrooms 11 Public /Commercial - Describe Use G(f r 1 4 t? kJ ❑ State Owned - Describe Use ❑City_ ❑Village wnship of r IIl. Type of Permit: (Check only one box online A. Complete line B if applicable) 0 g' _ Zp A. gNew System p y g p Y g Ys ❑ Replacement S ❑ Treatment/Holding Tank Replacement Only El Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl Y Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chat9ber ❑ Drip Ljjr, ❑ Gravel - ess Pipe Other ( plain) V. Dispersal/Treatment Area Information: o Z S Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) stem Ele ion VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units c.A �,.n�-�� Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank a �n LtJe e Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Pri nt) / Plumber' ignature MP/MPRS Number Business Phone Number r c/ r- I G %fin 1 er's Address (Street, City, State, Zip Cod VIII. County/Department Use Onl Approved El D d Sanitary Permit Fee (' cludes Groundwater Date Issued I uin g ent Sign Stamps) Surcharge Fee) �j� ❑ Reaso ia_I 3� _ �0 ""�J IX. Conditions prAppro v SYSTE ER: 1 Septic tank, effluent filter and dispersal cell must all be serviced ! maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in site SBD -6398 (R. 01/03) PLOT PLAN PROJECT Chris Kosin ADDRESS 520 2nd ave SE ant. 302 Minneanolis Minn. 55414 SE 1/4 NE 1/4S 14 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 s� DATE 5 -10 -05 BEDROOM 3 CONVENTIONAL XXXX At - rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 642 # of chambers 22 IL BENCHMARK V.R.P. top of 1" pvc pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H,R,P Same as BM Vent SYSTEM ELEVATION T -1 =947 T - =94.4 > 12" Of Bio Diffuser with Cov 3 1. 1 ft ^2 per chamber 6" Long 34" Elevation PL B B B2 Lj 42' �T 10' 87' B3 1� 25' PL O ob pipe st 15' 3 bed house 20 ' , co well Driv a i PLOT PLAN PROJECT Chris Kosin ADDRESS 520 2nd ave SE ant. 302 Minneanolis Minn. 55414 SE 1/4 NE 1/4S 14 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 , � 5 - 10 - 05 BEDROOM 3 DATE CONVENTIONAL XXXX tit rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 642 # of chambers 22 BENCHMARK V.R.P. top of 1" pvc pipe ASSUME ELEVATION 100 ❑ BOREHOLE O WELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =94.7 T -2 =94.4 >12" Of Bio Diffuser with Cove 3 1. 1 ftA2 per chamber 6" Long 34" Elevation PL 44' B B B2 42' 10' K9 U B3 J -_ 25' PL O ob pipe st 15' 3 bed house 20' well Drive a -� • Wisconsin De .p artment of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Cr oix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, andr6cation and to nearest road. Please print a Information. levee y Date Personal information you provide may be usec secondar)(„purps*s (Privacy Law, s. 5.04 (11 (m)). (m)). _ k w G Property Owner f ° -'- ` Pro erty Location Ewlen Properties, d ! ` ;Go Lot SW 1/4 NE 1/4 S 14 T 31 N R 1 8 R (or) W Property Owner's Mailing Address ' 1 ot_ Block # Subd. Name or CSM# 1 22 ve S � �`'�`�' 1 na Prairie View Estates City State Zip C �, O ode\ Phon g� J FFICE City ❑Village Town Nearest Road NEw Richmond WI. 1 54017 (,745 248 -731_ Star Prairie I = "C" �Vew Construction Use: U Residential / NumtibrtiCb' Code derived design flow rate 600 GPD ❑ Replacement , El Public or commercial - Describe: Parent material c> u1 sh Flood Plain elevation if applicable na ft. General comments and recommendations: trenches @ el. 94.70' ❑ Boring # Boring 99.90 1 [� pit Ground surface elev. ft. Depth to limiting factor +110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -9 10 2/2 none L 2msbk mfr cs if 5 8 2 9 -20 7.5 4/4 none scl 2msbk mfr 9W if .4 .6 20 -33 7 5 4/4 none sl 2msbk ml ClW na .5 •9 4 33-110 7.5 4 6 none ms 0sq na na na •7 1.2 2] Borin Boring # 99.70 +110 in. ® Pit Ground surface elev. ft. Depth to limiting factor = GPD/ff Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. k mfr rq 1f - - scl 2ms bk mfr ClW if 4 6 3 36 -50 7.5 4/4 c2 7.5 5/16 s jl M na qw na .0 .0 -11 7 5 4 6 none ms os ml na na •7 1.2 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L qnt #2 = BOD 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature X / "1 • CST Number Gary L. Steel 02298 Address Date Evaluation Cc ucted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 12 -1 -2000 715 - 246 -6200 1 ' I Property Owner. Ewlen Properties, Ltd Parcel ID # pending Page 2 of 3 [] Boring Boring # ® Pit Ground surface elev. 1 0 110ft Depth to limiting factor +110 in Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 -10 10yr 2/2 none L 2msbk mfr cs if .5 .8 2 10 -38 7.5yr 4/4 none sicl 2msbk mfr gw if .4 .6 3 386 -5/4 none sicl M na ClW na .0 .0 4 52 -11 7.5 5/15 none ms osq ml na na .7 1.2 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # E] ❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD4330 (R.GAO) t STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Ewlen Properties, Ltd. New Richmond, WI 54017 `�4�4 S14 -T31 N -R18W 715 MPRSW -3254 ( ) 246 -6200 town of Star Prairie lot #18- Prairie View Estates This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. IV. 1 " =40' BM..= top of 1" pvc pipe @ el. 100.00' Alt. BM.= top of 1" pvcpipe @ el. 100.20' � U70 f r\ to' Gary L. Steel 12 -1 -2000 POWTS OWNER'S MANUAL &' MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r r %. O /G� Septic Tank Capacity I E3 NA Permit # / Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS I , Effluent Filter Manufacturer 6� ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 4-� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) b gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) p -a gal/day Pump Manufacturer ❑ NA Soil Application Rate al /da M! Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly, average Dispersal Cell(s) ❑ NA Ox D (B OD,,) m /L ❑ In- Ground (gravity) ❑ In - Ground ( Bio chemic a l en errand OD ) ( 1 9 9 tY ( Y9 s . Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: _ Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA I MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) 121 NA A' - y ear(s) bin e and scum equals one -third (Y) of tank volume ❑ NA Pump out contents of tank(s) When combined sludge q 3 Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: -0 fnonth(s) ❑ NA j ir year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once eve ry: ❑ month(s) 13 NA ❑ year(s) Other: At least once every:' 0 month(s) ❑ NA Other: ❑ NA 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. Lank 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 on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for Any po nding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th, immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the e contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service rep within 10 days of com pletion of any, service e ort shall be p rovide to the local regulatory authority wit P P P Y 9 ry rltY GMW (4/01 Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have me 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 above.normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(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 Operator 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 cells. 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; foundation 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 withdhapter 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. ❑ The 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 systems 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 MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 4^t1 y, r Name G Phone / Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY . Name Name fro. Zoe i . Phone O Z C / Phoned 6 �� 2 b 1 � and 83.64(1), (2) if (3), Wisconsin Administrativs Code. This document was drafted in compliance with chapter Comm 83.221 it it )(d ) (fl ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address �� �/ fT �� �a ���C``0 t-�G �i �S �l7 Property Addres (Verification required from Planning Department for new construction) city/State Parcel Identification Number LEGAL DESCRIPTION Prop Location f,J /., ,Sec. T �J �W, Town of pay �lJ� ` / ' V4 T N -RZ ►� Subdivision /�'7"Gc i ✓ r < <� s "{ , Lot # Certified Survey Map # Volume • . Page # Warranty Deed # '7 7 . Volume Page # d Spec house ❑ yes Of no Lot lines identifiable-M yes ❑ no SYSTEM MAINTENANCE 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 lick pumper: What you put into die system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpamper verWing that (1) the on -site watstmalord4ma Wtem is in proper operating condition and/or (2) after inspection and pumping (if nxessary), the septic tank is less than 113 frill of sludge. Uwe, 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 Department of Natural Resources, State of Wig. Cartifieation stating that your septic system has been maintained must be completed and returned to the St. Croix County Zolag Office within 30 days of the three y expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION the owner(s) of I (we) certify that all statements on this form are true to the best of m y (our) knowledge. I (WO am (are) the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * *** * * the revoked the . Any information that is mis represented may r esult in the sanitary permit being by Zoning Department. •* Include with this application: a stamped warranty deed from the Reglater of Deeds office a copy of the certified sarM map if tefbrenee is made in the wansnty deed I U. 2 6 9 3 P 4 0 9 7-7`3E'i,8 tl STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIK CO., WI ' OR F RECEIVED RECORD This Deed, made between EWLEN Properties. LTD.. a Texas RECEI RECEI ED F 0 R E CORD Limited Partnership Grantor, and Christopher R. Rosin and Rosemary A. Kosin WARRANTY DEED Grantee. EXOPT # Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.80 the following described real estate in �St. Croix County, State of Wisconsin TRANS FEE: 116.70 (if more space is needed, please attach addendum): COPY YF FEE: Lot 18, Prairie View Estates, Township of Star Prairie, St. Croix County, PAGES: 1 Wisconsin. Recording Area Name and Return Address 03 8-12064;0 -000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and right -of -way of record, if any. Dated this day of_ 2004 * * BY: Paul Ande rson * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ---) ) ) ss. - — County ) authenticated this day of _ Personally came before me this - 5Q day of July 2004 the above named EWLEN Properties, LTD., a T exas Limited Partnership, BY: Paul Anderson TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of My Co fission is permanent. (If not, state expiration date: (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. �P!�! 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