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HomeMy WebLinkAbout020-1445-01-000 Z $ 03 6e, N c N O "a 1 C ~ c I O `V Mn I C 5D ~ O I C t Q Z 00 o° ° z z M c Li o o a 1 o O a > Q I I v ' y I 3 z H Q, w £ U) i ° I o N a co ~E-z c o I a z v c o N 2 d c to t- c CD z E 72 N y M N a O O N N a) N c O • ~l O I'' C C Q U 0 z H z O N Z0 : C C O « O : O c N c a N m U) U) E cn Lo H F F O o c :3 0 0 0 m z o •►v o ~CL CL IL ly c ►tN1V► 9 N ° N D N U = rn rn ^v c co o o c N O O ~ N i ~ _ O O O = 3 m rn a c c -O N ;5 N Ir~l o d Q Cp 1 w - in IU ~ O O N C O O I O O N c c O N cu ~p ~ 30 O C N U CL p °0 N F- . m y ~ m c N N G0. L CO ` y c N r O o1 M Etd w N O cli V 0 N "O W c° C .0 ~ N r (0 ~ C? to O O U • 7a 0 2 d' N O N z w Cl) Q c~ .rya ~ E N w# Q i N d ~~ww• m W .V d C (L 0 U) ST. CROIX COUNTY ZONING DEPARTMEN' " AS BUILT SANITARY REPORT RECEIVED Owner BKIAN t\I~~el~~ AR 199 Address /f~3c'~TA N N u L ~,r sClx dr) City/State Hu 1)5 t, N W I d c. 5l ~I (O XMINGOFF1 ~_7 Legal Description: Lot A Block Subdivision/CSM # '/4S L) '/4 N-r, Sec. T~N-RAW, Town of kumo m PIN # OZO 3 -176 -M SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: aw@(L IGUTank manufacturer e~ S Size STi` POU / Setback from: House Well t c is P/L Pump manufacturer Model Alarm location (HOLDING Setbacks: Service road Vent to ake Wate ine Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: J R-eN CWidth 3 Length _ Number of Trenches a Setback from: House 4S + Well N P/Los e it 10`' Vent to fresh air intake U V e R I o o' ELEVATIONS: -Ay Description of benchmark inA GO( Irk 4G. k ~ Elevation ~ D0 u Description of alternate benchmark t ec. rcb.ja NT' Pan - SO J L f the )i N e Elevation 1 L 0.0 56T 51.34" Building Sewer ST/HT Inlet I O5 -S t ST Outlet 5 . A PC Inlet - PC Bottom Header/Manifol Top of(0: --`anhole Cover d .23 Distribution Lines (k e) I T 9 ~ (L) I <o ( ) Bottom of System q4) (L) 4 r ( ) ~ ~ ( ) Final Grade A l o(J. Do Date of installation D A? / 1 b Permit number g 3 g State plan number Plumber's signature ~OU^0~7 License number 310 Date-1 9B Inspector I` Es k% a QK Complete plot plan or NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW Q - ►raaNC~s 3k~S 8s qs, Y~ yam---- I g'QouM y 3r Nom INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety'and Buildings Division INSPECTION REPORT , Cro/~• Sanitary PermitNo`.L GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 2$ Y Permit Holder's N e: ❑ City Village [Z Town of: State Plan ID No.: 8 irr i to I e-1 I\ v d so,7 CST BM Elev.: I . BM Elev.: BM Descript n: Parcel Tax No.: 1 ao ~ 00 lot © Z" PV(, r o ?,o -10/ 3- 0 -ooa TANK INFORMATION ELEVATION DATA A f7d©ZyZ-- TYPE MANUFACTURER CAPACITY STATION BS`s HI FS ELEV. .Septic p Btenchm k , 7.7T 1D 7 - ~~LyL Dosing ~(2L gho ~9.7T Aerat' n Bldg. Sewer p ~D,5:78 Holdin S r Inlet TANK SETBACK INFORMATION o Outlet TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet Septic '70Sr Yja. 172 NA Dt Bottom Dosing NA Header/ Man. lD.oZ 1~ Aeration A Dist. Pipe oP o,o do~ Holding Bot.System rv ~~.D 96.3 PUMP/ SIPHON INFORMATION Final Grade ob Manufacturer Demand jT At,t46 le, CoY . 5 ld(o.~7 Model Num GPM TDH Ift I Friction tem TDH Ft L Forcemain Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / RENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. L' i Depth DI E 3 -75 Z DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM L CHING Manufactur SETBACK HAMBER INFORMATION Type O I q0~ V!''v O UNIT M Number: Systeq tool DISTRIBUTION SYSTEM jk4itI[ed J#tAj&of#16ildew!"W 44P.44,6CA& IZ W t Header / Manifold Distribution Pipe(s) x Hole Size Hole Spacing ent To Air Intake Length Dia. Length Dia. Spacing 9r~~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ( 0~0-foo4l LA&4e, kf, bm -TO? 0~ trW pm~ M 411116fri"( ~A~ Uh ~oUfl~. (~a~Gine . ~rwl 11701"20 Ptah S Plan revision required? ❑ Yes L@No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector' Signature ert. o. ADDITIONAL COMMENTS AND SKET H SANITARY PERMIT NUMBER: X60 ~ ~ 1vru,c to 0 0 LAO ro v 4t 3u v ~o z° Pvc a,qe-6 o s 1 III 11 L~~dicu~ I Jccw~,►pY Lod ~iGlti( it P l~f ~~f-CvJat~ 1 ,TV r^=a.riR SANITARY PERMIT APPLICATION BureaSafetyu o oand ff Builuildin ng Water Systems ri 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application state Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro y Owner Name Property Location A7V& 1/4, S T , N, R I$F E (or #I 2f 5W yv) Property Owner's Mailing Address 1_97 I I& b ~ Block Number Air City, State Zip Code TP-hone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest Road E] Village Public 1 or 2 Family Dwelling - No. of bedrooms ~ Town OF 14 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) JD 79 J 1❑ Apartment/ Condo "'o-101.3- a 7 7 7 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) 1.1-vNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System SystemTank OnlyExisting 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage 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 Required (sq ft.) Proposed (sq. ft.) (Gals/ y/sq. ft.) (Mi /inch) H 77.6 El~v~op c D 7 V Su . t,. Feet co. Feet Capacity VII. TANK in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank a 0 V ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P e Ar's Na rint) Plu ber's Signature: (No Stamps) rPRSW No.: Business Phone Number: 1. / 3e6 - o - VVV - 9o -4 p Plumber's Address (Sty t, City, State, Zip Cod / (N)z IX. COUNTY / DE RTMENT USE ONLY - ❑ Disapproved Sa rtary Permit. Fee (Includes Groundwater Date Issue Issuing A nt Sig ture (No Sta Approved ❑ Owner Given Initial ~`rp} Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety 8 Buildings Di-,ion, Owner, Plumber INSTRUCTIONS . 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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, 608-266-3815. To be complete and accurate this sanitary'permit application must include: 1. 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. Vt. 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. VIII. Responsibility statement. Installing plumber isto fill in game, 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, Iocatfon 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 these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. a 'U b P 13 OJ EC -r N A M E #,~N a rn A-011A ~n~Q', N..A.M E ~ ~a ~ . L 0CA 10 n!_.. p .Nc L►~ L IC E NS E:/- P) - Y P1 r) (arm lop a" p j c f L lie Alt d y ' s' > cL 013 ct __7_ . i ~ LI i 3y .J NI AK `y fie , WD l? N T FRESH AI12 INLETS AND OBSERVATION PIRB CI:nSS SECTION Approved Vent Cap F1 Uj P p 'Minimum 12" Above/ Final ` A" Cast Iron Above Pipes Vent Pipe To Final Grade! Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labdr and Human Relations Page -/-of 'Division of Safety and Buildings iA~2tC with s. ILHR 83.09, Wis. o. 10 Attach complete site plan on paper not less than 8'14.x 11 inc s in size. I ust County include, but not limited to: vertical and horizon e.wrenc direc ' r{ d percent slope, scale or dimensions, north arr'aaQd locat nce to t road. Parcel I.D. # APPLICANT INFORMATION - Plea rindglif on. 'r Reviewed by Date Personal information you provide may be used for se nd purposes aw, S.15 1 (m)). Prope Owner Z perry Location S F P Govt. Lot 1/41/4,S `J T 9 N,R if(or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /p9 U0.c114,, a C~ ly,4 Im NA City State Zip Code Phone Number c~ So-" Nearest Road Gt~ f Vold (71S-) f!o ❑ City ❑ Village N Town 7a-rtite Z a.-, e & New Construction Use: [RResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow ~oy gpd Recommended design loading rate 7 bed, gpd/ft2 - 0 trench, gpd/ft2 Absorption area required 6' 5~bed, ft27S_0trench, ft2 Maximu desigj loading rate bed, gpd/ft2 - Y trench, gpd/ft2 Recommended infiltration surface elevation(s) 027.U) Les~ q~ ft (as referred to site plan benchmark) Additional design/site considerations //G'n c /i rs reec> A., M e., ale e T r,' Con ~o- Parent material ©a fWas Flood plain elevation, if applicable 64 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ®'s ❑ u ms's ❑ u Ws ❑ U ®'s ❑ U C's ❑ U ❑ S N'U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench X0 Ground elev. 103.9 ft. Depth to limiting factor 20tin. Remarks: Boring # ~ p /y /(j" / ~ o?~' . S ; . (o Ground elev. Depth to limiting factor ,?~L/ in. Remarks: CST Name (Please Print) Signature Tele one o. 714-01,117425 5~~~~, .flan /s' 5-5;e,3p -6"/ Address Diz1z CST Number / , / Somers 4-11, sYo2f hy, n/0/0 t SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Gep/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench O?mq r 3 G r 3 Ground 9 Q r b -s yy! CJ elev. /Qa. AY. Depth to limiting factor Remarks: Boring # ev~ C's If s V6 3 6-9a Ground elev. 99,Lft. Depth to limiting factor 3? Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # r 3/3 -~M r d~ 1,1 .7P .S Ground elev. . .,eft Depth to limiting factor 'n• Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) J: S~~,M,'tf CSTm oyo/o Pie 3o F~ T ~oma,-S.Pif,~ L✓s`-t1v1f QI'i4r1 ~0. fQ~~ 5F 6 S`/ GJ1 S y wry S 1 7ap~r Rl9c./ Pa rC ra/ 0. 10 _ Al 8Al TP o~ ioo. vo' /~l~ B= T~ o~ a" Pve V,~e tel. ioo. Q I grew R reG /OA Slope B I 3 wy oI s ~ 301 p I s v WIN l3f o~l I ~ S(, ~s 49ul TG ~Je,~ /1ro ~p 1 IA~~~~ bo~f \11 e~ G -a' l Sok+A rl e,, 4 JP Iler.Jay) L ouJ 7'i`e► vl i S 'I' 1115 S1i,11'I'IC TANK MAIN'1'1•;NANCl-" AGREEMI•:NT St. 0-oix County OWN1;R/I111Y1?It--_Gfi-- - MA1I,INC ADDRESS Lw _.i? = ---._-..~dSoY✓ PROPERTY ADDRESS (location of septic system) I'Icasc obtain fr m the I'lannin}; Dept. CITY/STATI; J PAW t - - p, 11RO11ERTY LOCATION 1/4, 114, Seetion TOWN OF V e ST. CM IX COUNTY, \\'1 1t SUBDIVISION _ LOT NUM1111 CERTIFIED SURVEY MAP , Vt9~LUMI: -^,1'ACI% ,1,07' NUM13f;(t ' Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out llte septic tank every three years or sooner, if needed by licensed septic lank pumper. What you put into the system can affect the function of the septic tank as a treatment 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 lite requirement that owners of all new systems agree to keep their system properly maintained. 'Ilse properly owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) allcr inspection and pumping (if necessary), Ilse septic tank is less than 113 full of sludge and scum I/We. the undersigned have read the above requirements and al,rcc to maintain the private sewage disposal system in accordance with the standards set fotlh, herein, as sct by the Wisconsin Wit Certification stating 111.11 your septic has been maintained must he completed and rctutocd In the St Croix ('aunty 1-oning 011icer within 10 days of the three year expiration date SIGNED %t t'ttn~ t tIluntv J.rntinl, l Illict 1 invettltln~nl 1'rnlct I lnl 1':unttrlrtrl Iit~:ul Ill'►~ 11ud-atn. Wl '1411111 8 T C - 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 ii 14M P-4 t, Er Local ion of property ~ 1/4 78 1/4, Section T L N-RAW . Township y DS&ra Mailing address 6 9 $ &4.bi.,4.vijs R& &4_so'~ Addr. ess of site Q p Subdivision name Lot no. Other homes on property? Ye"s~ X No Previous owner of property /#ePGt G l~~y g,?,A1A S Total size of property 2 VV !4 r-eS Total size of parcel Z 1. Le j Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes '2LNo Volume //-.3 L) and Page Number l~ as recorded with the Register of Deed;. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRAIV'I'Y DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refc,r•cnces to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (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. 5311 1( and•that I (we) presently own the proposed site for the sewage disposal system or rI (we) obtained an easement, to run 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. -31 0 LULL w Signature of AppI cant to-Applicant ~_I` -q'_? 7 I~.rt 1, c,t igrrr;I61" Date c,f Signature THIS SPACE RESERVED FOR RECORDING DAI A ~n •-('j)MENT NO STATE BAR OF V'IiSGONSIN FORM 1-1982 WARRANTY DEED I II n ,l 531171 ThiSDeed, ,Tartpoetwee,_Merlu Spinks_ and Kay Spinks, t+wulu~r. husband and wife s vLt. 2 1995 !I Grantor. . Brian H. Raleigh and Michelle L. Ra eib► us and and 11:00 A. wife _ _ t• ' _'4 - - Grantee. WItT1eS5@th, Tna, ine sa d G•a^te, for a valuat:teconsideratiun__-..-- RETURN TO a ,i,os w Grantee the following descr,oed real estate in St . Croix Mich %Ie . Rale igh State of wlsconsin Briaaleigh 4124 m Ave r La. g,r1 - - - - - -I 1 Tax Parcel No: Part o11-',=1#*~f__"4 and Part of NW 1/4 of SE 1/2 of Section 11, Township 29 North, Range 19~es't:;__Sr. Croix County, Wisconsin described a follows: Commencing at the SE corner of the NW 1/4 of SE 1/4 of Section 11-29-19; thence North 66 feet to the point of beginning; thence West 1320 feet to a steel stake; thence North 934 feet to a steel stake; thence East 835 feet to a steel stake; thence South 620 to a steel stake; thence East 485 feet to the center of Tanny Road; thence South 314 feet to the point of beginning, subject to the easement for said Tanny Road to the Town of Hudson. i i 22 Era -his is not homestead property. (is) (is not) 1 Tog-,her with all and singular the heroditaments and appurtenances thereunto boWnging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject to easements, reservations and restrictions of record. II and a +i1 warrant and defend the same. Dated this_ day of 4.,1 1g 95 I _ (SEAL) (SEAL) h l i Merle Spinks h (SEAL) ` ~aV Y(SEAL,) r ' _ Kay pinks AUTHENTICATION ACKNOWLEDGMENT Slgnature(st STATE OF WISCONSIN autnentlcatedfnisdayof .19 Personally came before mehallk I~ J o . I - ~ , 4.1 " 0ALIFQRMfA ALL-PURPOSE ACKNOWLEDGMENT No.SC07 State ot_ i County o# N On AV 12 1 before me, k~ Si I ) DATE personalty appeared " FL r; p r, C S fti1.E OF OFFICER Ea. r Y- IC OOE.NOTAAY MUM OF P48) Xpersonaffly known to me - OR - ❑ proved to me on the basis of satisfactory evidence to be "he person(s) whose name(s) re subscribed to the within instrument and ac- knowledged to me that xecuted the same in h4s4xW ei 'author! d capaciyy es , and that by ~ / hel signature(s on the instrument the person(;), K4nLYNN RAUVA or the entity upon behalf of which the comm. s 1019 n LOS a ~c person(s) acted, executed the instrument. cWM r MQ 61 war WITNESS my hand and official seal. Jim SIGNA CF NOTARY OPTIONAL - ThOtQh 9W daft telow fraud iwe amaa wnent ~ tom. ey it mar a vahiabls to pwsores R31yq>~ on ft doare and could ~r~er,l ~ CAPACFFY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ CORPORATE OFFICER mks) TITLE OR TYPE OF DOCUMENT ❑ PARTmmm ❑ LIMITED ~ ❑ ❑ ATTORWy-*4FACT GENERAL ❑ TRUSTBEM NUMBER OF PAGES 0 O~ NSERVATOR DATE OF DOCUMENT SIGNER IS RESENTING: HAW OF BOA 8WnTy(*S) SIGNER(S) OTHER THAN NAMED ABOVE - - - 01993 NATIONAL NOTARY ASSOCIATION • 6236 Remmel Ave.. P.O. Box 718/- -CA 15- Canoga Pang. CA 913D9-7164 • y Parcel 020-1013-70-000 03/12/2007 12:40 PM PAGE 1 OF 1 Alt. Parcel 11.29.19.58D 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/15/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - RALEIGH, RETIRED RETIRED RALEIGH Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 21.440 Plat: N/A-NOT AVAILABLE SEC 11 T29N R1 9W NW SE COM SE COR NW Block/Condo Bldg: SE;N 66' POB W 1320'-N 934'-E835'-S 620'- E 485'-S 314' TO POB 587/589 NKA Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) PT SUNSET HILLS '04 11-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1130/195 WD 07/23/1997 587/589 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/04/2005 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 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 Parcel 020-1445-01-000 03/12/2007 12:40 PAGE 10F 1 Alt. Parcel 11.29.19.2822 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/15/2004 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - LODAHL, KRIS A & REBECCA A KRIS A & REBECCA A LODAHL 1030 TANNEY LN HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1030 TANNEY LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: 10/15-SUNSET HILLS 020/04 LOTS 1/10 SEC 11 T29N R19W PT NW SE SUNSET HILLS Block/Condo Bldg: LOT 01 '04 LOT 1 (3.OOAC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 11-29N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 07/20/2005 800910 2847/300 WD 07/20/2005 800909 2847/297 WD 07/05/2005 799258 2835/256 QC 07/15/2004 768925 10/15 PLAT 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 3.000 79,000 270,200 349,200 NO Totals for 2007: General Property 3.000 79,000 270,200 349,200 Woodland 0.000 0 0 Totals for 2006: General Property 3.000 79,000 270,200 349,200 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