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HomeMy WebLinkAbout034-1032-30-025 M > a C o et r. E 0 ;y o 0 co 0 C O N f4 d = ~ N II N N O a) E -O y a -.0 2 w fl o~ m a c3 0o mo EN 2 m m c E o w -0 o m E wEa) o f Ea~ N~ w U a) -'6 9 - 10, y .CO 'v M L L E N T C N 7~ 0m) 0 > O 'O Co- N i r N Z' ~ > > a) ~ a) a) p cu a) (L) E a) > C C z C O; O L co 7 f0 0.0.0 ct o mp N C O C). c m o E E o-~E c 0 o a E a a) Oa c N~ n L V ~ (9 M Q a) uj N Z = 00 a E z a Co ~n z .o ~ N o c C7 (D L) O Z ? a L) 5 N O N F II' CD Z 72 p 2 M E a) O ~r C N •N~ -0 O ~i c m © c2 o a a w o Z Z p N N a) c C N N O 0 o CL (0 06 "O N d i a) 0 p o 0 a D D a N ns m °3 m v~ m O o f E C ~~V O d = 0 0 0 z O •wa a~CL CL CL m IL c > `n to fA J U rn rn Z v O N O O co O E N o = n_ M 00 W ns N O N -o_ az m w '0 C: O 0 W a) O U') C No 3 xS h c n E O co 0 o N c a) c c A rn o ce) a) a j p M (D (n aoi w • O r (n Z N O N Cl) U) M Co L) O y +-w I i V ~ Ey is d U 4) 0) t A c0 r Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and-*Haman Relations INSPECTION REPORT ST. CROIX Safety4, rrd Buildings Division 01 ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town o : State PI o.: NELSON, GENE & DONNA CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: Cc.{s TANK INFORMATION ELEVATION DATA/p~ ~S>h,%J:,-x 4-110-1,F TYPE MANUFACTURER CAPACITY STATION BS FS ELEV. Septic Benchmark 7, 67 Dosing Aeration Blda S r/ 91, Holding at S,SS 9/, TANK SETBACK INFORMATION Jutlet TANK TO P/ L WELL BLDG. Ventto ROAr Inlet Air Intake Septic r I Ut Bottom p S FlG, Dosing NA Header / Man. Aeration NA Dist. Pipe 7a~ o 3 ~b Holding Bot. System Cf3 Ool,, ISdAWON INFORMATION Final Grade I~ ~2 1 Manufacturer 171 el_ 0 Demand f'j, Model Number GPM TDH Lift Friction System TDH Ft I Loss mead Forcemain Length U Dia. 7;~' Dist.ToWell SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION LEACHING Manufacturer: l J~ SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM *1 ORMATION TypeO CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 xx Seeded/ Sodded Txx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil E] Yes E] No ❑ Yes ❑ No - ,r 'COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Springfield.15.29.15W, NW, NE, 100th Avenue Plan revision required? C] Yes E] No Use other side for additional information. I H SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ~•SANITARY PERMIT APPLICATION Bureau of Building water system, 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 9than 8 112 x 11 inches in size. , • See reverse side for instructions for completing this application State Sanitary Permit N7m¢er The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D.Itumber 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ,N,R/ -tMW Property Owner s'7 lvl iling Address 4. t Lot Number Bloc Num er CitVtate r Zip Cod Pone Number Subdivision Name o`r CSM Number ( f) I 1. IL IN . (check one) ❑ State Owned itr Nearest Road ❑ Public 1 or 2 Famil Dwelling- No. of bedrooms Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 0 3(~_ I ~ 3v -30- 1 ❑ Apartment /Condo 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. ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an syste System _____A--- --m 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 ❑ Seepage Bed 21 2'Mound 30 ❑ Specify Type 41 ❑ Holding-Tank 12 ❑ Seepage Trench 2Z[j 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/day/sq. ft.) (Min./inch) Elevation , Feet Feet VII. TANK apaelty site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION Gallons Tanks Concrete glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ El ❑ 1:1 El Lift Pump Tank /Siphon Chamber ❑ 1 r-1 I El 11 Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsi , sewage system shown on the attached plans. Plum is Name: (Print) mber' I na ps) MP/MPRSW No.: Business Phone Nu e 10, r Plumber's Address Tee rty, t Zi C ) IX. O NTY/DEPARTME T SE NLY ❑ Disapproved Sanit ry Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps) Approved ❑Owner Given initial ~ 02 vT) surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r y 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. r 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of t 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. VI. Absorption system information Provide all informatior; requested for numbers throucl, 7. VII. Tank -formation. Fill in the capacity of every new/or existing tank, list the total t,,ilons, .}u-obe( of tanks and manufacturer's name, indicate ;urefal~ or site constructed and tank material_ Cei, plete f : all septic, pump/siphon and holding tanks for this system- Check experimental approval only if tanks reci,,e,--i exoeri,aental roduct approval from DILHR. VIII Responsibility statement. Installing plumber is to fill in name, license numt,,er vi, h apprcr E,;e )refi x (e g. MP, etc.), address and phone number. Pig rnber must sign application form. IX. County/ Depar:_rnent Use Only X. County i Departs-lent Use Only .l Ci:• . _ ~ o ser)t:c .ii jc~ f) ali la nc ' sect:.,,. GROUNDWATER SURCHARGE sided the-, _ eel . n c surcharge (',aes) iar 0 numbe' h c, ich can effect 2 .jJ it w _a :C rnr~ t u J ' S~ _,ci.oigesare used for r110nltOring grow h lO~.Nc~ - ~ ?;aM I V S, < tlOnS t n of standards_ 595-0885 Gene & Donna Nelson - Mound RECEIVED 595-40885 AUK 15 1995 SAFETY & BLDGS. DIV. Location: NW 1/4, NE 1/4, Sec. 15, T 29 N, R 15 W Town: Springfield County: St. Croix Date: August 18, 1995 (in by 8/14/95) Owner: Gene & Donna Nelson Address: 3051 100th Ave. Glenwood City, WI 54013 Plumber: Horac Hurlburt Signature: /V-- L License # M 5650 Attachments: 6748-Plan Approval Application SBD 8330 page 1: cover 2: calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve page 1 of 7 System Calculations S95-40885 one family residence 3 be"- jms Loading rate gallons/sq ft per day Depth to ground water in Depth to bedrock ? S 3 in Cross slope iZ % " Force main length ft of in Manifold/header length ft of - in Drainback gallons Lateral length @ Ct ft of in Lateral elevation °Z• ~O ft (bottom of pipe) Lateral hole size in @ G6'O in ( ° ft) spacing holes/lateral, holes total Lateral volume gallons z ~ Total lateral discharge rate gpm @ ft head Elevation difference ft Friction loss ft @ gpm Total dynamic head ft Pump/si"b&on gpm @ ft of head (1 ~ BYO Manufacturer Model # S' Dose volume ~~01 gallons Lift/81146on tank gallons Septic tank gallons Measurement pump on & .off in Height alarm from tank bottom in Reserve capacity gallons calcs page of 4 ' Nw ~ 1y\ -~r• w ~.e< S95-4088 wsu~ 4 ~ ,V 10 L k 4J M oc r . l vdi v io \ j SL L,,9 41 Saw-.its- • a.,+ J ' , W ' M yw l trw0 is e-O d4 ft ~ ~ ~ ~ ~ mow. 4 ~ s ~ ~ vo' ~ ~ toy✓4~. ss U U S95-40885 / 1 ` Cn ~t1' sZ..o~, 4~ opt c•.......~ .,7 eX sv , \ 1 w..a ` ~ b i••~to:` s~•i1 aw 1 o 1. % Lr r ko .4, f - A ~fL T r 1 ~ 1 L h V i Q. ~ T. ' I • 4L %ro.- i o o o ; r o - _ - ~r I Pvc. A. aA, •~-...t w.,.: a~ r-O ! •d O I I , N 10 C ~~.1 z •2'S 2•S RI L laJ~.r _ -%'A 5 weA,T>`IEavaouF S -40885 LOCI(juG COVER 4.44,V A W L-44V- . `11rlelc a~coy~acti-~ 4~ C.T. 106w waft"IN& T _a .N. g • " 12 . PIPC IdOlbTui~ER ' I 4"C.t . Sat. 24" X.D. YfcwT MiN. A 4"r VV"P OPi'itOViQ - C.S. Pw I T ~r~'S ~ Bgi'.~LES 3• ono p~ F ECTIOMi. ON v, S5 5 • ~ CIr•R . PWIP t $S•O 6toGC -EPTIC SPEC. IFI'GATIOAJS ost ? nNK MAUUFACTUr.CK: LUMBER OF DOZES: J PER D" TAIJK SIZE: 6'2'iP ' 6 "%-1 GALLOWS DOSC VOLUME / ILARA 14"mCTtiR[R: lT haw- " .ANPLU01MCr &ACKFLOW- `(.s GALLONS CAPACITIES.•A= WCNES oft GAL.LOAIS SWITCH Ty►c: - g ax 2 "1T•r (f OR GALLOWS lump MAWUFAGTURCR: c• IuWE HE 5 c ImcNEwtS OR OWS MODEL WU#ADLK: tt D+ ~ INCHES ORGALLOWS SWITCH T>iP[: IJQTE PUMPAUD ALARM ARE TO BE, MIQ11MyM DISCHARGE RATC 23 co PIA INSTALLED ON 31'PARATE CIRCUITS ERTICAI DlfftRCAiCE pCTWGE,1f FU1 I OFF AW OISTRIbUTIOU PIPE.. FEET MIAI MUN NETWORK'"ft1F$V PRESSURE 2.5 _ FEET 10~ FEET Oi t<ORC[ AMU Y. i.,..: ~ 106n,FRICT101,! FACTOR. ►EET try~+ U~ TOTAL M JAMIC. HCAD an .Z.-..o.:..__ FEET 1T ERWAL DIM[AJSIOWt Of TANK: LEA1&TH04 ~ •wIDTH LIOWio DEPTH DIVENS16NS 8-95-40885 SP40 •16/1 4.6/18' I I TURN-ON rooL ~i 3.16/18' 13.1/18' 12.14 O 1 6.14r 8.13/18- r t1 w~ I 1-11110, PERFORMANCE SP40 - MAX SOLIDS 1-1/4" SPHERE -1750 RPM 28 24 20 4/10 HP TOTAL 16 HEAD IN FEET 12 8 FULL LOAD /AMPS AT 1a 115V 4 9.4, AT 230V 4.7 0 ±LLt± 0 20 40 60 80 100 120 U.S. GALLONS PER MINUTE Bulletin HW-201 New 10/88 (Replaces Bulletin 210.8) ~9 HYDROMATIC PUMPS Printed in U.SA 1840 Baney Road - Ashland, OH 44805 -419/289-3042 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY _ St. Croix Attach complete site plan on paper not less than 131: ~ ize. Plan must include, but s not limited to vertical and horizontal reference i if, of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location_and t to Barest roa' ` REVIEWED BY DATE APPLICANT INFORMATION-PLEAS NT ,tft KO Y,,,. PROPERTY OWNER: OPERTY LOCATION Gene & Donna Nelson VT. LOT NW 1/4 NE 1/4,S 15 T 29 N ,R 15 W PROPERTY OWNER':S MAILING ADDRESS` kr70T# BLOCK # SUBD. NAME OR CSM # 3051 100th Ave. tD C''''f-r.~f,xz IA~V CITY, STATE ZIP COD N fNBER ❑CITY ❑VILLAGE OWN NEAREST ROAD .x.72-.3349Springfield 100th Ave. New Construction Use rx] Residential / Number of bedrooms 3 ( ] Addition to existing building ixt Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 102.1 ft (as referred to site plan benchmark) Additional design/ site considerations install 4' x 95' rock bed mound on 101.1 as upslope edge of rock w/ 1' sand fill Parent material loess over till Flood plain elevation, if applicable NA ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S )El U ® S ❑ U ❑ S BU ❑ S B U ❑ S EN U ❑ S )MU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 0-8 10YR 3/2 - sil 2 f-m sbk dsh gs 2f .5 .6 2 8-19 10YR 313 - sil 3 m sbk dsh gs 1f/m .5 .6 Ground w/ co mon Gy si coat on peds which occasionally part to pl elev. 3 19-31 10YR 4/4 - sl 2 m sbk mfr gs if .5 .6 100.7 ft. Depth t0 4 31-42 7.5YR 313 f1d 7.5YR 4/6 scl 0 m - - - NP .2 limiting w/ cob, gr, & occasional st factor 31 Remarks: Boring # 1 0-12 10YR 3/2 - sil 2 m cr mvfr cs 1f/m .5 .6 2 12-20 10YR 3/3 - sil 2 m sbk dsh cs if .5 .6 w/ common Gy si coats on peds Ground elev. 3 20-36 10YR 4/4 - sl 1 m sbk mvfr cs - .4 .5 102.3 ft. w/ common Gy si coats on peds & w/ oc asional r Depth to limiting 4 36-47 7.5YR 4/4 f2d 7.5YR 613 scl 0 m - - 1f/m NP .2 factor 36" [--t I w/ gr & oc asional cob Remarks: CST Name:-Please Print Henry F. Grote Phone: 715-665-2681 Address: PO Box 57, Knapp, WI 54749-0057 Signature: Date: CST Number: ~ 7/13/95 3065 PROPERTY OWNER Gene/Donna Nelson SOIL DESCRIPTION REPORT Page 2 Hof 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-7 JQYR 3/2 _ 2 m cr dsh cs 2f/m .5 .6 2 7-12 10YR 3/2 - sil 2 m sbk dsh cs 1f1m .5 .6 w common y i coats on peas w c occa iona y par o p Ground 3 12-23 10YR 3/3 - sil 2 m sbk dsh cs 1m .5 .6 elev. w/ common Gy si coats on peds 99.9 ft. 4 23-31 7.5YR 5/4 - is 1 m sbk ds cs if .7 .8 Depth to limiting 5 31-53 7.5YR 4/6 f2d 5YR 4/6 scl 0 m - - 1m NP .2 factor 7.5YR 613 st 31 very poorly so ted w/ occasional r, co" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 4i•:i-iii::i:iii=ii Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05192) w S t0 ~ ZQ I Z9e ~ nn ee QI mL.L~ zvds\ L L,-9 OR-qo C .SZ~.. ao J ~ QK ~OY STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER //0 1_r6 MAILING ADDRESS 3 0 S A PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. C CITY/STATE t~ 1011 c" e) PROPERTY LOCATION w /2 N 1/4, Section ' S T 2!! N-R_L~L_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP N A- , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank 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 the requirement that owners of all new systems agree to keep their system properly maintained. The property 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) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED:L DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S 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 & C S. IUJsd Location of roperty 1/4, Section T c-1 N-R W Township Mailing address Address of site ~3c'% /off yc~~r/ Subdivision name Lot no. Other homes on property? Yes /-4 No Previous owner of property Total size of property c~ Total size of parcel qQ Date parcel was created a lr 1~e, -7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes )K No Volume "AO q and Page Number 71-0 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY 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 references 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. X30/ and that I (we) presently own the proposed site for the sewage disposal system or I (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. *SgnaturZf Applicant Co-Applicant S-@^3- Date of Signature Date of Signature - 03LI-1032-3o-m DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-19438' TN.a SPACE RESERVED ►oR RECORDING DATA L y11i1~F~►NTY DEED VOL 11 9 5~~881 PAGE 90 This Deed made between -Cla•rgnce,-A,___Thomp on... a...single_-person_• 51995 Grantor, and. Eugene..S...Nelson..and..Denna..RA.. Nei san.,.-husband......... 12:30 F.'a j a.nd_..rlfe..as..sucvixors.hip..mari.tel..RroRerxy.. tzar arc: Grantee, I, Witnesseth, That the said Grantor, for a valuable consideration...... I -I conveys to Grantee the following described real estate in ....$t...~t Q1)~........... "gruON To /Z p.- County, State of Wisconsin: tz" See Appendix "All attached hereto and made a part Tax Parcel No: . hereof. :"SE .l This JS homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And . warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except ,r all easements, restrictions and rights of way of record. and will warrant and defend the same. i Dated this Q------------------ day of jufie 19..5... (SEAL) Lr!h...:4.. . c (SEAL) ' . Clarence_ A.,_ Thompson. .............................•-•--..........(SEAL) ..........(SEAL) ' • AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 51-- C.fo !I . ---County. authenticated this --------day of.. 19 Personally came before me this 3D....... day of --.June 19.95.-- the above named lar_ence.A._..Ihnmpsnn,._a.single..person TITLE: MEMBER STATE BAR OF WISCONSIN (f not, ...--•---•--------------------Ste---- - authorized by § ?06.06, Wis. ts.) 't d4.kpo to be the person who executed the THIS INSTRUMENT WAS DRAFTED BY ; Dregolut 1 trument and acknowledge the same. ---PMERT.-.I-.-.RICHARMN...... t-- -i---...----•• • Attorne at Law >x L-: ---S1a-rcng-Galley-._.wl_-5.476.2. r; - 117 County, Wis. (Signatures may be authenticated or acknowledged. Both ission is~ are not necessary.) permanent. (if not, state expiration e. --••------NOWY_Ptty* Wisool>dn ) lulu C«Irrr+~xl Rick "NA rch 22-1998 19......... 'Names of persona signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. l FORM No. 1 - 1982 Milwsukee. Wis. t 1129PArE 91 VOL Appendix "A" Parcel No 1: The Southwest Quarter of the Southeast Quarter (SW; of SE4) of Section Ten (10), Township Twenty-nine (29) North, Range Fifteen (15) West; Parcel No 2• The West Half of the Northeast Quarter (Wh of NEk) of Section Fifteen (15), Township Twenty-nine (29) North, Range Fifteen (15) West, EXCEPT the South 60 rods of the East 40 rods thereof; Parcel No 3: The Northeast Quarter of the Northwest Quarter (NEh of NW4) of Section Fifteen (15), Township Twenty-nine (29) North, Range Fifteen (15) West; Parcel No 4• The South Half of the Northwest Quarter (Sh of NWT) of Section Fifteen (15), Township Twenty-nine (29) North, Range Fifteen (15) West, EXCEPT the West 661 feet thereof. -1- ~ N~~~ a ~1r~ A ~ a ~ A A _ i ,b\ '1, a ~ ~Q ~ ~ } r Parcel 034-1032-30-025 09/19/2007 04:40 PM • PAGE 1 OF 1 Alt. Parcel 15.29.15.226A 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/13/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner EUGENE S & DONNA R NELSON O - NELSON, EUGENE S & DONNA R 3051 100TH AVE GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 3051 100TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 17.830 Plat: N/A-NOT AVAILABLE SEC 15 T29N R15W PT NW NE EXC THAT PT Block/Condo Bldg: LYING NLY OF 100TH AVE & EXC CSM 19-4844 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-29N-15W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 09/13/2004 774064 2654/148 LC 07/23/1997 1129/90 WD 07/23/1997 878/598 07/23/1997 727/91 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/15/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 12.830 2,250 0 2,250 NO UNDEVELOPED G5 2.000 350 0 350 NO AGRICULTURAL FOREST G5M 1.000 1,750 0 1,750 NO OTHER G7 2.000 9,550 133,150 142,700 NO Totals for 2007: General Property 17.830 13,900 133,150 147,050 Woodland 0.000 0 0 Totals for 2006: General Property 17.830 12,300 111,950 124,250 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