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E: O N b CD w W 7 C v O CD L Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildin @s Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353190 Permit Holder's Name: ❑ City ❑ Village Q Town of: State Plan ID No.: T w of Hudson v.:. n Insp. BM Ele� BM DescriQtio� r 10 , Parcel Tax No.: Z N 020 -1159 -212 73 3 TANK INFORMATION ELEVATION DATA Lo T Z 1 � TYPE MANUFACTURER CAPACITY STATION BS FS EL Septi 0� ADU Benchmark ' Dosing It B /D3. y k3D Z Aeration ( Bldg. ewer — & • 7 S Holding St/ Ht Inlet �_ ZS— 41.1-7 TANK SETBACK INFO ATION St/ Ht Outlet H /o TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake (Ali Septic 35 ° ! NA Dt Bottom Dosing --° T A Header /Man. Aeration NA Dist. Pipe HoIdiryg Bot. S stem # , f v PUMP/ SIPHON INFORMATION Final Grade GS p Manu urer errand St ov 3 Model Number GPM 2 ►� �y S7 TDH Lift - L oss JF ri ion system TDH Ft For am I Length Dia. Dist: l SOIL TION SYSTEM IZy,_f,(�.� Be TREN Width , Length , '��` f enches PIT No. Of Pits Inside Dia. Liquid Depth DIM EN I N 3 of No. 3 DIMENSION SYSTEM TO / BLDG WE LAKE/ STREAM EACHING Manufacturer: SETBACK INFORMATION Type Of _ CFIAMBE M e Number System: �j, 35 S 1 OR U — *,u DISTRIBUTION SYSTEM OAa h - 7 ,r , Header / ifold Distribution Pipe(s) x Hole Si x Hole Spacing Vent To Air Intake length QQi Dia. '4- i Dia. Spacing — L ) r SOIL R x Pressure Systems Only xx Mound Or At -Grade Systems Only pth Over I Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Cent r Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No M S: (Include code discrepancies, persons present, etc.) Inspection #1: 11 / 03 / 00 Inspection #2: Location: 917 Daily Road, Huoon, WI (SW1 /4, SW1 /4, Secti n 16 =29N-1�12W) - 1 .29.19.2118 cw* 3 9G v 7 se PI Yes No se other side for additional information. (� Q� GUS-% P s i SBD 6710 _ Date J����" v Inspector's Si nature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a 7 g i y b ¢ i I ! I � _ �� q I } i . _ r — e b i = r � < 3 i i i � � � i I I � .. _ i a i t i ? i .._ «.�e.m ... .n:..m f.., ... . «...., 4 .. .de........,:,�. md.. �.m e . _ ... ! E }. ......... m. g .. am,,.e. e . s � .g..... .. . , . 9dw.. _...�. ,..,. ....,.». .gym .� ........»�.. ., ...........� �...,a..«. ,� y.me �.� .. .... t s �.... �.�.....» .................. ......A�....,........� .m g.»e..m.,..,.3»...,,. ( a.� «NOVAS-...... � d� ®d....i.. ..,w„+a....®.e. mX ®. .,A 6�. u.,.,... € ..A.�4....... �a.._..�.,_......J �..... .��..�.®.d�,a�eJ�.�...�- e+.b,., �&.....««.a e� 1 Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue W ` , isconsin P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. -{ 3f0 i • See reverse side for instructions for completing this application State Sanitary Permit Number 3 5 MIDI Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION I - Property Owner Name Property Location 'R tC1" Lo_ �° a � C_ 1 /4 �(�� 1/4, S j (a T o ? q , N, R jq E#e�j Property Owner's Mailing Address Lot Number Block Number 43 l 1 r , ...t Rc7 Uc l QC -- City, State Zip Code Phone Number Subdivision Name or C M Number 6 sor , WT- 5 �-} ► (°7 /S> j -s R ru o�c'cl - a rad r etzc « ; 11. TYPE OF BUILDING: (check one) ❑ State Owned Nearest Road Lj Public 14 1 or 2 Family Dwelling - No. of bedrooms 6 Town OF I - �uC�SJn >a 1�oc C3 III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Nu er(s) 1 ❑ Apartment/ Condo « I �O' �� ( o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ 'V New 2 ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an ______System ________System____ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 eepage Bed 21 [] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade O© Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq_ ft.) (Min. /inch) Elevation Cl // q,3. 9 Feet Feet TANK capacit VII- INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con Steel Fiber- Exper. Gallons Tanks Concrete glass Plastic App New Existing structed Tanks Tanks Septic Tank or-Weld Rg Tank 1 wirb A llylo wdl t 13 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber a ❑ I ❑ I ❑ I ❑ I ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) er's Signature: (No Stamps) MP /MPRSW No Business Phone Number: C aas PI si '7rs 4133 6 5 Z- / Plumber's Address (Street, City, State, Zip Code): $ y 1 5 1-H-) t. _R lvL1r Fa 5qo Z, IX. COUNTY / DEPARTMENT USE ON ❑ Disapproved S nitary Permit Fee (includes Groundwater ate Issued Issuing gent Signature (No Stamps) pA pproved ❑ Owner Given Initial �� Q Surcharge Pee) � � Adverse Determination 1 / 10 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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. 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. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIIL 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. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic. tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; 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; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through thesesurcharSes are used for monitoring groundwater contamination investigations and establishment of standards. t A i _i ti G � r t)auo •� C LC' `` 3 ul, —7/ / f 7/0 t, �4 L� r Wisconsin Departrnent of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations _ — Division of Safety & Buildings in accord with IL.HR 83.05, Wis. Adm. Code COUNTY Attach complete, site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST • C7 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O ZA - 1oZ-9- 4 Z APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION R IEWEDBY� o n DATE PROPERTY OWNER: \Z, tC\1t..p `h C1 a E PROPERTY LOCATION ivy S ti 0 v Ot R4 b 6e 00\A r, CA 3. GOW. 1:� S w 1/4 SW 1/4,S 16 T 7 ,N,R 19 E ( w PROPERTY OWNER':S MAILING ADDRESS, LOT # BLOCK # SUBD. NAME OR CSM # all 'ft�r- V\-VKJ 1Z.ap�v ZZ - PRUpOsn) - p fa(Rkwaub M&dN ,) S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN ' NEAREST ROAD �KM SG" IAJI Su01(, (7tS }381 - 5�1g5 11�SUN bpqt New Construction Use Residential / Number of bedrooms 6 [ J Addition to existing building (] Replacement [ J Public or commercial describe Code derived daily flow 'Di 00 gpd Recommended design loading rate bed, gpd/ft • 6 trench, gpolft Absorption area required \Z 5 6 bed, ft S trench, ft Maximum design loading rate bed, gpd/ft • g trench, gpd.4t Recommended infiltration surface elevation(s) 9t4-1:3' o2 lil61'r it (as referred to site pian benchmark) Additional design/ site considerations MIA 3 /- w /H1Gt+ CA - PAWY SiDEW"D� tXM4 a3eZ5' Parent material Sfq- dv fz3 t4 Flood plain elevation, if applicable M A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem RS ❑ U KS ❑ U IRS ❑ U 21 ❑ U IRS ❑ U ❑ S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch �<s �:<- a -`t3 1.0`1 R Zl Z - L Z�SU� wt�� �S - . S • � R i ry� Z g ►O`1 uZ 3I C - L 7,W) Sbk " s - • 5 • L Ground 0 19' s ft y' m - lo LD�2R Ylb - S O S�j ..I !'!I� .� •�b Depth to limiting , .. factor V t OaM Remarks: Boring # Z �: .Z 8 - l9 . t �`•t ►Z 3l � � L Zwl s bk m'�� cS - • S ' � j i 3 t9 - \ob tO'Lr tZ_ t/ /6 S 0 g� r,, ] - • `a Ground elev. 9 9-1 n Depth to limiting factor r 7 t V Remarks: TName:- Please Print Arthur L. We erer� 715 - 425 -0165 '. re ' errer Soil Testing & Design Service - P.O. Box 74 River_Fa11s,WI. 54022 _ Sgnature: �! J Date: �. CST Number:. 1S ' �9 220254 I PROPERTYOWNER SOIL DESCRIPTION REPORT Z • Page _ of 3 PARCEL I.D. # 0 LO^ 1 OZ9 - L4 Q) Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft In. Munsell Cu. Sz. Cont. Color Texture Consistence Boundary Roots ed Trer Gr. Sz. Sh. B� 3 o -� V��-tkZ 2.LZ Z�sbh Ground 3 2S-N Ill `j R y/4 - S elev. � • I tt, Depth to limiting factor Remarks: Boring # CS $ -�s 1 tI L R.. 3/6 Ground elev `r $ ft. Depth to limiting factor f > Remarks: Boring # %* rn 0-g s 6 ,S 2 -1 b ,10 2 j16 L IM sbk r1 `�1. S , Ground 3 - 4 -�7 ft. Depth to i limiting factor i i. � r Remarks: Boring # Rn I Ground i elev. # ft. Depth to - limiting factor f Remarks: 1 PLOT PLAN Page 3 of 3 SCALE 1 "= 60 ' 8Y"1�l - Lt-- L00.O ON \`' �\�oN pLPL LOT �OR7U�I2.- �jt►S� lU �� R T �_`�! � ZSuwl sH g� _ pm-t`A W X11. K ti 's tJ N s.s 1 - 6.2 - — E•3 I r l t —� 9q_�36 - �, 'ZZ 5 y ( 715 ) 42A-0169 CST Signature Date Signed Telephone No. CST # r Wisconsin Department of Indus SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations - - Division of safety 8 Stfi ings in accord with IL.H R 83.05, Wis. Adm. Code. . COUNTY Attach complete. site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST CR�1 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' 0 z- 13 Z9- d APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY GATE PROPERTY OWNER: \-h chsS P PROPERTY LOCATION $ V� - S%LV � 7". F8VT -1� Sw 1/4 SW 1 /4 1b T Zq ,N R 1q E( W �R D 6� OtAvs co , PROPERTY OWNER':S MAILING ADDRESS • LOT # BLOCK # SUBO. NAME OR CSM # all rnft r_ V& llzzp�v ZZ -- ?MY0 l) - pPCitlrt_wtxh) "&rbpw S CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE 9 TOWN ' NEAREST ROAD . SON, hVI SLIO1 New Construction. Use Residential / Number of bedrooms 6 [ J Addition to existing building [ ] Replacement [ J Public or commercial describe Code derived daily flow �QtZ gpd Recommended design loading rate bed, gpd/ft' - trench, gpd/ft Absorption area required \Z 8 6 bed, ft \ \ 2 S trench, ft Maximum design loading rate %") bed, gpolft trench, gpolft Recommended infiltration surface elevation(s) aU - O * o2 ! 6lt It (as referred to site plan benchmark) Additional design / site considerations - fMC ES M%A 3 i­IS'LM)6 w /MlGtE c 4 ?ACXi`f S1DEWUV Diu LLY off �3L'�' Parent material S `•f - o J"' f�a h Flood plain elevation, if applicable f'J A It S = Suitable for system CONVENTIONAL MOUND W -GROUND PRESSURE AT -GRADE snum W M HOLDING TANK U = Unsuitable for stem as [I U K S ❑ U ® S E] U ®S ❑ U RS 111.1 ❑ S L$U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou, Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Tench L z,`�s w1�1 -• cs _ . s • � ' Z g=tg ►o�1vz 31c� _ L Zw�sbk �n�� es — • 5 •� Ground 3 2$-tl $ S Lt lZ '.�N L y S o S5 h�) e S — �' 9 9- s fL y M-168 - ccZ VI L — S 0 s9 m 1 - •� € •� Depth to limiting factor Remarks: Boring # ) ° -� \o`-t 2 it z — 2,`�'s bi ►� `F� S _ CAI Ground elev. 9 -3 1L Depth to limiting factor b h - Remarks: CST Name - Please Print Arthur L. We erer 715- 425 -0165 C. egerer Soil Testing & Design Service -P:O. Box 74 River Yalls,1I1 54021 . Signatue: � /, Date• CST Number. 1, tit: LL- 71�.z t � q9- 136 -2-Z 220254 I 1 PROPERTYOWNER SOIL DESCRIPTION REPORT Z 3 PARCEL I.D. ()U 1 OZ - y Q • Page •_ of Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont Color Texture Consistence Bour>dary Roots Gr. Sz. Sh. Bed Trench D —� 10t�Z ZL2 _ 2.�S "b k L Z, rn stilt )rt `fit• cs • S -b Ground ll1 `J R y/6 — � I ft. Depth to limiting factor � ►off Remarks: Boring # z-[ - L Ground elev ` ft. Depth to i limiting , factor Remarks: i Boring # � 0 -8 tb`�R z[z. � L 2`�.s1�)z Y✓1'Fj,. c.S .S 6 3 t6 -��3 ►t�YIZ. 4�/6 — S � sg Ground — •� ! e ev. a ft. ! t Depth to i .limiting I factor Remarks: Boring # v , Ground elev. ft. I Depth to - t limiting factor Remarks: r r•rl n., •inrn .'.r •• .� _ PLOT PLAN Page 3 of 3 SCALE 1 "= by ' �. DPri u-r L2C P _ — li,M - 2 -- ez , g9 13' k k �pvS� lU Ue Pn UdtsT ZS ' F '7,GH s`1 ttEy -i H Lt \ t A y c g.s �L9°► a � ti 6M1i!-I 9q -136 _ 2.2. n "ZZoIsq 16 1a4., . �y� 6_1.S -�`j ( 715 ) 47.5 -0169 CST Signature Date Signed Telephone No. CST # SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Chamber Soil Absorption Systems Permit Number 10/25/99 Date X ° X ° Gravity Distribution only 1 Pressure Distribution 3 ft Suitable Soil , Note 1: Bury depth as per manufacturer 18 in Chamber Height 2 8 ft Maximum Bury Depth 3 900 gpd Estimated Daily Peak Flow 0.80 gpd /ft Wastewater Infiltration Rate 1125.0 ft Code SAS Size 40 % Down Sizing Credit 450.0 ft Reduction ( -) 675.0 ft Min. SAS Size 93.80 ft Proposed SAS Elevation Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 96.80 103.30 �j 1 99.50 108 93.50 97.33 Yes t3 2 98.80 99 93.55 96.63 1 Yes S 3 99.00 103 93.42 96.83 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is equivalent to top of aggregate. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. SBD- 10553 -E (R.05/98) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1 Mailing Address E �!! ��9rZr,�� � a Property Address a t I — ac (Verification required ram Planning Department for new construction) City /State Parcel Identification Number i.F DESCRIPTION p. property Location 1 /4, S�' /r Sec. �, T °Z 1 N -R W, Town of Subdivision f '4izL w ao 1 ocuWj s Lot #• Certified Survey Map # _ , Volume Page # WirrAnty Deed # 123 . Volume I SO L ( , Page # • .�.• Spec house,0 yes 0 no Lot lines identifiable 0 yes ❑ no MAINTENANC Improper use and maintenance of your septic system could result in its premature fail to handle What Proper o mainte yst6 consists of pumping out the septic tank every three years or sooner, if needed by a licensed umpe • Y P 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 tha certificati l site w by t tet sal by & mastor plumber, journeyman plumber, restricted plumber or a licensed pumper verifying ( ) the is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank's less than 15 full of sludge. I/we, 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 WisconsO�Certificatio stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three year expiration date. S /LIIQ� 4/�� e,0A15/. C �31� DATE SIGNATURE OF APPLICANT O CE TI � N I (we) certify that all statements on this form are coo the b st of m of Deeds wl0dcee. 1 (we) am (are) the own er(s) of the property described above, by virtue of a warranty decd i Reg i s te r DATE SIGNATURE OF APPLICANT *0 * Any information that is mis representedmay result in the sanitary permit being revokedby the Zoning Department. **s * *s ** Include with this application: a stamped warranty deed from the f ° t r re ma 0 in c warranty deed a copy of the certified survey map /v V0►: 1464PAGE347 STATE BAR OF WISCONSIN FORM 1 — 1982 612350 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. �j ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Howard LaVenture, three — fifths 11 10 -20 -1999 9:00 AN (3/5) interest in and Arlene LaVenture, two — fifths (2/5) interest in, as tenants in common. ; EXEMPT 1 DEED EXEMPT M 17 Grantor, �; CERT COPY FEE: C CO FE E: and t.a a ss a ry tom Hntne s , Ire i TRANSFER FEE: j! RECORDING FEE: 10.00 i PAGES: 1 i; Grantee, Witnesseth That the said Grantor, fora valuable considerati i I� THIS SPACE RESERVED FOR RECORDING DATA �I conveys to Grantee the following described real estate in St. Croix I F _ County State of Wisconsin: NAME AND RETURN ADDRESS I ii ti I i 1 LOTS 22 & 23 OF PLAT OF PARKWOOD MEADOWS, TOWN OF �I HUDSON ST. CROIX COUNTY, WISCONSIN li I� �I PARCEL IDENTIFICATION NUMBER ow 3 _ This deed is given in partial satisfaction of certain land contract dated February 19, 1999 arid recorded in Volume 1404 Page 616 as Document Number 598116 which was subsequently assigned by assignment dated May 28, 1999 and recorded in Volume _1 Page 352 as Document Number 604323 This is not homestead property. (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor ! warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all liens, covenants and restrictions of record, if any and any liens or' encumberances created by act or default of the Grantees and will warrant and defend the same. Dated this 14t day of October 19 99 (SEAL) (SEAL) * � Howard LaVenture (SEAL) X (SEAL) u * Arlene LaVenture AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. County authenticate of October 19 99 Personally came before me this day of 19 , the above named * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S.C. by Walter Hodynsky + 20 4 Locust St. PO Box 125 Hudson, WI 54016 Notary Public, County, Wis. � (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary) 19 .) . _.._ ' Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. 6ttANTY DEED Form No. t - 1982 Milwaukee. Wis. Ai l 2Fond Rock. WI 1- 80 0326-8 i-8 la , 1.5937 W mnese e.Nm SC s � &,cp— or- S (Z I� 1z 7 o I 3S I i Project Nome: CA3SE Conyxrtatioi : V Dal - - - -- - - - Location: d� ZZ - ew Checked B%: -- Datc: Pored i, vac S Title/hem: sheet: of: ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT s r a r rme slant ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715)386 -4680 Fax (715)3864686 Fax TO: A From: L c--v J A J C, 214 g i4 Fam S — 9' — bp i T Page ( 2 ) Phone: 4D Z - 60 Date: M q-Y� I q , 200 3 Re: CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle • Comments: t Parcel #: 020 - 1386 -02 -000 04/10/2007 03:37 PM PAGE 1 OF 1 Alt. Parcel #: 16.29.19.2374 020 - TOWN OF HUDSON 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 - HETCHLER, ROGER E & MARY I ROGER E & MARY I HETCHLER 726A WALDROFF FARM RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 917A DAILY RD / ,, n SC 2611 HUDSON n IF I L A cklj- . SP 1700 WITC l / Legal Description: Acres: 2.011 Plat: 2287 - PARKWOOD MEADOWS CONDO 020/01 SEC 16 T2 19 T SW SW PARKWOOD Block/Condo Bldg: LOT 02 MEADOW LOT 2 433AC NKA PARKWOOD MEADOWS OMINIUM UNIT 2 2.011AC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)� /b (SOUTH UNIT) 16- 29N -19W SW SW ! 7t Notes: Parcel History: Date Doc # Vol /Page Type / 08/30/2004 772961 2645/616 SD / d Oil 07/23/2003 731733 2328/506 l � 07/26/2001 652170 1687/578 AFF FF 06/01/2001 647118 1651/298 WD more 2007 SUMMARY 0 2W Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.011 77,000 149,200 226,200 NO Totals for 2007: General Property 2.011 77,000 149,200 226,200 Woodland 0.000 0 0 Totals for 2006: General Property 2.011 77,000 149,200 226,200 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 543 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 020 - 1386 -01 -000 04/10/2007 03:37 PM PAGE 1 OF 1 Alt. Parcel #: 16.29.19.2373 020 - TOWN OF HUDSON 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 - BLAKE, THOMAS & NANCY THOMAS & NANCY BLAKE 917A DAILY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 917B DAILY RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.423 Plat: 2287 - PARKWOOD MEADOWS CONDO 020/01 SEC 16 T29N R1 9W PT SW SW PARKWOOD Block/Condo Bldg: LOT 01 MEADOWS LOT 22 3.433AC NKA PARKWOOD MEADOWS CONDOMINIUM UNIT 1 1.423AC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) (NORTH UNIT) 16- 29N -19W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 07/23/2003 731730 2328/498 QC 10/01/2001 657810 1728/326 WD 05/23/2001 646269 1/66 CONDO 10/20/1999 612351 1464/348 WD more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.423 63,200 149,200 212,400 NO Totals for 2007: General Property 1.423 63,200 149,200 212,400 Woodland 0.000 0 0 Totals for 2006: General Property 1.423 63,200 149,200 212,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 563 Specials: User Special Code Category Amount es Special Assessments Special Charges Delinquent Char p P 9 q 9 Total 0.00 0.00 0.00 0 ■ o c - � o E ■ c (gn E ° ; k -0 T � 7 f \ _ r ■ cn Z 0 ■ C E 0 ° m E c» 8 - . 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