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HomeMy WebLinkAbout026-1143-60-000 Wiscontsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515007 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: Sorenson, Aaron & Sarah Richmond, Town of 026- 1143 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: . 9— (3 20.30.18.1047 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /J ` Benchmark Dosing h , � Alt. BM/ Aeration lJ Bldg. Sewer Holding SUHt Inlet n / -7 TANK SETBACK INFORMATION SUHt Outlet f Q,3 q� -3 TANK TO / W 1_ BLDG. Ven Air Intake ROAD Dt Inlet Septic 1, / � i r Dt Bottom Dosing Header /Man. Aeration w Dist. Pipe l Holding Bot.., ystem (� ! 3 ✓ (• PUMP /SIPHON INFORMATION FirGcade S� , Manufacturer Demand St Cover P Model Number TDH Lift Friction Loss stem Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Len th o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO CCC��� P/L LDG WELL LAK /STREAM EACHING Manufa r: r "r INFORMATION Type f System: qb, ' HAMBER OR r / ) � / D Model Number: i J D IBUTION SYSTEM !v �-� O Cet�G�� o- Header/ i old Distribution f x Hole Size x Hole Spacing lVaqt to Air Intake L Pipe(s) V �/ 4 Length Dia Length Dia / Spacing i I 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 A L Yes No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:� / /�Q Inspection #2: Location: 1045 144th Ave. –v New Ri hmond, WI 54017 (NE 1/4 SW 1/4 20 T30N R18W) Waldroff Meadows Lot 6 Parcel No: 20.30.18.1047 1.) Alt BM Description = I Up r 2.) Bldg sewer length = �/ - amount of cover =� q f Plan revision Required? Yes No �C� (�1✓!/ J� _ Use other side for additional information. I " U /n � 6 ( /0 SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. n Safety and Buildi "vision County 201 W. Washington Av . aiSOn itary Permit N ber ( to be filled in by Co.) l t i v L c nt of Commerce o Sanitary Permit Application tateTransacdopNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental ; // / unit is required prior to obtaining a sanitary permit_ Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide ma purpo in accordance with the Privacy Law, s. 15. 1 m , Stats. I. Application Information - Please Pr int All Information Property Owner's Name Parcel # Property Owner's Mailing Address � Property Location ) Code ST. CROIX COUNTY Go Lot (� 7 /7) 6: City, S to Zip ' /.,. Y, Section (circle on I Type of ' ing (check all that apply) Lot # T N; R E o a1 or 2 Family Dwelling // - Number of Bedrooms ( Subdivision Name �k � Block # El Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of II Type of Permit. (0 eck only one box on line A. Complete line B if applicable) A. I N. S stem Q R laccmcnt S y eP ystem Q T reabncnidHolding Tank Rcpl.ccmcnt Only Q Othe Modification to Exis ting System (csplam) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 9 Non - Pressurized In- Ground ❑ Pressurized In -Ground ❑ -Grade ❑ M >_ 24 in of suitable it ❑ Mound < 24 in. of suitable soil El Holding Tank El Other Dispersal Component (explain) - eatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) I Dispersal Area Required (sf) DispersaI Area Proposed (sf) System Elevation c VL Tank Wo Capacity in Total #Of Manufacturer Gallons Gallons Units o v New Tanks Existing Tanks o t: a c5 vs w c7 A Septic or Holding Tank - -�� Dosing Chamber /� r VIL Res risibility Statement- I, the undersigned, assume q4pmiibifi for imstadatiom of the POWTS shown on the attached plans. Plum r' Name Print) l / Plnm s S' a /. ^� MP /MFRS Number Business Phone Number Plum em's A ess (Street City , S te, Zip Cod VII1. /De artment Use Only Approved ❑Disapproved PermV Date Issued El Owner Given Reason for Denial S / IX. Conditions of ApprovaVReasonss for Disapproval a0 0 ' S _ f - � S' SYSTEM OWNER: �,-1 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained 0 Cs d GG as per management plan provided by lumber. bUtUa req ui rerrAlllttp%*6ftpft"@&mm and sabmit to the Coaaty only an paper aot t6am 8 i/2 =11 laetes in size as per applicable code /ordinances. SBD -6398 (R. 01/07) Valid thru 01/09 I t 2 - �M R7 i I 1 - 7� I off/ � /4� � w a i / STORMWATER / PONDING AREA \\ �� H.W.L. = 940.0 20' DRAINGAGE EASEMENT N4 X6 / 344.41' C3 C5 L1 S88 °23'30 "W TOWN ROA = 939.3 \ --'7.-;2 N88 °23'30 0E 344.41' —C9 13.32' 3 T 4%` 0.95 ( I W .s � LO F) g�� 1.631 ACRES \ I I w MIN FI LINE ( I Q (71,036 SO. FT.) M. �ry TO MEANDER LINE _ .. — f Q _ . °-• 1.8 ACRES ± 0 TO O.H.W.M. j I F L I �e �tij o� I 2.467A \�0, LOT 5 I I ir LOT 7 r (107,304 1.842 ACRES tp co p W c) 00 TOT. 80,251 SO. FT.) T e� 1.500 A 75' ( r m I O rn (65,36 TO MEANDER LINE �, ci I MIN FF = 939.5 cv __ \ °� 2.0 ACRES � �� I o 1.880 ACRES TO MEAN[ \ TO O.H.W.M.5 - a (81,876 SO. Ff.) -- - -97 . I TOTAL M \ M ( 1.735 ACRES o \ r 9 (75,568 SD. FT.) g TO MEANDER LINE / s I ....... � �� 1 (MIN FFE = 941.4 f /f..... CIS ` a ,,,,•...�.... `'• � `, MIN FFE = 939.8 �/� '� 0 s '•••..• - MIN FFE = 9 i I ' �,� ;,�• s ue° . \ . o ry ,- 142.60'6's, 165.Oa v� 37'± 78.01 6 .O6 96. 4' L16 889°" 6'03 "E `••... \�F� ` •..• 5' 1339.07 � \ lip Umrgo OO m[n�GD -------- - - - - -- wlsconsin Department of Commerce SOIL EVALUATION REPORT Page — I — of 3 D'MWon of Safety and Buildings „ in accordance with Comm 85,Wis. Adm. Code minty . Attach complete site plan on paper not less than 81/2 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 ordimensions, north arrow, and location and distance to nearest road. � Z 1/L1 — &e - 6 6 Please print all information. Re - Date Personal blkw_§" provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Property O Property Location Govt. Lot A �: 1/4 ,�}1 /4 S T N R `� E (or) Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSW 9S ivcr to I �.0 7 7 city State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 1 15tjOl (TI ) ichm C • W. A 50 New Construction Use: Residential / Number of bedrooms ` `") Code derived design flow rate �.{j?,� _ GPD Replacement ❑ Public or commercial - Describe: Parent material C) c� Cc� Flood Plain elevation if appli pp i�wcs ft General comments ��(Si -�. �`(� -Q 14? �y d �.1 I� LCE�V and recommendations: A L4 , Q 1-e \f y O U " - GE r ` ST CROIX F 1-1 70N1WG OFFICE Boring Boring # ® Pit Ground surface elev. 9 ft Depth to limiting factor 4 : -�.. Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou GPDff in. Munsell Qu. Sz. Court. Color Gr. Sz. Sh. "EMIM "EM Z C- 5 3 to �t l r7 1- z Boring# F1 Boring �- Pit Ground surface elev. ? so ft Depth to limiting factor I r in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "EW1 *Efr#2 i 0-Iq D 2 S• 2 c ! v . S " g Z j _yt, 1 SO rr C-5 -- . S . g 3 oft_ ! M 1 . t. 2 * Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 150 mg/L " Effluent #2 = BOD < 30 mg1L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number 2533o Adder Date Evaluation Conducted Telephone Number 2 + 5 2 — i5)Z4 7 -U� Property Owner Parcel ID # Page Z of ' a Boring # ❑ Bonng Pit Ground surface elev. / 9% 4.2 ft. Depth to uniting factor I I 2 in. Sod Application Rate Horizon Depth Dominant color . Redox Description Texture Structure Cormstance Boundary Roots GPDW in. Munsell Qu. Sz. Cont. color Gr. Sz. Sh. *Eff#1 *Eff#2 21Y,abk c5 Ivy' • S . $ 2 1 - 4 S.1 2n-abk c 3 U-1 (p r4ke i rn n s ) — 1. Boring ❑ Bori F ® Pit Ground surface elev. 7 1. ft. Depth to limiting factor U in. Sod is ation Rate Horizon Depth Dominant Color Redox Description Texture Structure fence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eti#1 'Efr#2 2tyxibb C ' 8 2 4 I lmahk CS S 3 11 �# Boring Pit Ground surface elm. %• 5� ft. Depth to limiting factor � � g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i *Eff#1 *Eff#2 o z 2 Si 1 C vc 5 .% 2 -3b SO J L AS MIS ` Effluent #1 = BOD > 30 <_ 220 mg/L and M >30 150 mg/L ` Effluent #2 = 800, :5 30 mg/L and TSS 1 30 mg/I. 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 departinent at 60 8-266-3151 or TTY 60 8-264 -8777. SBD -8330 (8.07/00) PAGE_3_OF NAME tLicad CC4 Pr LOT# (0 LEGAL DESCRIPTION NE' /,- CUA,SZOT SO N,R I $E (or)o) " SCALE: I '= yo BM I ELEVATION l�•a BM I DESCRIPTION (+p p gi j1 Q (poi r' BM 2 ELEVATION R Z 6 BM 2 DESCRIPTION +012 - � p $ loo, r SYSTEM ELEVATION O U ALTERNATE ELEVATION 9 / • O O CONTOUR ELEVATION ?. 50 4 Q. 1* 1 - qVI 1* 1 • B ,vY s I � ` c' � . 83 3 S • ;'� Ic �rnl •. o I I 1 SIGNATURE DATE ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer & r d yk j V Mailing Address /' k 4/, Property Address / y i (Verification required Planning & 2oning Department for new construction.) City /State 4kW a,, ft lL_lA fParcel. Identification Number 0 �3 - bo LEGAL DESCRIPTION Property Location &JIF- , O 1 /4 , Sec. 7-b , T 30 N R_t_S_W, Town of 41 k Subdivision _ Wq LA-r.<, 6F - y ao of , Lot # �. Certified Survey Map # , Volume , Page # Warranty Deed # M� , Volume , Page # Spec house y ' no Lot lines identifia e es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter '12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 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 Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FiLE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ga l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ONA Pump Tank Capacity al _ � NA Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer _ja NA Soil Application Rate gat /day /ft2 Pump Model ANA 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 <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) r7 NA Biochemical Oxygen Demand (BOD <30 mg /L 01n- Ground (gravity) ❑ In Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L r�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 MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once eve ❑. month(s) every: ,_3 ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge, and scum equals one -third (%) of tank volume ❑ NA Inspect dispersal cell(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA every: 0 year(s) Y Clean effluent filter At least once every: ❑ month(s) ❑ NA _' year(s) 'nsc -ect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush /ate-als and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) ��Jrer At least once every: ❑ month(s) ❑ year(s) ❑ NA ounmr.' ❑ 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. Tank 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 ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the 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 entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, 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 _ <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Pagq--->-7 of 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 the 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 with chapter 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 setba &k 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 IN ;TALL / POWTS MAINTAINER Name - Z / / Name Phone -- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was dra , '- _- :"ance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. fB45459 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 02/26/2007 02:30PH WARRANTY DEED EXEWT # THIS DEED, made between David J. Waldroff and Julie A. Waldroff. husband and REC FEE: 11.00 wife TRANS FEE: 172.58 ( "Grantor," whether one or more), COPY FEE: and Aaron I Sorenson and Sarah M. Sorenson, husband and wife CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant f�kk E3treen & Og land U-) interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): �p : 30 LQC USt St reet �FJ 5 Lot 6, Waldroff Meadows. St. Croix County, Wisconsin. Hudson, W! 5401 1 0264143 -60 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated 1/30/2007 (SEAL) (SEAL) * *David J. Waldroff (SEA. (SEAL) * * to A. Waldroff AUTHENTICATION ACKNOWLEDGMENT Signature(s) / 6 ��L� J ) authenticated on STATE OF ,(� n�� )ss. �/ COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on 3o a OP (If not, the above -named DmigbalvaWa roff and Julie A. Waldroff authorized by Wis. Stat. § 706.06) husband and to me knoto executed the foregoing THIS INSTRUMENT DRAFTED BY: instrumen sate. Attorney Kristina Ogland Hudson, WI 54016 Notary Pu "c, My Commi �h res: 61 - ) (Signatures may be authenticated or acknowledged. [no r NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FOR � E CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 ` Type name below signatures. INFO -PROTM Legal Forms 800- 655 -2021 www.infoproforms.com Parcel #: 026- 1143 -60 -000 10/09/2008 03:33 PM PAGE 1 OF 1 Alt. Parcel #: 20.30.18.1047 026 - TOWN OF RICHMOND 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 - SORENSON, AARON I & SARAH M AARON I & SARAH M SORENSON 482 PARK LN HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1045 144TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.861 Plat: 08- 089 - WALDROFF MEADOWS 026 -01 SEC 20 T30N R1 8W PT NE SW LOT 6 WALDROFF Block/Condo Bldg: LOT 06 MEADOWS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 20- 30N -18W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 02/26/2007 845459 WD 12/20/1999 615773 1479/210 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/0912008 Description Class Acres Land Improve Total State Reason UNDEVELOPED G5 1.861 24,000 0 24,000 NO 05 Totals for 2008: General Property 1.861 24,000 0 24,000 Woodland 0.000 0 0 Totals for 2007: General Property 1.861 300 0 300 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